Insomnia Causes, Symptoms & Treatment

woman sitting on bed

Identifying the Reasons for Sleep Disturbance

Insomnia can take many forms. Fleeting bouts of sleeplessness can be brought on by stress, temporary medical conditions, or poor sleep habits. Long-term sleep disturbance can often be associated with underlying emotional, mental, or physical issues, or even other sleep disorders.

Insomnia can manifest as inability to initiate or maintain sleep, or as inability to achieve restorative sleep, depending on the nature of the disorder. In most cases, identifying the underlying reason for insomnia symptoms is the first step to putting an end to sleeplessness and finally achieving a good night’s sleep.

Sleeping Disorders and Insomnia

Insomnia is a serious sleeping disorder in its own right, but can also be associated with other sleep disturbances as a symptom or as a secondary effect. Other sleep disturbances include the following:

  • Sleep apnea: The periodic cessation of breathing at night reduces the restorative benefits of sleep and causes periodic awakening. Secondarily, anxiety over the anticipation of episodes of sleep apnea can hamper the ability to relax enough to fall asleep.
  • Circadian rhythm sleep disorders: These disorders interfere with the ability to sleep on an appropriate schedule. When the body’s natural sleep patterns overlap with other obligations, this can manifest as insomnia.
  • Narcolepsy and idiopathic hypersomnia: It may seem counter-intuitive that a disorder characterized by excessive sleepiness can be a cause of insomnia, but in the days and months following diagnosis, insomnia can be a secondary effect until the correct dosage of stimulant medication is determined.

Mental and Emotional Insomnia Causes

A number of emotional disorders are characterized by persistent sleep disturbance. This can occur either as a primary characteristic of the disease, or as a side effect of medication. Among the many neurological insomnia causes are the following:

  • depression
  • anxiety
  • schizophrenia
  • bipolar disorder
  • brain injury
  • substance abuse

Sleep Disturbance Due to Physical Conditions

Some conditions associated with chronic pain can understandably create trouble falling asleep. Other conditions can be more annoying than painful, causing sufferers to awaken frequently during the night. Some of the more common of the numerous physical insomnia causes are:

  • Pregnancy: No matter how wanted a pregnancy is, it can come with some less than magical symptoms. Insomnia is one of these, brought about by a host of physical changes. Frequent urination, difficulty getting comfortable, as well as the expected emotional excitement and anxiety, often add up to trouble falling asleep or sleep disturbance during the night.
  • Menopause: Like pregnancy, menopause is a natural condition that can create some discomfort. Hot flashes, mood swings, and hormonal imbalances can all influence the ability to get a good night’s sleep.
  • Arthritis, fibromyalgia and other chronic conditions: Constant pain impacts quality of sleep in a number of ways. The pain itself as well as associated anxiety can cause trouble falling asleep. Unfortunately, sleep deprivation can often make symptoms worse, creating a vicious cycle of pain and sleeplessness.

Other Insomnia Causes

For a great many insomnia sufferers, the cause is nothing as troubling as a chronic emotional or physical disorder. Many individuals experience frequent bouts of insomnia due to relatively benign factors that can easily be corrected using self help techniques or natural sleep aids. Among the more common of these insomnia causes are:

  • Poor sleep habits: An after-dinner cup of coffee, a habit of watching television in bed, or a tendency to indulge in an afternoon nap can all negatively influence the ability to fall asleep and stay asleep.
  • Stress: Good or bad, stress can impact sleep health. Excitement for a trip or event, worry about financial matters, or nervousness over an upcoming job interview are all forms of stress. Effective stress management, like yoga, can be key to getting a good night’s sleep.
  • Bedtime anxiety: Ironically, a brief bout of sleeplessness can lead to a self-perpetuating cycle as the new insomniac worries himself awake each night.
  • Substance abuse: Alcohol and other substances can interfere with the sleep cycle, reducing the restorative effects of sleep, and withdrawal symptoms can cause premature awakening.

Learning to Fall Asleep

Whatever the cause, insomnia can be effectively treated by a combination of natural sleep aids, self-help techniques, and, if necessary, medical intervention. Getting a good night’s sleep is important to physical and mental health, and as such should be given the priority it deserves.

When Trouble Falling Asleep Becomes a Sleep Disorder

It is not uncommon for most people to have brief spells of sleep disturbance at some point, but for many people, insomnia can become a significant source of distress in occupational, social, or familial functioning during the day. When sleep deprivation effects begin to interfere with daily life, medical investigation is warranted.

Clinical Insomnia Symptoms

It can be difficult to distinguish between a simple spell of trouble falling asleep and a true sleep disorder. In most cases, the distinction lies in the length of time over which the problem persists, and the degree of disruption to daily activities.

Additionally, the Diagnostic and Statistical Manual of Mental Disorders distinguishes between bouts of sleeplessness with no underlying medical cause and those associated with a separate physical, mental, or sleep-related disorder.

Termed “primary insomnia,” sleep disturbance with no underlying cause is diagnosed based on the following criteria:

  • trouble falling asleep
  • inability to maintain sleep
  • non-restorative sleep

For a diagnosis of clinical insomnia, any or all of these symptoms must persist for a minimum of one month, and must cause a clinically significant degree of disruption in daily life. This can include anything from an elevated stress level to functional impairment of normal activities.

Patients diagnosed with clinical insomnia will receive medical help to achieve and maintain an improved quality of sleep, but that does little to help those who fail to meet those criteria.

Secondary Insomnia

A number of medical and psychological conditions are associated with trouble falling asleep, including sleep apnea, depression, generalized anxiety disorder, and substance abuse. Even benign conditions such as pregnancy can bring about secondary insomnia by frequently waking the patient with discomfort or the urge to urinate.

