1. What is insomnia?
Difficulty falling asleep is common to everyone and many of us experience nights when we cannot sleep, for example the night before an exam, the night before our wedding day, or when we have heard some bad news. In these situations, sleep difficulties are normal and they usually only last for a night or a very short period of time. However, there are people who regularly experience difficulties falling asleep, staying asleep or waking up early in the morning. As a result, these people experience feelings of fatigue and reduced daily performance. If a reoccurrence of this happens at least three times per week for a period of three months, this indicates that these people suffer from a sleep disorder called insomnia.
2. Causes, signs and symptoms
Insomnia can be caused by physical, medical, psychological and environmental factors. Certain health conditions like heart disease, hormonal problems, a stroke, or chronic fatigue syndrome can cause insomnia. Stress, mental illnesses (e.g. anxiety disorders, mood disorders), certain medications (e.g. antidepressants, hormonal and epilepsy medication), alcohol or drugs, jet lag and the use of technology shortly before attempting to sleep may all invoke insomnia.
The main signs of insomnia include difficulties falling asleep, difficulties around maintaining sleep and awaking early in the morning. As a consequence of these symptoms, the person will also experience feelings of fatigue during the day and restless sleep during the night. Some people may also experience some secondary symptoms like difficulties concentrating, poor memory, increased possibility of making mistakes and accidents, tension headaches, gastrointestinal symptoms, difficulties socializing and on-going worries about sleep.
As mentioned above, someone with insomnia will experience a persistent difficulty in falling asleep and that can result in people becoming severely fatigued. It is recommended that people seek treatment before their daily tasks are interrupted. In order for someone to be diagnosed with insomnia, the above symptoms will need to occur at least three times per week and be persistent for at least three weeks. A screening for physical conditions, mental illnesses, alcohol and drug use should be performed before diagnosing a person with insomnia. When discussing insomnia, it is important to distinguish ‘disturbed sleep’ from insomnia. Many of us have experienced at least a couple of days which we cannot fall asleep, but unless the symptoms do not interfere with daily routine and have an impact on our well-being, we will not fit the criteria for insomnia.
4. Insomnia treatment
Insomnia is generally treated with medication, psychotherapy or lifestyle changes. In acute cases of insomnia, people can see improvement by changing their lifestyle, by reducing stress, increasing exercise and healthy eating and practicing relaxation techniques, meditation or mindfulness,. According to the National Institute for Health Care Excellence (NICE) the recommended psychotherapy for insomnia is Cognitive Behavioural Therapy (CBT). This is a type of therapy that focuses on the connection between thoughts, emotions and behaviour and teaches the person new ways of thinking and behaving that may help to manage sleeping problems. CBT focuses on identifying unhealthy thinking patterns and behaviours that influence on sleep and then adjusting those thoughts and behaviours (e.g. changing sleeping patterns). Over time irrational thoughts are changed so that people can develop a more balanced and positive view on life and their behaviour is altered as a consequence. Stimulus control is another way of coping with sleeping problems, which focuses on understanding and changing the unhealthy association between bedroom and wakefulness.
Insomnia disorder can also be treated through the use of medication and your GP will be able to provide you with guidance on what medication to take. At present, there are over-the-counter and prescribed sleeping pills available to alleviate symptoms of insomnia. Doctors are usually reluctant to prescribe this type of medication for a long time, as sleeping tablets can be both highly addictive and ineffective in treating the cause of the insomnia. Instead this kind of medication only temporarily relieves the symptoms of insomnia. Antidepressant medication can also on some occasions be used to treat insomnia. Some of these medications start working immediately whilst others take several weeks to start working. Common to all medication is that it may cause side effects and some medication should not be taken for prolonged periods of time.