Symptoms of Insomnia – Treatment and Remedies

The definition of insomnia is the inability to go to sleep, stay asleep and wake up feeling refreshed. How big of a problem is it? Insomnia is the third most common health complaint after headaches and pain. Insomnia can lead to reduced functionality during waking hours and increased health risks if untreated.

People of all ages suffer from insomnia, even children, though this condition is mostly prevalent in adults. The chances of having insomnia increase with age, insomnia is not as common in men as women.

It is estimated that one third of Americans, or 70 million people, have difficulties sleeping. For most people this remains an untreated condition. For those that do pursue treatment, most are unsatisfied with the results. The need for better information on insomnia cures and help for insomniacs is clear.

Insomnia Types

There are three primary types of insomnia, based upon how long the symptoms last:

  • Transient insomnia lasts one week at the most. Commonly due to jet lag or temporary stress.
  • Short term insomnia lasts more than a week but not more than three weeks. Often results from stress or illness and resolves when the situation returns to normal.
  • Chronic insomnia, also known as long term insomnia, lasts more than three weeks. May be caused by acute medical illness, another sleep disorder or condition.

These types of insomnia are classified by when the sleeping difficulty occurs:

  • Sleep onset insomnia is experienced as a delay of more than 30 minutes in falling asleep – commonly associated with anxiety
  • Sleep maintenance insomnia is wakefulness during the night and difficulty returning to sleep – often associated with depression or medical illness
  • Early morning insomnia is waking before the desired time – causes include depression or circadian rhythm dysfunction

Other classifications of insomnia that a doctor may make include insomnia caused by the type of medical condition, sleep disorder, sleep hygiene problem, or source of stress.

Primary Insomnia

Primary insomnia is also known as psycho-physiological insomnia. This means that the insomnia is caused by learned behaviors which prevent sleep. People who have racing thoughts that prevent them from falling asleep suffer this type of insomnia due to an inability to relax mentally.

As they try to fall asleep, their mental function increases. This is sometimes a long-term problem and it can feed on itself, as the inability to sleep becomes a cause for anxiety, which leads to greater mental activity, which exacerbates the insomnia.

Approximately 15% of people who are evaluated for chronic insomnia have this type of insomnia. Cognitive Behavioral Therapy, or CBT, is often used for treatment of primary insomnia.

Idiopathic Insomnia

Idiopathic insomnia is insomnia that does not seem to have any cause whatsoever. It is also known as childhood onset insomnia or life-long insomnia. It is not very common, occurring in about 1% of young adults or adolescents. This type of insomnia is suffered by children and may continue on to adulthood.

People who suffer idiopathic insomnia just have difficulty falling asleep or staying asleep and are often fatigued during waking hours. Usually all the other factors have to be ruled out before this type of insomnia can be diagnosed. You are more likely to have idiopathic insomnia if someone else in your family has it.

Paradoxical Insomnia

Paradoxical insomnia is also known as subjective insomnia or sleep state misconception. People with this disorder feel they are insomniacs, but a formal overnight sleep study reveals these people to have a normal pattern of sleep.

Some conditions that are similar to insomnia are classified differently. Short duration sleep is when someone simply needs less time to get restful sleep. If it does not cause impaired function during the waking hours, it is not insomnia. Sleep deprivation is an avoidance of sleep, whether voluntary or involuntary. Insomnia is the inability to get proper sleep despite the attempt to get it.

Secondary Insomnia

Insomnia is also referred to as secondary insomnia, meaning that the insomnia is caused by another problem. The causes, symptoms and treatment of insomnia discussed here all apply to secondary insomnia and exclude primary, idiopathic and paradoxical insomnia detailed previously.

Causes of Insomnia

General insomnia causes include:

  • Being too hot or too cold while trying to sleep
  • Too much noise or light in the bedroom
  • Sleeping in unfamiliar surroundings
  • Heightened stress or anxiety
  • A change in work shifts
  • The use of illegal drugs
  • Certain medications
  • Smoking cigarettes
  • Caffeine
  • Alcohol
  • Jet lag

Most of the above causes result in either short-term or transient insomnia. Once the factor is removed, sleep patterns generally return to normal.

Medical and Psychiatric Causes of Insomnia

Common medical causes of insomnia include:

  • Respiratory problems stemming from certain heart or lung diseases, such as asthma or chronic pulmonary disease (COPD)
  • Frequent urination or urinary difficulties
  • Congestive heart failure
  • Being overweight
  • Parkinson’s disease
  • Acid reflux
  • Hyperthyroidism
  • Chronic pain
  • Fibromyalgia
  • Dementia
  • Fever

Psychiatric problems that can cause insomnia include:

  • Post-traumatic stress disorder, PTSD
  • Depression
  • Psychosis
  • Mania

Medical and psychiatric causes of insomnia may develop into chronic insomnia unless the underlying cause of the insomnia is treated.

