What Causes Insomnia?

Three common types of insomnia are acute, transient, and chronic insomnia.

Insomnia may have many causes and it can be classified based on the underlying cause.  Here are eight main causes of insomnia.

1. Adjustment insomnia (acute insomnia)
   • can be environmental- or stress-related 
   • new environment and unfamiliarity
   • excessive noise or light
   • extremes of temperature
   • uncomfortable bed or mattress
   • new job or school
   • relocation to a new place
   • work deadlines or examinations
   • deaths of relatives or close friends
   • difficulties in a relationship
2. Psychophysiologic insomnia (primary insomnia)
   • begins due to a prolonged period of stress and bad sleep habits
3. Paradoxical insomnia (people who mistakenly perceive their sleep as wakefulness)
   • due to depression and other psychological conditions
4. Insomnia due to a medical condition
   • nasal block and sinus allergies
   • acid reflux 
   • thyroid disease
   • chronic pain
   • neurological conditions such as Parkinson’s disease
   • obstructive sleep apnea
5. Insomnia due to mental disorders
6. Insomnia due to medication
   • antihypertensives (blood pressure medication)
   • respiratory medications (albuterol, theophylline)
   • anti-histamines
   • hormonal medication
   • antiepileptic drugs (seizure medication)
   • medication stimulating the central nervous system
   • Insomnia due to drug or substance abuse
   • excessive caffeine, smoking, alcohol, and hard drugs
7. Behavioral problems of childhood
8. Age
   • the satisfaction of sleep declines with age

Insomnia is defined as repeated difficulty with sleep initiation, maintenance, consolidation, or quality that occurs despite adequate time and opportunity for sleep and results in some form of daytime impairment.

There are three common types of insomnia:

1. Acute insomnia
   • Lasts up to 1 month
   • Commonly referred to as adjustment insomnia 
   • Occurs due to acute situational stress such as a new job, deadline, or exams
   • It typically resolves when the stressor is no longer present or the individual adapts to the stressor.
2. Transient insomnia
   • Lasts for less than 1 week 
   • Caused by another disorder, changes in the sleep environment, stress, or depression
3. Chronic insomnia
   • Lasts more than 1 month
   • Insomnia is usually a transient or short-term condition. In some cases, insomnia can become chronic
   • Associated with chronic medical and psychiatric conditions 
   • Usually occurs in patients with an underlying risk of insomnia

The most common symptom of insomnia is impairment of daytime functioning.  Other symptoms of insomnia include the following:

• Difficulty falling asleep at night
• Disturbed sleep
• Waking up early
• Irritability
• Poor concentration, focus, and memory problems
• Problems in coordination
• Frequent headache 
• Acid reflux
• Excessive worrying
• Increased risk for depression and anxiety 
• Daytime fatigue or sleepiness, such as...
  • fatigue,
  • tiredness,
  • lack of energy,
  • irritability,
  • reduced work performance, and
  • difficulty concentrating

Different treatment options for insomnia include the following:

Cognitive-behavioral therapy

Multiple therapies can be combined with/without medication, such as...

• Sleep hygiene education
• Cognitive therapy
• Relaxation therapy
• Stimulus-control therapy
• Sleep-restriction therapy

Sleep hygiene education

Addresses behaviors that are incompatible with sleep such as caffeine or alcohol use, environmental noise, inappropriate room temperature, and watching TV in bed.

Cognitive therapy and relaxation therapy

• Correct inaccurate beliefs about sleep
• Reduce fear and excessive worrying
• Relaxation therapy: The patient is advised to recognize and control tension through a series of exercises that consist of first tensing and then systematically relaxing each muscle group.
• Guided imagery and meditation to focus on neutral or pleasant thoughts

Stimulus-control therapy

Works by associating the bed with sleepiness instead of arousal.

Rules for this therapy include the following:

• Use the bed only for sleeping and sexual activity (no reading, TV, eating, or working in bed).
• Go to bed only when sleepy.
• If unable to fall asleep in 15-20 minutes, get out of bed to do something relaxing until sleepy; this can be repeated as often as needed.
• Do not spend more time in bed than needed.
• Establish a standard wake-up time.
• Avoid daytime napping.

Sleep-restriction therapy

• Sleep-restriction therapy is based on the fact that excessive time in bed can lead to insomnia. Limiting the time spent in bed leads to more efficient sleep.
• Works by limiting time in bed to the patient’s estimated total sleep time (not less than five hours) and increasing it by 15-30 minutes for a given week period until the optimal sleep duration is achieved.

Medication to treat insomnia

• Sedative-hypnotic drugs
• Sedating antidepressants
• Antihistamines
• Other drugs

Devices

• FDA-approved prescription devices can be used in patients with insomnia.

Diet, exercise, and lifestyle

• Avoid caffeinated beverages in the late afternoon or evening.
• Avoid alcohol in the evening.
• Avoid large meals right before bedtime.
• Exercising in the late afternoon or early evening (6 hours before bedtime) can promote sleep.

Acupressure for insomnia