Insomnia: Symptoms, Causes, Diagnosis, Treatment & Prevention

 

Insomnia is a common sleep problem that makes it difficult to fall asleep and remain asleep. It can also cause you to wake up too early making it difficult for you to fall back asleep. You can still feel tired when you wake up. Insomnia can deplete your energy and alter your mood. It can also have an impact on your health, job performance, and overall quality of life.

 Insomnia occurs when you do not sleep well or sufficiently, resulting in disruptions to your ability to feel and function. Insomnia affects approximately 10% of the world's population and is considered a medical disorder. It is rarely dangerous, and there are numerous treatment options available, including medication and mental health treatments.

How much sleep is adequate varies from person to person. However, most adults require 7 to 9 hours every night.

Many adults experience brief periods of sleeplessness. This can continue for several days or weeks. Short-term sleeplessness is frequently the result of stress or a distressing occurrence. However, some people experience long-term insomnia, commonly known as chronic insomnia. This lasts for three months or longer. Insomnia may be the primary issue, or it may be linked to other medical issues or medications.

You do not need to put up with sleepless nights. Simple modifications to your everyday routine can frequently be beneficial.

What is insomnia?

Insomnia occurs when you do not sleep properly. That could indicate that you aren't sleeping enough, aren't sleeping well, or are having difficulty falling or staying asleep. For other folks, insomnia is merely an annoyance. For others, Insomnia can cause significant disturbance. Insomnia can have a wide range of causes.

Sleep is necessary for many reasons. Experts understand that not getting enough sleep can result in sleep deprivation, which is usually unpleasant (at the very least) and prevents you from functioning at your best.

Also Read: Brain diseases: Types, Causes, Symptoms, Diagnosis, Treatment & Prevention

Types of Insomnia:

Experts categorize insomnia in two ways:

• Primary insomnia. This suggests your sleep problems do not relate to any other health condition or disease.

• Secondary insomnia. This indicates that you struggle to fall asleep due to a health problem (such as asthma, depression, arthritis, cancer, or heartburn), pain, medicine, or drug misuse (such as alcohol).

you might hear about:

• Sleep-onset insomnia. This suggests you have problems getting to sleep.

• Insomnia related to maintaining sleep. This occurs when you wake up too early or struggle to stay asleep during the night.

• Mixed insomnia. With this form of insomnia, you have problems both getting to asleep and staying asleep during the night.

• Paradoxical insomnia. You underestimate how much time you spend sleeping when you experience paradoxical insomnia. It feels like you sleep a lot less than you really do.

Symptoms:

Insomnia symptoms can include:

• Having difficulty falling asleep at night.

• Waking up at night.

• Waking up early.

• Feeling tired or sleepy throughout the day.

• Feeling irritable, depressed, or nervous.

• Having trouble paying attention, focusing on work, or remembering.

• Making more mistakes or causing more accidents.

• I'm still concerned about my sleep.

Causes:

Insomnia may be the primary problem, or it may be associated with other conditions.

Long-term insomnia is frequently caused by stress, life events, or sleep-disrupting habits. While fixing the underlying cause of your sleep problem will help your insomnia, it can often persist for years.

Long-term insomnia is commonly caused by the following:

• Stress. Concerns about job, school, health, money, or family can keep you up at night, making it difficult to sleep. Stressful life events, such as a loved one's death or illness, divorce, or job loss, can also cause insomnia.

• Travel or work schedules. Circadian rhythms, or your body's "internal clock," regulate your sleep-wake cycle, metabolism, and temperature. Disrupting these rhythms can cause insomnia. Jet lag from flying across numerous time zones, working a late or early shift, or often changing shifts are all potential causes.

• Poor sleeping patterns. Poor sleep habits include going to bed and waking up at different times each day, taking naps, being excessively active before bedtime, and having an uncomfortable sleep environment. Other unhealthy sleep behaviors include working, eating, or watching television in bed. Using a computer or smartphone, playing video games, or watching TV right before bed can all interrupt your sleep cycle.

• Eating too much at late-night meals. It's acceptable to have a small snack before going to bed. However, consuming too much can make you uncomfortable when you're lying down. Heartburn also affects a lot of people. This occurs when the tube that transports food from your mouth to your stomach becomes backed up with stomach acid. The esophagus is the name of this tube. Heartburn could keep you up at night.

• Mental disorders. Your sleep may be disturbed by anxiety disorders like post-traumatic stress disorder. Depression may be indicated by waking up too early. Other mental health issues frequently coexist with insomnia.

• Medications. Numerous prescription medications, including some antidepressants and medications for blood pressure or asthma, can disrupt sleep. Caffeine and other stimulants included in many over-the-counter medications, including some pain relievers, cold and allergy remedies, and weight-loss drugs, might interfere with sleep.

