Overview
Insomnia is a type of sleep disorder. It’s usually divided into two categories depending on how long symptoms last. Chronic insomnia describes symptoms that occur on more than three nights a week for three months or more. When symptoms persist for less than one month, the disorder is called short-term or acute insomnia.
This type of disorder can involve difficulty falling asleep, issues maintaining sleep, or early-morning awakening with the inability to return to sleep.
Some sleep conditions can be impacted by other mental health or medical conditions. In some cases, sleeplessness is triggered by stress or a traumatic event. Although insomnia occurs in people of all ages, it’s most commonly diagnosed in elderly patients.
Statistics
These insomnia statistics will give you an idea of how common the disorder is and the populations it impacts most.
- 33% of adults in a 2016 sample population had chronic insomnia, but only 6% were aware of the condition.
- Short sleepers are 55% more likely to be obese than people who sleep 7 hours a night.
- 18.5% of teens age 16 – 18 met the medical criteria for this disorder in 2016.
- As many as 50% of older adults complain of trouble falling asleep or maintaining sleep.
- Compared to men, women are at a 40% greater risk for this sleep condition.
- It’s estimated that American adults sleep an average of 6.7 hours a night.
What is insomnia?
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) defines insomnia as a sleep-wake disorder. In other words, it’s a condition that causes disruptions in your sleep-wake cycle that reduce the quality and amount of sleep you get.
To be diagnosed with this type of disorder, your sleep issues must meet specific criteria.
First of all, people with insomnia experience sleep disturbances despite giving themselves plenty of time and opportunity for sleep. This condition is distinguished from sleep deprivation caused by external circumstances, such as long work hours, loud noises, or waking up with an infant.
In addition, the DSM-5 defines insomnia as causing distress or impairment that’s clinically relevant, which may occur in social, occupational, educational, academic, behavioral, or other essential areas of life.
In other words, if a person functions well with six hours of sleep, they wouldn’t qualify for an insomnia diagnosis. But for another person, sleeping the same number of hours may cause distress or impairment, which indicates this condition.
What causes insomnia?
Insomnia has several potential causes, ranging from stress to an interruption in your body’s circadian rhythm. Hormone levels and the function of neurotransmitters in your brain also play a role in your sleep cycles.
Risk factors
Stress
Adults who experience high stress reported not getting enough sleep because their minds race 4x as much as adults with low stress.
Irregular sleep schedule
Changes in your sleep schedule can disrupt your internal clock, called a circadian rhythm. Sleep issues commonly develop in people who work late shifts or experience frequent jet lag.
Mental health disorders
Chronic sleep issues are reported by 50 – 80% of the patients in a typical psychiatric practice. Patients with anxiety, depression, bipolar disorder, and attention deficit hyperactivity disorder (ADHD) are the most vulnerable.
Physical illness
One in four people with chronic pain have a sleep disorder, and certain chronic conditions, such as thyroid disease and diabetes, may contribute to sleeplessness.
Medication
Sleep issues may be a side effect of common medications. These include alpha-blockers, beta-blockers, corticosteroids, SSRI antidepressants, ACE inhibitors, statins, and others.
Caffeine, nicotine, and alcohol
Stimulants, like caffeine and nicotine, can keep you from falling asleep. Although alcohol is a depressant, it can inhibit or delay REM sleep, an essential part of the sleep cycle.
Neurological problems
Alzheimer’s disease, epilepsy, neuromuscular disorders, and Parkinson’s disease are some examples of neurological conditions associated with trouble sleeping.
Insomnia and mental health
Insomnia and mental health issues are closely linked. Sleep issues are a symptom of many mental health disorders, and, in turn, sleep deprivation can worsen the symptoms of psychophysiological insomnia, like anxiety.
By disrupting sleep, this condition alters the levels of neurotransmitters and stress hormones in your brain, which can impair your thinking and emotional regulation.
If you have an existing mental health disorder, insomnia may amplify the symptoms of that condition. Likewise, existing sleep issues may be worsened by a mental health challenge. A typical example is anxiety from insomnia.
For this reason, we list mental health disorders as both a risk factor and a complication for sleep disorders.
The following statistics indicate that this sleep condition shares similar biological mechanisms with specific mental health disorders:
- 90% of children with major depression experience some kind of sleep disturbance.
- It’s estimated that between 69% and 99% of patients with bipolar disorder experience insomnia or report less need for sleep during a manic episode.
- More than 50% of adult patients with generalized anxiety disorder (GAD) report sleep disturbances.
- Sleep issues impact 25% to 50% of children with ADHD.
