Insomnia: Symptom, Cause, Types, Diagnosis and Treatment

What is insomnia

Insomnia is when people struggle to fall or stay asleep, leading to daytime fatigue and difficulty focusing. Individuals with insomnia sleep disorder experience non-restorative sleep that leads to significant daytime impairments, including fatigue, irritability, and concentration problems. 

Insomnia involves difficulty falling or staying asleep, leading to daytime fatigue and trouble concentrating. People with insomnia experience non-restorative sleep that causes significant daytime impairments such as irritability and concentration problems. According to a study by Carrión-Pantoja S. et al. 1989, “Insomnia Symptoms, Sleep Hygiene, Mental Health, and Academic Performance in Spanish University Students: A Cross-Sectional Study,” the main symptoms include trouble falling asleep, frequent nighttime awakenings, and early morning awakenings with an inability to return to sleep.

The causes of insomnia are diverse and include factors like medications affecting the central nervous system, mental health conditions such as stress and anxiety, and substances like nicotine and alcohol. According to a study by Carrión-Pantoja S. et al. 1989, “Insomnia Symptoms, Sleep Hygiene, Mental Health, and Academic Performance in Spanish University Students: A Cross-Sectional Study,” irregular sleep schedules also contribute by misaligning the body’s internal clock.

Insomnia manifests in various forms, including acute insomnia, which is short-term and triggered by temporary stressors, and chronic insomnia, which persists for three months or longer due to ongoing stress or psychiatric conditions. Other types are onset insomnia (difficulty falling asleep), maintenance insomnia (frequent awakenings), and terminal insomnia (early morning awakenings). According to Vargas I, Nguyen AM, Muench A, et al. 2020, “Acute and Chronic Insomnia: What Has Time and/or Hyperarousal Got to Do with It?” each type requires a different management approach.

Diagnosing insomnia involves a detailed evaluation of medical history and specialized tests. According to an article by the National Heart, Lung, and Blood Institute 2022, “Insomnia – Diagnosis,” diagnosis is based on identifying sleep patterns and potential contributing factors.

Treatment for insomnia includes Cognitive-Behavioral Therapy (CBT), medications, mental healthcare, homeopathic remedies, and essential oils. CBT effectively addresses the cognitive and behavioral issues behind insomnia, as noted by Sleep Foundation 2024, “Cognitive Behavioral Therapy for Insomnia (CBT-I): An Overview.” Medications offer temporary relief, but comprehensive management also includes mental healthcare and alternative treatments to improve sleep quality and reduce stress and anxiety.

What is Insomnia?

Insomnia is a sleep issue defined by the persistent difficulty in falling asleep, maintaining sleep, or waking up too early and being unable to return to sleep. This condition results in non-restorative sleep, leading to significant daytime impairment such as fatigue, irritability, and difficulties in concentration, according to a study by Roth T. et al. 2007, “Insomnia: definition, prevalence, etiology, and consequences.” Insomnia is classified into acute or chronic forms, depending on its duration. Acute insomnia lasts for a short period, triggered by stress or a temporary situation, whereas chronic insomnia persists for three or more months, occurring at least three times per week.

Globally, insomnia is a pervasive issue affecting millions. In the United States, the prevalence of insomnia is notably high, with about  30% to 40% of adults experiencing symptoms of insomnia annually, as reported by the American Journal of Managed Care 2020, “Insomnia.” Around 50 to 70 million adults in the U.S. are affected by various sleep disorders, according to the American Sleep Association 2021, underscoring the significant burden of sleep issues on the population.

Insomnia is closely associated with various mental health conditions. It significantly increases the risk of developing mood disorders, such as depression and anxiety, as reported by Riemann D, Krone LB, Wulff K, Nissen C., et al. 2020, “Sleep, insomnia, and depression.” Chronic sleep disturbances exacerbate symptoms of depression, while those suffering from mood disorders are more susceptible to insomnia. Individuals with insomnia experience heightened emotional distress, including mood swings and irritability. This cyclical relationship between sleep issues and mental health underscores the importance of addressing insomnia to mitigate its impact on emotional well-being and overall mental health.

