Insomnia is one of the most common sleep disorders out there that should not be taken easily. But how do you become insomniac and what happens if it’s left untreated? All your questions will be answered here.
Insomnia is a sleep disorder that causes difficulty in sleeping. Insomniacs find it hard to fall asleep or stay asleep, causing them to feel tired and become irritable. Some also become excessively sleepy during the day.
People with insomnia may experience different problems caused by the disorder, but it mostly involves having low energy levels and emotional problems.
Insomnia can be short term or long term. It may last for days, weeks or a month. If it goes on longer than a month, insomnia is severe and may be the case of fatal familial insomnia.
It can also come independently or as a symptom of another disease a person might have.
There are many factors that can potentially cause insomnia such as psychological stress, chronic pain, heart failure, hyperthyroidism, restless leg syndrome, sleep apnea and certain medications.
Treating insomnia can be done in many ways, but it is a fact that lifestyle changes or improvement with sleep hygiene can contribute positively more than actual medications.
Between 10% and 30% of adults have insomnia at any given point in time and up to half of people have insomnia in a given year.
About 6% of people have insomnia that is not due to another problem and lasts for more than a month.
People over the age of 65 are affected more often than younger people. Females are more often affected than males.
Descriptions of insomnia occur at least as far back as ancient Greece.
Symptoms
The main symptom of insomnia regardless of its type is difficulty falling asleep. It can be accompanied by other symptoms as well and can be treated with the help of proper diagnosis.
- 15 Signs that you might have Insomnia:
- Difficulty falling asleep
- Complete inability to fall asleep
- Shifting sleeping positions continuously
- Waking up during the night and being unable to go back to sleep
- Waking up too early or getting lesser / shorter time of sleep
- Decreased ability to focus
- Poor memory
- Excessive daytime sleepiness
- Lack of emotional stability
- Depression
- Anxiety
- Feeling tired or having low energy during the day
- Sudden weight gain
- Impulsive behavior or being irritable
- Spacing out during random moments
It is common for patients who have difficulty falling asleep to also have nocturnal awakenings with difficulty returning to sleep.
Two-thirds of insomnia patients wake up in the middle of the night, with more than half having trouble falling back to sleep after a middle-of-the-night awakening.
Early morning awakening is an awakening occurring earlier (more than 30 minutes) than desired with an inability to go back to sleep, and before total sleep time reaches 6.5 hours.
Early morning awakening is often a characteristic of depression.
Anxiety symptoms may well lead to Insomnia. Some of these symptoms include tension, compulsive worrying about the future, feeling overstimulated, and over analyzing past events
Sleep-onset insomnia, on the other hand, is difficulty falling asleep at the beginning of the night. This is often a sign of anxiety disorders.
Reminder: Please keep in mind that experiencing one or more of the symptoms listed above does not automatically confirm that you have insomnia. It is best to visit your doctor for an actual examination and proper diagnosis.
Consult your doctor
Diagnosis
- Athens Insomnia Scale
- Insomnia is most commonly diagnosed using the Athens insomnia scale (AIS). More details will be shown further below.
- Polysomnography (Sleep Study)
- The overall method to diagnose sleep-related conditions is called a “polysomnography” or a sleep study / sleep test, it uses all possible methods to diagnose a person’s condition
- Actigraphy
- Actigraphy is similar to polysomnography but less expensive. It is used to record the sleep and wake cycles, by analyzing the patient’s limb movements.
It is also helpful in ruling out other sleep disorders, especially circadian disorders, leading to an excess of sleepiness during the day, too.
(Related: “How to Do a Sleep Study?”)
- Actigraphy is similar to polysomnography but less expensive. It is used to record the sleep and wake cycles, by analyzing the patient’s limb movements.
- Actigraphy
- The overall method to diagnose sleep-related conditions is called a “polysomnography” or a sleep study / sleep test, it uses all possible methods to diagnose a person’s condition
- Sleep diary
- Patients can keep a sleep diary to help diagnose insomnia.
