What is insomnia - causes, symptoms, and treatment

Insomnia - causes, symptoms and treatment

Table of contents

• What is insomnia
• Causes of insomnia
• Risk factors for insomnia
• Symptoms of insomnia
• Types of insomnia
• The stages of sleep throughout the night
• Sleep requirements by age
• How does lack of sleep affect us?
• Diagnosing insomnia
• Treatment for insomnia
• Recommendations for good sleep

Insomnia - what is it?

Insomnia is a sleep disorder that affects up to 35% of adults. It can be characterized either by difficulty falling asleep, staying asleep, or even by short periods of sleep. For some people, insomnia is a minor inconvenience, but for others, insomnia can be a major disruption and can have serious effects, leading to excessive daytime sleepiness, a higher risk of car accidents, and negative effects on behavior due to lack of sleep. Chronic insomnia can even contribute to the occurrence of serious health problems.

If you have trouble sleeping, the Centrokinetic team can help you with the following therapies:

- NESA therapy. NESA® technology helps you improve the quality of your sleep, which translates into a superior quality of life and well-being, reduced stress, and prevents the development of diseases such as Alzheimer's, cardiovascular disease, etc. Thanks to NESA®'s non-invasive neuromodulation, deep sleep levels are improved and melatonin secretion is increased with prolonged effects over time.

- Psychotherapy.

Causes of insomnia

Sometimes, insomnia lasts only a few days and goes away on its own, especially when it is related to a temporary cause, such as stress caused by a presentation at work or jet lag. Other times, insomnia is persistent. Chronic insomnia is usually related to an underlying mental or physical problem.

Anxiety, stress, and depression are among the most common causes of chronic insomnia. Sleep problems can also worsen symptoms of anxiety, stress, and depression. Other common emotional and psychological causes include anger, worry, grief, bipolar disorder, and trauma. Treating these underlying problems is essential to getting rid of insomnia.

Medical problems or illnesses. Many medical conditions and illnesses can contribute to insomnia, including asthma, allergies, Parkinson's disease, hyperthyroidism, gastroesophageal reflux disease, kidney disease, and cancer. Chronic pain is also a common cause of insomnia.

Medications. Many prescription medications can interfere with sleep, including antidepressants, ADHD stimulants, corticosteroids, thyroid hormones, blood pressure medications, and some contraceptives. Over-the-counter medications that can affect sleep quality include cold and flu medications that contain alcohol, pain relievers that contain caffeine, diuretics, and diet pills.

Sleep disorders. Insomnia is itself a sleep disorder, but it can also be a symptom of other sleep disorders, including sleep apnea, restless legs syndrome, and circadian rhythm disorders related to jet lag or night shift work.

Pregnancy. It is not uncommon for pregnant women to develop insomnia, especially during the first trimester. This is due to symptoms associated with pregnancy, such as increased need to urinate, nausea, vomiting, and back pain. 

Risk factors

There are certain groups of people who are at increased risk of developing insomnia. It has already been observed that people who face stressful situations or medical conditions, such as depression or those that cause physical discomfort or pain, are more at risk of developing insomnia.

People who have a very irregular sleep schedule are at risk of developing insomnia, because irregular rest schedules disrupt the circadian rhythm that regulates sleep and wakefulness. Those whose jobs involve frequent schedule changes or shift work are at high risk of insomnia. Other groups include:

• People who worry constantly are at risk of insomnia. 
• People who do not relax and are daily stressed at work are more prone to poor quality sleep.
• People with other sleep disorders, such as restless legs syndrome and sleep apnea.
• People with a genetic predisposition are also more likely to develop insomnia. Although there are currently no genetic tests that can identify people at risk of insomnia, twin studies show that genetics plays a role in insomnia.
• Women are twice as likely to have insomnia as men.
• Older adults are more prone to insomnia.

Symptoms of insomnia

If it is present for several months and occurs several days per week, then it is chronic insomnia. On the other hand, acute or transient insomnia will last only a few days or weeks. However, you can consult a doctor as early as the first month of persistent symptoms. Some of the symptoms of insomnia are:

• Lying awake in bed for a long period of time before sleep. More common in young adults.
• Fragmented sleep. More common in older adults. There may be more frequent awakenings in the middle of sleep during the night.
• Early awakening with the inability to fall back asleep.
• Lack of quality sleep leading to a feeling of restlessness, fatigue, irritability, depression, and reduced ability to concentrate and carry out daytime activities.
• Symptoms persist despite the use of common sleep-improvement strategies.

