Insomnia | Types, Causes, Symptoms & Treatment

Insomnia is a sleep disorder that causes regular sleeping issues lasting for months or years. 

The disorder can be short-term, lasting less than 3 months, or long-term, lasting more than 3 months.

Insomnia can be primary and secondary. Primary insomnia means your sleep problems aren’t linked to any other health condition or problem. Secondary insomnia occurs because of a health condition.

There are different types of insomnia, such as:

  • Sleep-onset insomnia: You have trouble getting to sleep.
  • Sleep-maintenance insomnia: You have trouble staying asleep through the night or wake up too early.
  • Mixed insomnia: You have trouble falling asleep and staying asleep through the night.  
  • Paradoxical insomnia: You underestimate the time you’re asleep, meaning you feel like you sleep a lot less than you do.

man in a bed struggling to get to sleep because of insomnia

Signs of Insomnia

You have insomnia if you regularly:

  • find it hard to go to sleep
  • wake up several times during the night
  • lie awake at night
  • wake up early and cannot go back to sleep
  • still feel tired after waking up
  • find it hard to nap during the day even though you’re tired
  • feel tired and irritable during the day
  • find it difficult to concentrate during the day because you’re tired

What’s life like for an insomniac?

Insomnia can have a huge effect on someone’s life. Lack of sleep can affect the body and mind, causing the individual to have difficulty concentrating and thinking clearly whilst causing an array of problems like irritability, sadness and migraines

Waking up feeling unrested is a common sign of insomnia. A lack of rejuvenation after sleep can majorly affect a person’s relationships, career, studies, and general well-being

Possible causes of insomnia

Stress and anxiety

Stress can occur due to major life events like losing a loved one, a career change, moving home, or planning a wedding can cause stress-related insomnia. Stress has been associated with the activation of the HPA axis, which releases cortisol, which is known to cause arousal and sleeplessness in humans.

Depression

About three-quarters of depressed patients have insomnia symptoms, and hypersomnia is present in about 40% of young depressed adults.

Some experts say it is hard to differentiate between which issue came first, the depression or the insomnia. This is because poor sleep can cause emotional difficulties, which may leave individuals more vulnerable to depression. Depression itself is associated with sleep difficulties, such as shortening the amount of restorative slow-wave sleep a person gets each night.

Noise

According to ‘The Sleep Foundation,’ noise has a major effect on sleep. It not only wakes you up, but it can also have subconscious effects by changing the time you spend in certain sleep stages. 

Temperature

It’s been shown that increases in core temperature during sleep promote waking. This is because a drop in core body temperature signals our bodies to prepare for sleep.

Discomfort

An uncomfortable mattress or pillow can cause sleep disturbances during important sleep stages.

Substance use

Insomnia is one of the most common complaints among patients in recovery from a substance use disorder. Continued abuse of and sustained abstinence from a substance alters sleep patterns, and this change can cause some recovering users to suffer from insomnia for days or even weeks.

Jet lag

The main symptoms of jet lag are difficulty sleeping at bedtime and waking up in the morning, tiredness and exhaustion, and difficulty staying awake during the day.

These symptoms will cause major disruption to your ‘body clock’.

Shift work

Similar to jet lag, shift work can cause insomnia. Shift work schedules go against most people’s internal body clocks or circadian rhythms.

Medicines

Many prescription drugs can interfere with sleep, such as certain antidepressants and medicines for asthma or blood pressure. Many medicines available without a prescription, such as some pain medicines, allergy and cold medicines, and weight-loss products, contain caffeine and other stimulants that can disrupt sleep.

Nutrition

New research claims that ultra-processed foods can cause insomnia.

Researchers led by a team from Sorbonne Paris Nord University in France found a statistically significant association between higher UPF consumption and increased chronic insomnia risk.

Conditions that can affect sleep

If you have any of these conditions and you think they are the cause of your sleeping problems, you have what is called “secondary insomnia”. Secondary insomnia is when your insomnia is caused by a health condition.

  • long-term pain
  • sleepwalking
  • snoring or interrupted breathing while sleeping (sleep apnoea)
  • suddenly falling asleep anywhere (narcolepsy)
  • nightmares or night terrors (particularly in children)
  • mental health conditions, such as schizophrenia or bipolar disorder
  • Alzheimer’s disease or Parkinson’s disease
  • restless legs syndrome
  • Recent heart surgery
  • overactive thyroid
  • menopause

Sleep hygiene for insomnia

In some cases, insomnia can get better by implementing sleep hygiene. 

