Ashwin Lewis
Insomnia is a sleep disorder that affects 10-30% of adults. It is characterised by difficulty falling asleep, staying asleep, or both. While insomnia is not a disease and there is no specific test to diagnose it, a sleep study can be used to rule out other conditions that could be causing or contributing to insomnia. A sleep study, or polysomnogram, is a diagnostic test that tracks and records the activity of multiple body systems, including the heart, brain and respiratory system, to give healthcare providers a comprehensive view of sleep quality. Sensors are attached to the patient's scalp, face, eyelids, chest, limbs and one finger to monitor brain wave activity, heart and breathing rates, oxygen levels and muscle movements. Sleep studies are usually conducted overnight in a sleep lab, but can also be performed during the day for people who work night shifts. They are non-invasive, painless and very common, with over 800,000 people on Medicare in the US alone undergoing the procedure in 2014.
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What You'll Learn
What are the symptoms of insomnia?
Insomnia is a common sleep disorder that affects your ability to fall asleep, stay asleep, or both. As a result, you may get too little sleep or poor-quality sleep, and you may not feel refreshed when you wake up. The symptoms of insomnia fall into a few categories, and people commonly shift between them over time.
The first category is initial (sleep onset) insomnia, which is when you have trouble falling asleep. The second is middle (maintenance) insomnia, where you wake up in the middle of the night but fall back asleep. This is the most common form of insomnia, affecting almost two-thirds of people with insomnia. The third type is late (early waking) insomnia, where you wake up too early in the morning and don't fall back asleep.
The effects of insomnia can cause disruptions while you're awake. These include feeling tired, unwell, or sleepy, as well as delayed responses and trouble concentrating or remembering things. Mood disruptions, especially anxiety, depression, and irritability, are also common. Insomnia can also cause other serious problems, such as drowsy driving, which could lead to a car accident.
Chronic insomnia is characterised by specific circumstances, frequency, duration, and explanation. It occurs without circumstances that would typically interfere with sleep, such as changes in work schedules or life events. It also requires insomnia to occur frequently (at least three times a week) and last for at least three months. Additionally, chronic insomnia cannot be attributed to substances, medications, or other sleep disorders, and other medical or mental health conditions cannot fully explain the insomnia.
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What causes insomnia?
Insomnia is a sleep disorder that affects up to 35% of adults. It is characterised by difficulty falling asleep, staying asleep, or sleeping as long as one would like. Insomnia can have serious effects, leading to excessive daytime sleepiness, an increased risk of car accidents, and various health issues caused by sleep deprivation.
There are two main ways to categorise insomnia:
- Time: Insomnia can be acute (short-term) or chronic (long-term). The chronic form is known as insomnia disorder and lasts for at least three months.
- Cause: Primary insomnia occurs on its own, while secondary insomnia is a symptom of another condition or circumstance.
There are many factors that can cause or contribute to insomnia. These include:
- Family history and genetics: Sleep traits and conditions, including insomnia, often run in families.
- Brain activity: People with insomnia may have more active brains or differences in brain chemistry that affect their sleep.
- Medical conditions: Any condition that causes pain or discomfort can make it harder to fall asleep and stay asleep. Conditions affecting the circadian rhythm, the body's natural sleep/wake clock, are also factors.
- Mental health conditions: About half of those with chronic insomnia also have at least one other mental health condition, such as anxiety or depression.
- Life circumstances and stress: While stressful or difficult life events may not directly cause insomnia, they often contribute to it.
- Lifestyle and habits: Unhealthy lifestyle choices and sleep habits can increase the risk of insomnia. These include irregular sleep schedules, napping late in the afternoon, consuming caffeine or alcohol, and using electronic devices before bed.
- Neurological problems: Neurodegenerative and neurodevelopmental disorders can affect the circadian rhythm and increase the risk of insomnia.
- Specific sleep disorders: Conditions such as obstructive sleep apnea, restless leg syndrome, and parasomnias (e.g., sleepwalking, nightmares) can cause or contribute to insomnia.
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How is insomnia diagnosed?
Insomnia is a sleep disorder that affects 10-30% of adults. It is characterised by difficulty falling asleep, staying asleep, or both, despite having the time and environment to sleep.
