Can’t Sleep? Causes, Cures, and Treatments for Insomnia

Insomnia is a sleep disorder that millions of people worldwide have to live with. Individuals with insomnia find it difficult to either fall asleep and/or stay asleep.

Insomnia commonly leads to daytime sleepiness, lethargy and a general feeling of being unwell both mentally and physically.

What is insomnia?

According to a survey by the National Sleep Association, 22% of US people say they experience insomnia every or almost every night.

Insomnia includes a wide range of sleeping disorders, from lack of quality of sleep to lack of quantity of sleep.

Insomnia is commonly separated into three types:

Transient insomnia - occurs when symptoms lasts from a few days to some weeks.
Acute insomnia - also called short-term insomnia. Symptoms persist for several weeks.
Chronic insomnia - this type lasts for at least months, and sometimes years. According to the National Institutes of Health1, the majority of chronic insomnia cases are secondary,

meaning they are side effects or symptoms of some other problem.

According to a survey by the National Sleep Association, 22% of US people say they experience insomnia every or almost every night.

Although insomnia can affect people at any age, it is more common in adult females than adult males. The sleeping disorder can undermine school and work performance, as well as being a cause of obesity, anxiety, depression, irritability, concentration problems, memory problems, poor immune system function, and reduced reaction time. Insomnia has also been associated with a higher risk of developing chronic diseases.

The National Sleep Foundation informs that between 30% and 40% of American adults say they have had some symptoms of insomnia within the previous 12 months, and 10% to 15% of adults claim to have chronic insomnia.

What causes insomnia?

Insomnia can be caused by physical factors as well as psychological factors. There is often an underlying medical condition that causes chronic insomnia, while transient insomnia may be due to a recent event or occurrence.

Insomnia can commonly be caused by:

Studies have suggested that electronic devices with self-luminous "backlit" displays can affect evening melatonin, which might result in delayed sleep.

Disruptions in circadian rhythm: jet lag, job shift changes, high altitudes, noisiness, hotness or coldness
Psychological issues: people with mood disorders, such as bipolar disorder or depression, as well as anxiety disorders or psychotic disorders are more likely to have insomnia.
Medical conditions: brain lesions and tumors, stroke, chronic pain, chronic fatigue syndrome, congestiveheart failure, angina, acid-reflux disease (GERD), chronic obstructive pulmonary disease, asthma, sleep apnea, Parkinson's and Alzheimer's diseases,hyperthyroidism, arthritis
Hormones: estrogen, hormone shifts during menstruation
Other factors: sleeping next to a snoring partner, parasites, genetic conditions, overactive mind, preganancy
Media technology in the bedroom - researchers from the University of Helsinki, Finland, reported in the journal BMC Public Health that media technology in the bedroom disrupts sleep patterns in children. They found that children with TVs, computers, video games, DVD players and mobile phones in their bedrooms slept considerably less than kids without these devices in their bedrooms. In addition, a study conducted by Rensselaer Polytechnic Institute found that back-lit tablet computers can affect sleep patterns.

Studies have suggested that electronic devices with self-luminous "backlit" displays can affect evening melatonin, which might result in delayed sleep.

Medications - according to the American Association of Retired Persons (AARP), the following medications are known to cause insomnia in some patients:

Corticosteroids - used for treating patients with allergic reactions, gout, Sjögren's syndrome, lupus, rheumatoid arthritis, and inflammation of the muscles and blood vessels. Examples include: prednisone, triamcinolone, methylprednisolone and cortisone.
Statins - medications used for treating high cholesterol levels. Examples include: simvastatin, rosuvastatin, lovastatin and atorvastatin.
Alpha blockers - used for treating hypertension (high blood pressure, Raynaud's disease and BPH (benign prostatic hyperplasia). Examples include: terazosin, silodosin, alfuzosin, prazosin, doxazosin and tamsulosin.
Beta blockers - used for treating hypertension and irregular heartbeat (arrhythmias). Examples include: timolol, carvedilol, propranolol, atenolol, metoprolol and sotalol.
SSRI antidepressants - used for treating depression. Examples include: fluoxetine, citalopram, paroxetine, escitalopram, sertraline and fluvoxamine.
ACE inhibitors - used for the treatment of hypertension, and other heart conditions. Examples include: ramipril, fosinopril, trandolapril, quinapril, benazepril, enalapril, lisinopril, moexipril, perindopril and captopril.
ARBs (Angiotensin II-receptor blockers) - used when the patient cannot tolerate ACE inhibitors or has type 2 diabetes or kidney disease from diabetes. Examples include: candesartan, valsartan, telmisartan, losartan and irbesartan.
Cholinesterase inhibitors - used for treating memory loss and other symptoms for patients with dementia, including Alzheimer's disease. Examples include: rivastigmine, donepezil and galantamine.
2nd generation (non-sedating) H1 agonists - used for treating allergic reactions. Examples include: loratadine, levocetirizine, fexofenadine, desloratadine, cetirizine and azelastine.
Glucosamine/chondroitin - dietary supplements used for relieving the symptoms of joint pain and to reduce inflammation.

