Insomnia: Causes, Treatment, and Symptoms
Learn about the causes and types of insomnia, common symptoms, and treatment options for this sleeping disorder.
Apr 21st, 2021 •
Expert Insights from Dr. Luis Javier Peña-Hernández, MD, FCCP, a lung health specialist at PCSI, the largest integrated pulmonary and chest specialty group in Palm Beach County.
Insomnia is a common sleep disorder in which an individual fails to fall and stay asleep. It’s estimated that one in three people suffer from a mild form of insomnia, and nearly every person will experience some form of insomnia at some point in their lives.
“Insomnia is a fairly common sleep disorder that can be surprisingly difficult to diagnose,” says Dr. Luis Javier Peña-Hernández.
However, experiencing one or more of the following symptoms is a good indication you suffer from insomnia:
- Difficulty falling asleep on a consistent basis
- Frequently waking up and failing to fall back asleep
- Excessive tiredness throughout the day
- Growing concern or frustration about sleep
“Some insomnia cases may only last for a few nights or weeks, while other cases are more complex and can last for months or years,” says Dr. Peña-Hernández.
There are two categories of insomnia:
- Primary Insomnia: Insomnia that has no other explanation, meaning that it’s not due to another health condition or life experience.
- Secondary Insomnia: Insomnia that occurs due to something else, like a medication condition, traumatic life event, or substance abuse.
From here, insomnia is further categorized into either acute or chronic insomnia. Acute insomnia is short-term insomnia, such as when you travel or experience a life stressor. Chronic insomnia, however, is long-term. It occurs when you struggle to fall asleep or stay asleep throughout the night three nights or more per week for a minimum of three months.
In order to properly target your insomnia and find an effective treatment, you first must understand what causes your insomnia. This is done by identifying which type of sleeping disorder(s) you’re experiencing.
Read on to learn about the 9 insomnia disorders as defined by the International Classification of Sleep Disorders, 2ndEdition.
1. Adjusted Insomnia
Also known as acute insomnia, adjusted insomnia is one of the more common types of insomnia. It’s a short bout of sleep difficulties that lasts up to a few months. It’s usually caused by a life event that disrupts our mood or routine, such as getting a divorce or moving to the other side of the globe.
2. Behavioral Insomnia of Childhood
Do your kids fight going to bed at night, or wake up in the middle of the night and not go back to sleep? From time-to-time, it can be easy to just let them do what they want to do and make your way to your bedroom-escape so that at least some of the family can get some shut-eye.
Related: How sleep works
Unfortunately, not instilling a strict bedtime can contribute to behavioral insomnia of childhood. This type of insomnia is quite common among children, with approximately 25% of children affected. It occurs when certain behaviors of either parents or children lead to troubles falling asleep and sleeping throughout the night.
3. Psychophysiological Insomnia
Psychophysiological insomnia is a type of chronic insomnia that’s both common and difficult to treat. It occurs when someone worries about their inability to sleep, with the resultant anxiety making it much harder to sleep well.
What happens is this: a person experiences insomnia and then begins to stress about how this lack of sleep is going to affect their day and quality of life. They are unable to stop this worrying, so even if the initial cause of their insomnia has left, their worry will keep them from getting the sleep they need.
4. Paradoxical Insomnia
Someone who is experiencing paradoxical insomnia believes they are struggling with insomnia, but they don’t demonstrate the symptoms associated with being sleep deprived. Sleep studies reveal normal sleep onset latency (the time it takes to fall asleep) and sleep efficiency (how well they sleep during the night).
5. Idiopathic Insomnia
Idiopathic insomnia is one of the hardest types of insomnia to treat because there is no obvious cause. This type of insomnia begins in childhood and lasts throughout one’s lifetime. This may be caused by biological abnormalities in sleep patterns and the sleep and awakening systems.
6. Inadequate Sleep Hygiene
Sleep hygiene consists of “the behaviors, practices, rituals, and habits that result in sleep onset or maintenance difficulties and unrefreshing sleep.” Inadequate sleep hygiene occurs when activities that you do interfere with your sleep.
