Most people make the connection in their real lives when they struggle to find sleep. It isn't unusual for a person to struggle to sleep a few nights out of the year. However, insomnia, while being an easy catch-all phrase, is more complicated than that. It can last for days, even weeks... some people have suffered insomnia their entire lives, to a certain degree. It's no badge of courage or point of pride to claim long-term insomnia, however. Insomnia is a dangerous condition which can rob you of energy, focus, good health and sound judgment.
Most people who suffer from insomnia experience at least one of these components:
- You struggle to initiate sleep, despite the opportunity to do so.
- You struggle to maintain sleep, waking up frequently across the span of the night.
- You tend to wake up too early and are unable to go back to sleep.
There are two ways insomnia presents itself:
- Primary insomnia occurs when you struggle with sleeplessness that cannot be attributed to another medical illness, another sleep disorder, an emotional issue or disorder, an environmental cause or drug use
- Secondary insomnia occurs when you struggle with sleeplessness that can be attributed to any of these situations
Finally, there are two ways to describe insomnia's severity:
- Acute insomnia is short-term and does not last more than a few weeks. It comes and goes and is usually the result of significant life stress, pain, illness, poor sleep environment, medications or sleep schedule disruptions (like Daylight Saving Time)
- Chronic insomnia persists almost nightly (at least every other night) for months, even years, and is usually caused by depression and/or anxiety, poorly managed stress and pain
It's important to note that there is a difference between insomnia and sleep deprivation, and it is summed up in one word: opportunity. In example, if you can't sleep because you are working late and then have to rise early to go back to work, for instance, you are not suffering from insomnia because you have been shorted the opportunity for a full night of sleep. If you are a new parent, up all night with a crying baby, then you are sleep deprived, and not suffering from insomnia.
Where do you fit inside the insomnia puzzle?
Up to thirty percent of all adults suffer some form of insomnia, with a third of them suffering enough of its symptoms to impair daytime functioning. Most people have acute short-term insomnia, while it is estimated that less than ten percent of all adults actually have ongoing chronic forms of this disorder.
Insomnia has been broken down into a variety of categories as well:
- Inadequate sleep hygiene refers to insomnia that is caused by poor sleep habits (too much light, too warm a room, pets in the bed, ambient noise, uncomfortable mattress or pillow, late meals, "screen time" too late into the evening, etc.)
- Paradoxical insomnia is the condition in which someone is actually sleeping at night but believes they are not; this is an extremely common form of subjective insomnia
- Insomnia due to drug or medication use (many drugs have insomnia as a side effect; some drug interactions can cause insomnia; tapering off of a drug can also cause insomnia)
- Insomnia due to medical condition (physiological imbalances of any kind can lead to insomnia, as can pain or discomfort caused by illness or injury)
- Insomnia due to mental health condition (depression and anxiety can either lead to insomnia or can be caused by insomnia)
- Psychophysiological insomnia relates to sleep patterns impaired by excessive worry, anxiety and racing thoughts
- Behavioral insomnia of childhood is the result of children not following an established bedtime
- Idiopathic insomnia is a lifelong condition which cannot be explained by any of the above situations
Treatments for insomnia can include one or more of the following:
• Cognitive behavioral therapy (CBT)
• Over-the-counter sleep aids (usually antihistamines)
• Prescription drugs: hypnotics, antidepressants, anticonvulsants, antipsychotics, barbiturates or non-hypnotic benzodiazepines
An occasional night of insomnia is nothing to worry about, in most cases, but if you have ongoing problems, it is best to seek a diagnosis so you can properly treat your problem.
Insomnia is not something to trivialize. The dysfunction that this condition causes (excessive daytime sleepiness, irritability, memory and focus issues) puts sufferers at real risk for poor performance on the job or at school, drowsy driving, job loss due to absenteeism, suicidal ideation, workplace accidents, relationship stress, and slow or inadequate decision making and judgment, which could lead to risky behavior and even death.
The best way to diagnose insomnia is to visit your doctor (and not the Internet!). A trained physician can review your medications, history and symptoms and rule in or out common causes immediately, such as stress or sleep hygiene. If you have adequate sleep hygiene habits and aren't suffering from stress, and you still suffer from insomnia, you will be referred to a sleep physician who can help rule out other sleep disorders you might not be aware you have.
This is no joke. In recent clinical research from the Mayo Clinic, which studied hundreds of chronic insomniacs who had failed all drug therapies to treat their disorders, over 90 percent were found to have a moderate to severe sleep-associated breathing disorder that had gone undiagnosed. This is concerning as many sleep aids used to treat insomnia can actually aggravate or worsen an underlying sleep breathing disorder.
Other physicians you might see to treat insomnia include behavioral therapists who can address underlying emotional and/or behavioral roots to your problems with insomnia or specialists who can address other specific physical complaints you have (neurologists for multiple sclerosis, for instance) to help identify the root cause of the sleep disturbance.
Sources consulted
"Chronic Insomnia: A Practical Review." Rajput V, Bromley SM. American Family Physician. 1999 Oct 1;60(5):1431-1438.
Insomnia [PDF] || American Academy of Sleep Medicine
Insomnia: Overview and Facts. || Sleep Education
An Overview of Insomnia || WebMD
"Pharmacotherapeutic Failure in a Large Cohort of Patients With Insomnia Presenting to a Sleep Medicine Center and Laboratory: Subjective Pretest Predictions and Objective Diagnoses." Krakow B, Ulibarri VA, McIver ND. Mayo Clinic Proceedings. December 15, 2014. DOI: http://dx.doi.org/10.1016/j.mayocp.2014.04.032