Complications
This sleep condition can increase your risk of developing other serious health conditions. Most notably, researchers have observed strong links between insomnia and obesity, diabetes, hypertension, and cardiovascular disease.
In addition, insomnia may cause:
- Lower functioning on the job or at school
- Mental health issues, such as depression and anxiety
- Issues with breathing
- Pregnancy complications
- Pain
- Reduced immune response
- A higher risk of car accidents
Types of insomnia
The DSM-5 only lists two main categories for this type of disorder: acute and chronic. Below, we’ve included some additional terminology that may help you understand the different disorders and how they impact your sleep habits.
Acute insomnia
Acute insomnia describes short-term insomnia that lasts less than one month with sleep disturbances at least three nights a week.
Chronic insomnia
Chronic insomnia, sometimes called persistent insomnia, features symptoms that continue for three months or longer. Insomnia may be described as chronic when the patient experiences two or more episodes within a year.
Episodic insomnia
This term describes insomnia that lasts at least one month but fewer than three months.
Sleep onset insomnia
People with sleep onset insomnia have trouble falling asleep. If you experience sleep onset insomnia, you may be unable to fall asleep 20 – 30 minutes after going to bed. To clarify, this means you can’t fall asleep even within 30 minutes of unplugging from electronics and resting quietly in bed. Sleep onset insomnia reduces the total time you spend sleeping.
Sleep maintenance insomnia
This condition describes the type of sleeplessness in which a person wakes up at least once in the middle of the night. It may take another twenty minutes or longer to fall back asleep, so sleep maintenance insomnia reduces your total sleep time and disrupts the overall sleep cycle.
Most adults experience REM sleep, the fourth stage of the sleep cycle, for a quarter of the time they’re asleep. When sleep is disrupted due to sleep maintenance insomnia, the total amount of time spent in REM sleep is significantly less. Since REM sleep is essential to memory, learning, creativity, and other crucial cognitive functions, going without adequate amounts of the fourth sleep stage can cause significant impairments.
Early-morning awakening insomnia
Waking up before you intend to and being unable to fall back asleep is known as early-morning awakening insomnia. This can reduce your total sleep time and cause drowsiness throughout the day.
Primary vs. comorbid insomnia
The DSM-5 makes a distinction when insomnia appears alongside another health condition.
- In some cases, insomnia is diagnosed alongside a non-sleeping disorder mental health issue. This may include addictive disorders, depressive disorders, or anxiety disorders.
- Insomnia can occur with medical comorbidities, such as Parkinson’s disease or heart disease.
- Other sleep disorders comorbidities, such as restless legs syndrome or sleep apnea, often accompany an insomnia diagnosis.
When no other health conditions are present, medical professionals use the term primary insomnia to indicate that this sleep disorder is the sole diagnosis.
Insomnia symptoms
People with insomnia disorder have trouble staying asleep or falling asleep. The resulting sleep deprivation causes daytime symptoms that interfere with everyday activities and quality of life.
The following symptoms may result from either chronic or acute insomnia:
- Trouble falling asleep
- Trouble staying asleep
- Poor-quality sleep
- Daytime sleepiness
- Frequent yawning
- Irritability
- Depression
- Lack of focus
- High blood pressure
- Weight gain
- Weakened immunity
- Impaired memory
- Worry about sleep
- Poor balance
- Frequent errors
- Frequent accidents
Do I have insomnia?
Wondering, “why can’t I sleep?” If you have a hard time falling asleep or staying asleep at least three nights per week and sleep deprivation impacts your waking life, you may have insomnia. If you have acute insomnia, your sleep issues may resolve quickly.
On the other hand, chronic insomnia can continue for months, or even years, if left untreated.
This disorder makes it challenging to get a good night’s sleep, even when you give yourself ample time to rest. The underlying cause may be hormonal, neurological, psychological, or some combination of causes—but the end result is the same.
You get less sleep and, when you do sleep, you spend less time sleeping deeply. Since REM sleep is crucial for cognitive functions, such as memory, creativity, and learning, you’ll notice an impairment in your ability to think and function when sleep quality is reduced. This is often one of the first signs of insomnia.
You may experience this condition as restlessness early in the night, throughout the night, or in the early hours of the morning. When it comes to an insomnia diagnosis, the total number of hours you sleep each night is less significant than the way sleeplessness impacts your life.
Testing & diagnosis
There is no single diagnostic insomnia test. Instead, your healthcare professional will ask you questions about your sleep patterns and symptoms. They’ll also ask you about any medications you’re taking and other health conditions.
In some instances, you’ll be asked to do additional tests, including blood tests or polysomnograms (sleep studies), to evaluate for sleep apnea.
