Most people have experienced the frustration of lying in bed, wide-eyed and awake, instead of being comfortably asleep. Sleep problems are extremely common. One of the resultant conditions is insomnia.
Insomnia presents in several ways. Most people are familiar with the symptom of lying in bed, awake, for long periods of time. Other people experience waking up many times during the night. Still others experience the symptom of failing to feel rested after having slept for a long period of time.
For many people, insomnia occurs as a result of stress or long working hours. However, for some people, insomnia can be chronic. Chronic insomnia can affect a person’s quality of life by decreasing a person’s mental and physical function.
There are many strategies to improve sleep, and these strategies are supported by scientific evidence.
We will describe the various aspects of insomnia including definitions, symptoms, causes, types, and other areas. Additionally, we will describe methods that can be done by a person to improve their sleep, and the various options that are available to a person to get better sleep.
What Is Insomnia?
Insomnia is the inability to attain restful sleep, despite the availability of an opportunity to rest and an adequate environment for rest.
Insomnia is defined medically as the recurring inability to fall asleep when seeking sleep, repeatedly waking up before the desired time, or waking up feeling unrefreshed and tired. This inability to attain rest may manifest itself in other ways such as lying awake for long hours before falling asleep, waking up several times during the night, or waking up very early in the morning. Insomnia does not mean an inability to sleep altogether.
There are several symptoms associated with insomnia, including exhaustion, sleepiness, and brain fog during the day. People with insomnia often have anxiety about their inability to attain rest and fear that the anxiety may prevent them from falling asleep in the future.
What are the Effects of Insomnia?
The effects of insomnia may include falling asleep at socially inappropriate times or being less alert and less focused. The effects of insomnia may occur in conjunction with other symptoms such as fatigue or irritability.
The manifestation of insomnia may take varying forms in different people. For some people, the inability to attain rest takes the form of a mental struggle to slow down their thoughts and relax their bodies in order to fall asleep. For other people, the inability to attain rest takes the form of waking up repeatedly during the night.
There can also be psychological symptoms.
If you have repeated bouts of poor sleep you might start to think things like:
"I’m going to be lying in bed for hours again and feel terrible tomorrow..."
Having these sorts of thoughts can increase alertness, and lead to feelings of apprehension at bedtime.
Thus, anxiety, thoughts and worries, and behaviors associated with insomnia can develop a feedback loop which can perpetuate and maintain insomnia.
Symptoms of Insomnia
Symptoms of insomnia can occur during the night, or during the day.
Night time Symptoms
These can include:
- Taking a long time to fall sleep
- Frequent awakenings during the night
- Early-morning awakenings
- Inability to return to sleep
- Light and unrefreshing sleep
Daytime Symptoms
These can include:
- Tiredness and sleepiness
- Reduced energy
- Inability to concentrate
- Inattention
- Irritability
- Impaired mood
- Impaired motivation
- Decreased performance of daily activities
Insomnia can also impact upon your quality of life.
According to the Mayo Clinic, insomnia can impact your energy, mood and quality of life.
Not everybody experience all of these symptoms.
What Causes Insomnia?
There are multiple causes of insomnia.
There are biological, psychological, social and environmental factors that can influence a person’s ability to sleep. Sometimes there are numerous factors at play. Other times, there may be one apparent factor.
1. Psychological Factors
Psychological factors that can lead to insomnia may include worry or stress about certain circumstances in a person’s life. These factors can include financial concerns, work situations, family concerns, or relationships.
If a person is stressed about something, they may be mentally working out the issue while attempting to sleep. This can prevent them from being able to fall asleep.
2. Social and Environmental Factors
Some social and environmental factors that can lead to insomnia may include, for example, infrequent and/or changing bedtimes. This can include, for instance, oversleeping on the weekends or taking very long naps during the week.
Frequent or irregular changes in a person’s schedule can alter their body’s sleep rhythm. This can include, for example, new work schedules or shift work. Traveling to a new time zone can also alter a person’s body’s sleep rhythm.
3. Poor Sleeping Practices
Poor habits can lead to inconsistent sleep. This includes, for example, using electronics in bed, taking long naps during the day, or going to bed at different times each day.