• Medical conditions. Chronic pain, cancer, diabetes, heart illness, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson's disease, and Alzheimer's disease are a few disorders associated with insomnia.

• Problems associated with sleep. Your sleep is disturbed by sleep apnea, which causes you to occasionally cease breathing during the night. When attempting to fall asleep, people with restless legs syndrome have a strong, uncomfortable urge to move their legs. You might not be able to fall or return to sleep as a result of this.

• Alcohol, nicotine, and caffeine. Stimulants include tea, coffee, cola, and other beverages that contain caffeine. You can avoid falling asleep at night if you drink them in the late afternoon or evening. Another stimulant that might interfere with sleep is nicotine, which is found in tobacco products. While alcohol can help you fall asleep, it typically causes you to wake up in the middle of the night and prevents deeper stages of sleep.

Insonmia and aging

As people age, sleeplessness becomes more prevalent. As you age, you might:

• Modify the way you sleep. As you get older, your sleep becomes less restful, making you more susceptible to being awakened by noise or other disturbances in your environment. Your internal clock frequently advances in time as you age, causing you to wake up earlier in the morning and feel exhausted earlier in the evening. However, the amount of sleep that older individuals require is usually equal to that of younger people.

• Modify how active you are. You might engage in less social or physical activity. A restful night's sleep might be disturbed by inactivity. Additionally, you may be more likely to take regular sleep if you are less active. At night, napping can interfere with sleep.

• Your health has changed.  Sleep disturbances can be caused by persistent discomfort from ailments like arthritis or back issues, as well as by sadness or worry.  Sleep disturbances can result from conditions like prostate or bladder issues that increase the likelihood of needing to urinate at night.  As people age, sleep apnea and restless legs syndrome become increasingly prevalent.

•  Take extra medications.  Prescription medication use is generally higher among older adults than younger adults.  This raises the probability of insomnia connected to medication.

Children and teenagers experiencing insomnia

Children and teenagers may also have sleep issues. However, because their internal clocks are more delayed, some teens and children just struggle to fall asleep or refuse a regular bedtime. They wish to sleep later in the morning and go to bed later.

Risk Factors:

Almost everyone experiences the occasional sleepless night. However, you are more likely to experience insomnia if:

• You are a woman. Hormonal changes during the menstrual cycle and menopause could play a role. During menopause, nocturnal sweats and hot flashes frequently impair sleep. Insomnia is prevalent throughout pregnancy.

• You are over the age of sixty. As you get older, your sleep patterns and health change, making it more probable that you will experience insomnia.

• You have a mental or physical health condition. Sleep can be disrupted by a variety of mental and physical health conditions.

• You are under a lot of stress. Stress can lead to short-term insomnia. Major or prolonged stress can cause long-term insomnia.

• You do not keep a regular schedule. For example, switching shifts at work or traveling can disturb your sleep-wake cycle.

Complications:

Sleep is just as crucial to your health as a nutritious diet and frequent physical activity. Insomnia, whatever the cause, can hurt both your emotional and physical health. People with insomnia report a lower quality of life than those who sleep well.

Insomnia can have the following complications:

• Lower performance at work or school.

• Slower reaction time when driving and an increased chance of accidents.

• Depression, anxiety, and substance abuse are all examples of mental health disorders.

• Long-term diseases or conditions, such as high blood pressure and heart disease, are more likely to develop or worsen.

• Slow response time when driving can lead to a car crash.

• An increased risk of asthma or other respiratory issues

• A weaker immune system, leaving you more sensitive to disease and less able to fight infection, as well as higher inflammation

• Overweight, obesity, metabolic syndrome, and diabetes can result from metabolic issues brought on by insomnia's effects on hunger hormones and digestion.

• Worsening of chronic pain if you already have this condition

• Problems during pregnancy, such as low birth weight, premature delivery, more pain during delivery, and a larger possibility you may require a cesarean surgery (C-section)

Diagnosis and Tests:

How is insomnia diagnosed?

A healthcare provider can diagnose insomnia by a variety of methods, including questions about your health history, life circumstances, sleep habits, symptoms, and more. They may also suggest tests to rule out other conditions that could cause or contribute to insomnia.

What tests will be used to diagnose insomnia?

There are no tests that can diagnose insomnia directly. Instead, tests can help rule out other conditions that cause similar symptoms to insomnia. The most likely tests are:

• Sleep apnea testing might include an overnight sleep study in a sleep lab (polysomnography) or an at-home sleep apnea screening device.

• Actigraphy.

• Multiple sleep latency tests (MSLTs).

• Depending on your symptoms and other factors, more testing may be required. Your healthcare practitioner is the best person to advise you about the tests they recommend.

How do you treat insomnia?

Insomnia can be treated in many ways, from simple changes in lifestyle to medication. The major methods for treating insomnia are:

• Creating and maintaining healthy sleep habits (also known as sleep hygiene).

