Insomnia

Overview

Insomnia, a prevalent sleep disorder, can hinder the ability to initiate or maintain sleep, leading to early awakenings with difficulty returning to slumber. Upon waking, individuals may still experience fatigue. The effects of insomnia extend beyond mere sleep disturbances, impacting energy levels, mood, overall health, work performance, and quality of life.

The optimal duration of sleep varies among individuals, but most adults generally require 7 to 9 hours per night. Short-term insomnia, lasting days or weeks, is a common experience for many adults and is often attributed to stress or distressing events. In contrast, chronic insomnia persists for three months or more and may be an independent issue or linked to other medical conditions or medications.
Fortunately, enduring sleepless nights is not a necessity. Implementing simple adjustments in daily habits can often alleviate insomnia and improve sleep quality.

Symptoms

Symptoms of insomnia can manifest as follows:

• Difficulty initiating sleep at night.
• Awakening in the middle of the night.
• Experiencing early awakening from sleep.
• Feeling irritable, depressed, or anxious.
• Experiencing daytime tiredness or sleepiness.
• Struggling with attention, task focus, or memory.
• Increased errors or accidents.
• Persistent concerns and anxieties related to sleep.

If insomnia hinders your ability to perform daily tasks, it is advisable to consult with your doctor or another primary care professional. Your doctor will investigate the underlying cause of your sleep difficulties and offer appropriate treatment. If there is suspicion of a sleep disorder, your doctor may recommend visiting a sleep center for specialized testing.

Causes

Insomnia can either be a primary issue or be associated with other conditions. Long-term insomnia is typically linked to stress, life events, or habits that disrupt sleep. While addressing the root cause may resolve insomnia, it can persist for an extended period.

Common causes of long-term insomnia encompass:

• Poor sleep habits: Irregular bedtimes, napping, excessive activity before bedtime, and an uncomfortable sleep environment contribute to poor sleep habits. Activities like working, eating, or watching TV in bed, as well as using electronic devices before sleep, can disrupt the sleep cycle.
• Stress: Worries about work, school, health, finances, or family can keep the mind active at night, hindering sleep. Stressful life events such as the loss of a loved one, illness, divorce, or job loss can also contribute to insomnia.
• Caffeine, nicotine, and alcohol: Stimulants like caffeine in coffee, tea, and cola, if consumed late in the day, can interfere with falling asleep. Nicotine found in tobacco products is another stimulant capable of disturbing sleep patterns. Although alcohol may induce sleep, it often disrupts deeper sleep stages and may lead to waking up during the night.
• Late-night eating: Consuming a large meal before bedtime may cause discomfort and heartburn, potentially leading to insomnia.
• Travel or work schedule: Disruptions to the body’s circadian rhythms, governing the sleep-wake cycle, metabolism, and body temperature, can lead to insomnia.

Causes include jet lag from crossing multiple time zones, late or early shift work, or frequent shift changes.

• Mental health disorders: Anxiety disorders, post-traumatic stress disorder, and depression can disrupt sleep patterns and contribute to insomnia.
• Medications: Certain prescription drugs, including some antidepressants, asthma medications, and blood pressure drugs, can interfere with sleep. Over-the-counter medications like pain relievers, allergy medications, and weight-loss products containing stimulants may also disrupt sleep.
• Medical conditions: Insomnia can be associated with various health conditions such as chronic pain, cancer, diabetes, heart disease, asthma, GERD, overactive thyroid, Parkinson’s disease, and Alzheimer’s disease.
• Sleep-related disorders: Sleep apnea interrupts breathing during the night, disrupting sleep, while restless legs syndrome creates an uncomfortable urge to move legs, hindering sleep initiation or maintenance.

Insomnia and aging

Insomnia tends to become more prevalent with advancing age. As individuals grow older, they may experience the following changes:

• Alterations in sleep patterns: The restfulness of sleep often diminishes with age, making individuals more susceptible to being awakened by noise or environmental changes. Aging commonly prompts a forward shift in the internal clock, leading to an earlier onset of tiredness in the evening and waking up earlier in the morning. However, despite these changes, older individuals typically require a similar amount of sleep as their younger counterparts.
• Adjustments in activity levels: Reduced physical or social activity may occur with age, potentially disrupting the quality of sleep. A lack of activity can contribute to disturbances in nighttime sleep. A decrease in overall activity may lead to an increased likelihood of daytime napping, which can interfere with nighttime sleep.
• Health-related changes: Persistent pain from conditions like arthritis or back problems, as well as mental health issues such as depression or anxiety, can disrupt sleep. Health issues that contribute to nocturnal urination, such as prostate or bladder problems, can also disturb sleep. Additionally, sleep apnea and restless legs syndrome tend to become more prevalent as individuals age.
• Medication usage: Older individuals commonly rely on a greater number of prescription drugs compared to their younger counterparts, increasing the likelihood of insomnia associated with medication use.

Insomnia in children and teens

Sleep issues can also be a matter of concern for children and adolescents. However, some youngsters may face challenges in falling asleep or adhering to a consistent bedtime due to a delay in their internal clocks. These individuals are inclined to prefer going to bed at a later hour and waking up later in the morning.

Risk factors

Almost everyone experiences the occasional sleepless night, but the likelihood of developing insomnia increases if:

• As a woman: Hormonal changes during the menstrual cycle and menopause may contribute to insomnia, with disturbances like night sweats and hot flashes being common during menopause. Insomnia is also prevalent during pregnancy.
• Age over 60: Changes in sleep patterns and health make insomnia more likely as you age.
• Mental or physical health condition present: Various conditions affecting mental or physical health can disrupt sleep.
• Stress is present in life: Experiencing stress can result in short-term insomnia, while prolonged or significant stress can contribute to long-term insomnia.
• Lack of routine: Irregularities in your daily routine, such as changing work shifts or frequent travel, can disrupt your sleep-wake cycle.