Understanding Insomnia

Most people deal with sleepless nights from time to time. Whether it's a big presentation at work keeping you up or the more mundane stress of managing your kids, pets, and household, it's normal to struggle to sleep every now and again. When sleep problems persist, however, occurring night after night and week after week, it's no longer a minor issue; it's insomnia.

Insomnia has the power to interfere with virtually every area of your life. It robs you of your energy, contributes to chronic pain, weakens your psychological resilience, and can worsen virtually every health condition—including mental health conditions such as depression and anxiety.

Insomnia is common: According to the American Academy of Sleep Medicine, between 30% and 35% of Americans experience periodic insomnia. For some, however, insomnia becomes a damaging way of life. 15% to 20% of Americans have short-term acute insomnia, but 10% struggle with chronic insomnia that lasts for an extended period of time—sometimes for years.

Insomnia is treatable, and you probably won't have to take medication for the rest of your life. Keep asking questions, trying solutions, and working at it, since insomnia is a challenging disorder to treat and what works for one person won't necessarily work for the next.

What is Insomnia, and Do I Have it?

Insomnia is a symptom, not a medical diagnosis. Simply put, you have insomnia if you have difficulty falling or staying asleep. Common symptoms include needing more than 30 minutes to fall asleep each night and waking frequently during the night.

Doctors generally divide insomnia into a couple of different sub-types. Knowing your sub-type may help you determine the cause of your insomnia, enabling you and your doctor to more effectively treat your symptoms:

  • Acute insomnia is short-term insomnia that lasts for a few weeks and then disappears. It may recur later.
  • Chronic insomnia is insomnia that lasts a month or more, affecting you two or more nights per week.

Your doctor will only diagnose you with acute or chronic insomnia if your sleeplessness is not better explained by another condition. Some medical causes of insomnia include:

  • Maintenance insomnia. People with this variety of insomnia don't have difficulty getting to sleep but have trouble staying asleep. This is common among people as they age and is sometimes an early symptom of dementia.
  • Psychiatric insomnia is insomnia due to a psychiatric condition. For instance, if your anxiety prevents you from sleeping, or you're so depressed you can't stop crying as you fall asleep, you may have psychiatric insomnia.
  • Medication-induced insomnia. Some drugs, notably stimulants, can interfere with your ability to sleep.
  • Co-occurring insomnia. This insomnia results from or is complicated by a medical condition. For instance, the pain associated with rheumatoid arthritis might keep you up at night.

What Causes Insomnia?

Insomnia is a complex medical condition without a single cause. Your specific symptoms of insomnia can shed light on potential causes. For instance, if you wake in the night to go to the bathroom and then struggle to go back to sleep, you may have a co-occurring form of insomnia resulting from a bladder or prostate issue. Some of the most common causes of insomnia include:

  • Poor sleep hygiene. Just as negative thoughts increase depression and poor time management can make anxiety worse, bad sleep practices—such as waking at a different time each day or sleeping too long—can become a habit. Over time, this habit becomes like second nature to your brain, causing you to struggle more and more to fall asleep.
  • Medical conditions. Insomnia itself is not a medical disorder, but dozens of medical conditions can cause or worsen insomnia. Those conditions include but are by no means limited to, depression, anxiety, chronic pain, bladder problems, gastrointestinal issues, allergies, asthma, arthritis, neurological conditions such as Parkinson's or Alzheimer's, endocrine system disorders, and acid reflux.
  • Lifestyle issues. People who don't get enough exercise are more likely to suffer from insomnia. Dietary issues, especially excessive consumption of caffeine, may also play a role.
  • Certain medications, especially those that increase activity in the central nervous system, such as stimulants used in the treatment of ADD/ADHD.
  • Genetics. There's some evidence of a genetic link to insomnia. A single gene won't cause insomnia, and not everyone who has insomnia is genetically vulnerable to it. But a family history of insomnia increases your risk, particularly if mental health issues also run in your family.

What to Expect at the Doctor

Insomnia doesn't always warrant medical intervention. If you've tried a handful of lifestyle strategies and your symptoms have disappeared, it's unlikely that you have a medical condition that's causing your insomnia. The process will likely begin with an assessment of your symptoms. Your doctor will ask how much sleep you're getting, how long you've struggled with insomnia, whether anything you've done has helped, and how long you've faced this issue.

In some cases, your doctor may send you home to make a sleep log before doing anything else. If you're considering treatment for insomnia, try making a sleep log on your own. Sometimes it's impossible to identify long-standing patterns on your own, but once you begin logging these patterns, they become readily apparent. Maintaining a sleep log isn't difficult, but it does require a willingness to honestly assess your symptoms. Commit to logging your sleep for at least two weeks, and make note of the following each day:

  • Approximately how long you slept, how long it took you to fall asleep, and whether and how frequently you awoke during the night.
  • What foods you consumed; if you struggle to maintain a food log, consider logging only the foods you consumed in the four hours immediately before bed.
  • How much caffeine you drank; don't forget about the caffeine in tea and soda.
  • Your mood, and any psychological symptoms you've experienced, as well as any stressful events.
  • How frequently you exercised, and what type of exercise you did.
  • Any other symptoms you experience, especially those relevant to sleep, such as chronic pain and frequent urination.

Wherever possible, use objective standards to measure your symptoms. Don't just note that you were in pain; rank how strong the pain was. Don't just note that you drank caffeine; write down precisely how much. You might find, for instance, that you're fine with just a cup of coffee in the morning, but that when you drink caffeine in the afternoon, you can't sleep.

