Insomnia the most common sleep disorder. A person with insomnia experiences difficulty falling asleep or staying asleep, even when a person is trying to go to sleep. At some point, many adults experience short-term insomnia, which lasts for days or weeks, which is usually the result of stress or a traumatic event. But some people have long-term insomnia that lasts for a month or longer. It is possible that insomnia may be the primary problem, or it may be associated with other medical conditions or medications. The National Institutes of Health estimates that roughly 30 percent of the general population complains of sleep disruption and approximately 10 percent have associated symptoms of daytime functional impairment consistent with the diagnosis of insomnia. Most cases of insomnia are related to poor sleep habits, depression, anxiety, lack of exercise, chronic illness, or certain medications.
Insomnia Disorder Defined
Insomnia is a dissatisfaction with sleep quantity or quality with complaints of difficulty initiating or maintaining sleep. The sleep impairments have significant impacts in social, occupational, or other important areas of functioning. Difficulty maintaining sleep is the most common single symptoms of insomnia, followed by a difficulty falling asleep. A combination of the two is the most common presentation of insomnia. The onset of insomnia can occur at anytime during someone’s life but the first episode is most commonly in young adulthood. Sleep often becomes less restful as people age, so noise or other changes in the environment are more likely to impact sleeping. With age, the internal clock often advances, so you get tired earlier in the evening and wake up earlier in the morning. But older people generally still need the same amount of sleep as younger people do. Other changes that occur with age that can cause insomnia are changes in health, sleep patterns, and changes in activity. Insomnia can be characterized based on its duration.
Different Types of Insomnia Disorders
There are specifiers identified in the Diagnostic and Statistical Manual of Mental Disorders related to insomnia:
- Episodic: Symptoms last eat eat 2 month but less than 3 months.
- Persistent: Symptoms last 3 months or longer.
- Recurrent: Two (or more) episodes within the space of 1 year.
The Diagnostic and Statistical Manual of Mental Disorders also identifies different manifestations of insomnia that occur at different times of the sleep period:
- Sleep-onset insomnia (or initial insomnia): Difficulty initiating sleep at bedtime.
- Sleep maintenance insomnia (or middle insomnia): Frequent or prolonged awakenings throughout the night.
- Late insomnia: Early-morning awakening with an inability to return to sleep.
Insomnia Disorder Causes
There are various causes for insomnia, all depending on the person and situation. Stress can be a major source of insomnia. Concerns about finances, trauma, stressful life situations, family, work, health, etc., can keep an individual’s mind active at night, making it difficult to sleep. If an individual travels a lot or has a busy work schedule (jet lag, changing shifts, or traveling across multiple time zones), disrupting the body’s circadian rhythms can lead to insomnia. Circadian rhythms act as an internal clock, guiding such things as the sleep-wake cycle, metabolism and body temperature. Eating late at night can cause insomnia because it can cause physical uncomfortableness due to how the food is being digested. Poor sleeping habits like stimulating activities before bed, watching tv or other screen time before bedtime, naps, or irregular sleeping schedules may also cause insomnia.
Other causes of insomnia could be associated with medical conditions or the use of certain drugs or medications. This can include medications for blood pressure or antidepressants and medical conditions like heart disease or asthma. Mental health disorders like depression, anxiety, such as post-traumatic stress disorder, may disrupt sleeping. Other sleep-wake disorder can also cause insomnia. This can include but not limited to restless leg syndrome, or sleep apnea can prevent individuals from falling asleep. The intake of stimulants like drinking coffee or nicotine has also been a hindrance to falling asleep or staying asleep.
Insomnia Disorder Symptoms
To be diagnosed with Insomnia, according to the Diagnostic and Statistical Manual of Mental Disorders, the following criteria must be met:
A. A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms:
- Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention).
- Difficulty maintaining sleep, characterized by frequent awakenings or problematic returning to sleep after awakenings. (in children, this may manifest as difficulty returning to sleep without caregiver intervention).
- Early-morning awakening with inability to return to sleep.
B. The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
C. The sleep difficulty occurs at least 3 nights per week.
D. The sleep difficulty is present for at least 3 months.
E. The sleep difficulty occurs despite adequate opportunity for sleep.
F. 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, or a parasomnia).
G. The insomnia is not attributable to the physiological effects of a substance (e.g., a drug abuse or medication).
H. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.