One common example is using smartphones right before bed, or keeping them next to the bed, alerts on and ready to go. This can encourage mental stimulation, sleep disruption, and excess blue light exposure, making it harder to get a good night’s sleep.
7. Insomnia Due to Mental Disorders
Sometimes insomnia is caused by an underlying psychiatric condition like depression, anxiety, attention deficit hyperactivity disorder (ADHD), or schizophrenia.
Related: Sleep and mental health
8. Insomnia Due to Medical Conditions
There are many health conditions that can lead to trouble sleeping. These include sleep apnea, pain, cancer, a recent surgery, and more. If your medical condition is chronic, like arthritis, you are likely to experience chronic insomnia, but if it’s temporary, like a sprained ankle, insomnia will likely be acute.
9. Insomnia Due to Drugs or Substances
We’ve all had too much coffee or alcohol, making it hard to fall asleep or sleep soundly. Some of the biggest offenders are stimulants like caffeine and ADHD medication, but there are other recreational and pharmaceutical drugs that have side effects that can interfere with your ability to sleep well.
Insomnia can be caused by a variety of things. Acute insomnia and chronic insomnia have very different causes.
Causes of Acute Insomnia
“Acute insomnia is often caused by an increase in stress or a change in environment,” says Dr. Peña-Hernández.
You might experience acute insomnia if:
- You are under a significant amount of stress from work, after the death of a loved one, divorce, or some other life circumstance. Stress and anxiety about difficulties in sleeping may in itself be enough to perpetuate the insomnia, in a kind of vicious circle (sometimes referred to as conditioned insomnia).
- You are sick or recovering from an injury that causes physical discomfort.
- Your environment is not conducive for sleep (i.e. it’s noisy, too bright, or too hot).
Acute insomnia is experienced temporarily but can develop into chronic insomnia.
Causes of Chronic Insomnia
“Chronic insomnia may have more serious underlying causes like depression, chronic pain, or even another sleep disorder like sleep apnea,” says Dr. Peña-Hernández.
The causes of chronic insomnia are more difficult to identify and vary from person to person. It’s possible for chronic insomnia to develop as a result of short-term insomnia that goes untreated, but it’s more likely that a combination of factors is contributing to the problem.
The Spielman Model of Chronic Insomnia (aka the 3 P’s)
The Spielman Model of chronic insomnia identifies three components that contribute to chronic insomnia:
- Predisposing factors
- Precipitating factors
- Perpetuating factors
Some individuals are more prone to developing insomnia than others. While some people have a low predisposition to insomnia and can drink caffeine, experience chronic pain or undergo stress without missing a lick of sleep, others have a high predisposition to insomnia and may develop insomnia with nearly any physical, emotional, or cognitive arousal.
For example, genetics is a predisposing factor to insomnia that may make an individual more prone to developing this type of sleep disorder. It’s believed that light sleepers, or those who are aroused more easily while sleeping, have a greater tendency to develop insomnia. When untreated, predisposing factors can become perpetuating factors.
Precipitate means to cause. Unlike predisposing factors that are inherited, precipitating factors of insomnia are catalyzed by an event that causes stress or an existing medical condition that leads to insomnia.
Examples of medical conditions that contribute to insomnia include:
- Another sleep disorder like sleep apnea or restless leg syndrome
- Chronic pain
- Depression or anxiety
- Cardiovascular disease
Other common precipitating factors of insomnia are often caused by stressful events related to relationships and careers. For example, divorce, the death of a loved one, a big move, or a job transition.
Finally, perpetuating factors are those that don’t go away. They are a result of a change in behavior or cognition. For example, even if the original cause of insomnia is resolved, insomnia continues (or perpetuates) because the individual’s mindset or lifestyle has been altered to accommodate the initial battle with insomnia. Perpetuating factors, like a sedentary lifestyle or poor sleep hygiene, last indefinitely and prevent an individual from re-establishing proper sleep.