Although sleep deficiency and insomnia are used interchangeably, they are not the same thing. In the case of insomnia, these symptoms are present even when you have the right time and place to sleep. Although tired, people with insomnia are generally unable to take a nap during the day. This differs from sleep deficiency, which represents an inadequate amount of sleep due to a lack of time to sleep or a personal decision not to sleep. Sleep deficiency can be caused by an acute stress factor, such as a trip or an impending deadline, which reduces the amount and quality of sleep. People who have sleep deficiency will fall asleep easily when given the opportunity to do so.

Types of insomnia

Insomnia is most often classified according to duration:

• Transient insomnia - Less than one month
• Short-term insomnia - Between one and six months
• Chronic insomnia - More than six months

Insomnia can also be classified as:

• Primary insomnia - Insomnia that is present without other coexisting illnesses. Most studies on the treatment of insomnia have been conducted with people who have primary insomnia.
• Secondary insomnia - When insomnia exists together with another medical or psychiatric condition. Most cases of insomnia fall into this category. Sometimes, insomnia can worsen the medical or psychiatric condition and can hinder its treatment. For example, people with depression and insomnia do not respond as well to depression treatment as people without insomnia.

The stages of sleep throughout the night

There are 4 stages of sleep: 

• Light sleep, also the first phase of non-REM sleep. In this stage, the transition from wakefulness to sleep takes place. 
• The second stage is the one in which brain waves slow down – it represents approximately 50% of total sleep and experts say it is the phase in which we can be easily woken from sleep.
• Deep sleep – represents the non-REM stage in which the body is least responsive to external stimuli.
• REM sleep – represents the stage in which dreams occur and sets in approximately an hour and a half after we fall asleep.

Each stage of sleep plays a role in allowing the mind and body to wake up refreshed. In addition, deep sleep is a very important stage not only for the brain's recovery process, but it also plays an important role in memory consolidation. Understanding the sleep cycle also helps explain how certain sleep disorders, including insomnia and obstructive sleep apnea, can affect a person's sleep and health.

Sleep requirements by age

The amount of sleep we need to stay healthy, alert, and active depends on each individual's age and varies from person to person. Most adults need at least seven hours of sleep every night.

The National Sleep Foundation (NSF) and a group of 18 experts analyzed over 300 studies to identify the ideal amount of sleep by age. Thus, the following is recommended:

• Newborns (0 to 3 months): 14 to 17 hours of sleep
• Infants (4 to 11 months): 12 to 15 hours of sleep
• Toddlers (1 to 2 years): 11 to 14 hours of sleep
• Preschoolers (3 to 5 years): 10 to 13 hours of sleep
• Children aged 6 to 13 years: 9 to 11 hours of sleep
• Teenagers (14 to 17 years): 8 to 10 hours of sleep
• Young adults (18 to 25 years): 7 to 9 hours of sleep
• Adults (26 to 64 years): 7 to 9 hours of sleep
• Older adults (65 years or more): 7 to 8 hours of sleep

Although there is no difference between sleep recommendations for men and women, sleep needs and patterns can differ. In general, women tend to need more sleep than men and are diagnosed with sleep disorders more often than men. For example, women are 40% more likely to suffer from insomnia than men and are almost twice as likely to face anxiety and depression - conditions that are both linked to insomnia. Women also face other gender-specific factors that disrupt their sleep, including hormonal changes related to menstruation and menopause, as well as pregnancy and postpartum.

How does lack of sleep affect us?

Not spending enough time in each stage of sleep, or not properly progressing through the stages of sleep, can affect us in different ways, having potential short- and long-term consequences.

A few examples of problems that can occur following a disrupted sleep cycle include problems with:

• Learning and concentration
• Creativity
• Making rational decisions
• Problem solving
• Recalling memories or information
• Controlling emotions or behaviors

People with a disrupted sleep cycle are also at greater risk for:

• Pain
• Inflammation
• High blood pressure
• Heart disease
• Overweight/obesity
• Diabetes
• Reduced quality of life

It is no surprise that insomnia can reduce the ability to think clearly. Studies have shown that people with insomnia show declines in cognitive performance in terms of short-term memory, attention, and some more complex brain functions, such as the ability to speak clearly.