How Common is Insomnia?

Insomnia is a prevalent condition affecting a large segment of the population. In the U.S., both chronic and short-term insomnia affects approximately 10% of individuals, equating to around 33 million people, according to an article by Healio 2023, “Insomnia in women common, increases with age.” 

Insomnia rates vary by age and gender: 25% of children, 35% of adolescents, and 45% of young adults experience insomnia symptoms, as reported by PennState Health News 2022, “Children with insomnia likely to continue to suffer as adults.” Among adults, nearly a third of women report insomnia, with prevalence ranging from 31% to 42%, especially increasing for women in late-stage menopause (60%) compared to earlier stages (16%), according to Healio 2023, “Insomnia in women common, increases with age.” Women are 40% more likely than men to experience insomnia over their lifetimes, as highlighted by the Sleep Foundation 2024, “Insomnia and Women.”

Insomnia is also quite common during pregnancy. Two meta-analyses of 24,362 participants indicate that the overall risk of sleep problems in pregnant women is 38.2%, with the prevalence of insomnia during the third trimester reaching 42.4%, according to a meta-analysis by Sedov ID, Anderson NJ., et al. 2021, “Insomnia symptoms during pregnancy: a meta-analysis.” 

This high prevalence during pregnancy underscores the significant impact of insomnia on expectant mothers, emphasizing the need for effective management and support strategies during this critical time.

What are the Symptoms of Insomnia?

The main symptoms of insomnia include difficulty falling asleep, frequent awakenings during the night, and early morning awakenings with an inability to return to sleep. These symptoms lead to fatigue, impaired concentration, and overall daytime effects that impact daily functioning. Individuals with chronic insomnia experience significant challenges in maintaining mental health and academic performance due to disrupted sleep patterns, according to a study by Carrión-Pantoja S. et al. 1989, “Insomnia Symptoms, Sleep Hygiene, Mental Health, and Academic Performance in Spanish University Students: A Cross-Sectional Study.”

Insomnia Symptoms

The most common symptoms of insomnia are as follows:

  • Difficulty Falling Asleep: It refers to the challenge of initiating sleep, taking longer than 30 minutes to fall asleep after going to bed. This difficulty ranges from mild, where sleep is delayed by only a few minutes, to severe, where it takes hours to fall asleep. The impact on the body includes increased stress levels, heightened anxiety, and a reduction in total sleep time, which disrupt the body’s natural circadian rhythm. This symptom lasts for several nights to weeks, and in chronic cases, it persists for months or even years.
  • Frequent Nighttime Awakenings: Frequent nighttime awakenings are episodes where individuals wake up multiple times throughout the night and find it hard to fall back asleep. These awakenings are brief or prolonged, with the severity depending on how they occur and how long they last. The impact of frequent awakenings includes decreased sleep efficiency, leading to less time spent in deep, restorative sleep stages. This symptom causes fatigue, irritability, and a decline in cognitive functions such as memory and attention. The duration of this symptom varies, but when it becomes chronic, it leads to long-term sleep deprivation.
  • Early Morning Awakenings: It occurs when a person wakes up earlier than intended and is unable to return to sleep, even if they are still tired. This symptom ranges from waking up 30 minutes early to hours before the intended wake time. The severity of early morning awakenings lies in the consistent reduction of total sleep duration, affecting the body’s ability to rejuvenate and prepare for the day ahead. The impact includes persistent fatigue, mood disturbances, and an increased risk of developing depression. This symptom persists over weeks, and if it becomes a regular pattern, it contributes to chronic insomnia.
  • Persistent Fatigue: It is a state of constant tiredness and lack of energy, regardless of how much sleep is obtained. This fatigue ranges from a mild sense of tiredness to severe exhaustion that hinders daily activities. The impact of persistent fatigue includes impaired immune function, increased susceptibility to illness, and a higher risk of developing chronic conditions such as hypertension and diabetes. The duration of fatigue depends on the severity of the insomnia, lasting as long as the sleep disturbance continues, potentially leading to long-term health issues.
  • Poor Concentration: It is a common cognitive symptom of insomnia, characterized by difficulty focusing, making decisions, and processing information. The severity of poor concentration varies from occasional lapses in attention to a constant struggle to maintain focus on tasks. The impact on the body includes a decrease in work or academic performance, an increase in errors and accidents, and difficulties in learning and retaining new information. Poor concentration develops quickly and persists as long as the insomnia remains untreated, potentially becoming a chronic issue.
  • Daytime Sleepiness: It involves feeling excessively sleepy or drowsy during the day, leading to an overwhelming urge to nap or rest. The severity of daytime sleepiness ranges from mild drowsiness to an inability to stay awake during activities. This symptom impacts the body by reducing alertness, increasing the risk of accidents, and impairing the ability to operate machinery or drive safely. Daytime sleepiness appears after just one night of poor sleep, but it becomes a constant and debilitating issue if insomnia persists, severely affecting the quality of life and day-to-day functioning.