• Medications that aid in falling or staying asleep (particularly those that are not habit-forming or may otherwise disrupt your sleep).

• Mental healthcare.

Medications for falling or staying asleep

Many different medications can help you fall and stay asleep. Many of them are sedative or hypnotic drugs, both prescription and nonprescription, as well as mental health medications and certain plants and supplements.

In general, your healthcare practitioner is the best person to inform you about the available treatments and which ones they recommend for you. They are also the finest source of information regarding potential side effects or complications from treatments.

The following material provides examples of medication; however, it is not an exhaustive list of all possible treatments. Remember that medications for insomnia may not work for everyone. Some medications may interact with others, and your age and physical health are other important considerations.

It's also important to remember that, while certain medications can help you sleep, others may disrupt your sleep cycle. Sleep quality, not quantity, is crucial. That means you should utilize medications, including over-the-counter ones, with caution.

Prescription medications for insomnia

There are several prescription drug types that can be used to treat insomnia. Depending on your location, some medications may be subject to regulatory restrictions due to how they act or their effects.


Controlled drug types include:

• Benzodiazepines: Examples include estazolam, quazepam (Doral®), temazepam (Restoril®), and triazolam (Halcion®).

• "Z-drugs" (experts frequently group these with benzodiazepines despite the name because they have very similar qualities).  The most popular ones are eszopiclone (Lunesta®), zaleplon (Sonata®), and zolpidem (Ambien®).

• Dual orexin receptor antagonists (DORAs): Orexin is a substance found in your brain that promotes wakefulness. Blocking orexin helps you sleep. Examples include suvorexant (Belsomra®), lemborexant (Dayvigo®), and daridorexant (Quviviq®).

• Gabapentin (Neurontin®) and pregabalin (Lyrica®) are two antiseizure medications that can assist with disorders such as restless leg syndrome, which can keep you awake.

Noncontrolled medication kinds include the following:

• Sedating antidepressants include tricyclic antidepressants (TCAs) such as doxepin (Silenor®), amitriptyline (Elavil®), and trazodone.

• Melatonin and Related Drugs: Melatonin is a chemical found in your brain that informs you when it's time to sleep. It is available in prescription strength, as well as lesser dosages over the counter*. Ramelteon (Rozerem®) is one of several synthetic medicines that operate similarly to melatonin.

*NOTE: Do not exceed the prescribed dose of melatonin without first seeing your healthcare physician. Doses more than ten milligrams may be harmful.

Over-the-counter medications for insomnia

Antihistamine drugs used to treat allergies can also induce sleep. Examples of this include diphenhydramine (the active ingredient in drugs like Benadryl®) and doxylamine (generally known under the trade name Unisom®).


Herbs and vitamins

Many plants or supplements can help treat insomnia. Even though a lot of these are popular and well-known, you should never assume that a supplement or plant is safe for you. You should talk to a healthcare practitioner about herbs and supplements before taking them. That helps you prevent any side effects or interactions, especially if you have any medical problems or use any other medications.

Mental healthcare

Because your mental health may considerably impact your ability to sleep, mental healthcare is one of the most effective strategies to enhance your sleep, either directly or indirectly. The best person to tell you more about your options for mental health treatment and to provide you with information on how to obtain it is a healthcare professional.

Prevention:

How to avoid insomnia?

• Keep your bedtime and wake-up time consistent every day, including weekends.

• Stay active. Regular physical activity can help you sleep better at night.

• Limit your naps or avoid taking them altogether.

• Limit or avoid using caffeine, alcohol, and nicotine.

• Avoid eating heavy meals or drinking a lot of fluids before bedtime.

• Get regular exercise. Try not to work out close to bedtime because it may make it hard to fall asleep. Experts suggest exercising at least three to four hours before bed.

• Avoid having a large dinner in the middle of the day. However, a small food before bed could make it easier for you to fall asleep.

• Make your bedroom comfortable: Dark, peaceful, and not too warm or too chilly. If light is a concern, wear a sleeping mask. To block out sounds, try earplugs, a fan, or a white noise machine.

• Before going to bed, establish a pattern for relaxation. Take a bath, read a book, or listen to music.

• Make a to-do list before you go to bed if you have a tendency to lie awake worrying about things. You might be able to put your worries aside for the evening by doing this.

Having Insomnia:

The same sleep habits that can help you prevent insomnia will also assist if you currently have it. In addition to practicing proper sleep hygiene as stated above, you also should perform the following:

• Talk to your doctor if your insomnia does not improve or gets worse.

• Even if your sleep becomes better, stick to your insomnia therapy plan.

• Manage any health issues that may be contributing to your insomnia.

• Find techniques to cope with stress, a frequent cause of insomnia.

• It may take months to treat chronic insomnia, so be patient.

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