Sleep diary should include time to bed, total sleep time, time to sleep onset, number of awakenings, use of medications, time of awakening, and subjective feelings in the morning.
- Patients can keep a sleep diary to help diagnose insomnia.
- Multiple Latency Test (MLST)
- Insomnia is also identified through “multiple sleep latency test (MLST)”, used to measure the time elapsed from the start of a daytime nap period to the first signs of sleep called “sleep latency”.
The MLST is based on the idea that the sleepier the person is, the faster the person will asleep.
- Insomnia is also identified through “multiple sleep latency test (MLST)”, used to measure the time elapsed from the start of a daytime nap period to the first signs of sleep called “sleep latency”.
The Athens insomnia scale is measured by assessing eight factors among which first five factors are related to nocturnal sleep and last three factors are related to daytime dysfunction.
- Athens Insomnia Scale for measuring Insomnia
- Sleep induction
- 0: No problem
- 1: Slightly delayed
- 2: Markedly delayed
- 3: Very delayed or did not sleep at all
- Awakenings during the night
- 0: No problem
- 1: Minor problem
- 2: Considerable problem
- 3: Serious problem or did not sleep at all
- Final awakening
- 0: Not earlier
- 1: A little earlier
- 2: Markedly earlier
- 3: Much earlier or did not sleep at all
- Total sleep duration
- 0: Sufficient
- 1: Slightly insufficient
- 2: Markedly insufficient
- 3: Very insufficient or did not sleep at all
- Sleep quality
- 0: Satisfactory
- 1: Slightly unsatisfactory
- 2: Markedly unsatisfactory
- 3: Very unsatisfactory or did not sleep at all
- Well-being during the day
- 0: Normal
- 1: Slightly decreased
- 2: Markedly decreased
- 3: Very decreased
- Functioning capacity during the day
- 0: Normal
- 1: Slightly decreased
- 2: Markedly decreased
- 3: Very decreased
- Sleepiness during the day
- 0: None
- 1: Mild
- 2: Considerable
- 3: Intense
- Sleep induction
The 8 factors are rated on a 0–3 scale and the sleep is finally evaluated from the cumulative score of all factors and reported as an individual’s sleep outcome.
Over the period of time, AIS is considered to be an effective tool in sleep analysis, and it is validated in various countries by testing it on local patients.
A qualified sleep specialist should be consulted for the diagnosis of any sleep disorder so the appropriate measures can be taken.
Past medical history and a physical examination need to be done to eliminate other conditions that could be the cause of insomnia.
After all other conditions are ruled out a comprehensive sleep history should be taken.
The sleep history should include sleep habits, medications (prescription and non-prescription), alcohol consumption, nicotine and caffeine intake, co-morbid illnesses, and sleep environment.
Types of Insomnia
- Transient Insomnia
- Lasts for less than a week and can be caused by another disorder or changes in a person’s sleep environment. It can also be caused by depression or stress.
- Acute Insomnia
- The inability to consistently sleep well for a period of less than a month.
- Chronic Insomnia
- Lasts for longer than a month. It can be caused by another disorder or can also be the primary disorder.
People with high levels of stress hormones or shifts in the levels of cytokines are more likely than others to have chronic insomnia.
- Lasts for longer than a month. It can be caused by another disorder or can also be the primary disorder.
Insomnia for DSM-5
Insomnia can also qualify as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Here’s the criteria that must be met.
- Difficulty initiating sleep
- Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings
- Early-morning awakening with inability to return to sleep
- The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
- The sleep difficulty occurs at least 3 nights per week.
- The sleep difficulty is present for at least 3 months.
- The sleep difficulty occurs despite adequate opportunity for sleep.
- The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia).
- The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).
- Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.
Causes
There are many factors that can potentially cause insomnia or worsen it. Insomnia may be an independent disorder or it may come as a symptom of another disease.
Here’s a long list of different possible causes of insomnia.
