Insomnia

What is insomnia?

Insomnia is a sleep disorder which is characterised by disturbed sleep patterns and feeling like you cannot get to sleep even when you are tired. Insomnia is usually due to one of the following causes or a combination of:

• A lack of sleep
• Waking up regularly during the night
• Struggling to get back to sleep once you have woken up
• Feeling tired and dissatisfied despite sleeping for several hours
• Waking up early and being unable to get back to sleep

The condition affects people in different ways and cannot be defined according to the amount of hours of sleep the person gets or the time it takes them to go to sleep once they get into bed. People are different in terms of how much sleep they need and the quality of sleep they require to feel healthy and fresh. Insomnia commonly causes problems for people during the day, which may include irritability and short-temperedness, tiredness and a deficiency in energy and difficulty concentrating.

There are different classifications of insomnia; there is transient which is short-term, intermittent which is on and off, and chronic (long-term). Transient insomnia refers to insomnia that lasts from one night to a couple of weeks, while intermittent insomnia is associated with frequent bouts of insomnia, and then there is chronic insomnia which is defined as insomnia that lasts for over a month or occurs almost every night.

What causes insomnia?

There are risk factors which tend to increase the likelihood of insomnia, including:

• Depression (either current or in the past)
• Anxiety
• Age: the risk of insomnia tends to increase with age
• Taking certain medications
• Gender: females are more likely to suffer from insomnia than males

Other factors including stress and medical conditions further increase risk if an individual already has the factors listed above.

There are many possible causes of insomnia. In most cases, transient and intermittent insomnia are caused by:

• Stress
• Noise and disturbances in the nearby environment
• Changes in temperature or extreme temperatures
• Changes in the surrounding environment
• Side-effects of taking medication

Chronic insomnia is often more complex than transient and intermittent insomnia, and the causes are usually underlying physical and psychological disorders or conditions. One of the main sources of chronic insomnia is depression, but other possible causes include:

• Anxiety
• Stress
• Asthma
• Sleep apnoea
• Heart disease
• Kidney disease
• Restless legs syndrome
• Narcolepsy
• Parkinson's disease
• Arthritis

Insomnia can also be triggered by misuse of drugs, caffeine or drinking alcohol, and some people suffer from insomnia due to changes in their normal sleep/wake cycles; for example, when nurses work a night shift but are used to working day shifts.

The following behavioural habits or actions have also been proven to contribute to insomnia (this applies to chronic insomnia and short-term insomnia):

• Worrying about not getting enough sleep
• Drinking alcohol before bed
• Having a drink containing caffeine before bed
• Smoking before bed
• Sleeping during the day

Who gets insomnia?

Insomnia affects people of all ages but tends to be more prevalent among females and people over the age of 60. Age seems to increase difficulty with sleeping, despite the fact that many people feel they need more sleep when they get older.

How is insomnia diagnosed?

Patients who suffer with insomnia are diagnosed based on their medical history and details about their sleep pattern and their sleep/wake cycle. Many patients are asked to keep a sleep diary over a period of time so that doctors can assess their sleep history and identify possible causes. Doctors will also ask the patient questions about how well they are sleeping, their routine during the evenings before bed and their mental state (for example, if they are suffering from stress or anxiety or have experienced emotional difficulties). Sleep studies are sometimes recommended, but this is generally the case when sleep disorders such as narcolepsy or sleep apnoea are suspected.

What is the treatment for insomnia?

In many cases, no treatment is required for transient and intermittent insomnia. This is because insomnia often only lasts for a short period of time and a normal sleep cycle will be restored without the need for treatment; if an individual has jet lag, for example, the body's natural clock will adjust without the need for treatment.

If transient insomnia is affecting an individual's daily life – for example, if they are feeling tired during the day and this is affecting their mood or their performance at work – treatment may be recommended. Sleeping pills can be prescribed on a short-term basis, but as with all drugs there is a risk of side-effects. Some doctors advise against over-the-counter medication for insomnia and recommend patients see their doctor for advice.

What is the treatment for chronic insomnia?

Before a treatment plan is drawn up, tests will be performed to determine if there is any underlying physical or psychological condition. If this is the case they will usually be treated as priority, and doctors will then wait to see if necessary treatment eliminates the condition before recommending specific insomnia treatment.

Patients with chronic insomnia are invited to discuss their symptoms and talk to doctors about their sleep patterns to try and identify any causes or triggers. A sleep diary will be helpful for this. If behaviours or triggers are identified the patient will be advised to reduce or stop them and see if this enables them to sleep better.

In some cases, sleeping pills are advised but extended use of sleeping pills is generally not recommended. All patients taking sleeping pills should be monitored by doctors, and as a general rule, the lowest dose of sleeping medication is prescribed and the dose is short-term. In some cases, the dose will be gradually reduced because immediately stopping the course can lead to the return of insomnia.

Behavioural techniques can be beneficial for some patients. This may include finding ways to wind down and relax during the evenings, known as relaxation therapy, stress management techniques and sleep restriction, which is usually helpful for people struggling to sleep during the night because they nap during the day. Sleep restriction involves limiting the amount of sleep to begin with so initially the restriction may be for just a few hours sleep, which will gradually increase to a normal night's sleep.

Reconditioning is a process that may be helpful for some people and involves associating their bed and bedroom with sleep. Individuals are advised to stay up until they feel tired and then go to bed, rather than getting into bed and waiting hours to fall asleep. The reconditioning process aims to allow people to associate bed and the bedroom with sleep and relaxation.