nsomnia is a sleep disorder that millions of people worldwide have to live with. Individuals with insomnia find it difficult to either fall asleep and/or stay asleep. Insomnia commonly leads to daytime sleepiness, lethargy and a general feeling of being unwell both mentally and physically.
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This Medical News Today (MNT) article includes some general information on insomnia, what causes it, who gets it, the most common signs and symptoms, how it is diagnosed, as well as currently available treatment options.
At the end of each section you may see details on recent developments that have been covered by MNT's news stories.
What is insomnia?
Insomnia includes a wide range of sleeping disorders, from lack of quality of sleep to lack of quantity of sleep.
Insomnia is commonly separated into three types:
- Transient insomnia - occurs when symptoms lasts from a few days to some weeks.
- Acute insomnia - also called short-term insomnia. Symptoms persist for several weeks.
- Chronic insomnia - this type lasts for at least months, and sometimes years. According to the National Institutes of Health1, the majority of chronic insomnia cases are secondary, meaning they are side effects or symptoms of some other problem.
Although insomnia can affect people at any age, it is more common in adult females than adult males. Thesleeping disorder can undermine school and work performance, as well as being a cause of obesity, anxiety,depression, irritability, concentration problems, memory problems, poor immune system function, and reduced reaction time. Insomnia has also been associated with a higher risk of developing chronic diseases.
The National Sleep Foundation2 informs that between 30% and 40% of American adults say they have had some symptoms of insomnia within the previous 12 months, and 10% to 15% of adults claim to have chronic insomnia.
Recent developments on insomnia from MNT news
Researchers from the University of Pittsburgh reported in the journal Sleep in October 2012 that lack of sleep during a person's teenage years increases the risk of developing diabetes type 2.
Lack of sleep makes people want to eat junk food - researchers from UC Berkeley reported in Nature Communications that sleeplessness affects our decision-making regarding which foods we eat.What causes insomnia?
Insomnia can be caused by physical factors as well as psychological factors. There is often an underlying medical condition that causes chronic insomnia, while transient insomnia may be due to a recent event or occurrence.
Medications - according to the American Association of Retired Persons3 (AARP), the following medications are known to cause insomnia in some patients:
- Corticosteroids - used for treating patients with allergic reactions, gout, Sjögren's syndrome, lupus,rheumatoid arthritis, and inflammation of the muscles and blood vessels. Examples include: prednisone, triamcinolone, methylprednisolone and cortisone.
- Statins - medications used for treating high cholesterol levels. Examples include: simvastatin,rosuvastatin, lovastatin and atorvastatin.
- Alpha blockers - used for treating hypertension (high blood pressure, Raynaud's disease and BPH (benign prostatic hyperplasia). Examples include: terazosin, silodosin, alfuzosin, prazosin, doxazosin and tamsulosin.
- Beta blockers - used for treating hypertension and irregular heartbeat (arrhythmias). Examples include: timolol, carvedilol, propranolol, atenolol, metoprolol and sotalol.
- SSRI antidepressants - used for treating depression. Examples include: fluoxetine, citalopram, paroxetine, escitalopram, sertraline and fluvoxamine.
- ACE inhibitors - used for the treatment of hypertension, and other heart conditions. Examples include: ramipril, fosinopril, trandolapril, quinapril, benazepril, enalapril, lisinopril, moexipril, perindopril and captopril.
- ARBs (Angiotensin II-receptor blockers) - used when the patient cannot tolerate ACE inhibitors or has type 2 diabetes or kidney disease from diabetes. Examples include: candesartan, valsartan, telmisartan, losartan and irbesartan.
- Cholinesterase inhibitors - used for treating memory loss and other symptoms for patients with dementia, including Alzheimer's disease. Examples include: rivastigmine, donepezil and galantamine.
- 2nd generation (non-sedating) H1 agonists - used for treating allergic reactions. Examples include: loratadine, levocetirizine, fexofenadine, desloratadine, cetirizine and azelastine.
- Glucosamine/chondroitin - dietary supplements used for relieving the symptoms of joint pain and to reduce inflammation.
Insomnia can also be caused by:
- Disruptions in circadian rhythm: jet lag, job shift changes, high altitudes, noisiness, hotness or coldness
- Psychological issues: people with mood disorders, such as bipolar disorder or depression, as well asanxiety disorders or psychotic disorders are more likely to have insomnia.
