If you have difficulty falling or staying asleep or your sleep is not refreshing, you may be suffering from insomnia and seeking help for insomniacs. Learn about the various subtypes of insomnia, the common symptoms, various potential causes, how it is diagnosed, and the treatment options including medications and behavioral changes.
Insomnia is the inability to fall or stay asleep. It may also describe sleep that is of poor quality resulting in excessive daytime sleepiness. It is the most common sleep disorder, affecting nearly everyone at some point in our lives. There may be identifiable factors that interfere with sleep such as poor sleep environment, pain, stress, or getting up to urinate (nocturia). Insomnia may be episodic, for instance only occurring during periods of stress, but if it persists chronically it may require treatment.
There are multiple subtypes of insomnia and other sleep disorders may have insomnia as a component, including:
- Acute Insomnia
- Fatal Familial Insomnia
- Circadian Rhythm Sleep Disorders
- Advanced Sleep Phase Syndrome
- Delayed Sleep Phase Syndrome
- Jet Lag
How Common Is Insomnia?
Insomnia is one of the most common medical complaints. A survey of patients found that 69 percent had insomnia, with half of these individuals saying it was occasional but 19 percent reporting chronic difficulties. It is estimated that 10 percent of people have chronic insomnia with daytime deficits. Women tend to report more insomnia complaints. Insomnia becomes more common as we get older. Individuals who are unemployed, live alone, and are of lower socioeconomic status also have more complaints of insomnia.
Symptoms of Insomnia
Insomnia is characterized by difficulty falling or staying asleep or by sleep that is of poor quality. There are, however, other symptoms that may be associated with insomnia. These symptoms include:
- Excessive daytime sleepiness
- Malaise (feeling unwell)
- Difficulty concentrating or paying attention
- Mood problems (anxiety or depression)
- Decreased energy
- Difficulties at work, school, or in social activities
- Upset stomach
Causes of Insomnia
There are almost innumerable potential causes of insomnia. It may occur in the context of other sleep disorders, general medical conditions, or illnesses. Insomnia may be the result of stress or suggest psychiatric problems such as depression, post-traumatic stress disorder (PTSD), or even dementia. It may happen with the use of medications or street drugs. Insomnia may be present in the context of shift work or travel (such as in jet lag). It may occur temporarily if caffeine or cigarettes are used too close to bedtime or as the result of other poor sleep habits. It is unlikely to occur because of a vitamin deficiency. It frequently occurs when the sleep environment is disrupted, such as when pets or the television are allowed to disrupt sleep. Insomnia may even have no recognized cause.
Most individuals with insomnia can be diagnosed after a brief discussion with their doctor. However, there are multiple tests available to diagnose insomnia if they are needed. Some of these include:
Treatment of Insomnia
If insomnia results in disrupted daytime function, especially if it persists chronically, it may require treatment. There are many medications that act as sleeping pills that can be effective. Two major classes include benzodiazepine and nonbenzodiazepine medications. Some of these prescription and over-the-counter medications include:
There are also alternatives to treatment with medications. Many of these options include changes in behavior or sleep habits. Some of the more common alternative therapies for insomnia include:
- Relaxation and Biofeedback Therapy
- Stimulus Control
- Better Sleep Guidelines
- Circadian Rhythm Treatment
- Jet Lag Treatment
- Shift-Work Sleep Disorder Treatment
- Sleep Environment
- Sleep Restriction
- Cognitive Therapy
Insomnia is the most common sleep complaint, affecting nearly everyone at some point in our lives. It can exist in multiple subtypes or even as part of other sleep disorders or medical conditions. There may be associated symptoms such as difficulties with memory, concentration, and mood. Insomnia may be caused by many things, and a careful evaluation by a doctor is usually sufficient to establish a diagnosis. Occasionally further tests may be indicated. Fortunately, there are effective treatments for insomnia, including many prescription and over-the-counter sleeping pills as well as alternative therapies such as improving sleep habits or the sleep environment.
American Academy of Sleep Medicine. "International classification of sleep disorders: Diagnostic and coding manual." 2nd ed. 2005.
Ohayon, MM. "Epidemiology of insomnia: what we know and what we still need to learn." Sleep Med Rev. 202; 6:97.
Shochat, T et al. "Insomnia in primary care patients." Sleep. 1999; 22 Suppl 2:S359.