There are a number of health risks associated with chronic insomnia that goes untreated. Chronic sleep deprivation puts your mental, physical, and emotional well-being in jeopardy.
A decline in Physical Health
Sleep is the glue that holds us together. It is the body’s time to rest and regenerate cellular tissue. Without it, every system in the body is affected. Below are a number of physical consequences associated with long-term sleep deprivation:
- Weight gain
- Increased risk of diabetes
- Increased risk of heart disease
- Increased risk of stroke
- Sensitivity to pain
Increased Risk of Mental Illness
Sleep and mental health are very closely related. In many ways, sleep is the fuel our brains need to operate at full capacity. Without proper sleep, we cannot properly process new information, memories, or emotions. Not to mention, our brains regulate and produce hormones during sleep. Therefore, when we don’t sleep hormone levels are disrupted, leading to a whole slew of mental and emotional consequences. Chronic insomnia can result in the following mental health consequences:
- Increased risk of depression and anxiety
- Hormonal Imbalances
- Increased risk of hallucinations
- Memory impairment
But don’t be fooled. Even if you experience acute insomnia, you are at risk for short-term effects of sleep deprivation that include:
- Lack of concentration
- Decreased sex drive
- Increased appetite (especially craving for carbs)
- Delayed memory retrieval
- Slower reaction times
- Daytime sleepiness
- Increased risk for accidents
So what can one do? First and foremost, consult a physician regarding your sleep disorder. They can help craft the most effective treatment plan for you. But depending on the type and cause of insomnia, your sleep disorder can be treated via therapy, medication, or simple lifestyle changes.
“Treatment for insomnia varies by case and severity, but common treatments include Cognitive Behavioral Therapy, stimulus control, medications, or lifestyle changes,” says Dr. Peña-Hernández.
If you regularly suffer from insomnia, your best bet is to see a sleep therapist. There are a number of therapies used to treat insomnia, but two of the most popular and effective are Cognitive Behavior Therapy and Stimulus Control, also known as sleep restriction.
While many people turn to sleeping pills or sleep medicine for insomnia, pharmaceuticals come with unwanted side effects. As a natural alternative, countless people are trying sleep restriction therapy (SRT).
Sleep Restriction Therapy (SRT) is a form of cognitive behavioral therapy for insomnia. Human studies have found restrictive therapy to work as well as pills while lasting longer. In a nutshell, SRT is a behavioral strategy designed to promote restful sleep by using restricted sleep time and a sleep schedule.
Cognitive Behavioral Therapy for Insomnia
Cognitive Behavioral Therapy for Insomnia consists of seeing a sleep specialist to help cure you of insomnia. The primary objective of CBT-I is to change behavior in such a way that you are able to train yourself to fall and stay asleep. CBT is achieved by devising a custom plan that reveals the root of the problem (what is keeping you up at night) and implements strategies that improve your sleep behavior. The ultimate goal of CBT is to challenge unhealthy beliefs about sleep and replace these fears with positive thinking backed by healthy sleep hygiene.
The purpose of stimulus control is to help an individual associate their bedroom with nothing but sleep. This is achieved by restricting certain activities, like watching TV or working, in the bedroom. One important aspect of stimulus control is retiring to bed only when you are sleepy and leaving the room if you have lain awake for 20 minutes or more. This helps eliminate the association between your bedroom and wakefulness.
Paradoxical therapy, which asks the insomniac to do the exact opposite of trying to fall asleep, has proven to be a surprisingly effective therapeutic approach to conquering insomnia. By instructing a patient to continue the symptomatic behaviour instead of stopping it, this forces them to confront the problem and to make a deliberate decision on how to proceed, which in some cases may serve to eliminate any subconscious resistance to treatment.
Depending on your lifestyle and/or personal preferences, you may opt for a medication to help aid in sleep. Sleep aids can be purchased over-the-counter or prescribed by a physician. Some people may prefer taking an all-natural supplement to assuage your insomnia.
