Insomnia: Everything You Need to Know
Updated 18th November, 2021
Co-authored and medically reviewed by Dr. Temitope Oyetunji
Insomnia is a sleep disorder which makes it difficult for one to fall asleep or enjoy a sound and uninterrupted sleep at night. Insomnia is one of the major causes of sleeplessness. In this article, we explore insomnia especially its attendant causes and remedies that work.
You may have found yourself in situations where you want to sleep at night, and you are just laying down there on your bed, willing the sleep to come. The clock keeps ticking, yet you are still awake. Only for you to sleep off an hour or two before your alarm wakes you up to face another new day.
In another case, you might actually sleep off, only to wake up in the middle of the night and for one reason or the other you find yourself unable to go back to sleep. This is one of the most common sleep complaints and it is known as Insomnia.
Insomnia can make you to be tired and sleepy all through the next day, you may have a headache, and you will feel irritated, depressed and anxious. Also, insomnia may make you not to be able to focus on your activities for the day.
Sleep is very important for the body system to work efficiently. It is a necessary restorative process that affects all aspects of human functioning. It is an active process for the brain. Early in sleep, slow-rolling eye movements occur (non-rapid-eye movement). This is followed by rapid eye movements (REM) associated with irregular breathing and increased heart rate.
Restful and restorative sleep is achieved here before moving on to the rapid eye movement.
Insomnia is defined as repeated difficulty with sleep initiation, maintenance, consolidation, or quality that occurs despite adequate time and opportunity for sleep. This results in some form of daytime impairment.
Specific criteria for identifying insomnia vary, but common ones include:
Insomnia is not a disease; it is a sleep disorder resulting from someone’s habit or as a symptom of an underlying mental or health condition. It can affect your day-to-day activities; it makes you weak and sleepy during the day. Insomnia also affects your memory and ability to stay focused throughout the day.
The signs and symptoms of insomnia tend to vary greatly among those who suffer from it. Generally, the signs and symptoms of insomnia reported are:
Insomnia can make you react very slowly, and according to a recent study, lack of sleep is linked to increased risk of accident at home, on road and in the workplace.
Chronic insomnia can increase your risks for serious health conditions such as stroke, high blood pressure, diabetes, coronary diseases and obesity.
Insomnia does not only make you feel fatigued but worrying about lack of sleep can also make you to be anxious, depressed, confused and easily irritated.
Chronic insomnia can affect your skin health. It causes dark circles under your eyes, loose skin and appearance of age lines.
Lack of proper sleep can cause one to be more hungry than usual, increasing our cravings for sugary food. It also makes you snack late in the night, and all these can result in weight gain.
Insomnia usually results from an interaction of biological, physical, psychological, and environmental factors.
Although transient insomnia can occur in any person, chronic insomnia appears to develop only in a subset of persons who may have an underlying predisposition to insomnia.
Stress is a major cause of insomnia. It makes it difficult for you to be comfortable and well relaxed to enjoy a sound sleep. Many people develop insomnia after a stressful event, such as bereavement, problems at work or financial difficulties.
This can continue long after the event has passed because they start to associate, going to bed with being awake. This develops into anxiety about sleep itself.
Having more general worries about work, family, or health is also likely to keep you awake at night.
Going to bed at inconsistent times or nap during the day can affect your night sleep.
A poor sleeping environment can also contribute to insomnia; for instance, an uncomfortable bed or a bedroom that’s too bright, noisy, hot or cold can disrupt your sleep. To enjoy a sound sleep, you need an environment that is peaceful, quiet and relaxed.
Your habits and activities during the day and before your bedtime can affect your sleep. Some activities carried out during the day can affect your sleep at night. Some of those habits are
Insomnia can occur in people of any age group, but your chances of having it increase as you age. This may result from a change in sleeping pattern and health conditions that come with age and medications.
The risk of insomnia is higher in women than in men. Sleeplessness in women is caused mostly due to hormonal changes that occur during pregnancy, menopause and premenstrual syndrome.
Underlying mental health problems can often affect a person’s sleeping patterns. Conditions like:
Insomnia can also be caused by underlying physical conditions, including:
Some prescriptions or over-the-counter medications can cause insomnia as a side effect.
Insomnia can be classified based on its cause and how it manifests.
Also referred to as Idiopathic, this form of Sleeplessness usually cannot be attributed to a medical, psychiatric or environmental cause.
This is also more commonly referred to as Comorbid Insomnia. When insomnia is being caused by some other outside factor, illness, or disorder including:
Another name for this is Adjustment insomnia. It entails a brief episode of difficulty sleeping. Acute insomnia is often caused by a life event such as a stressful change in a person’s job, receiving bad news or travel. It is important to note that this kind of insomnia often resolves without any treatment.
This involves a long-term pattern of difficulty in sleeping. It is usually considered if a person has trouble falling asleep or staying asleep at least three nights per week for three months or longer.
This manifests in persons who always have a hard time falling asleep. This type of insomnia occurs in people who have difficulty falling asleep after lying down on their bed for a long time.
This type of insomnia occurs in people who have difficultly staying asleep or going back to sleep after waking up in the night for whatever reason
A combination of both sleep-onset and sleep maintenance difficulties and people with chronic insomnia may find that these symptoms shift over time.
The patient history is the most important part of the evaluation for insomnia.
It must include a:
The physical examination may be helpful because findings may offer clues to underlying medical disorders that predispose the patient to insomnia.
It may also facilitate the differential diagnosis or classification of insomnia
Insomnia is not a disorder that can necessarily be “cured”. Symptoms are treated in order to relieve a patient of distress. Its treatment is dependent on the cause. Treated by two different methods:
This is attempted before the use of medications, typically for at least 2-3weeks.
This mainly has to do with attempting to improve sleep habits
Some of the methods used are
Learn more on 5 Easy Ways to Improve Your Sleep Hygiene
This is based on the premise that insomnia is a conditioned response based on cues associated with sleep. It trains the brain to associate the bed/bedroom with sleep.
This method has been seen to be very useful if used over a prolonged period of time. Effective for improving sleep onset as well as sleep maintenance.
This is the treatment of insomnia with the use of pharmacological agents
⮚ Herbal agents/supplements
⮚ Over the counter drugs
⮚ Prescription drugs
There are four major classes of prescription agents
Benzodiazepines, e.g. Fluraepam, Triazolam
Benzodiazepine Receptor Agonists, e.g. Zolpidem, Zaleplon
Melatonin Receptor Agonists, e.g. Ramelteon
Antidepressants/Antipsychotics, e.g. Amitriptyline, Nortriptyline, Trazodone
Speak to a Doctor for proper diagnosis and treatment should you notice any of the following:
Insomnia can be caused by a variety of physical, mental and environmental factors. It has an impact on the quality of your life. Lack of proper sleep does not only affect your daily activities, cognitive processes and productivity but lack of sleep can also make your immune system to deteriorate resulting to health problems such as hypertension, diabetes, depression and obesity.
In severe cases, insomnia can also cause hallucination. Sleep is very important to your physical and mental well being. Improving sleep hygiene remains a very important remedy, even in cases where pharmacologic agents are employed.
Having troubles falling asleep or enjoying interrupted sleep? Speak to a Doctor Now!
Temitope Oyetunji is a Resident Doctor in Family Medicine Department, National Hospital Abuja. She holds an MBBS degree from Ladoke Akintola University of Technology. She enjoys writing and teaching.