Insomnia is one of the most common medical issues faced by adults in North America. Research conducted by the National Sleep Foundation revealed that up to 40 percent of the population experiences at least one episode of sleeplessness per year. Temporary episodes of insomnia, while frustrating and disruptive, are normal and generally nothing to worry about. For the 10-15 percent of the population who experience chronic insomnia, however, this condition can represent a significant threat to overall health and well being. In addition to struggling with feelings of fatigue, mood swings, irritability, and reduced performance, those with chronic insomnia have a higher risk of developing several serious health conditions. People with chronic insomnia are more likely to suffer from obesity, cardiovascular disease, and type 2 diabetes. They are also more likely to be involved in motor vehicle collisions and workplace accidents. The National Heart, Lung, and Blood Institute estimates that up to 20 percent of motor vehicle accidents (where the driver was not impaired by drugs or alcohol) are directly caused by fatigue.
Causes
The causes of insomnia are extremely diverse, which can complicate diagnosis and treatment. Insomnia may be caused by lifestyle factors, including poor sleep hygiene, caffeine overuse, substance abuse, stress, frequent long-distance travel, and shift work. The origins of insomnia can also be physical in nature: A number of medications can play a role in causing insomnia, as can both physical and mental illnesses. People with chronic pain, chronic fatigue syndrome, cardiovascular disease, acid-reflux disease (GERD), breathing disorders (e.g., asthma, sleep apnea, and COPD), thyroid disorders, Parkinson's, Alzheimer's or dementia, cancer, depression, schizophrenia, bipolar disorder, anxiety, or ADHD are more prone to developing chronic insomnia.
Hormones are also thought to play a role in the development of insomnia. Insomnia affects more females than males, and many women report experiencing fluctuations in their circadian rhythm that coincide with changes in their menstrual cycle or the onset of pregnancy. Symptoms of insomnia may increase in severity during and after menopause.
Signs
Insomnia can take a number of different forms, depending on its underlying cause and the unique physiology of the patient. Insomnia may be transient (lasting only a few nights), acute (lasting for up to three weeks), or chronic (lasting for several months or years). The patterns that govern insomnia can also vary substantially: Some people experience a persistent delay in sleep onset (taking over an hour to fall asleep on most nights), while others experience restlessness during the night or frequent early waking. Anyone who regularly does not feel rested after sleeping should be assessed for a sleep disorder, as factors impairing sleep quality (such as sleep apnea) are not always obvious.
To diagnose insomnia, doctors begin by assessing the individual's overall health and examining his or her current sleep patterns. They will often conduct a physical exam in order to determine whether or not an underlying medical condition is causing the patient's insomnia. If no physical health issues are detected, doctors will then attempt to rule out psychological and lifestyle factors, including mental illness, substance abuse, screen use, stress levels, and problems with the patient's bedtime routine or environment. To receive a diagnosis of insomnia, the patient must have experienced symptoms severe enough to interfere with daily functioning for at least one month or longer.
To verify the presence of insomnia and assess the nature of the patient’s sleep disturbance, doctors will often have the patient take a specialized sleep test known as a polysomnograph. This overnight test measures and records sleep patterns. Patients may also be asked to wear an actigraph device around their wrist while sleeping and/or maintain a sleep diary for at least two weeks.
Treatment
The treatment for insomnia varies depending on its cause. In many cases, lifestyle modifications, like avoiding the use of electronics, caffeine, and alcohol in the hours leading up to bedtime, can improve or eliminate the symptoms of insomnia. If more persistent psychological issues are present, patients may be asked to undergo cognitive behavioural therapy. This type of therapy aims to improve patients’ sleep hygiene, resolve anxiety surrounding sleep, and alter counterproductive habits. Aside from lifestyle modifications, some of the methods used to improve sleep quality during CBT include:
- Relaxation therapy. This type of therapy helps patients learn how to relax as they wind down for bed. It’s helpful for those who struggle with nighttime anxiety, especially anxiety about not being able to get to sleep.
- Stimulus control therapy. Stimulus control therapy involves avoiding mental stimuli while in bed. Patients are instructed to never eat, read, or watch TV while in bed. By associating the bed primarily with sleep, patients can train their brains to “shut down” and become sleepy when they enter the bedroom.
- Sleep restriction. This therapy may sound counter-intuitive, but temporarily restricting sleep can be helpful for some patients. Sleep restriction causes patients to fall asleep faster the following night. This reduces the amount of time spent lying awake and thereby lessens the patient's anxiety about not being able to fall asleep.
Wherever possible, doctors advise trying non-pharmacological solutions before using sleep-inducing medications. Sleeping pills are limited in their effectiveness, have side-effects, and some may be habit-forming, so they’re no longer recommended as a first line of treatment for insomnia. However, if the patient's insomnia is being caused by a physical malady, or it proves difficult to treat with lifestyle modifications, medication may be utlilized. Medications for insomnia include supplements (like melatonin and herbal sleep aids), sedating antihistamines, and prescription sleeping pills. Though insomnia is complex and it often takes time to find the right treatment, most sleep disturbances can be managed or cured.
