MSD Manual

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Overview of Insomnia
Overview of Insomnia
Overview of Insomnia

    Have you ever had one of those nights where you just couldn’t seem to fall asleep? While that happens to everyone every once in awhile, people with insomnia have to deal with these symptoms night after night.

    Some people with insomnia have trouble falling asleep, whereas others wake up throughout the night, and struggle to fall back asleep, and these disturbances typically happen at least 3 times each week. Acute insomnia lasts less than a month, whereas chronic insomnia lasts over a month.

    Insomnia affects both the quantity and quality of sleep, which makes it hard for individuals to reach the restorative levels of sleep which causes daytime sleepiness and fatigue, and over time—feelings of irritability, anxiety, and depression. This can lead to professional and personal problems, as well as day-to-day challenges like falling asleep while driving. Although insomnia can happen without an underlying cause, it can also accompany and worsen other problems like pulmonary diseases, psychiatric conditions, and a whole variety of conditions that might cause pain. Insomnia is also a common side effect of stimulants like caffeine, as well as depressants like alcohol, which can both disrupt the regular sleep cycle. Finally, and probably most commonly, insomnia can be the result of daily stresses from work or relationships as well environmental factors such as having to work a night shift, or having a newborn baby.

    There are a number of biological factors associated with insomnia. Studies have shown that people with insomnia might have heightened levels of the stress hormone cortisol, which plays a role in the process of waking up every morning. People with insomnia are also more sensitive to the effects of cortisol, typically waking up at much lower levels of cortisol as compared to the general population. In addition, insomnia is also associated with reduced levels of estrogen and reduced levels of progesterone, which can happen during menopause.

    Commonly, individuals with insomnia will self-medicate with alcohol and benzodiazepines, both of which can be extremely dangerous. Alcohol abuse can lead to a number of physical and psychological changes that can rapidly worsen the sleep-wake cycle and lead to dependence. Similarly, benzodiazepines, especially short-acting ones, can also create dependence and have a high abuse potential, which can actually worsen insomnia if someone tries to stop using them.

    One method of treatment is getting good sleep hygiene, which includes going to sleep and waking up at the same time every day including weekends, getting good exercise (but not right before bed), reducing alcohol intake, avoiding day-time naps, avoiding caffeine and smoking in the evening, and not going to sleep hungry.

    Another potential treatment is stimulus control which includes using the bed only to sleep rather than a place from which to watch television, text, or talk on the phone. It also helps to keep the environment calm by removing bright lights like a computer or a phone screen, and minimizing noise. Sometimes, though, these are unavoidable in which case eye covers and earplugs can definitely help. It’s also not helpful to try to force sleep to happen, which means that people that can’t sleep after 20 minutes should simply leave the bed and then return when they feel ready to sleep. These suggestions help the individual associate sleep—and only sleep—with the bedroom.

    Also there’s behavior therapy, which includes relaxation techniques as well as cognitive behavior therapy to help better manage problems and life stressors. While these techniques are being used, some medications such as melatonin agonists, non-benzodiazepine sedatives, and occasionally benzodiazepines might be prescribed to help with sleep. These medications can often have side effects, though, so they are generally used for less than two months, usually in combination with the behavioral therapy techniques.

    Alright so as a quick recap. Insomnia is an inability to get restorative sleep that causes daytime sleepiness and fatigue, and can be managed with good sleep hygiene, stimulus control, behavior therapy, and occasionally short courses of medications.

Video credit: Osmosis (