Insomnia

What is Insomnia?

Insomnia is a common sleep disorder that makes it difficult to sleep, stay asleep, or get good quality sleep. The International Classification of Sleep Disorders (ICSD) identifies three different types of insomnia disorder: chronic insomnia, short-term insomnia, and other insomnia, which is when the patient experiences symptoms of insomnia but does not meet all criteria for the two main types. Insomnia can have a substantial adverse effect on the quality of life.

Who is most likely to experience insomnia?

Studies show that insomnia is more common among individuals with underlying psychological or medical conditions, older individuals, females, and individuals with a family history of insomnia. Psychiatric or medical conditions that increase the risk of insomnia include the following:

• Depression
• Anxiety
• Post traumatic stress disorders
• Substance use disorders
• Other Sleep Disorders
• Hypertension
• Lung disease
• Diabetes
• Cancer
• Neurological disorders

Is Insomnia common?

Insomnia is a very common condition that causes over five million office visits per year in the US alone. 

Can medications or substances cause insomnia?

Insomnia can be associated with numerous classes of medications and substances including:

• Central nervous system stimulants (such as caffeine)
• Beta-blockers
• Respiratory stimulants
• Antidepressants
• Appetite Suppressants
• Glucocorticoids
• Alcohol, tobacco, and caffeine
• Over the counter medications, such as nasal or oral decongestants (such as Sudafed), aspirin, and ibuprofen

What causes Insomnia?

The causes of insomnia vary widely from person to person. However, studies have observed that insomnia is associated with increased changes in cardiac, metabolic hormonal, and neurological functions. Individuals who suffer from insomnia generally tend to exhibit higher metabolic rates, increased heart rates, and increased levels of cortisol (also known as the stress hormone). Short-term insomnia is usually a response to an identifiable stressor while chronic insomnia often has no identifiable trigger.

What is the insomnia symptoms test?

The insomnia symptoms test is a self-report screening tool that can be used to determine severity of insomnia as well as track changes in symptoms over time. It can be in the form of a questionnaire or even a sleep diary.

What are the symptoms of insomnia?

Insomnia symptoms include: 

• Difficulty initiating or maintaining sleep
• Compromised function during the day related to one or more of the following:
• Fatigue or malaise
• Poor attention or concentration
• Social or vocal/educational dysfunction
• Mood disturbance or irritability
• Daytime sleepiness
• Reduced motivation or energy
• Increased errors or accidents
• Behavioral problems such as hyperactivity, impulsivity or aggression
• Continued worry about sleep

How is chronic insomnia differentiated from short-term insomnia?

Short-term insomnia lasts less than 3 months while chronic insomnia lasts for 3 months or more. 

How is insomnia diagnosed?

According to the third edition of the International Classification of Sleep Disorders (ICSD-3), insomnia is confirmed when all four of the following criteria are met and occur at least three nights a week:

• Difficulty initiating sleep, maintaining sleep, or waking up too early
• Despite adequate opportunity and circumstances for sleep, sleep difficulties still occur
• Sleep difficulties cause daytime impairment 
• Sleep difficulties are not caused by a different sleep disorder

Parasomnias

Parasomnias are a group of sleep disorders characterized by abnormal experiences that occur during initiation of sleep, during sleep or during arousal from sleep.

Other sleep disorders

Sleep disorders that do not meet all of the diagnostic criteria according to the ICSD-3 for any of the above conditions are considered other sleep disorders.

Sleep-related movement disorders

Sleep-related movement disorders are characterized by physical movements that disturb sleep and/or daytime functioning. Patients may not always be aware of these movements.
 

Circadian rhythm sleep-wake disorders

In individuals with circadian rhythm sleep-wake disorders, sleep cycles are misaligned with the body’s internal clock. This can cause chronic sleep disturbances.

Central disorders of hypersomnolence

The central disorders of hypersomnolence are a group of disorders that result in excessive daytime sleepiness that is present despite normal quality and timing of nighttime sleep.
 

Sleep-related breathing disorders

Sleep disorders that involve abnormal respiration while sleeping are classified as sleep-related breathing disorders. The most common is obstructive sleep apnea (OSA). 
 

Are there any natural remedies for insomnia?

Melatonin, cannabidiol (CBD), and tetrahydrocannabinol (THC) are recognized as potential natural remedies for insomnia. There are various other dietary supplements that are marketed for insomnia but there is not sufficient evidence to support their efficacy. It is also important to note that dietary supplements are not regulated by the FDA so the concentration or purity of the ingredients is not guaranteed.

How to deal with insomnia?

Minimizing stress and keeping a regular schedule are the best ways to deal with insomnia. Lifestyle changes that can help improve insomnia symptoms include:

• Sleeping in a cool and quiet place
• Avoiding blue light from electronic devices
• Going to bed and waking up at the same time every day (even weekends)
• Avoiding caffeine, nicotine, and alcohol
• Exercising regularly during the daytime
• Avoiding long naps
• Eating meals on a regular schedule
• Limiting how much fluid you drink before bedtime

How to cure insomnia?

Short term insomnia can be cured by identifying and removing the physical or physiological stressor that is disturbing sleep. With severe cases, short-term use of a sedative medication can also help minimize the effects of poor sleep. Chronic insomnia may also be cured by removing the contributing factors. However, in most cases of chronic insomnia there is either no identifiable trigger or the insomnia may be a symptom of other comorbid illnesses. Therefore, the treatment shifts to management of symptoms. 

How to treat insomnia?

Insomnia should be treated in a step-by-step approach. The first step to treat all types of insomnia is to try to minimize any contributing factors or comorbid illnesses that may be getting in the way of optimal sleep. Lifestyle changes can often help improve short-term insomnia. In chronic insomnia, cognitive behavioral therapy (CBT) and prescription medication are the main treatment options if the attempts to manage contributing factors are not sufficient. 

CBT treatment for insomnia
Cognitive behavioral therapy (CBT) is the first treatment option for chronic insomnia. CBT is a multi-component approach that addresses common thoughts and behaviors that interfere with sleep. It is commonly delivered over 4-8 sessions with a qualified professional. Components of this therapy include:

• Cognitive therapy 
• Relaxation or meditation therapy
• Sleep education
• Sleep restriction therapy
• Stimulus control therapy

Medication treatment for insomnia
While prescription medication should not be the sole treatment for insomnia, it can be very helpful as part of an integrated approach that includes behavioral strategies and treatment of comorbidities. There are various types of medications that can help treat insomnia. They include:

• Over the counter sleep aids
• Prescription medications approved specifically for the treatment of insomnia
• Off-label prescription medications
• Dietary supplements