4. Other Substances
Certain substances, like caffeine and nicotine, can disrupt a person’s ability to sleep if they are used later in the day. Alcohol can make it harder to stay asleep.
Often times, alcohol makes people feel tired and sleepless, and can even cause restlessness during the night.
To improve your sleep quality, it’s best to avoid alcohol in the hours leading up to your bedtime.
5. Medical Conditions
Often times, health conditions can disrupt your ability to sleep. These conditions can include:
- Pain
- Respiratory conditions
- Gastrointestinal conditions
- Disorders of the nervous system
- Disorders of the endocrine system
A large number of these conditions can be improved by treating the condition that is causing them. This can then improve your sleep as well.
6. Mental Health Conditions
Mental health conditions can certainly make it difficult to sleep. It is important to note that while sleep conditions can be associated with mental health conditions, it does not always mean that there is a mental health condition present.
If you are experiencing sleep conditions and persistent changes in your mental health and wellbeing, you should speak with a healthcare professional.
7. Medications
There are a number of medications that can disrupt your sleep.
If you believe your sleep conditions are being caused by your medications, you should speak with a healthcare professional. They may be able to adjust when you take your medications.
8. Your Environment
The conditions of your surrounding environment can cause sleep conditions.
The NHLBI states that sleep conditions can be caused by external factors such as light and noise.
Types of Insomnia
Insomnia may be of different types, depending on duration and other features.
Two principal types of insomnia are acute (or short term) and chronic insomnia.
Acute (or Short-term) Insomnia
This type of insomnia may be related to a specific event or circumstance and may not last for more than a few months.
Examples of events may be change in job, travel, other relationship changes, financial problems or illness.
Chronic Insomnia
This type of insomnia may persist for more than three months, despite the presence of adequate opportunity and environment for sleep.
This has also been defined as the inability to sleep at night more than 3 times a week for more than 3 months.
Chronic insomnia is complex, and it is advisable to get a professional opinion rather than trying to treat it yourself.
Sleep-Onset vs. Sleep-Maintenance Insomnia
Insomnia can be further described based on what part of the sleep process is affected.
Sleep onset is the process of initially falling asleep.
If an individual is having issues with this step, it is considered sleep onset insomnia.
If a person is able to eventually fall asleep, but is then unable to stay asleep and experiences frequent breaks in continuity, it is considered sleep maintenance insomnia.
Early-morning awakenings
Finally, an individual may be able to fall asleep and remain asleep, but is then awakened before the intended termination of the sleep period and is then unable to return to sleep.
It is possible for a person to experience more than one of these symptoms.
How Is Insomnia Diagnosed?
There are many reasons you may have a few restless nights. It's important you and your physician can distinguish between normal restlessness and a symptom of a greater issue. You may be referred to a sleep specialist if it's determined you experience frequent and long-term issues with the quality of your sleep.
While evaluating insomnia, a physician may consider the following:
- Your chronology of sleep
- Your symptom duration
- How sleep problems contribute to your daily routine
- Day-to-day symptoms
- Stress and environmental factors
- Factors that may include lifestyle, medication and family history
You may be asked to keep a sleep diary. A sleep diary may help your physician identify abnormal patterns and contributing factors to your sleep issues by documenting the following over a period of time:
- Time you go to bed
- Time you fall asleep
- Times you wake up during the night
- Times you get up in the morning
- Naps
- Caffeine and alcohol intake
- Exercise
- How you feel during the day
The NHLBI mentions that sleep diaries are an effective tool for health care professionals to identify abnormal patterns related to sleep and assess contributing factors.
Additional testing may be needed to assess other sleep disorders.
What Are The Options For Treating Insomnia?
Depending on what is causing the sleep issue, there are different treatment options.
One of the most recommended treatment options for chronic insomnia is cognitive behavioral therapy for insomnia (CBT-I).
CBT-I helps people change the thoughts and actions that prevent them from sleeping. It includes tactics such as teaching people about sleep, relaxing, changing the way they think about sleeping, restricting the time they spend sleeping, and changing the environment in which they try to sleep.
The American Academy of Sleep Medicine suggests that CBT-I should be the treatment of choice for people 18 years of age and older with chronic insomnia.
If needed, health care providers may suggest other types of treatment and medications.