What are the Types of Insomnia?

The main types of insomnia include acute insomnia, chronic insomnia, onset insomnia, maintenance insomnia, short-term insomnia, comorbid insomnia, and terminal insomnia. Different patterns and durations of sleep disturbances characterize each type. 

The main types of insomnia are:

  • Acute Insomnia 
  • Chronic Insomnia 
  • Onset Insomnia 
  • Maintenance Insomnia 
  • Short-term insomnia 
  • Comorbid Insomnia 
  • Terminal insomnia 

Acute Insomnia

Acute insomnia is a short-term sleep disorder that lasts less than three months. This type of insomnia arises from transient stressors such as significant life changes or traumatic events. Factors like jet lag, acute illness, or temporary emotional disturbances cause acute insomnia, according to a study by Ellis JG. et al., 2012, “ Acute insomnia: Current conceptualizations and future directions.”

The primary effect of acute insomnia is difficulty initiating or maintaining sleep, which leads to daytime fatigue and impaired concentration. Fortunately, acute insomnia usually resolves on its own once the triggering stressor is addressed, with symptoms diminishing within a few weeks, according to a study by Krystal AD. et al., 2005, “The Effect of Insomnia Definitions, Terminology, and Classifications on Clinical Practice.”

Chronic Insomnia

Chronic insomnia is characterized by persistent sleep disturbances lasting for three months or longer. This type of insomnia is caused by underlying neurological problems, chronic stress, or ongoing psychiatric conditions such as depression or anxiety, according to Vargas I, Nguyen AM, Muench A, et al. 2020, “Acute and Chronic Insomnia: What Has Time and/or Hyperarousal Got to Do with It?” Chronic insomnia leads to severe daytime effects, including significant fatigue, reduced cognitive function, and mood swings. It requires more comprehensive management strategies, including behavioral therapies and sometimes pharmacological treatments, as it does not resolve without intervention.

Onset Insomnia

Onset insomnia is defined as difficulty falling asleep at the beginning of the night. This form of insomnia is caused by psychological factors like stress or anxiety or by behavioral issues such as irregular sleep schedules, according to a study by Bollu PC, Kaur H., et al. 2019, “Sleep Medicine: Insomnia and Sleep.” The main effects include prolonged periods of lying awake in bed and an increased time to fall asleep, leading to insufficient sleep duration and associated daytime sleepiness. Onset insomnia requires behavioral interventions and improvements in sleep hygiene to manage effectively, according to an article by Medical News Today 2023, “What to know about sleep onset insomnia.”

Maintenance Insomnia

Maintenance insomnia is defined by frequent awakenings during the night, with difficulty returning to sleep. Causes of maintenance insomnia include underlying medical conditions, such as sleep apnea or restless leg syndrome, or psychological factors like stress and anxiety, according to a study by Lacks P. et al. 1983, “The treatment of sleep-maintenance insomnia with stimulus-control techniques.” The effects of maintenance insomnia include fragmented sleep and subsequent daytime impairment, such as fatigue and reduced concentration. This type of insomnia is persistent and requires both medical evaluation and lifestyle adjustments to address, according to a study by Hoelscher, T. J., & Edinger, J. D. et al. 1988, “Treatment of sleep-maintenance insomnia in older adults: Sleep period reduction, sleep education, and modified stimulus control.”