Sleep Disorders Cause Insomnia

Other sleep disorders can also develop into insomnia, including:

There are also some physiologic (something that is otherwise normal) conditions, that can contribute to insomnia:

  • Menopause
  • The menstrual cycle
  • Pregnancy

Insomnia Symptoms

A reduced ability to function during waking hours, poor attention or the ability to concentrate are the most common symptoms of insomnia. Other symptoms include:

  • Fatigue and sleepiness during waking hours
  • An increase in errors and mistakes
  • Forgetting things from the day before
  • Changes in mood, for the worse
  • Lowered social abilities
  • A listless feeling
  • Anxiety
  • Headaches

Diagnosing Insomnia Tests

Insomnia caused by transient or short-term factors does not usually require a visit to the doctor. Once the condition that causes the inability to sleep is gone, the symptoms will usually go away. Chronic insomnia may require a medical examination as this might be a sign that the insomnia is related to a medical or mental condition.

Assessment and diagnosis of chronic insomnia can require both a medical examination and even psychiatric evaluation. There are many physical, physiological, and psychological causes for insomnia and each must be discovered or ruled out.

It is important to get a general physical examination as a first step to see if anything is out of the ordinary, such as an assessment of general brain function and neurological activity; heart, lungs, and abdominal organs; ear, nose, and throat; and even measurements of certain body proportions, such as the waist and neck.

The doctor will also want to know what medications the patient is using, as well as the use of any illegal drugs, tobacco, alcohol, or caffeine. Family members and bed partners may also be interviewed to get a full picture of the patient’s sleep patterns and habits, such as snoring or movements while sleeping.

A sleep history will have to be compiled and questions will be asked of the patient, focusing on:

  • The time the person goes to bed and wakes up in the morning
  • How long and how often the person naps during the day
  • How many times the person awakens at night
  • How long it takes to fall asleep
  • The duration of sleep

A full assessment may require the use of a sleep log or diary to find sleep patterns. Questions will also be asked concerning functioning during waking hours, tiredness, ability to concentrate or remain attentive.

There are specialists in sleep disorders who can diagnose and treat insomnia, as well as other sleep disorders. Pulmonologists, or lung doctors, are often used to assess and treat sleep apnea and neurologists will be consulted if there is the nervous system is a perceived cause of the insomnia.

Polysomnography Test

A polysomnography is a special test that can be performed in sleep centers when specific conditions, such as sleep apnea, may be present. It will be necessary for the patient to sleep a full night at the sleep center. During that period, the patient’s brain waves, heart rate, respiration, movements, oxygen levels, and various other factors will be monitored and measured. This data is then put together and given to a physician specially trained to assess sleep disorders.

Actigraphy Test

An Actigraphy is a test that is a detection device that monitors the patient’s movements during sleep and while awake. It can be worn around the wrist, like a watch, and is used over a period of days or weeks. The data is recorded and analyzed to fully understand the patient’s sleep patterns and movements. This test is mostly useful in cases where primary insomnia disorder, circadian rhythm disorder, or sleep state misconceptions are suspected as the cause of the insomnia.

Insomnia Treatment

There are two main approaches to insomnia treatment. They may be used alone or in conjunction with an OTC sleep aid, prescription sleep aid or all natural sleep remedy.

Non-Medical Treatments of Insomnia

There are a number of techniques that are useful for insomnia treatment such as sleep hygiene, stimulus control, relaxation techniques, and sleep restriction.

Sleep hygiene is a term that doctors use to describe the personal habits that can impact sleep. It is comprised of a number of simple tips that may improve the ability to fall asleep and stay asleep.

  • Do not go to bed until you feel ready for sleep, if you cannot fall asleep get out of bed until you are ready to try again
  • Establish a regular night-time ritual to condition yourself that it is time to sleep
  • Consume caffeinated beverages only in the morning
  • Get exercise, but not four to five hours before bed
  • Try to go to bed without any stress or anxiety
  • Avoid smoking, especially late in the day
  • Try to keep to a regular sleep schedule
  • Avoid drinking alcohol before sleep
  • Do not try to force sleep
  • Do not go to bed hungry

Part of good sleep hygiene is known as stimulus control. These techniques include:

  • Use the bed only for sleeping or for sex, avoid mentally stimulating activities such as reading, watching television, working or eating
  • Try not to sleep in a room that is too noisy or too brightly lit
  • Do not sleep in a bedroom that is cluttered

Relaxation Techniques – Relaxation treatment involves sitting or lying in a comfortable position and focusing on the muscles one at a time, first contracting them, then relaxing them one at a time. Often, this relaxation technique is matched with deep, relaxed breathing to reduce stress before bed and induce sleepiness.

