Insomnia refers to experiencing unsatisfactory levels of sleep on a regular basis. It refers to issues in the quantity or quality of sleep or both. Symptoms of insomnia manifest in the following ways1:
- Difficulties in falling asleep (Sleep Onset Insomnia)
- Difficulties in remaining asleep (Sleep Maintenance Insomnia)
- Early morning wakening (Late Insomnia)
- Not feeling refreshed after sleeping
A common compliant of people suffering from insomnia is that they have immense difficulty in falling asleep. Thus, a person may go to bed and find themselves lying awake or tossing and turning. In contrast, some insomniacs have trouble staying asleep and may wake up immediately at the slightest environmental change or disturbance. Insomnia may also include poor quality of sleep. This involves feeling lethargic, tired, or tense, even after sleeping for few hours. Usually a combination of these complaints is presented by patients.
The subjective or objective limits of what is considered normal sleep duration is not the primary method of diagnosing insomnia. This is because many people tend to be short sleepers and feel completely comfortable with their schedule. While there are others who sleep for durations of up to six to seven hours but, suffer immensely due to the poor quality of their sleep. It is also important to know that sleep difficulties persist despite adequate opportunities for sleeping.
In addition, individuals exhibiting symptoms of insomnia also report feeling different concerns at bedtime. For example they may feel anxious, worried, or irritable. Preoccupation with sleeplessness is also prominent and can further interfere in establishing a normal sleep pattern. Due to the disturbed elements of sleep, individuals may then find themselves feeling mentally and physically tired in the morning.
These issues in sleep characteristics cause significant distress in daily life. Daytime impairments include difficulties with memory, concentration, and attention. Daytime sleepiness is also is also common. Mood disturbances like irritability and depressive symptoms are also experienced sometimes. Persistent complains of insomnia are also related to maladaptive sleep routines and habits such as daytime napping, staying in bed for long periods, etc. Alternate ways of inducing sleep are also tried by some people such as drinking alcohol, and smoking cigarettes. These don’t prove to be beneficial and cause more disturbances to the sleep cycle.
Although the onset of insomnia can occur at any time or age, it is more prevalent in middle age and older adults. The first episode of insomnia commonly occurs during young adulthood. Insomnia can also be one of the concerns associated with menopause.
Assessment and Treatment Of Insomnia
Sleep related issues including insomnia can be reported to professionals including general physicians, psychiatrists and clinical psychologists. An in depth history related to the patient’s health is elicited. A thorough assessment of sleep patterns is also conducted. A common example of assessment of sleep patterns in the use of sleep diaries (https://sleepfoundation.org/sites/default/files/SleepDiaryv6.pdf) to document bed time routines, wake up times and other associated trends that are further evaluated.
Treatment options for insomnia include:
- Pharmacological Treatments: Insomnia is often treated with medications that may assist in achieving sleep However, these medication are prescribed only by trained medical professionals under discretion.
- Psychotherapeutic Approaches: Specific approaches for insomnia have been developed. The cognitive behavioural therapy for insomnia (CBTi) is one example. This therapy aims at developing better sleep habits including maintaining a bedtime routine, the bedroom environment, maintaining a sleep habit diary etc. It also addresses thoughts and emotional factors that underlie poor sleep patterns. For example, worrying about the effects of not having enough sleep can keep a person awake till very late and continue to affect their sleep cycle. Sleep hygiene (can hyperlink the Hope Qure article here) is an important element associated with the treatment of insomnia and is commonly suggested.
Insomnia can cause disturbances in maintaining quality of life and affect overall health. Thus, consulting a professional about symptoms is very important to receive timely interventions.
1. American Psychiatric Association. (2013).Sleep-wake disorders. In Diagnostic and statistical manual of mental disorder (5th ed.). Washington, DC: Author.
2. World Health Organization (1993). Behavioural syndromes associated with physiological disturbances and physical factors. In International classification of diseases-Classification of mental and behavioural disorders (5th ed.). Geneva: Author
3. Australian Sleep Association. Insomnia [Fact sheet]. Retrieved from https://www.sleep.org.au/documents/item/355
4. National Sleep Foundation. Sleep diary. Retrieved from: https://sleepfoundation.org/sites/default/files/SleepDiaryv6.pdf