Short-term Insomnia

Short-term insomnia is characterized by temporary sleep disturbances lasting for a few weeks. This type of insomnia is triggered by specific events, such as a stressful situation or travel-related disruptions, according to a study by Momin RR, Ketvertis K. et al. 2023, “Short-Term Insomnia.” The primary effect is a noticeable decrease in sleep quality, resulting in daytime drowsiness and impaired cognitive function. Short-term insomnia usually resolves as the underlying issue is managed, but if symptoms persist beyond a few weeks, it transitions into a longer-term condition.

Comorbid Insomnia

Comorbid insomnia is defined as insomnia occurring simultaneously with other medical or psychiatric conditions. Common causes include disorders such as depression, anxiety, or chronic pain. The effects of comorbid insomnia are compounded by the symptoms of the coexisting conditions, leading to exacerbated daytime fatigue and decreased overall quality of life, according to a study by Khurshid KA. et al. 2018, “Comorbid Insomnia and Psychiatric Disorders: An Update.” Addressing comorbid insomnia requires treating both the primary condition and the sleep disorder to achieve effective management, according to research by Blom K. et al. 2024, “Psychological Treatment of Comorbid Insomnia and Depression: A Double-Blind Randomized Placebo-Controlled Trial.”

Terminal Insomnia

Terminal insomnia is characterized by waking up too early in the morning and being unable to return to sleep. This type of insomnia is caused by factors such as aging, depression, or idiopathic insomnia, where no specific cause is identified, according to an article by Health Match 2023, “How To Tell If You Have Terminal Insomnia.” The effects of terminal insomnia include insufficient sleep duration and subsequent daytime impairment, such as decreased energy and mood disturbances. Terminal insomnia necessitates a combined approach of medical evaluation and therapeutic interventions to improve sleep patterns.

What are the Causes of Insomnia?

The main causes of insomnia are medications, mental health conditions, nicotine and alcohol use, and irregular sleep schedules. Medications affecting the central nervous system disrupt sleep patterns, while mental health conditions such as anxiety and depression lead to difficulty falling or staying asleep due to excessive worry and emotional instability. Nicotine and alcohol adversely impact sleep quality; nicotine acts as a stimulant, and alcohol disrupts the sleep cycle despite initial sedative effects. 

What Are The Causes Of Insomnia?

The main causes of insomnia are as follows:

  • Medications: Certain medications, particularly those affecting the central nervous system, such as stimulants or antidepressants, interfere with sleep. These medications disrupt the sleep cycle, making it difficult to fall asleep or stay asleep throughout the night. Insomnia is a known side effect of many prescription drugs, according to a study by Van Gastel A. et al. 2018, “Drug-Induced Insomnia and Excessive Sleepiness,” highlighting the need for careful management of medication use.
  • Mental Health Conditions: Mental health conditions such as anxiety, depression, and bipolar disorder are strongly linked to insomnia. These conditions cause excessive worry, emotional instability, and altered sleep patterns, contributing to both the onset and maintenance of insomnia. Over 50% of individuals with major depressive disorder experience significant sleep disturbances, according to an article by Johns Hopkins Medicine, “Depression and Sleep: Understanding the Connection.”
  • Nicotine and Alcohol: The consumption of nicotine and alcohol adversely affects sleep quality. Nicotine is a stimulant that delays sleep onset, while alcohol, although initially sedating, disrupts the sleep cycle and leads to fragmented sleep. Individuals who smoke or consume alcohol regularly are at a higher risk of experiencing insomnia, according to a study by the National Sleep Foundation 2024, “Alcohol and Sleep – Sleep Foundation.”
  • Irregular Sleep Schedules: Irregular sleep schedules, including varying bedtimes and wake times, disrupt the body’s internal clock and lead to insomnia. This misalignment makes it difficult for the body to establish a consistent sleep pattern. Irregular sleep schedules trigger sleep disorders by interfering with the body’s natural circadian rhythms, according to a study by the Sleep Foundation 2024, “Irregular Sleep-Wake Rhythm Disorder.”