- Medical conditions: brain lesions and tumors, stroke, chronic pain, chronic fatigue syndrome, congestiveheart failure, angina, acid-reflux disease (GERD), chronic obstructive pulmonary disease, asthma, sleep apnea, Parkinson's and Alzheimer's diseases, hyperthyroidism, arthritis
- Hormones: estrogen, hormone shifts during menstruation
- Other factors: sleeping next to a snoring partner, parasites, genetic conditions, overactive mind, preganancy
- Media technology in the bedroom - researchers from the University of Helsinki, Finland, reported in the journal BMC Public Health that media technology in the bedroom disrupts sleep patterns in children. They found that children with TVs, computers, video games, DVD players and mobile phones in their bedrooms slept considerably less than kids without these devices in their bedrooms.
Who gets insomnia?
Some people are more likely to suffer from insomnia than others. These include:
- Travelers
- Shift workers with frequent changes in shifts
- The elderly
- Drug users
- Adolescent or young adult students
- Pregnant women
- Menopausal women
- Those with mental health disorders
What are the symptoms of insomnia?
Insomnia itself may be a symptom of an underlying medical condition. However, there are several signs and symptoms that are associated with insomnia.
- Difficulty falling asleep at night
- Awakening during the night
- Awakening earlier than desired
- Still feeling tired after a night's sleep
- Daytime fatigue or sleepiness
- Irritability, depression or anxiety
- Poor concentration and focus
- Being uncoordinated, an increase in errors or accidents
- Tension headaches
- Difficulty socializing
- Gastrointestinal symptoms
- Worrying about sleeping
Sleep deprivation can cause other symptoms. The afflicted person may wake up not feeling fully awake and refreshed, and may have a sensation of tiredness and sleepiness throughout the day.
Having problems concentrating and focusing on tasks is common for people with insomnia.
According to the National Heart, Lung and Blood Institute4, 20% of non-alcohol related car crash injuries are caused by driver sleepiness.
How is insomnia diagnosed?
A sleep specialist usually will begin a diagnostic session by asking a battery of questions about your medical history and sleep patterns. A physical exam may be conducted to look for conditions that may be causing insomnia. Similarly, physicians may screen for psychiatric disorders and drug and alcohol use.
The Stanford Center for Sleep Sciences and Medicine5 explains that the term "insomnia" is often used colloquially in reference to "disturbed sleep".
For somebody to be diagnosed with an insomnia disorder their disturbed sleep should have persisted for over one month. It should also negatively impact on the patient's well being, either because of the distress it causes or because it undermines mood or performance.
A sleep specialist is trained to determine whether the symptoms are being caused by an underlying condition.
The patient may be asked to keep a sleep diary in order to examine his or her sleeping patterns more closely.
More sophisticated tests may be employed such as a polysomnograph, which is an overnight sleeping test that records sleep patterns. In addition, actigraphy may be conducted, which uses a small, wrist-worn device called an actigraph to measure movement and sleep-wake patterns.
How is insomnia treated?
Some types of insomnia resolve themselves when the underlying cause is removed or wears off. In general, treating insomnia focuses on determining the cause of the sleeping problems. Once identified, this underlying cause can be properly treated or corrected. In addition to treating the underlying cause of insomnia, both medical and non-pharmacological (behavioral) treatments may be employed as adjuvant therapies.
Non-pharmacological approaches to treating insomnia include:
- Improving "sleep hygiene" - don't over- or under-sleep, exercise daily, don't force sleep, try to maintain a regular sleep schedule, avoid caffeine at night, do not smoke, do not go to bed hungry, make sure the environment is comfortable
- Using relaxation techniques - such as meditation and muscle relaxation
- Cognitive therapy - one-on-one counseling or group therapy
- Stimulus control therapy - only go to bed when sleepy, refrain from TV, reading, eating, or worrying in bed, set an alarm for the same time every morning (even weekends), avoid long daytime naps
- Sleep restriction - decrease the time spent in bed and partially deprive your body of sleep so you are more tired the next night.
Medical treatments for insomnia include:
- Prescription sleeping pills (often benzodiazepines)
- Antidepressants
- Over-the-counter sleep aids
- Antihistamines
- Melatonin
- Ramelteon
- Valerian officinalis
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