After your doctor has a clear picture of your symptoms, he or she may recommend medication as a short-term strategy. If this happens, consider asking for a referral to a sleep specialist, since medication does not treat the problem; it only masks it. Your sleep specialist may:

  • Conduct a psychiatric assessment to determine whether you may have symptoms of depression, anxiety, or other disorders.
  • Perform blood work to test for endocrine system problems and other disorders.
  • Refer you to a specialist for treatment of any other symptoms you have, such as frequent urination or chronic pain.

Ultimately, your sleep specialist will likely perform a sleep study. During a sleep study, you spend a night or longer in a lab. You'll sleep in a normal bed, but may be hooked up to various monitors to track things like whether you snore, how often you wake, and whether your blood pressure changes during the time you're asleep. A sleep study can provide a wealth of information, so even if you've struggled with insomnia for years, consider signing up for a sleep study to get the most accurate details about your insomnia.

Lifestyle and Natural Remedies for Insomnia

Devotees of natural living will be thrilled to learn that, even for mainstream doctors, lifestyle and natural remedies are often the first line of defense against insomnia. Sleep drugs can be addictive, and may cause symptoms such as aggressive behavior during the night and unusual dreams. For these reasons, it's may be preferable to try natural remedies first. For the overwhelming majority of insomnia sufferers, lifestyle remedies are highly effective.

To be the most scientific in your approach, try gradually introducing one lifestyle remedy at a time. This way you can easily track what works and what doesn't. Note that for most insomnia sufferers, it's a combination of lifestyle remedies, rather than just a single strategy, that alleviates symptoms. Some strategies to try include:

  • Herbal remedies and supplements. Research suggests that both valerian root and melatonin can help regulate the body's circadian rhythms. Some insomnia sufferers find relief with chamomile tea or aromatherapy. Lavender essential oil sprayed on the sheets or run through a diffuser in the bedroom can help one drift off into peaceful repose. A natural sleep product such as Sleep Essentials can also be an effective option.
  • Practicing healthy sleep hygiene. Healthy sleep hygiene is important for all people, not just those who suffer from insomnia. Go to bed and get up around the same time each day, even if you're tired. Reserve your bed for sleeping and sex, as spending too much waking time in bed may confuse your brain and body. If you can't sleep, don't lie in bed tossing and turning; get up, since struggling to fall asleep can create an association in your brain between being in bed and being awake. Keep your bedroom cool, since your body temperature has to drop slightly to fall asleep.
  • Eliminating or reducing your caffeine intake. If you can't cut out caffeine, then, at least, eliminate it for a minimum of six hours before you go to bed.
  • Getting plenty of exercise. The Centers for Disease Control and Prevention recommends at least 150 minutes of moderate cardio exercise, such as swimming or walking, each week. The CDC also advises spending at least two days working on strength-building activities, such as lifting weights. Exercise not only helps insomnia; it can also treat some of the conditions associated with insomnia, such as depression and anxiety. To get the most out of your exercise routine, exercise during the day—ideally during the morning. Exercising too close to bedtime can give you a burst of energy that makes it more difficult to fall asleep.
  • Practicing relaxation methods. Meditation is highly effective at curbing the anxiety that so often leads to difficulty sleeping. Yoga and other relaxation methods can also be helpful, particularly if you suffer from a physical or mental health condition.
  • Eating a healthy, balanced diet. Research is mixed on the value of specific diets; some insomniacs swear by going gluten-free while others insist on an anti-inflammatory diet. The most important thing is getting plenty of fruits and vegetables, along with high-quality fats and protein, and limiting your intake of processed foods and sugary snacks. Consider experimenting with your nutritional choices, or working with a nutritionist, until you find a strategy that works.
  • Acupuncture. Research is increasingly pointing to a role for acupuncture in the fight against anxiety. This ancient Chinese remedy can be particularly effective if your insomnia is due to another medical condition, such as anxiety or chronic pain.
  • Massage. Massage helps relax your muscles and brain, and its effects last long after the massage is over. If you struggle with chronic pain or have trouble relaxing at night, consider trying a weekly massage for a month to see if you get good results.
  • Therapy to address psychological factors that may contribute to your insomnia. Even if you don't have an underlying psychiatric condition, research consistently points to the efficacy of therapy, especially cognitive-behavioral therapy (CBT).

Medical Treatments for Insomnia

If natural remedies aren’t effective, or your insomnia is caused by a medical condition, or if it is so severe that it's interfering with your ability to function, then it could be time to consider the physician-recommended remedy.

Many people first seek help for insomnia from a general practitioner. But because insomnia is a complex medical condition, with both psychological and physiological ramifications, you'll get the most effective and up-to-date treatments if you work with a sleep specialist. Ask for a referral before you agree to take sleeping pills. Some of the most effective medical remedies for insomnia include:

  • Nasal surgery. This won't treat generalized insomnia, but if chronic congestion or allergies are keeping you up at night, nasal surgery may be an option worth considering.
  • Uvulopalatopharyngoplasty. This surgery, better known as UPPP, is the most effective surgical treatment for sleep apnea. UPPP helps maintain a wider air passageway and can clear tissue that impedes your ability to sleep at night.
  • Medications. There are dozens of medications that can treat insomnia. The appropriate treatment for you will depend upon a number of factors, including your health and any addiction history. If your insomnia is due to depression, PTSD, nightmares, or another condition, your doctor might prescribe a psychoactive drug. Some of these drugs can induce sleepiness as a side effect.
  • Antihistamines. These over-the-counter drugs don't just treat congestion—a common cause of insomnia—they also increase sleepiness. Some heart conditions make antihistamines unsafe to take, so talk to your doctor before trying an over-the-counter remedy, especially on a long-term basis.

Insomnia can seem intractable, and may leave you feeling hopeless. Remember that exhaustion makes everything seem worse, and your hopelessness may be due as much to fatigue as it is to your insomnia. Treatments that work are available, but you must be prepared to experiment, advocate for yourself, and make necessary adjustments to the way you live.

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