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Insomnia is one of the most widely reported sleep-related problems wherein it affects an individual’s ability to fall asleep, staying asleep, or both. Long-term health-related consequences of insomnia include high blood pressure, diabetes, and weight gain. When left untreated, it can interfere with an individual's ability to concentrate, give rise to memory problems, and increase the risk of automobile accidents.

The prevalence of insomnia is influenced by various factors such as gender, age, socioeconomic status, and pre-existing mental disorders. It is found to be more common in women than in men. A study from India reported that 33% of adults suffer from insomnia.

Types

Insomnia can be categorised into three types based on duration:

• Transient Insomnia: Insomnia that usually lasts less than a month


• Short-term insomnia: Also known as acute insomnia. It lasts between one to six months


• Chronic insomnia: Insomnia is chronic when it lasts for more than six months

Insomnia can further be classified as:

• Primary insomnia: Insomnia that doesn’t have a known cause is called primary insomnia.


• Secondary insomnia: This type of insomnia develops due to pre-existing medical conditions such as mental disorders or certain other types of sleep disorders. Substance abuse is also responsible for triggering secondary insomnia.

Symptoms

The symptoms of insomnia usually vary from one person to another. Numerous biological, psychological, and social factors impact the development of symptoms of insomnia. Some of the common symptoms include:

• Having to wake up many times in the middle of the night


• Facing difficulty returning to sleep


• Feeling tired throughout the day


• Inability to concentrate on day-to-day tasks


• Experiencing problems with memory


• Feeling depressed or getting irritated easily


• Impulsive behaviour or aggression

Causes And Risk Factors

Several factors may lead to an increase in the risk of insomnia. Here is a low-down on the most prominent ones.

Stress:  Anxiety about work, academics, financial issues and relationship can keep you active at night and make it troublesome to doze off. Traumatic life experiences like the loss of a loved one and divorce, among others, can also have the same effect.

Poor sleep habits: Insomnia can develop from everyday lifestyle habits such as staying up too late, not sleeping at a fixed time every night, using electrical gadgets in bed, sleeping during the day, sleeping in a room that is too noisy or bright and working late in the evening or doing night shifts.

Unhealthy food habits: Eating a lot in the evening or before going to bed can lead to digestive problems such as heartburn or discomfort in the stomach, making it difficult for you to fall asleep.

Mental health challenges: Poor sleep quality and quantity can result from psychological disorders like depression, anxiety and bipolar disorder.

Medications: Certain drugs can interfere with your sleep cycle. They include antidepressants, medicines for allergies, cough and cold, asthma, blood pressure and various others.

Health conditions: Neurodegenerative conditions like Parkinson's disease and Alzheimer's disease, cardiac ailments, asthma, acute pain, cancer, and diabetes can be the culprits behind insomnia. A sleep-related breathing disorder, known as sleep apnoea, can also disrupt your shut-eye time.

Stimulants: Caffeine, nicotine (in tobacco products), and alcohol are stimulants that can keep you awake through the night. They may also lead to disrupted sleep.

Gender: Women are more prone to insomnia than men, which could be attributed to the discomfort and hormonal changes during pregnancy and menopause.

Age: Evidences suggest that senior citizens experience disturbed sleep. Changing health conditions, medications and sleep patterns probably raise their chance of insomnia.

Diagnosis 

As insomnia is not a disease, it cannot be diagnosed by any particular test. If your insomnia symptoms last for less than three months, you may have short-term insomnia. Following good sleep hygiene may help you overcome your sleeping problem. However, it is best to visit a sleep specialist if you experience disturbed sleep and other signs and symptoms associated with insomnia for more than three months. He will start by evaluating your medical history and go on to review your sleep-wake pattern. He may ask you if you experience daytime sleepiness and fatigue or not and suggest that you maintain a sleep journal for 1 or 2 weeks to track your sleep schedule and habits. This will help him to understand your sleep schedule better.

