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Brain & Nerve
Behavioral & Mental Health
Contributed byKrish Tangella MD, MBAApr 20, 2020

What are the other Names for this Condition? (Also known as/Synonyms)

  • Chronic Insomnia
  • Dyssomnia
  • Sleeplessness

What is Insomnia? (Definition/Background Information)

  • Insomnia is a medical disorder characterized by disturbed sleep. It is the inability of an individual to sleep soundly, or there are sleep difficulties such as initiating, or maintaining one’s sleep
  • Insomnia is classified as the following:
    • Transient or Episodic - lasts for a short period of less than a week
    • Acute or short-term - lasts for a period of less than a month
    • Chronic or long-term - lasts for a period longer than a month           

Who gets Insomnia? (Age and Sex Distribution)

  • All individuals irrespective of age, gender, race, and ethnicity may be affected by some degree of Insomnia, at some point in their lives
  • Individuals over the age of 65 years are more likely to be affected by Insomnia
  • Sleeplessness is more common in adult women rather than in adult men

What are the Risk Factors for Insomnia? (Predisposing Factors)

The following individuals are at high risk for Insomnia:

  • Gender: Women have a higher risk than men; however, older men are at high risk of this sleep disorder than older women
  • individuals affected by certain medical conditions such as:
    • Arthritis
    • Ulcers
    • Urinary disorders
    • Heart-related abnormalities or disorders           
  • Medications: Insomnia can be a side effect of many, commonly prescribed medications
  • Childhood fears: Children may get Insomnia when they suffer from nightmares, or when they are frightened of the dark while sleeping
  • Travelers: Those who constantly travel across various time zones are susceptible to this condition
  • Night-shift workers who have constant change in their working time are at a high risk
  • Smoking is thought to be a factor for Insomnia
  • Those who are addicted to alcohol
  • Use of other stimulants also increases the risk
  • High caffeine intake increases the possibility of Insomnia
  • Pregnant women, females in the menopausal stage
  • Individuals with mental disorders and diseases are also susceptible

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Insomnia? (Etiology)

Insomnia is a medical disorder characterized by disturbed sleep. The individuals experience difficulty in falling asleep, staying asleep, or getting sleep that is of a very poor quality. The causes for Insomnia may be classified into situational factors, medical or psychiatric conditions, and primary sleep problems. The causes differ for different types of Insomnia, such as for Transient Insomnia and Chronic Insomnia.

Causes for Transient or Short-Term Insomnia may include:

  • Age: Older people experience changes in sleeping pattern; they may sleep early and wake up early
  • Jet-lag for travelers
  • Changes in shift work
  • Excessive or unpleasant noise
  • Uncomfortable room temperature
  • Stressful situations in life
  • Acute medical or surgical illness; hospitalization
  • Withdrawal symptoms of drugs, alcohol, sedatives, or stimulants
  • Living in high altitude such as mountainous regions
  • Uncontrolled physical symptoms such as:
    • Pain
    • Fever
    • Breathing difficulties
    • Nasal congestion
    • Cough           
    • Diarrhea

Causes for Chronic or Long-Term Insomnia may include:

  • Psychological causes such as:
    • Anxiety, depression
    • Mental, emotional, or situational stress
    • Schizophrenia - a type of mental disorder
    • Mania, bipolar disorder
  • Physiological causes:
    • Chronic pain syndromes
    • Congestive heart failure
    • Chronic fatigue syndrome
    • Night-time chest pain from heart diseases
    • Acid reflux disease (GERD)           
    • Chronic obstructive pulmonary disease (COPD)
    • Nocturnal asthma (asthma with night time breathing symptoms)
    • Obstructive sleep apnea: The flow of air stops or decreases while breathing when asleep
    • Degenerative diseases such as Parkinson’s disease (brain disorder leading to extreme difficulty in walking) and Alzheimer’s disease (a common form of dementia that seriously affects an individual’s ability to carry his daily activities)
    • Brain tumors, strokes, and any trauma to the brain
  • Medications: Medicines prescribed for treating cold, fever, blood pressure, depression, anxiety and stress, contain stimulants that affect sleep

Other causes may include:

  • High intake of caffeine, nicotine, or alcohol
  • Bed partners with loud snoring and periodic leg (or body) movement
  • Poor sleeping habits such as:
    • Irregular sleep schedule
    • Stimulating activities before bedtime
    • Uncomfortable sleep environment         
  • Use of bed for other activities, other than sleep
  • Worrying too much about not being able to sleep well
  • Eating too much, late into the night
  • Hormone changes and shifts during menstruation
  • Pregnancy
  • Overactive mind
  • Certain genetic conditions
  • Daytime napping

What are the Signs and Symptoms of Insomnia?

The signs and symptoms associated with Insomnia include:

  • Daytime fatigue
  • Trouble falling asleep on most nights
  • Not feeling refreshed
  • Waking up several times during the night
  • Awakening too early
  • Irritability
  • Depression, anxiety
  • Difficulty in concentration, difficulty completing tasks
  • Increased errors, increased accidents
  • Tension headaches
  • Gastrointestinal symptoms
  • Ongoing worries about sleep

How is Insomnia Diagnosed?

