Insomnia: Symptoms, Treatment & Prevention

By Rachael Rettner, Senior Writer | June 21, 2017 02:36pm ET

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Insomnia: Symptoms, Treatment & Prevention

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Insomnia is a sleep disorder characterized by difficulties falling or staying asleep, even though people
have the chance for adequate sleep.

The condition can be short term (acute), lasting days or weeks, or long term (chronic), lasting for a
month or more. Acute insomnia is often caused by stressful events, such as a death in the family, said
Dr. Ulysses Magalang, director of the Sleep Disorders Program at The Ohio State University Wexner
Medical Center, while chronic insomnia often has a secondary cause, such as another medical or
psychiatric problem.

People with insomnia can feel sleepy during the day, have difficulty concentrating and learning, and may
feel irritable, anxious or depressed, according to the National Institutes of Health. Those with persistent
sleep disturbances are also at increased risk for traffic accidents, have higher rates of absenteeism from
work, and are less satisfied with their jobs, according to a literature review conducted by the University
of Rochester in February 2010.

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Insomnia is a common condition — about 30 percent of adults experience one or more symptoms of
insomnia, according to a 2007 review in the Journal of Clinical Sleep Medicine. About 10 percent of
people experience impairment or distress as a result of their insomnia, and about 6 percent experience
symptoms for at least 1 month, and don't have another disorder that could account for the sleep
difficulties.

Causes
Insomnia can be a consequence or symptom of another problem, which is known as secondary
insomnia. According to the NIH, causes of secondary insomnia can include depression, anxiety, post-
traumatic stress disorder (PTSD), headache disorders, sleep disorders such as restless legs syndrome, or
symptoms of menopause such as hot flashes. Certain medications, such as asthma and cold medicines,
can cause insomnia. Commonly used substances such as caffeine, tobacco, and alcohol can also cause
insomnia, the NIH says.

Research also suggests that exposure to light at night — such as computer or smartphone screens — can
contribute to insomnia, Magalang said.

In some cases, insomnia is not a side effect of another problem, in which case, the disorder is known as
primary insomnia. The causes of primary insomnia are not well understood, the NIH says, but major life
changes, long-lasting stress, and travel may trigger primary insomnia.

Symptoms

People with insomnia typically have trouble falling or staying asleep. They may lie awake in bed for a
long time before falling asleep, sleep for a short amount of time, wake up too early or feel as if they
haven't slept during the night, according to the NIH.

It's common for people to have an occasional bad night of sleep, especially if they are stressed about
something, Magalang said. But people should speak with their doctor if they experience difficulty falling
asleep, or they feel unrefreshed when they wake up, which lasts for three months or longer, Magalang
said.

People should also speak with their doctor if they feel that their sleep problems are interfering with
their ability to function during the day according to the Mayo Clinic.

Risk factors
Older adults are more likely to have insomnia compared to younger people, according to the NIH.
Women are also more likely to have the condition than men — hormonal changes during the menstrual
cycle and during menopause may affect sleep, the Mayo Clinic says.

Other risk factors for insomnia include:

Being under a lot of stress

Having a mental disorder

Working at night, or undergoing changes in work hours

Traveling long distances

In addition to psychological well-being, your genes may also play a role in one's risk of developing the
sleep disorder, according to research out of the Netherlands published June 12, 2017 in the journal
Nature Genetics. The researchers analyzed the DNA of 113,000 people with an average age of 57, asking
them about sleep issues. They found seven genes that were more common in those who had insomnia,
which in this study was defined as "usually" having trouble going to sleep or waking up in the middle of
the night. [7 Strange Facts About Insomnia]

Another study, which involved 600 people, revealed that people who procrastinate were more likely to
have symptoms of insomnia. The study researchers explained the link may be the result of worry —
people who put things off may ruminate about the things they need to do but haven't. That research
was published in October 2016 in the journal Personality and Individual Differences

Diagnosis

To diagnose insomnia, doctors will ask patients a number of questions about their sleep habits, such as
how often they have trouble sleeping, how long it takes them to fall asleep and how often they wake up
at night, as well as what their routine before bedtime is like. Patients may consider keeping a sleep diary
for a week or two to help answer these questions, and write down when they fall asleep, wake up and
take naps, the NIH says.
Looking at the timing of a person's insomnia can help doctor's determine its cause, Magalang said. For
example, if people find it hard to initially fall asleep at night, the problem might be related to their
biological clock or circadian rhythm, Magalang said. Whereas, waking up too early in the morning is
often linked with psychiatric problems, he said.

Doctors will also take a medical history, which includes questions about the patient's health problems,
medications, mental health conditions, and work and leisure habits, as well as whether the patient has
recently experienced stressful life events. Doctors will also conduct a physical exam, which may include
blood tests to check for thyroid problems that may cause sleep disturbances.

An overnight sleep test may be needed if doctors think that a patient's insomnia may be caused by
another sleep disorder.

Treatment

Lifestyle changes often help improve sleep for people with short-term insomnia. These include avoiding
caffeine and other stimulants, going to bed and waking up around the same time every day, and
avoiding heavy meals, exercise and bright lights before bedtime, according to the NIH.

For people with chronic insomnia, a type of therapy called cognitive-behavioral therapy may help reduce
anxiety linked to insomnia, such as anxiety about sleep loss, the NIH says. Studies have shown that the
effects of cognitive behavioral therapy are more long lasting than those of medications, Magalang said.

But if other methods don't work to relieve insomnia, doctors may recommend prescription medications,
such as zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata) or ramelteon (Rozerem). These
medications are usually taken for only a few weeks, according to the Mayo Clinic.

Sleep medications can have side effects — patients may feel groggy the next day, or rarely, they may
sleep walk or drive while sleeping.
Patients should speak with their doctor before using over the counter products that contain
antihistamines. These medications have not been proven effective for treating insomnia, and they can
have a long-lasting effect and make people feel drowsy the next day, Magalang said.

Melatonin has also not been proven effective for chronic insomnia, but it may be beneficial for certain
sleep conditions, such as jet lag, Magalang said.

Editor's Note: Additional reporting by Iris Tse, Live Science Contributor.

Additional resources

The National Institutes of Health: Insomnia Treatment

Insomnia: Definition, Prevalence, Etiology, and Consequences