If your doctor suspects sleep apnoea or other sleeping disorders (parasomnias) to be the cause of your problem, in that case, he/she may ask you to get a sleep study done, which is a laboratory test to monitor brain waves, breathing, heartbeat, eye movements and body movements as you sleep. Actigraphy is also used as a diagnostic method for sleep issues. A wearable device known as an actigraph measures your sleep-wake pattern.

Lifestyle/management

Identifying the underlying cause of insomnia is very important for its treatment. Usually, no treatment is needed for an individual suffering from short-term insomnia as it may go away on its own. However, a combination of lifestyle modifications, medications and other treatments may be suggested for someone with chronic insomnia.

Lifestyle modification

• Set up a regular time to wake up and go to bed


• Make sure your room is dark, quiet and comfortable when sleeping


• Avoid coffee, stimulants and heavy meals before bedtime


• Exercise routinely but not close to bedtime as this may keep you awake


• Avoid drinking large quantities of fluid in the evening to prevent night-time trips to the restroom


• Get out of bed and go to some other room if you are unable to fall asleep after fifteen minutes, and return only when you feel tired


• Do not use mobile phones, laptops or watch TV before bedtime


• Refrain from consuming alcohol before bed. Even though it may help one fall asleep in the beginning it increases the likelihood of getting up in the middle of the night, which makes it difficult to go back to sleep


• Relaxation techniques in the form of yoga, breathing exercises, muscle relaxation, and visualising peaceful scenarios help by calming one’s mind and relaxing the body, thereby promoting sleep

Treatment

If the lifestyle measures and therapies described above  do not work for you, your doctor may suggest oral medicines to manage insomnia. Sleep medications are prescribed for inducing sleep. It may not be able to treat the underlying causes of insomnia. They are only beneficial when used for a short-term. Antidepressants and novel sleep inducers among other medications, may be suggested. A word of caution: Do not self-medicate with over-the-counter medicines if you are suffering from insomnia. They may backfire or give you serious side effects.

Sleep medications can make one feel tired and light-headed; hence the following precautions should be taken when using them:

• Driving, using heavy machinery or engaging in any risky activities should be avoided while on these drugs


• Refrain from consuming alcohol


• Avoid taking sleep medications immediately before sleeping


• If taking the drugs for several days, do not stop suddenly

The following are the potential side effects of sleep medications:

• Tiredness


• Memory loss or amnesia


• Depression


• Unpleasant taste in the mouth


• Vision changes


• Thoughts of suicide


• Allergic reaction like swelling of the face, difficulty in breathing or rashes


• Headache


• Being clumsy


• Having hallucinations, behaving strangely or being confused


• Vivid dreams


• Rebound insomnia, worsening of sleeping problems prior to starting the medications, may occur if the drugs are stopped suddenly

The key point to remember is that insomnia needs to be treated properly as it may have long term complications. Adequate sleep hygiene and behavioural therapies are the mainstay of treatment. Pharmacotherapy could be considered as short-term option and should not be considered as a cure for insomnia.

Alternative Treatments

Cognitive Behaviour Therapy (CBT)

Cognitive Behaviour Therapy works by focusing on the patient's thoughts and behaviours. This therapy is an effective way of treating underlying problems such as anxiety, depression, and stress rather than just focusing on the superficial symptoms. The patient's negative thoughts and beliefs regarding sleep are changed into positive ones with the help of CBT. This will ultimately help the individual develop a healthy sleeping habit for life.

Natural Therapies

The following have also been used for the management of insomnia:

• Aromatherapy, which involves the use of scented oils to improve sleep.


• Melatonin is a hormone produced within our body that helps to promote sleep.


• Chamomile, a herb from a daisy-like flower, has been used in preparations such as tea or as aromatherapy to help induce sleep.

References

1. Cleveland Clinic. Insomnia [Internet] [Updated on October 15, 2020] Available at: https://my.clevelandclinic.org/health/diseases/12119-insomnia#symptoms-and-causes. Accessed on February 24, 2021.