A physical examination and a careful evaluation of the medical history of the individual by the physician is the basic diagnostic method. Other tests the physician may order include:

  • Polysomnography: It is an overnight sleeping test for recording one’s sleep patterns
  • Sleep study at a sleep lab to identify the root cause of the disorder and to observe various activities, such as the brain waves, breathing, heartbeat, and eye and body movement, while one is sleeping
  • Occasionally, a blood test may be performed to test for abnormal thyroid conditions
  • Actigraph: A test which uses a small wrist-worn device to examine one’s movement and the sleep-wake pattern

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Insomnia?

Insomnia affects an individual both mentally and physically. Insomnia is not a fatal condition, but there are many complications that can arise as a result of this sleep disorder. These include:

  • Problems in concentrating at schools or offices
  • Lower level of performance at the workplace, at school or college
  • Higher risk of accidents
  • Onset of psychiatric conditions such as depression and anxiety
  • Overweight or obesity
  • Poor immune system function
  • Risk of long-term lifestyle disorders such as:
    • Blood pressure
    • Heart diseases
    • Diabetes
  • Poor quality of life because of:
    • Decreased energy
    • Irritability
    • Mistakes at work
    • Poor relationships

How is Insomnia Treated?

Finding the cause of Sleeplessness or Insomnia is the basis of the treatment. The treatment may differ as per each individual’s condition and may include non-pharmacologic (non-medical) therapies and pharmacologic (medical) methods.

Non-pharmacologic therapies may include:

  • Sleep hygiene therapy - the steps and instructions that are to be followed while doing a sleep hygiene therapy include:
    • Sleeping as much as an individual would need
    • Oversleeping has to be avoided
    • Regularly exercise for 20 minutes and at least 4-5 hours before sleeping
    • Individuals should not force themselves to sleep
    • A regular sleep and awakening schedule should be followed          
    • Avoid caffeinated beverages late in the evenings
    • Alcohol should be avoided before going to bed
    • Avoid smoking in the evening
    • Do not go to bed with an empty stomach
    • Adjust the temperature, the light and noise levels in the room in such a way that it does not affect one’s sleep
    • Avoid going to bed with worries
  • Relaxation therapy - the steps and instructions that are to be followed while doing a relaxation therapy include:
    • Meditation
    • Yoga
    • Muscle relaxation
    • Dimming the lights
    • Playing some soothing music        
    • Exercise
    • Mind-body therapies such as  guided imagery or hypnotherapy
    • Reading, while lying in a relaxed position
    • Having a soothing bath or shower before going to bed
    • Gentle massage of the neck, shoulder, and leg muscles
  • Stimulus control therapy - the following steps and instructions that may be adhered to while doing a stimulus control therapy:
    • Go to bed only when you really feel sleepy
    • Do not watch TV, read, eat, or worry in bed
    • If you are not able to sleep even after 30 minutes of going to sleep, get up and do the relaxation therapy
    • Avoid napping during daytime
  • Sleep restriction therapy - the following steps and instructions to be followed while doing a sleep restriction therapy include:
    • Restricting your time in bed only to sleep may increase the quality of the sleep
    • This therapy is done by averaging the time in bed that an individual spends only for sleeping
    • Avoid large and grand meals before sleeping
    • Avoid excessive fluids before bedtime
    • Control the sleep environment by dimming the light, setting the favorable room temperature, playing soothing music, etc.

Pharmacological therapies may include:

The use of medications and sleeping pills is often considered as a last option, when all other methods have failed. Treating Insomnia with medication can sometimes be beneficial, though it involves certain side effects and risks. The following may be considered:

  • Use of OTC or prescription medications
  • Melatonin: Melatonin is a hormone secreted by the pineal gland. Melatonin supplements are used to increase the melatonin levels in the body, which regulates the sleep-wake cycle of an individual
  • Herbal remedies:
    • Valeriana officinalis (Valerian) are given to treat patients with Chronic Insomnia
    • Natural herbals, such as dogwood, kava kava, and L-tryptophan, are used in the treatment of Insomnia
  • Light treatment: Bright light is a stimulus to circadian rhythm; it can be used as a rhythm synchronizer
  • Sedatives should be used only under the instructions of a medical practitioner
  • Consulting with psychiatrist or other mental health providers could be useful, as they may use talk therapy and counselling sessions to help you gain control over anxiety and depression

How can Insomnia be Prevented?

Prevention of Insomnia may involve the following measures:

  • Adhering to sleep hygiene practices
  • Promoting a healthy lifestyle
  • A large meal before bedtime is generally not recommended
  • A glass of warm milk, 15 minutes before bedtime is recommended, because the proteins in milk can help calm one’s nerves and make you to relax
  • A warm water bath an hour before bedtime is advised
  • Reading, meditation
  • Taking a leisurely walk before bedtime can reduce the chances of an Insomnia
  • Try to set all worries aside before going to bed

A combination of rest, recreation, and exercise, along with stress management techniques and a healthy diet can aid in preventing Insomnia.

What is the prognosis of Insomnia? (Outcomes/Resolutions)

The prognosis for Insomnia depends on the type and duration of the condition:

  • Transient Insomnia symptoms typically go away in few days
  • Acute Insomnia can be resolved with short course of hypnotics
  • Chronic Insomnia may need to be supported with hypnotics and cognitive behavioral therapy

Additional and Relevant Useful Information for Insomnia:

The following DoveMed website link is a useful resource for additional information:

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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team


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