Diagnosis

Although many people choose to self-diagnose, it is best to seek the advice of a healthcare professional. Expressing your sleep-related concerns and behaviors allows the doctor to make a better-informed clinical decision. The doctor will need a relevant sleep, medical, family, substance use, and psychiatric history. The doctor can then perform a physical exam and may request tests. If your family doctor rules out common medical causes of sleep disorders, they will refer you to a sleep specialist.

The sleep specialist will perform tests to determine whether you have insomnia or any other sleep disorder. Here are some of the ways a sleep specialist can make a diagnosis:

Sleep diary

You will need to keep track of all the times you go to bed, the times you wake up during the night, and anything unusual you might experience. They may also want to know your meal schedule and other lifestyle details. 

Sleep study

A sleep study is performed while you sleep. The sleep specialist will attach electrodes to your scalp and body. You will be placed in a quiet, dark room to sleep overnight. Cameras and computers track every movement. Polysomnography continuously records brain waves during sleep, as well as a series of nerve and muscle functions. The study is also used to evaluate sleep disorders, such as sleep apnea, periodic limb movement disorder, narcolepsy, and hypersomnia.

With the help of these two main tests, the sleep specialist will be able to determine the activity of your brain and body while you sleep. The doctor may also want to perform additional tests depending on what the sleep study shows.

Treatment for insomnia

Behavioral and lifestyle changes can improve your overall sleep quality and help you fall asleep faster. These changes do not have the side effects that sleep medications can cause. And the improvements last longer over time.

Cognitive therapy

Cognitive behavioral therapy for insomnia is a type of therapy that can help improve sleep patterns until you are able to achieve better quality sleep.

Part of this therapy is learning to have good sleep hygiene, which includes getting rid of distractions in your room and keeping a consistent sleep schedule. You also need to focus on goals such as:

• Changing the thoughts and behaviors that interfere with good sleep.
• Creating a sleep schedule that will gradually help you sleep more over time.
• You can work with a therapist who will help you identify and change the thoughts and behaviors that are preventing you from getting good sleep.

Lifestyle changes

Making some simple lifestyle changes will help you sleep better. These may include:

• Changing your sleep area or schedule. Keep regular bedtimes and wake times every day and try not to take naps during the day.
• Avoiding large meals or too many fluids later in the evening.
• Try to exercise regularly.
• Avoiding alcohol before bedtime.
• Do relaxation exercises. For example, you can try progressive muscle relaxation, a technique in which you focus in turn on each part of the body, tensing and relaxing the muscles until you relax your whole body.

Medications

Behavioral and lifestyle changes can best help you improve your sleep in the long term. In some cases, however, taking sleeping pills for a short period of time can help you sleep. Doctors recommend taking sleep medications only occasionally or only for a short period of time. These are not the first choice for treating ongoing (chronic) insomnia.

Your doctor may recommend sleep medications with or without a prescription. Or you may take other medications that can help you relax and fall asleep, such as benzodiazepines or antidepressants.

Many sleep medications cause side effects, such as low blood pressure, anxiety, and nausea. These medications can also become less effective as your body becomes used to them. They can cause withdrawal symptoms when you stop using them.

Complementary medicine

Complementary medications are sometimes used to treat insomnia. These include dietary supplements, such as melatonin or valerian.

Recommendations for good sleep

There are things everyone can try to help improve the quality and quantity of sleep:

• Limit electronic devices before bedtime.
• Try to get at least half an hour of natural sunlight per day.
• Go to bed and wake up at approximately the same time every day.
• Get some exercise every day.
• Do not eat a heavy meal before bedtime.
• Avoid alcohol.
• Keep your room cool and dark.
• Read, listen to music, do gentle yoga or stretching, reflect on the important moments of the day, think about the positive things you will do tomorrow.
• Practice deep breathing for relaxation: inhale through your nose and exhale through your mouth. 
• Maintain a comfortable room temperature. Your body temperature drops as part of the normal sleep cycle. Although some people might be inclined to raise the bedroom temperature, studies have shown that an environment that is too warm can interfere with sleep and cause fatigue the next day. Taking a warm shower or bath before bedtime can also help you relax, promoting a natural cooling effect afterward.