How to Approach a Loved One
If a loved one displays symptoms of insomnia it is important to recommend that they visit their current doctor and request an evaluation. While preventing someone from developing insomnia is not possible, providing support and information on treating insomnia is. Insomnia is very common, and reassuring loved ones that there is treatment and that they are not alone in their experience can be helpful. For more information on how to approach a loved one with insomnia visit: https://www.helpguide.org/articles/sleep/insomnia-causes-and-cures.htm/
Types of Insomnia Disorder Treatment
Treatment for insomnia can include behavioral, psychological, medical components or some combination thereof, but it is usually treatable. It is important to distinguish the best course of treatment individually.
A significant treatment for insomnia is lifestyle changes. Doing things like making sure not to eat heavy before bedtime, finding ways to relax, not staying in bed when you are not sleeping, avoiding the intake of stimulants before bed, and eliminating screen time before bedtime are all ways to change sleeping habits. Remaining active and sticking to a sleep schedule constantly may improve an individual’s sleeping habits. If an individual is taking medications, it is important to know the side effects of the medication.
There are various prescription sleeping pills that can assist with falling asleep and/or staying asleep. It is not advised to rely on prescription sleeping pills to sleep, but there are some that are used for long term use. It is important to consult with a doctor when using sleeping pills as they do have side effects like daytime grogginess. Some medications include Eszopiclone (Lunesta) or Zaleplon (Sonata). Taking over the counter non prescription sleeping pills are not intended for regular use and may cause side effects like dizziness, difficulty urinating, daytime sleepiness, etc. Again, please consult with a doctor before taking any kind of sleeping pills.
Cognitive Behavioral Therapy for Insomnia (CBT-I)
Cognitive behavioral therapy for insomnia is a common form of treatment for insomnia, as it can teach individuals how to control or eliminate thoughts that can cause individuals not to stay asleep or fall asleep. CBT-I teaches individuals how to develop good sleeping habits and behaviors that will assist with sleeping habits. Some strategies learned are relaxation techniques or sleep restriction (controlling naps, changing the amount of time spent in bed, etc).
There are other ways to treat insomnia that people try like using meditation or yoga to calm the mind and reduce stress. Other ways include the use of an over the counter supplement, melatonin, or other dietary supplements like valerian. Discuss with a doctor before using melatonin or valerian as they have various side effects.
Differences Between Common Disorders
There are other disorders that may resemble insomnia, so it is important to differentiate the difference between common disorders that may get confused with this disorder.
- Normal sleep variations-Normal sleep duration varies considerably across individuals. Individuals who require little sleep are often concerned about their sleeping habits. Short sleeps differ from individuals with insomnia disorder by the lack of difficulty falling asleep or staying asleep, as well as daytime symptoms like irritability and fatigue. Clinical insomnia should also be distinguished from normal, age-related sleep changes. This is the same for sleep deprivation due to inadequate opportunity or circumstance for sleep.
- Situational/acute insomnia- Situational/acute insomnia is a condition lasting a few days to a few weeks, often associated with life events or with changes in sleep schedule.
- Delayed sleep phase and shift work types of circadian rhythm sleep-wake disorder- Individuals with the delayed sleep phase type of circadian rhythm sleep-wake disorder report sleep-onset insomnia only when trying to sleep a socially normal hours., but do not report difficulty falling asleep or staying asleep when their bed and rising times are delayed and coincide with their internal circadian rhythm.
- Restless leg syndrome- Restless leg syndrome often produces difficulties initiating and maintain sleep, but the urge to move legs and any other accompanying leg sensations is different then insomnia disorder.
- Breathing- related sleep disorder- Individuals with breathing-related sleep disorder have a history of loud snoring, breathing pauses during sleep, and excessive daytime sleepiness.
- Narcolepsy- Narcolepsy may cause insomnia complaints but is distinguished from insomnia disorder by the predominance of symptoms of excessive sleep paralysis, excessive daytime sleepiness, etc.
- Parasomnias-Parasomnias are characterized by a complaint of unusual behavior or events during sleep that may lead to intermittent awakenings and difficulty resuming sleep. However, it is the behavioral events, rather than the insomnia.
- Substance/medication-induced sleep disorder, insomnia type- Substance/medication-induced sleep disorder, insomnia type is different from insomnia disorder by the fact that a substance (i.e., a medication or drug abuse) is judged to be etiologically related to the insomnia. The onset of insomnia is due to the substance or medication.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders.
(5th ed.) Arlington, VA: American Psychiatric Association.
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