In the case of secondary insomnia, symptoms and treatment are usually specific to the particular disorder that is causing the sleep disturbance and should be discussed with the appropriate health care provider.

Occasional Sleeplessness

It may not warrant clinical diagnosis, but occasional sleeplessness can wreak havoc on daily life just the same. This temporary insomnia can become chronic if it leads to night time anxiety or dependence on over-the-counter sleep medication, and therefore should be treated carefully and conservatively to avoid creating a new problem.

Temporary sleep disturbance is a common condition, often brought about by stress, poor sleep habits, or unrealistic expectations of sleep requirements. Natural sleep aids and behavior modifications should usually be attempted before employing sleep medications, which have the potential to alter sleep patterns and create a cycle of dependence (Maxmen and Ward 1995.)

Treating Insomnia Symptoms

Sleeplessness, be it fleeting or chronic, is a serious condition and warrants attention. Symptoms of sleep deprivation have the potential to damage personal and professional relationships, cause accidents, and bring about other medical problems.

If trouble falling asleep persists despite self-care options and good sleep habits, it is important to consult a medical professional to rule out underlying health conditions. With or without a diagnosis of clinical insomnia, a good doctor will evaluate possible insomnia causes and explore all treatment options to work toward the ultimate goal of sleeping better.

Insomnia Treatment

Pharmaceutical, Behavioral, and Natural Sleep Aids

Insomnia is an insidious sleep disorder that robs sufferers of one of the few things humans cannot live without: simple, restorative sleep. The effects of sleep deprivation can invade every aspect of life and wreak havoc on personal and professional relationships.

Whether diagnosed with a clinical sleep disorder or simply going through a spell of trouble falling asleep, it can be useful to explore the various levels of self-care options and natural sleep aids before turning to over the counter medication or prescription drugs.

Self Care Options for Insomnia Treatment

For simple periods of sleeplessness brought on by temporary causes such as stress or poor sleep habits, the simplest remedies can often be the most effective. In Essential Psychopathology and its Treatment by Maxmen and Ward (W.W. Norton and Company) the authors recommend that the following behavior and lifestyle modifications be attempted before resorting to medical intervention:

  • Avoid alcohol, cigarettes, or caffeine close to bedtime. These substances interfere with normal sleep patterns and disrupt restful sleep.
  • Avoid excessive noise before bedtime and while falling asleep. Employ the use of earplugs or white noise to minimize sounds that cannot be avoided.
  • Resist the urge to nap during the day.
  • When possible, avoid stressful or upsetting activities before bedtime.
  • Keep bedroom temperature between 60-65°F (about 15-18°C.)
  • Seek out fresh air and exercise in the afternoon or early evening.
  • Have a small glass of warm milk and a light snack before retiring.
  • Enjoy satisfying sex before sleep.
  • Employ visualization of a peaceful, tranquil scene while falling asleep
  • Awaken at a regular time each morning and retire only when sleepy at night.
  • Don’t spend more than 20 minutes trying to sleep. Get up and relax quietly in another room and attempt sleep again only when feeling sleepy.

If restful sleep remains elusive despite following good sleep habits, natural sleep aids or medical intervention may be necessary to restore healthy sleep function.

Natural Sleep Aids

Natural therapies offer a less invasive approach to achieving a good night’s sleep. Most of these therapies are associated with few side effects, are generally not habit forming, and are accessible without a prescription.

  • Massage: Either by a professional or by a loved one, massage can relax the body and the mind, preparing both for restful sleep.
  • Acupuncture: According to Contemporary Medical Acupuncture by Guan-Yuan Jin (Higher Education Press 2007) acupuncture is a safe and effective remedy for insomnia, with no side effects and up to 90% effectiveness.
  • Meditation: Meditation and visualization free the mind of extraneous thoughts that might be causing stress and preventing sleep.
  • Melatonin: While its use remains controversial and its long-term effects as a supplement are unknown, some scientists acknowledge the potential for melatonin use in treating jet lag, circadian rhythm disorders and other causes of sleeplessness (Biological Psychology by James Kalat. Nelson Education)

Over-the-Counter Sleep Aids

Many physicians recommend against the use of over the counter sleep aids, citing that such medications can suppress REM sleep and that tolerance and dependence develop rapidly (Maxmen and Ward.) If over the counter sleep aids are used, treatment should normally be short-term and be carried out under the supervision of a medical professional.

Medical Help for Sleep Disorders

Persistent sleeplessness that continues despite conservative insomnia treatment should be evaluated by a doctor. The diagnosis of a clinical sleep disorder such as insomnia is normally carried out in partnership with a medical specialist. Once the cause of the insomnia is determined, treatment can begin in the form of prescription sleep medications that can assist with falling asleep, staying asleep or both.

Alternatively, cognitive behavioral therapy can be an effective insomnia treatment, and can be carried out without the use of drugs. This form of sleep therapy may require patience, but there is no worry about harmful side effects and the ultimate reward – a good night’s sleep – will make it worth the effort.

Sources:

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association:1132-1137.

Maxmen, J.S. and Ward, N.G. Sleep Disorders in Essential Psychopathology and its Treatment 2nd EdW.W. Norton & Company, New York.: 349-377

Santrock, J.W. and Mitterer, J.O. States of Consciousness in Psychology, Third Canadian EditionMcGraw-Hill Ryerson, Toronto: 226-266.

Maxmen, J.S. and Ward, N.G. Sleep Disorders in Essential Psychopathology and its Treatment 2nd Ed. W.W. Norton & Company, New York.: 349-377

Santrock, J.W. and Mitterer, J.O. States of Consciousness in Psychology, Third Canadian Edition. McGraw-Hill Ryerson, Toronto: 226-266.