How is Insomnia Diagnosed?

To diagnose insomnia, a combination of evaluating health and medical history and conducting specialized tests is required, according to an article by the National Heart, Lung, and Blood Institute 2022, “Insomnia – Diagnosis.” Key diagnostic methods include reviewing the patient’s health and medical history, employing polysomnography (PSG), utilizing the Multiple Sleep Latency Test (MSLT), and using actigraphy to track sleep patterns and physical activity over time. These methods collectively provide a comprehensive assessment to diagnose insomnia and inform appropriate treatment accurately.

The diagnostic process, according to Mayo Clinic 2024, “Insomnia,” includes:

  • Health History and Medical History: This involves a comprehensive review of the patient’s overall health history and any prior medical history that affects sleep. This assessment helps identify potential underlying causes or contributing factors of insomnia.
  • Polysomnography (PSG): PSG is a detailed sleep study conducted in a sleep clinic. Various physiological parameters, such as brain waves, heart rate, and breathing, are monitored throughout the night. It provides a thorough assessment of sleep architecture and disturbances.
  • Multiple Sleep Latency Test (MSLT): Multiple sleep latency test measures how quickly a person falls asleep during the day. It is conducted the day after a PSG. It assesses daytime sleepiness and helps diagnose sleep disorders by evaluating the speed of falling asleep in controlled environments.
  • Actigraphy: Actigraphy is a diagnostic method that uses a wrist-worn device to track sleep patterns and physical activity over an extended period. It offers insights into sleep-wake cycles and helps identify abnormalities in sleep patterns.

What are the Treatments for Insomnia?

The primary treatments for insomnia include Cognitive-Behavioral Therapy, medications, mental healthcare, homeopathic medicines, and essential oils. These treatments are used in combination to manage and alleviate symptoms of insomnia effectively.

The primary treatments for insomnia are as follows:

  • Cognitive-Behavioral Therapy 
  • Medications 
  • Mental healthcare 
  • Homeopathic Treatments 
  • Essential oils

Cognitive-behavioral therapy (CBT)

Cognitive-behavioral therapy (CBT) is a structured, time-limited psychotherapy that aims to identify and alter negative thought patterns and behaviors contributing to insomnia. CBT for insomnia (CBT-I) involves techniques such as cognitive restructuring, sleep restriction, and stimulus control. This approach is beneficial because it addresses the underlying cognitive and behavioral factors perpetuating sleep issues. CBT-I significantly improves sleep onset and maintenance by reducing sleep anxiety and promoting healthy sleep habits, according to Sleep Foundation 2024, “Cognitive Behavioral Therapy for Insomnia (CBT-I): An Overview.”

Medications

Medications for insomnia are pharmacological treatments prescribed to help manage sleep disorders. This category includes various drugs, according to an article by WebMD 2022, “Drug Treatments for Sleep Problems, ”such as:

  • Sedative-Hypnotics (e.g., benzodiazepines)
  • Melatonin Agonists (e.g., ramelteon)
  • Antidepressants (e.g., trazodone)

Sedative-Hypnotics help induce sleep quickly, Melatonin Agonists regulate sleep-wake cycles, and Antidepressants are used for patients with insomnia linked to mood disorders, according to the Medscape 2022, “Insomnia Medication: Sedative-Hypnotics, Antidepressants, Agonists.” These medications are effective for the short-term management of insomnia but should be used cautiously due to potential side effects and dependency risks.

Mental Healthcare

Mental Healthcare refers to a broad range of therapeutic interventions aimed at addressing psychological factors contributing to insomnia. This includes counseling, therapy, and support groups to manage stress, anxiety, and other mental health conditions, according to a news by RACGP 2021, “Does insomnia fall under mental health treatment plans?” Mental healthcare is crucial because many individuals with insomnia also experience co-occurring mental health issues that exacerbate their sleep problems. Integrated mental health treatment improves overall sleep quality and helps address underlying psychological issues impacting sleep, according to a study by the Journal of Clinical Sleep Medicine 2021, “Insomnia.”

