Insomnia is a common sleep disorder defined by night time and daytime symptoms. Night time symptoms include persistent difficulties falling and/or staying asleep and/or non-restorative sleep. Daytime symptoms of insomnia can include diminished sense of well-being, compromised functioning such as difficulties with concentration and memory, fatigue, concerns and worries about sleep. The diagnosis is made when the symptoms persist for at least 1 month and insomnia is considered chronic if it persists for at least 6 months. Nearly one in 10 adults in the United States suffers from insomnia.
It is important to realize that not everyone who has problems sleeping has insomnia. The word persistent is emphasized because many people occasionally experience disturbed sleep at night but their problem is transient.
Insomnia is most often classified by duration:
However, insomnia can also be classified as:
About 75% of people with insomnia can identify a specific cause of their insomnia. One of the most common causes is stress related to family or work situations. Poor sleep is a common reaction to stress, but there are large individual differences in how people react to and cope with stress. These differences likely play a role in the development of insomnia.
Conditions that cause chronic pain, such as arthritis and headache disorder
Certain medications and commonly used substances can disrupt sleep. These include the following:
Sleep disruptions caused by medical conditions, medications and substances may resolve with treatment. However, this is not always the case and for some individuals, insomnia may persist after the medical condition is managed or resolved.
In some cases, despite stress subsiding and medical conditions receiving treatment, insomnia can persist. Patients will find that they have trouble either falling asleep or staying asleep, and occasionally both. Here are a few of common reasons people experience persistent insomnia.
There are certain groups of people who are at increased risk for the development of insomnia in comparison to others. It has already been noted that people who are experiencing stressful situations or medical conditions such as depression or those that cause physical discomfort or pain are more at risk to developing insomnia.
The term insomnia is sometimes used colloquially in reference to disturbed sleep. An insomnia disorder is diagnosed when the disturbed sleep lasts more than a month and negatively impacts general well being, either because it is very distressing or because it leads to impairment in performance or mood. Sleep specialists can determine if the symptoms are not better explained by other disorders, including sleep, psychiatric, or medical.
Your doctor will obtain a clinical history and may obtain additional information from questionnaires and/or objective measures to help diagnose your insomnia and rule out other sleep disorders. Some examples can include:
CGH Sleep Center physicians can treat insomnia using a number of different methods, from nonpharmacological to pharmacological or a combination of both.
Psychologists have developed and tested a specific therapy for insomnia called cognitive behavioral therapy, a specific psychotherapeutic approach with variants for treating different mental conditions such as depression, anxiety and eating disorders. In general, psychotherapies that are not insomnia focused are not very effective for treating chronic insomnia. When insomnia is experienced in the context of another disorder, such as depression, general psychotherapy might be effective in helping with depression but not be as helpful with the insomnia.
CBTI consists of several components that are tailored to the patient’s individual presentation. Stimulus control is a set of instructions that address conditioned arousal. These instructions strengthen the bed as a cue for sleep and weaken it as a cue for wakefulness. Sleep consolidation training is a procedure originally designed to eliminate prolonged middle-of-the-night awakenings but it can also help with problem falling asleep at the beginning of the night.
This step-wise procedure aims to first improve sleep quality and later worry about its quantity. Initially the time spent in bed is restricted to the amount of sleep that is currently feasible. In subsequent steps the time spent in bed is gradually increased. A third component of CBTI consists of strategies for reducing sleep interfering thoughts and worries, managing stress, calming an active mind that won’t shut off when trying to sleep and relaxing. The key is shifting from “trying hard to sleep” to “allowing sleep to happen.” CBTI takes into account people’s biological clocks and aims to align bed time and rise time with an individual’s internal clock. This may sometimes involve properly timed exposure to bright light.
There are a number of different medications currently on the market which are used to manage insomnia. Properly used, they can be very beneficial, however possible side effects should be carefully considered.