Treatment should be personalized because not everyone responds to the same treatment for insomnia.
If insomnia is caused by another medical condition or disorder, treatment may need to focus on that condition in order to improve the person's sleeping issues.
What is CBT-I?
Cognitive Behavioral Therapy for Insomnia (CBT-I) is a psychological intervention focused on the relationship of thoughts, behaviors and sleep.
Let’s say you have a client who has a work-related injury and is not able to sleep because of the pain. The pain and injury cause a great deal of anxiety. After a week of this, the client becomes worried and anxious about going to bed because of the pain and the lack of sleep. The client may try a variety of strategies to try to go to sleep including taking a long warm bath or alternatively keeping the room very cold to try to relax. Ultimately, going to bed may cause anxiety. CBT-I addresses these thoughts and behaviors.
CBT-I utilizes several different techniques to address these thoughts, behaviors and symptoms.
Sleep education may help people learn about normal sleep patterns and help develop skills to improve sleep and health.
Stimulus control and other behavioral strategies may help reduce anxiety and serve to recondition a person to use the bed only for sleep.
Relaxation techniques may also help to address anxiety and assist a person to go to sleep.
10 Healthy Sleep Habits That May Improve Your Sleep
Creating healthy sleep habits may improve your sleep. Below are a few of those habits.
1. Maintain a Consistent Sleep Schedule
It is important to go to sleep and wake up at the same time every day.
This helps your body and mind understand when it is time to sleep and when it is time to wake up.
2. Practice a Relaxing Bedtime Routine
It is important to unwind before going to bed. There are many things you can do to help relax your mind and body. For example:
- Take a warm shower
- Practice gentle stretching and breathing exercises
- Read
- Listen to calming music
- Treat yourself to a massage
This may help you relax enough to fall asleep.
3. Watch Your Caffeine Intake
Caffeine is a stimulant. Try to not consume any caffeine in the afternoon if you're having trouble with sleep.
4. Watch Your Alcohol Intake
Many people believe that alcohol helps them fall asleep, but that is a myth. Alcohol actually reduces the quality of your sleep.
5. Exercise
Regular exercise may help with improving your quality of sleep, but exercising vigorously a few hours before bed may negatively impact your ability to fall asleep.
6. Creating a Comfortable Bedroom
Try for a bedroom that is:
- Quiet
- Dark
Properly Tempered (Neither too hot, nor too cold)
7. Avoid Taking Long Daytime Naps
Taking long or late naps can make it harder to get to sleep at night.
8. Avoid Stimulating the Mind Before Bed
Electronic devices keep the mind stimulated making it harder to go to bed.
9. Don't Make Bedtime a Challenge
Trying to fall asleep when you can't gets you nowhere.
10. Be Aware of Sleep Trends
When you can't seem to get quality sleep, keep track of your sleep patterns to see if you can identify any trends that may help you understand why or what factors may be causing your poor sleep.
Can Natural Remedies Aid in Treating Insomnia?
The word "natural" does not guarantee effectiveness, or lack thereof, of an adverse effect.
Examples of various approaches taken to address sleep issues may include (but are not limited to):
- Herbal Remedies
- Melatonin
- Meditation/Yoga
- Cannabinoids
There is variance in the existing evidence to support each of the aforementioned approaches.
For instance, the Mayo Clinic has published that there is limited to no evidence to support the efficacy of many over the counter sleep aids and supplements, and in fact, may potentially adversely interact with other medications.
It is especially pertinent that one considers the potential adverse effects of pharmacologically active compounds.
If you take other medications, have an underlying condition, are pregnant or nursing, and/or have persistent sleep issues, you should consult your health care professional prior taking a new supplement.
What About CBD and THC in Relation to Sleep?
There is a growing interest in the relationship between cannabinoids and sleep. However, it is important to distinguish between research and unsubstantiated claims.
CBD and THC are two different cannabinoids. As such, they can produce varied effects.
The effects of cannabinoids on sleep are still being researched. The results of such studies are inconclusive and vary based on the cannabinoid, the dose, the formulation, and other factors.
It is inaccurate to say that THC or CBD can "cure" insomnia.