Sleep hygiene refers to healthy habits, behaviours and environmental factors that can be adjusted to help you have a good night’s sleep. Insomnia sufferers could potentially improve their sleep by adopting the following practices.

Work with your body clock

The body has a sleep-wake cycle, partly controlled by an internal ‘clock’ within the brain. This ‘clock’ controls functions such as temperature and the release of hormones synchronised within this 24-hour clock.

To work with your body clock, you can:

  • go to bed and wake up at the same time every day
  • go to bed when your body tells you it’s ready to sleep
  • don’t go to bed if you are not tired
  • try to expose yourself to early morning sunshine to re-set your body clock

Improve your sleeping environment

Sleeping will be much easier if your bedroom is relaxing and comfortable.

  • Set the temperature between 17 to 19 degrees Celsius
  • Ensure the bedroom is completely dark by investing in blackout blinds or curtains if required
  • Try to reduce noise, and if this is not possible, wear earplugs
  • Only use your bedroom for sleep and sexual relations. By associating the bedroom as a second lounge area, your mind will keep your brain too active for sleep
  • Invest in a comfortable mattress and pillow

Avoid certain substances

Often people turn to drugs or medications to help their insomnia, however this can have the opposite effect.

Cigarettes

Some smokers claim that cigarettes help them relax. However, nicotine is a stimulant. Stimulants cause accelerated heart rates and increased blood pressure, likely affecting sleep.

Alcohol

As a depressant on the nervous system, alcohol before bed can disturb the rhythm of sleep.

Sleeping pills

Falling asleep without sleeping pills can become very difficult after prolonged use.

Treatment for insomnia

Cognitive Behavioural Therapy

For people who have long-term insomnia (more than 3 months), the first suggested treatment recommended by NICE and the World Health Organisation (WHO) is cognitive behavioural therapy for insomnia.

Medication

Sleeping pills such as zopiclone and zolpidem are prescribed by the NHS, but the recommended time of use is a maximum of 4 weeks. This time frame is put in place to avoid sleeping pill dependency

Daridorexant was another drug recommended by NICE for the short-term treatment of chronic insomnia.

Supplements

Natural sleep aids are intended to help you fall asleep faster and for longer periods. Commonly plant-based or vitamin—or mineral-based, sleep aid supplements have fewer side effects than prescribed sleeping pills. 

Melatonin

Melatonin is a sleeping-regulating hormone produced in the pineal gland in our brains. It plays an important role in managing our circadian rhythm, which is responsible for when we wake up, feel alert or tired, and sleep. Nighttime exposure to light, ageing, and some diseases can suppress melatonin production, which can cause insomnia.

Cannabis

Some studies suggest that THC and CBD, alone or in combination, help some people fall asleep, stay asleep, and enjoy higher-quality sleep. It’s worth noting that the use of these substances can form dependencies. 

Magnesium

Studies suggest that magnesium influences sleep quality and quantity. If you have kidney disease, always talk to your doctor before taking supplements.

Researchers believe magnesium may promote better sleep in various ways, such as reducing the stress hormone cortisol, increasing a sleep-promoting hormone called melatonin, and helping to regulate neurotransmitters for the central nervous system (CNS).

L-Theanine

L-theanine is an amino acid found in the leaves of tea plants. Some research suggests that supplementing with L-theanine can reduce stress and anxiety, boost relaxation, and improve sleep.

Glycine

Glycine is an amino acid and neurotransmitter that plays an important role in sleep. Recent research suggests that taking a small supplement before bed may improve sleep quality.

Valerian

According to some evidence, Valerian, from the stems of the valerian plant, can help people fall asleep and improve sleep quality. However, some study participants suggested it had the opposite effect, causing sleeplessness.

Are sleep aid supplements safe?

Although the word ‘natural’ is associated with safety, supplemental sleep aids can come with risks. These risks could be anything from:

  • Interaction with other drugs or supplements.
  • Contraindicating someone’s medical condition or if they are breastfeeding or pregnant.
  • Inaccurate labelling
  • Overdosing
  • Side effects

Always ask your doctor before introducing sleep aids. 

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