- 35 Potential causes of Insomnia:
- Using psychoactive drugs
- Distraction from electronic devices
- Drinking or consuming caffeine
- Excessive alcohol intake
- Withdrawal symptoms from alcohol or drugs
- Using opioids
- Heart disease
- Breathing problems
- Restless leg syndrome
- Periodic limb movement disorder
- Having an injury that causes constant pain or discomfort
- Hormonal shifts such as menstruation
- Being in a state of fear
- Having anxiety or depression
- Distracting stress levels
- Heartburn or constipation
- Bipolar disorder
- Post traumatic stress disorder
- Schizophrenia
- Obsessive compulsive disorder (OCD)
- Dementia
- Attention deficit hyperactivity disorder (ADHD)
- Disrupted sleep pattern due to shifting work schedules
- Chronic circadian rhythm disorders
- Brain lesions
- Traumatic brain injuries
- Hyperthyroidism
- Rheumatoid arthritis
- Genetics / Hereditary
- Poor sleeping environment
- Unhealthy sleep routine
- Fatal Familial Insomnia
- Too much physical activities
- Exposure to blue-light such as phones or computers
- Asthma
Here is a list of risk factors to help you determine who is more at risk of having insomnia.
- 16 Risk factors:
- Old age (being older than age 60)
- Having history of other mental health disorders
- Having depression or anxiety
- Being stressed
- Working night shifts
- Traveling to different time zones
- Having diabetes
- Kidney disease
- Lung disease
- Alzheimer’s disease
- Heart disease
- Drinking alcohol
- Heavy smoking
- Drug usage
- Gastrointestinal reflux disease
- Fatigue
Treatment
Insomnia can be treated in various ways and sometimes, the treatment method can be different depending on the cause.
If insomnia is independent, treatment focuses on stopping the symptoms to completely stop the condition. If insomnia is a symptom of another disease, the underlying disease is the main focus for treatment.
- Cognitive behavioral therapy
- Generally the first line treatment for insomnia. It has been found to be effective for chronic insomnia.
- Medications
- Sleeping pills or sedatives are the second line of treatment for insomnia.
Eszopiclone, Zaleplon, and Zolpidem are prescribed drugs for insomnia, but has a risk for triggering its side effects such as “sleep walking“.
- Sleeping pills or sedatives are the second line of treatment for insomnia.
- Antihistamines
- For alternatives, an average person seeking short-term help may find relief by taking over-the-counter antihistamines such as diphenhydramine or doxylamine.
Diphenhydramine and doxylamine are widely used in nonprescription sleep aids.
They are the most effective over-the-counter sedatives currently available and are more sedating than some prescription hypnotics.
- For alternatives, an average person seeking short-term help may find relief by taking over-the-counter antihistamines such as diphenhydramine or doxylamine.
- Melatonin
- Though melatonin is not as strongly effective as other treatment options, it may work for some people. However, it is simply an alternative if other treatments do not work.
- Antidepressants
- Insomnia is a common symptom of depression making antidepressants effective for treating sleep problems.
- Amitriptyline
- Doxepin
- Mirtazapine
- Trazodone
- Insomnia is a common symptom of depression making antidepressants effective for treating sleep problems.
- Benzodiazepines
- Antidepressants are better than benzodiazepines, but can be used as alternatives if antidepressants are not effective.
- Antipsychotics
- The use of antipsychotics for insomnia, while common, is not immediately recommended as it does not have enough evidence of effectiveness and might have bad side-effects.
- Herbs or Aromatherapy
- Herb drinking or aromatherapy, both can help improve a person’s overall health by relieving feelings of stress due to its relaxing nature.
- Valerian
- Chamomile
- Lavender
- Cannabis
- Hops
- Withania somnifera
- Passion-flower
- Herb drinking or aromatherapy, both can help improve a person’s overall health by relieving feelings of stress due to its relaxing nature.
- Acupuncture
- Acupuncture is a form of body therapy, almost like a massage that can help insomniacs relax. However, strong evidences haven’t been found to prove its effectiveness.
Apart from the commonly used treatment methods, here’s a list of lifestyle changes that can possibly help stop insomnia.
