Why Am I Having Trouble Sleeping at Night?

5 Different types of insomnia and the causes may differ according to the type of Insomnia.

Having repeated difficulty with sleep initiation, maintenance, or poor quality of sleep that occurs despite adequate time and opportunity for sleep, resulting in some form of daytime impairment is called insomnia.

Acute insomnia is the most common type of insomnia. It is also commonly called adjustment insomnia because it is usually caused by a change in environment or stressful events. There are thirteen common causes of acute insomnia.  

There are five types of insomnia, and the causes may differ according to the type of insomnia.

Acute insomnia:
Acute insomnia is the most common type of insomnia. It is short term and lasts for a few days up to a month. It’s the most common type of insomnia. It is also commonly called adjustment insomnia because it is usually caused by a change in environment or stressful events. Thirteen common causes of acute insomnia are as follows:

• New environment and unfamiliarity
• Excessive noise or light
• Extremes of temperature
• Uncomfortable bed or mattress
• New job or school
• Relocation to a new place
• Jet lag
• Work deadlines or examinations
• Deaths of relatives or close friends
• Difficulties in a relationship
• Physical discomfort like pain 
• Certain medications
• Acute illness and allergies

Chronic insomnia:
Insomnia is usually a transient or short-term condition. In some cases, insomnia can become chronic or long term. It may occur due to other underlying medical conditions (comorbidities).
Common causes of chronic insomnia include:

• Chronic medical conditions: Acid reflux disease, thyroid disease, diabetes, sleep apnea, neurological conditions such as Parkinson’s disease and chronic pain
• Psychological conditions: Depression, anxiety, schizophrenia, and bipolar disorder
• Medications: Anti-hypertensives (blood pressure [BP] medication), respiratory medications, anti-histamines, hormonal medication, anti-epileptic drugs (seizure medication), anti-depressants and chemotherapy
• The central nervous system (CNS) or brain stimulants: Nicotine and excessive caffeine
• Lifestyle factors: Frequent travel causing jet lag, constantly rotating shift work, irregular naps and sleep timings
• Nasal block and sinus allergies
• Age: Insomnia increases with age

Onset insomnia:

Onset insomnia is difficulty initiating sleep. The common causes are as follows:

• CNS stimulants such as nicotine and excessive caffeine
• Change in environment and unfamiliarity
• Stress and anxiety
• Chronic pain

Maintenance insomnia:
Maintenance insomnia is when the patient has difficulty staying asleep or waking up too early and difficulty going back to sleep. Some medical conditions that may cause maintenance insomnia are as follows:

• Asthma and other respiratory conditions
• Nose block and sinus allergies 
• Obstructive sleep apnea
• Restless leg syndrome
• Acid reflux disease
• Chronic pain

Behavioral insomnia of childhood:
Behavioral insomnia of childhood (BIC) usually occurs due to negative associations with sleep such as needing to go to sleep by being rocked or nursed or watching TV while going to bed or a child’s refusal to go to bed.

• Difficulty falling asleep at night
• Disturbed sleep
• Waking up early
• Irritability
• Poor concentration, focus and memory problems
• Problems in coordination
• Frequent headache 
• Gastrointestinal problems such as acid reflux
• Excessive worrying
• Depression and anxiety 
• Daytime fatigue or sleepiness

The treatment usually includes a combination of more than one treatment modality and uses a multidisciplinary approach. Treatment options include the following:

Cognitive-behavioral therapy:

• Sleep hygiene education: It 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: It involves inculcating correct sleep beliefs, reducing stress and anxiety, relaxation exercises, and meditation. Acupressure and massage therapies can help in relaxation and reducing chronic pain.
• Stimulus-control therapy: It works by associating the bed with only sleepiness and when it is time to sleep.
• Sleep-restriction therapy: This is based on the fact that excessive time in bed can lead to insomnia. Hence, it is advised for adults to limit sleep time to around five to seven hours.

Medication to treat insomnia:
Sedative-hypnotic drugs, sedating antidepressants, antihistamines, and other drugs may be prescribed by a physician.

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

Diet and exercise:

• Patients are advised the following:
• To avoid caffeinated beverages in the late afternoon or evening
• To avoid alcohol in the evening
• To avoid large meals right before bedtime
• To exercise in the late afternoon or early evening (six hours before bedtime) that can promote sleep