Homeopathic Treatments

Homeopathic Treatments involve using highly diluted substances to stimulate the body’s self-healing mechanisms. Common remedies for insomnia include natural extracts like valerian root and chamomile. Homeopathy helps balance sleep patterns by addressing imbalances in the body. While the evidence supporting homeopathy’s effectiveness is mixed, a study published in Peace Health 2017, “Sleeplessness (Homeopathy),” indicated that some patients experience improvements in sleep quality with these treatments, though more rigorous studies are needed.

Essential Oils

Essential Oils are aromatic compounds extracted from plants that are used in various therapeutic practices. For insomnia, essential oils such as lavender and chamomile are used for their calming and sedative effects. These oils are used in aromatherapy or as part of a relaxing bedtime routine. Aromatherapy with essential oils improves sleep quality and reduces insomnia symptoms, particularly when combined with other relaxation techniques like meditation, according to research published in the Sleep Foundation 2023, “The Best Essential Oils for Sleep.”

What are the complications of insomnia?

Insomnia leads to several significant complications affecting various aspects of health and daily functioning. One major complication is the increased risk of driving accidents, as individuals with insomnia experience impaired concentration and slower reaction times, which lead to dangerous situations on the road, according to the Institute of Medicine (US) Committee on Sleep Medicine and Research; 2006, “Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem.” Additionally, insomnia is closely associated with sleep apnea, a condition characterized by interrupted breathing during sleep, which aggravates sleep disturbances and impacts overall health. Chronic insomnia also contributes to the development of high blood pressure, as ongoing sleep deprivation has been shown to disrupt hormonal regulation and increase cardiovascular strain. Untreated insomnia significantly raises the risk of hypertension and other cardiovascular issues.

What are the tips to prevent insomnia?

Treat Insomnia

The tips to prevent insomnia are:

  • Maintain a Consistent Sleep Schedule: Go to bed and wake up at the same time every day to regulate your body’s internal clock and improve sleep quality.
  • Create a Relaxing Bedtime Routine: Before bed, engage in calming activities, such as reading or taking a warm bath, to signal to your body that it’s time to wind down.
  • Limit Exposure to Screens: Reduce screen time from phones, tablets, and computers at least an hour before bed, as the blue light emitted interferes with melatonin production.
  • Manage Stress and Anxiety: Incorporate stress-reducing practices like mindfulness meditation or deep-breathing exercises to alleviate anxiety that impacts your ability to fall asleep.
  • Avoid Stimulants Before Bed: Limit your intake of caffeine and nicotine in the hours before bedtime, as these substances disrupt your sleep cycle.
  • Create a Comfortable Sleep Environment: Ensure your bedroom is cool, quiet, and dark to create an ideal environment for restful sleep.

Can COVID-19 cause insomnia?

Yes, COVID-19 can cause insomnia. The pandemic has led to increased sleep disturbances, including insomnia, due to heightened stress, anxiety, and disruptions in daily routines. Individuals experiencing COVID-19, whether through direct infection or the stress of the pandemic, report worsening sleep quality and increased insomnia symptoms, according to a study by Sleep Foundation 2024, “Can COVID-19 Cause Insomnia and Sleep Problems?” The impact of COVID-19 on sleep is linked to the psychological stress associated with the pandemic, changes in lifestyle, and, in some cases, the physiological effects of the virus itself. This underscores the need for effective strategies to address sleep issues in the context of ongoing global health crises.

Is insomnia a side effect of depression?

Yes, insomnia is a common side effect of depression. Depression frequently disrupts sleep patterns, leading to insomnia as one of its symptoms. Sleep disturbances, including insomnia, are prevalent among individuals with depression, with approximately 90% of those affected reporting significant sleep problems, according to an article by Medical News Today 2022, “Can depression cause insomnia?” This association is attributed to the complex interplay between mood disorders and sleep regulation, where depression causes both difficulty falling asleep and maintaining sleep, exacerbating overall mental health challenges. Addressing insomnia is thus crucial for effective management of depressive symptoms.

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