2. Sleep Foundation. What causes insomnia? [Internet]  Available at: https://www.sleepfoundation.org/insomnia/what-causes-insomnia. Accessed on February 24, 2021.


3. La YK, Choi YH, Chu MK, Nam JM, Choi YC, Kim WJ. Gender differences influence over insomnia in Korean population: A cross-sectional study. PloS one. 2020 Jan 9;15(1):e0227190.


4. Akhtar N, Mallick H. Recommendations for a National Sleep Policy in India. The National medical journal of India. 2019;32(1):59.


5. Standford Health Care. Types of insomnia. [Internet] Available at: https://stanfordhealthcare.org/medical-conditions/sleep/insomnia/types.html. Accessed on February 26, 2021.


6. American Academy of Sleep Medicine. Insomnia. Available at: https://aasm.org/resources/factsheets/insomnia.pdf. Accessed on February 26, 2021.


7. Sleep education. Insomnia – Symptoms and causes [Internet] [Updated on March 4, 2015]  Available at: https://sleepeducation.org/essentials-in-sleep/insomnia/symptoms-causes . Accessed on February 25, 2021.


8. Medline Plus. Insomnia [Internet] [Updated on October 5, 2020] Available at: https://medlineplus.gov/ency/article/000805.htm Accessed on March 2, 2021.


9. Sleep Foundation. What causes insomnia? [Internet] Available at: https://www.sleepfoundation.org/insomnia/what-causes-insomnia. Accessed on March 2, 2021.


10. Sleep Education. Insomnia – Symptoms & Causes [Internet] [Updated on March 4, 2015] Available at: https://sleepeducation.org/essentials-in-sleep/insomnia/symptoms-causes.  Accessed on March 2, 2021.


11. Stanford Health Care. Diagnosis [Internet] Available at: https://stanfordhealthcare.org/medical-conditions/sleep/insomnia/diagnosis.html.  Accessed on March 2, 2021.


12. Sleep Education. Insomnia – Diagnosis & Self Tests [Internet] [Updated on March 6, 2015] Available at: https://sleepeducation.org/essentials-in-sleep/insomnia/diagnosis-self-tests#:~:text=If%20you%20think%20you%20may,wake%20up%20earlier%20than%20desired%3F.  Accessed on March 2, 2021.


13. Sleep Foundation. Diagnosing Insomnia [Internet] Available at: https://www.sleepfoundation.org/insomnia/diagnosis#:~:text=If%20symptoms%20occur%20at%20least,short%2Dterm%20or%20acute%20insomnia.  Accessed on March 2, 2021.


14. Winchester Hospital. Treatments for insomnia [Internet] Available at: https://www.winchesterhospital.org/health-library/article?id=19710.  Accessed on March 2, 2021.


15. Stanford Health Care. Treatments for insomnia [Internet] Available at: https://stanfordhealthcare.org/medical-conditions/sleep/insomnia/treatments.html.  Accessed on March 2, 2021.


16. Harvard Health Publishing. Overcoming insomnia [Internet] Available at: https://www.health.harvard.edu/newsletter_article/overcoming-insomnia.  Accessed on March 2, 2021.


17. Family Doctor. Insomnia [Internet] [Updated on October, 2020] Available at: https://familydoctor.org/condition/insomnia/.  Accessed on March 2, 2021.


18. Winchester Hospital. Insomnia [Internet] Available at: https://www.winchesterhospital.org/health-library/article?id=21730.  Accessed on March 2, 2021.


19. Srivastava JK, Shankar E, Gupta S. Chamomile: A herbal medicine of the past with a bright future. Molecular medicine reports. 2010 ;3(6):895-901.


20. Help Guide. Insomnia [Internet] [Updated on October, 2020] Available at: https://www.helpguide.org/articles/sleep/insomnia-causes-and-cures.htm.  Accessed on March 2, 2021.


21. Winchester Hospital. Medications for insomnia [Internet] Available at: https://www.winchesterhospital.org/health-library/article?id=19701.  Accessed on March 2, 2021.

Prevention

Prevention