Who gets insomnia?

Shift workers commonly suffer with insomnia because of inconsistent sleep routines.

Some people are more likely to suffer from insomnia than others. These include:

Travelers
Shift workers with frequent changes in shifts
The elderly
Drug users
Adolescent or young adult students
Pregnant women
Menopausal women

Shift workers commonly suffer with insomnia because of inconsistent sleep routines.

Signs and symptoms of insomnia

Insomnia itself may be a symptom of an underlying medical condition. However, there are several signs and symptoms that are associated with insomnia.

Difficulty falling asleep at night
Awakening during the night
Awakening earlier than desired
Still feeling tired after a night's sleep
Daytime fatigue or sleepiness
Irritability, depression or anxiety
Poor concentration and focus
Being uncoordinated, an increase in errors or accidents
Tension headaches
Difficulty socializing
Gastrointestinal symptoms
Worrying about sleeping.

Sleep deprivation can cause other symptoms. The afflicted person may wake up not feeling fully awake and refreshed, and may have a sensation of tiredness and sleepiness throughout the day.

Having problems concentrating and focusing on tasks is common for people with insomnia.

According to the National Heart, Lung and Blood Institute4, 20% of non-alcohol related car crash injuries are caused by driver sleepiness.

Tests and diagnosis

A sleep specialist usually will begin a diagnostic session by asking a battery of questions about your medical history and sleep patterns. A physical exam may be conducted to look for conditions that may be causing insomnia. Similarly, physicians may screen for psychiatric disorders and drug and alcohol use.

The Stanford Center for Sleep Sciences and Medicine explains that the term "insomnia" is often used colloquially in reference to "disturbed sleep".

For somebody to be diagnosed with an insomnia disorder their disturbed sleep should have persisted for over one month. It should also negatively impact on the patient's well being, either because of the distress it causes or because it undermines mood or performance.

A sleep specialist is trained to determine whether the symptoms are being caused by an underlying condition.

The patient may be asked to keep a sleep diary in order to examine his or her sleeping patterns more closely.

More sophisticated tests may be employed such as a polysomnograph, which is an overnight sleeping test that records sleep patterns. In addition, actigraphy may be conducted, which uses a small, wrist-worn device called an actigraph to measure movement and sleep-wake patterns.

Treatment options for insomnia

Some types of insomnia resolve themselves when the underlying cause is removed or wears off. In general, treating insomnia focuses on determining the cause of the sleeping problems. Once identified, this underlying cause can be properly treated or corrected. In addition to treating the underlying cause of insomnia, both medical and non-pharmacological (behavioral) treatments may be employed as adjuvant therapies.

Non-pharmacological approaches to treating insomnia include:

Improving "sleep hygiene" - don't over- or under-sleep, exercise daily, don't force sleep, try to maintain a regular sleep schedule, avoid caffeine at night, do not smoke, do not go to bed hungry, make sure the environment is comfortable
Using relaxation techniques - such as meditation and muscle relaxation
Cognitive therapy - one-on-one counseling or group therapy
Stimulus control therapy - only go to bed when sleepy, refrain from TV, reading, eating, or worrying in bed, set an alarm for the same time every morning (even weekends), avoid long daytime naps
Sleep restriction - decrease the time spent in bed and partially deprive your body of sleep so you are more tired the next night.