Sleep Restriction – Sleep restriction restricts time spent in bed to sleeping only. Many insomniacs tend to stay in bed for a long period of time after awakening due to the poor quality of their sleep. Spending too much time in bed and falling back asleep after your normal waking up time can disrupt the body’s circadian rhythm and create something of a vicious circle, making it more difficult to fall asleep the following night.

Insomnia Sleep Aids

There are three kinds of sleep aids used to treat insomnia: OTC sleep aids, benzodiazepines and the non-benzodiazepine sleep aids.

OTC Sleep Aids

There are several different over the counter sleep aids that can be taken. However, if you do experience any serious side-effects, consult your doctor. Some of the OTC sleep aids include:

  • Diphenhydramine (found in brand names like Sominex, Benadryl, Tylenol PM
  • Doxylamine (brand name Unisom)

These sleeping pills can be effective in treating short term and transient insomnia and can be conveniently purchased without a prescription.

Benzodiazepine Sleep Aids – There are a number of medications classed as benzodiazepines that have been effective in treating insomnia, including:

  • Triazolam (Halcion)
  • Estazolam (ProSom)
  • Temazepam (Restoril)
  • Flurazepam (Dalmane)
  • Lorazepam (Ativan)
  • Diazepam, better known as Valium, may be prescribed off-label to treat insomnia.

Non-benzodiazepine sleeping pills are commonly used to treat insomnia. These drugs have been developed more recently; Lunesta was first released in 2006. Among them are:

Melatonin is a chemical naturally produced by the brain that induces sleep. It has been used as a supplement to treat insomnia. Unfortunately, it is not generally helpful in treating some common types of insomnia, unless the disorder is caused specifically by low levels of melatonin. Melatonin can be purchased without a prescription, over the counter.

There is a newer sleeping pill that mimics the chemical action of melatonin, known as Ramelteon or Rozerem. This drug is known as a melatonin receptor agonist. This has been an effective medication for some groups of insomniacs.

Other Sleep Aids

There are anti-depressants including Desyrel (trazodone), Elavil or Endep (amitriptyline), and Sinequan or Adapin (doxepin), which have been used to some degree of success in insomniacs who also suffer from depression. It is possible to also use anti-psychotic drugs to treat insomnia, but using them for insomnia is not suggested for the majority of insomniacs.

Any use of sleeping pills for treating insomnia should be discussed with a doctor or a sleep specialist to determine which one is best. A number of these drugs can cause abuse or addiction, so they should only be used with supervision and care. Most will require a prescription and use should be discussed with your doctor.

Preventing Insomnia Tips

These better sleep tips may help anticipate conditions that can lead to insomnia and help reduce them before they become a problem.

Insomnia Caused by Jet Lag

  • To minimize jetlag, begin to shift your bedtime to that of the destination before the trip to minimize the number of hours that your sleep cycle needs to adjust once you are there
  • Sleeping pills have been known to be helpful in cases of insomnia caused by jet lag, speeding the adjustment to the new time zone
  • All natural sleep aids such as melatonin can also help the traveler adjust to the new sleep schedule at the destination

Insomnia Caused by Shift Changes

  • Follow good sleep habits, including a regular bedtime and awakening
  • Supplemental naps to the longest period of sleep may also be helpful
  • Behavioral therapy is often helpful with difficulty sleeping from shift work

Insomnia Caused by Stress

  • Minimize the source of the stress as much as possible, use relaxation techniques
  • Sleep medicine can aid getting a good night’s sleep until the end of a stressful period
  • Applying good sleep habits will improve your sleep as well

Effective Tips for Curing Insomnia

General tips for getting better sleep and treating insomnia include:

  • Learn to properly relax, using methods like self-hypnosis, biofeedback, and breathing techniques
  • Keep the sleeping environment conducive to sleeping by avoiding bright light, noises, or rooms that are too hot or too cold
  • The bed should only be used for sleeping and sex, never for television watching or reading
  • Keep to the same sleep schedule every day and night
  • Do not eat heavy meals, drink lots of fluids, or engage in exercise before bedtime and avoid caffeine and nicotine
  • If sleep does not occur within twenty or thirty minutes, try something else relaxing, such as reading before coming back to bed
  • Naps should be avoided while you are having insomnia to increase your ability to get to sleep at bed time

The good news is that once the cause of the insomnia has been addressed a few nights of extra sleep followed by resuming a normal sleep schedule should alleviate the symptoms of insomnia.

Essential further reading:

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