Over-The-Counter (OTC) Sleeping Pills
OTC sleeping medications may be a good option for those who are experiencing a small bout of short-term insomnia. They are not intended for regular use. Nonprescription sleeping pills contain antihistamines that make you drowsy. Be aware that they can cause side effects such as daytime sleepiness, dizziness, confusion, cognitive decline and difficulty urinating, which may be worse in older adults. Some examples include:
- Diphenhydramine (Benadryl, Aleve PM, others)
- Doxylamine succinate (Unisom SleepTabs)
Prescription medications should never be a long-term solution for insomnia (although some prescription medications have been approved for long-term use). However, they may be prescribed when you first see a doctor about your insomnia. Examples of prescription medications for sleep include:
- Eszopiclone (Lunesta)
- Ramelteon (Rozerem)
- Zaleplon (Sonata)
- Zolpidem (Ambien, Edluar, Intermezzo, Zolpimist)
Natural Sleeping Aids
If you prefer not to taking medication, there are a plethora of natural remedies to sleep. See our in-depth guide to the best all-natural sleeping aids for an extensive list of options. Some natural sleeping aids include:
- Melatonin supplements
- CBD oil
- Essential oils
In conjunction with therapy and sleeping aids, making a few simple changes to your lifestyle can help combat insomnia. The following tips can also help prevent the onset of insomnia or keep it from worsening:
- Change your diet
- Create and bedtime and stick to it
- Craft a wind-down routine that includes a warm bath or meditation to help prepare your mind and body for sleep
- Keep your bedroom cool
- Stick to calming hues in your bedroom
- Make sure your room is as dark as possible (invest in blackout curtains if it receives a lot of natural light)
In order to prevent or reduce your insomnia, try to balance your blood sugar during the day properly. Feeling fatigued, irritable, and tired during the day is ordinary with AFS, but making changes to your diet could help give you the energy and relief you need. Here are some tips:
- Begin your morning with breakfast. Skipping breakfast after a long night without food could lower your blood sugar levels. Essentially, don’t load your breakfast up with sugar-loaded cereals, waffles, granola, or toast. Instead, try having eggs, oatmeal with walnuts or almonds, or other foods high in protein and minerals.
- Drink calming herbal teas, such as peppermint, lavender, chamomile, or passionflower.
- Have healthy snacks on hand. Eating organic raw nuts, a bit of dried fruit, hummus and vegetables, seeds, or nut butter could balance your blood sugar, without you consuming too many sweeteners.
- If you are reaching for fruit, try consuming them whole. Don’t go for fruit gummies, fruit juice, or other drinks loaded with added sugar. More importantly, if you are eating a high glycemic food such as a pear or an apple, try pairing it with a protein and fat- such as almond butter. This stabilizes your blood sugar and causes the carbohydrates to be absorbed into your system more slowly.
- If you experience hypoglycemia, eat every two to three hours; don’t wait until your body is in starvation mode to decide to snack or have a meal.
- Focus on a diet high in protein and quality fats, like wild-caught salmon, raw and organic nuts such as almonds, cashews, hazelnuts, pecans, and walnuts, avocados, extra virgin olive oil, and virgin coconut oil.
- Have a light snack before bed to calm your body, balance your blood sugar, and provide you with improved sleep.
- Avoid consuming coffee, caffeinated tea, alcohol, refined sugar, high fructose corn syrup, and processed food.
Want to learn more about the different types of insomnia and how to manage it? See our related articles on insomnia below.
Dr. Luis Javier Peña-Hernández, MD, FCCP, is a lung health specialist at PCSI, the largest integrated pulmonary and chest specialty group in Palm Beach County. His areas of expertise include asthma and immunotherapy, COPD, lung cancer, and invasive diagnostic techniques in pulmonary medicine including endo-bronchial ultrasound and diagnostic bronchoscopy. He is also one of the few experts in cardiopulmonary exercise testing and exercise physiology in Palm Beach County.
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