Doing a sleep study may help uncover another sleep disorder that’s causing your issues. Some sleep studies are performed in a sleep center, but you may also be able to complete a sleep study at home, following instructions from a sleep specialist.
Treatments
Once you’ve been diagnosed with a clinical sleep disorder, a healthcare professional can help you develop a customized treatment plan. Tools like prescription medications, therapy, and behavioral strategies are available to help you manage your symptoms.
Medication
Your doctor may recommend a prescription sleeping pill as a way to treat insomnia. These medications include Eszopiclone (Lunesta), Ramelteon (Rozerem), Zaleplon (Sonata), and Zolpidem (Ambien, Edluar, Intermezzo, Zolpimist).
Lemonaid doesn’t offer any of these medications, as they’re controlled substances and cannot be prescribed online.
Most prescription sleeping pills aren’t recommended for long-term use, but some have been approved to treat chronic insomnia.
Non-prescription medications shouldn’t be used to treat chronic insomnia disorder. The antihistamines in most over-the-counter sleep medicines make them unsafe for frequent use.
Side effects from sleep aids that contain antihistamines may involve confusion and cognitive decline. Talk to your doctor before taking antihistamine medication for insomnia.
Melatonin supplements, which mimic the sleep hormone your body naturally produces, are another option. Many people take melatonin as a sleep aid, but the supplement’s long-term safety and effectiveness are unknown.
Therapy
Cognitive behavioral therapy for insomnia (CBT-I) is usually the first-line treatment for this disorder. A six- to eight-week treatment plan, CBT-I offers patients a mix of education and therapy designed to promote good sleep habits.
The protocol involves restricting the amount of time you spend in bed and developing relaxation techniques to help you fall asleep faster. Healthcare providers can deliver CBT-I by telephone and online, making this treatment convenient for people who have this sleep condition.
Sleep-enhancing behaviors
Practicing good sleep hygiene can help you manage the symptoms of insomnia.
Simplify your schedule
Try to keep a consistent schedule by falling asleep and waking up at the same time every day.
Avoid shift work and time zone changes
These kinds of disruptions can make it more challenging to treat your sleep issues.
Upgrade your sleep space
Try to sleep in a cool room, free of loud noises and artificial light. Avoid using your phone, computer, and TV starting an hour or two before bedtime.
Stop napping
Daytime naps can cause restlessness at bedtime. Focus on giving yourself ample time to sleep during the night.
Limit the amount you eat and drink in the evening
Enjoying meals at the same time each day can help to regulate your sleep-wake cycle. Plus, limiting your intake in the evening may prevent you from waking in the night.
Keep a sleep diary
Keeping track of your sleep habits can help you identify behavioral patterns and areas for improvement. In addition, you can share your notes with your healthcare professional to ensure a specific, customized treatment plan.
Lifestyle changes
Some simple lifestyle changes work to promote high-quality sleep while improving your overall health.
Get exercise
Not only does exercise reduce insomnia, but aerobic exercise appears to be as effective as sleeping pills in the treatment of this condition.
Eliminate caffeine, nicotine, alcohol, and illegal drugs
These substances can influence your sleep-wake cycle, leading to poor sleep, insomnia, and sleep disturbances.
Avoid certain medications
Talk to a medical professional about how to reduce your use of over-the-counter and prescription meds that could be disrupting your sleep.
Practice mindfulness
You can do this with activities like meditation, yoga, or tai-chi. Studies suggest that they may help to improve sleep quality and reduce stress.
Try acupuncture
There’s some scientific evidence that acupuncture can help people with this sleep issue, but more research is needed.
Outlook
For some patients, acute insomnia goes away on its own. In other cases, the condition may continue for months or even years. Chronic insomnia disorder, which lasts for more than three months, can cause significant physical and psychological symptoms.
If you’ve been tossing and turning for more than three nights each week, help is available right now. A healthcare professional may be able to prescribe non-habit-forming medication to help you sleep.
When combined with CBT-I and good sleep hygiene, medication can improve your symptoms and help you get the rest you need.
Visit Lemonaid to see a medical professional for your sleep issues. We’ll connect you with a health care provider who can help you develop a personalized treatment plan.
You can schedule online visits and follow-ups with our medical team whenever you need them. Plus, we’ll support you with tools and strategies to improve your sleep.
Takeaway
- Women and older adults are more likely to experience an insomnia disorder.
- This disorder may be chronic or acute, depending on the duration of the symptoms.
- Comorbid diagnoses like mental illnesses, physical conditions, or other sleep disorders may accompany an insomnia diagnosis.
- A medical professional can recommend safe and effective treatments for sleep issues.