There is no specific test to diagnose insomnia, but a doctor can help determine the cause of poor-quality sleep by checking your health and sleep history. They will ask about your medical history, any medical problems, and any medications you are taking. They may also recommend blood tests to rule out certain conditions, such as thyroid problems.
Your doctor may ask you to keep a sleep journal for one or two weeks to track your sleep patterns and habits. They may also ask your bed partner questions about your sleep. This information can help them spot habits that may be affecting your sleep and identify any hidden health problems.
If your doctor suspects a sleep disorder, they may refer you for a sleep study, also known as a polysomnogram test. This involves spending the night at a dedicated sleep centre with sensors on your scalp, face, eyelids, chest, limbs, and one finger. The sensors monitor brain wave activity, heart and breathing rates, oxygen levels, and muscle movements that occur before, during, and after sleep. Home sleep studies can also be conducted with a portable kit.
In some cases, your doctor may recommend additional diagnostic tests, such as actigraphy or blood tests, to help identify the underlying causes of your insomnia.
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What are the risk factors for insomnia?
There are several risk factors for insomnia, some of which are inherited, while others are the result of aging or lifestyle choices. Here are the key risk factors:
- Advancing age: The risk of insomnia increases as you get older.
- Family history and genetics: Your genetics can predispose you to insomnia and influence the depth of your sleep.
- Sex: Women are more likely to experience insomnia than men.
- Lifestyle choices and habits: Certain habits can increase the risk of insomnia. For example, taking long naps close to bedtime, consuming excessive caffeine, alcohol, or nicotine, and having an irregular sleep schedule can all contribute to insomnia.
- Stress and worry: Stress and anxiety about sleep or daily life can increase the risk of insomnia. This can create a vicious cycle where losing sleep leads to more worry, which in turn exacerbates the insomnia.
- Medical and psychiatric disorders: Medical conditions such as heart disease and asthma, as well as psychiatric disorders like depression and anxiety, are often associated with insomnia.
- Social and environmental factors: Insomnia symptoms are more prevalent in poorer neighbourhoods with higher crime rates. Urban areas with increased nighttime light exposure can also disrupt the natural release of melatonin and circadian rhythm, leading to poorer sleep.
- Socioeconomic status: Individuals with lower socioeconomic status and persons of colour have higher rates of insomnia, often due to health disparities and the higher likelihood of living in poorer neighbourhoods.
- Alcohol consumption: People who consume alcohol are more likely to experience insomnia.
- Feelings of unsafe home environments: People who don't feel safe in their homes, such as those experiencing repeated violence or abuse, are at a higher risk of insomnia.
- Fear or anxiety about sleep: Individuals with disruptive sleep issues like nocturnal panic attacks or nightmare disorder are more susceptible to insomnia.
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How is insomnia treated?
Insomnia is a sleep disorder that affects 10-30% of adults. It is characterised by difficulty falling asleep, staying asleep, or both, despite having the opportunity and environment to sleep. To be diagnosed with chronic insomnia, a person must experience these symptoms at least three times a week for a minimum of three months.
There are a variety of treatment options for insomnia, including:
- Cognitive Behavioural Therapy (CBT): CBT can help patients identify and change negative thoughts and behaviours that may be affecting their sleep. This may include setting a sleep schedule, improving sleep hygiene, and developing relaxation techniques.
- Lifestyle Changes: Improving sleep hygiene by establishing a bedtime routine, avoiding naps, limiting caffeine and alcohol intake, and creating a comfortable sleeping environment can help treat insomnia. Regular physical activity and maintaining a consistent sleep schedule are also important.
- Medications: Various prescription and non-prescription medications can aid in falling and staying asleep. These include sedative and hypnotic drugs, antidepressants, melatonin, antihistamines, and herbal supplements. However, it is important to use these cautiously as they may negatively affect the sleep cycle and can interact with other medications. Always consult a doctor before taking any medication for insomnia.
- Alternative Therapies: Mental healthcare is one of the most effective ways to treat insomnia. This may include counselling, meditation, and other relaxation techniques to reduce stress and improve sleep.
It is important to note that the treatment for secondary insomnia, which is caused by an underlying medical or psychological condition, will typically also address the patient's underlying condition.
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