There are several factors that consumers of cannabinoid sleep products should consider. These include the cannabinoids used in the product, the dose, the CBD/THC ratio, other ingredients, potential drug interactions, and the rules and regulations that apply to the product.
The public is welcome to learn more about the science and research relating to CBD and THC and sleep. Our series on Sleep & Wellness will cover this and related topics.
When should you be concerned about your sleep?
If your sleep problems are short-term, they probably do not require medical attention. Long-term problems should be discussed with a medical professional.
Make an appointment to see a healthcare professional if your sleep problems are ongoing and causing problems in your day to day life.
Like adults, children may have medical conditions that may cause problems with sleep. Children may need to see a healthcare professional if they experience the following:
- Sleep difficulties that last for weeks to months
- Problems sleeping that affects behavior
- Sleep problems that cause issues with school performance
Common signs in children that may indicate a sleep problem and/or a condition that requires medical attention may include:
- Sleep problems that are accompanied by changes in mood and/or mental status
- Daytime sleepiness
- Recurring bedwetting
- Sleepwalking and/or sleep talking
- Inability to stay awake during the day
- Excessive sleep that can’t be explained
Symptoms that may indicate a child has a sleep-disordered breathing condition include:
- Breathing interruptions during sleep
- Snoring
- Abnormal movement of the belly during sleep
- Sweating during sleep
If the child exhibits the above symptoms, a healthcare professional may be able to recommend a diagnostic sleep study to evaluate the child for certain sleep disorders.
Frequently Asked Questions
What is insomnia?
Insomnia is a condition where a person cannot fall asleep, stays awake for long periods of time, or wakes up many times throughout the night. Someone with insomnia may also feel sleep doesn’t refresh them or they may feel sleep deprived after a full nights rest.
What are the most common symptoms of insomnia?
Some symptoms of insomnia may include; waking up many times during the night, feeling extreme fatigue during the day, being irritable, anxious, and/or depressed, and having a lack of concentration.
What causes insomnia?
There are many causes of insomnia. Some causes may include anxiety and/or stress, medications, environmental noises, caffeine, an irregular sleep schedule, other sleep disorders, and a number of other conditions.
How long does insomnia last?
Insomnia may last from days to months at a time, or it may persist indefinitely.
Is insomnia a mental health disorder?
Insomnia is a sleep disorder; however, mental health conditions such as depression and anxiety may cause and/or be caused by insomnia. Other medical conditions may cause insomnia as well.
Can insomnia be cured?
It can be temporary and can be treated with behavioral and/or lifestyle changes. Permanent treatment of insomnia may require the use of therapy and/or medication.
What is the best treatment for chronic insomnia?
Yes. Medications may be used to treat insomnia in addition to cognitive behavioral therapy (CBT). The use of sleep medications may not treat chronic insomnia and other conditions that affect an individual’s sleep may need to be treated as well.
Can CBD or THC help with insomnia?
Though more research is required, the available data shows that CBD and THC are not 1-to-1 substitutes for traditional pharmaceutical insomnia aids. Many factors such as formulation, dose, and user context can alter the effects of CBD and THC. As such, they cannot be viewed as a substitute for traditional insomnia aids. Prior to using any cannabinoid product, you should evaluate traditional and atypical cannabinoid product interference, as well as possible side effects. Finally, the legality and regulations regarding the use and sale of such products should also be considered.
When should I seek help for insomnia?
If your insomnia is long-lasting and disrupts your everyday activities, including work, and if it affects your mental and physical health and well-being, you should consult a doctor.
Final Thoughts
Insomnia is more than just having a single bad night of sleep. If you have any of the following issues, you may have insomnia:
- Taking a long time to fall asleep
- Waking up frequently
- Waking up too early
- Not feeling refreshed after a night of sleep
There can be many factors including your mental and physical health, habits and lifestyle, the environment, and other circumstances.
To manage your insomnia, it's helpful to adjust your lifestyle, and to develop good habits and routines, especially for bedtime. For many people, this can improve their sleep. If you still have insomnia after making these changes, you should consider professional help. CBT-I is an effective treatment for insomnia that can be performed by a professional.
Disclaimer
This article is intended for educational purposes only and does not diagnose, treat, cure or prevent any medical condition. If you have persistent or severe sleep problems, consult a qualified healthcare professional.