- 14 Tips for preventing Insomnia
- Follow a proper, healthy sleep schedule
- Try to avoid working on night shifts or maintain a proper sleep schedule.
- Try to get plenty of exercises
- Keeping your body awake and properly energized can improve your overall health. But remember not to exercise too much and exercise only in the morning.
- Eat a healthy, balanced diet
- Your diet plays a role in improving the quality of your sleep. There are also certain food that can help a person sleep.
- Related: “Best Foods to Eat Before Going to Sleep” & “Foods for Deep Sleep“
- Your diet plays a role in improving the quality of your sleep. There are also certain food that can help a person sleep.
- Avoid alcohol before sleep
- Alcohol can make sleeping difficult. The same goes for nicotine and caffeine.
- Stop unnecessary drug usage
- When under the influence of drugs, a person’s body may become dysfunctional and prevent proper sleep hygiene.
- Treat other illnesses (mental illnesses)
- Focusing on your anxiety, depression and other mental health issues can help stop the symptoms of insomnia.
Your mental health is important and affects your overall physical wellness.
- Focusing on your anxiety, depression and other mental health issues can help stop the symptoms of insomnia.
- Do some therapeutic activities
- Relaxing before bed can also take your mind off your worries and help you sleep better.
- Manage your stress
- Stress, regardless if it’s physical or mental, can cause you to feel restless and prevent you from sleeping. It can make you overthink, so try to manage your stress.
- Avoid eating too close to bed time
- Certain food can give you a burst of energy that may prevent you from feeling sleepy when you try to go to sleep at night.
- Try to improve your surrounding environment
- Your surroundings can affect you, mentally, or physically. Even your bedroom can boost your mental health.
If possible, consider improving your lifestyle and surroundings.
- Your surroundings can affect you, mentally, or physically. Even your bedroom can boost your mental health.
- Avoid or limit naps
- Taking too much naps in the day can make sleeping a lot more difficult at night.
- Treat what makes you feel in pain
- If something is causing you pain and makes it harder to fall asleep, start treating it to make your nights much better.
Many of us like to ignore pain such as headaches and hope it goes away on its own, but using proper medication can help fix that much faster.
- If something is causing you pain and makes it harder to fall asleep, start treating it to make your nights much better.
- Use white noise machines
- It may not be effective for all, but background noise from white noise machines can help make sleeping a lot easier.
It will also mask distracting noises that can prevent you from sleeping.
- It may not be effective for all, but background noise from white noise machines can help make sleeping a lot easier.
- Don’t look at the time
- There are insomniacs that have a habit of checking the time over and over again. Keep clocks out of sight, turn off your devices and focus on sleeping.
- Follow a proper, healthy sleep schedule
Keep in mind that all these treatments as well as lifestyle changes tips may or may not work for you. It is still best to see a doctor to determine which treatment option will be effective for your case.
Risks
Lack of sleep caused by insomnia is health-threatening in the long run. It can slowly destroy the body’s system and lead to other potential illnesses.
Aside from that, insomnia in its early stages simply increase the risk of getting into accidents as sleep deprivation can cause a person to easily lose focus on tasks such as driving, walking or others.
Untreated insomnia that may grow severe is alarming enough that it can cause heart and brain diseases and for rare cases, may develop into fatal familial insomnia which ends with death.
Related Questions
Can insomnia go away on its own?
Acute insomnia can go away on its own. However, different types of insomnia may last and may not disappear until the primary cause is eliminated or treated.
Are there levels of insomnia?
Yes, insomnia has three types that can be considered “levels”.
Transient Insomnia lasts for less than a week and can be caused by another disorder or changes in a person’s sleep environment. It can also be caused by depression or stress.
Acute Insomnia is the inability to consistently sleep well for a period of less than a month.
Chronic Insomnia lasts for longer than a month. It can be caused by another disorder or can also be the primary disorder.
A different kind of insomnia, however, is called “fatal familial insomnia” wherein insomnia is severe and have no cure, it leads to death.
