Insomnia Crash Course

Insomnia and/or sleeping disorders affect about 2 billion people worldwide. At some point in your life, you will most likely experience insomnia.

This is a ...l o n g... article. For ease of navigation, here are shortcut links to the different sections of this article:

The Different Types of Insomnia
Do I have Insomnia?
Habits Keeping You Awake
Risk Factors for Insomnia Increase as You Age
Insomnia Related Disorders
Natural Approaches to Curing Insomnia
Medical Approaches to Curing Insomnia

The Different Types of Insomnia

There are two types of insomnia: primary and secondary.

Primary Insomnia

Primary insomnia is just a matter of not being able to get to sleep but there is no excuse: no meds or drug abuse, no medical conditions and no psychiatric or environmental factors affecting your sleep. You just can't sleep, and we don't know why. Eerrg! Frustrating.

Secondary Insomnia

Secondary insomnia is the one where you need to start paying attention. Secondary insomnia encompasses factors such as mental disorders, substance abuse or medical illnesses. You could even have an actual sleep disorder. Within Secondary insomnia, there are some sub-types.

Transient Insomnia. This type of insomnia can last from one night to several weeks.

Short-Term Insomnia. This particular type of insomnia will not allow you to sleep for almost three weeks.

Chronic Insomnia. Your sleep pattern is so disrupted that it happens nightly for a month or longer period of time. You can’t fall asleep, stay asleep or you have non-restorative sleep.

-Primary Chronic Insomnia. This type of insomnia appears to be the only complaint.

-Secondary Chronic Insomnia. This type of insomnia is caused by things beyond your control such as emotional or psychiatric disorders, drugs, medical conditions or psychiatric conditions. Some common types of secondary insomnia include:

• Substance use or withdrawal (drugs, alcohol, stimulants, sedatives)
• Emotional Problems (worrying, sadness, loss, depression)
• Restless Legs Syndrome (burning, pulling, itching in the legs or feet)
• Medical Conditions (drugs, medical problems, physical discomfort)
• Sleep Apnea (breathing difficulty during sleep)
• Circadian Rhythm Disorders (unnatural sleep patterns i.e. night time workers)
• Menopause/Night Sweats (women)

Do I have Insomnia?

Symptoms which may indicate insomnia problems

There are both intense and hidden symptoms indicating you’re suffering from insomnia. Some of these symptoms include:

• Chronic headaches caused mostly by tension.
• Awakening early or in the middle of the night.
• Lethargy or tiredness during day time hours.
• Difficulty going to sleep at night (30 minutes or more).
• Feeling unrest or sleepiness after waking.
• Worries about sleep.
• Gastrointestinal and stomach problems.
• Irritability and anger toward others.
• Depression and anxiety.
• Frequent accidents during waking hours.
• Inability to focus on tasks.
• Memory problems.

If you have any of these problems normally associated with insomnia, you should see a health care provider who may refer you to a sleep clinic for further diagnosis. Or, you may be asked to keep a sleep journal for awhile, noting your sleep patterns.

Some people are unaware of symptoms they’re having are related to insomnia issues. For example, if you suffer from sleep apnea, you may wake yourself up in the middle of the night and not realize why you awoke.

Symptoms of insomnia may eventually morph into real mental and physical problems, so you’ll want to have your sleep patterns evaluated to be sure and receive the proper diagnoses.

 

Habits keeping you awake.

Certain habits may contribute to insomnia issues and keep you from getting the rest you need to stay healthy. Some may be difficult to break while others are just a matter of tweaking your schedule a bit. Habits which may keep you awake are:

• Drinking caffeine or alcohol or smoking at the end of the day – Stimulants such as these can prevent you from falling asleep and alcohol may cause you to wake during the night.
• Eating a heavy meal before bed – A heavy meal can wreak havoc with your digestive system when you’re trying to get to sleep. A snack, however, may help you sleep all night.
• Exercising before bedtime – Exercise is a stimulation you don’t need right before bed. If you must exercise in the evening, try doing it about three or four hours before bed time.
• Follow a relaxing routine before bed time – Relaxing before you turn in is important to help shut down your metabolism so it doesn’t keep you up during the night. Taking a warm bath, reading a book or listening to soothing music are alternative ways to relaxation choices.

Be sure your bedroom is comfortable and conducive to sleep and use your bedroom only for sleeping (and sex) rather than a television room or working on your computer.

 

Risk factors for insomnia increase as you age.

As you age, your chances for developing insomnia and other related sleeping disorders increase. Some changes you may experience as you age increase your chances for insomnia includes:

• Less activity – Aging may result in a slower lifestyle. You may slow down your physical and social activities so eventually it interferes with you having a good night’s sleep. You may also nap in the afternoon, which can also interfere with how fast you fall asleep at night.
• Sleep pattern interference – As you age, you may become restless as you’re trying to sleep – especially if noise or other changes in the environment occur. Your internal clock may move forward as you age, meaning you’re more fatigued at the end of the day and get up earlier in the morning – even though you still may need the same amount of sleep as when you were younger.
• Medication interference – With age, comes increased use of medication, especially the more powerful ones which warrant a prescription. Many medications are factors in developing insomnia.
• Health changes – Chronic pain which occurs with conditions such as arthritis and psychological problems such as anxiety, depression and stress related conditions may lead to insomnia. Conditions such as enlargement of the prostate in men and hormonal changes in women may also be disruptive to your sleep patterns.

If you’re experiencing insomnia as a result of aging, speak to your health care provider about a solution.

 

Insomnia-Related Disorders

Medical conditions resulting in insomnia.

Some disorders and medical conditions which may result from or cause insomnia include:

• Sleep apnea – Sleep apnea can kill you. It’s caused by an obstruction to the airway when you sleep and limits the supply of air your body receives. Snoring loudly may occur with sleep apnea and you may also be awakened because of choking. You’ll likely feel very fatigued the next day and have problems falling asleep at night. Learn more about Sleep Apnea here.

• Alcoholism – Alcohol or drug addiction turns any condition into a vicious cycle altering your life in negative ways. Insomnia is one of them. The chemicals in alcohol and other drugs can compromise your immune system, gain weight, become anxious and depressed, raise blood pressure and much more. See your physician if you abuse alcohol or drugs and suffer from insomnia.
• High blood pressure – New studies indicate that some people who have been diagnosed with chronic insomnia are at risk for developing high blood pressure. The longer it takes you to fall asleep, the more agitated you may become, causing a rise in blood pressure.
• Restless Leg Syndrome - The sensations surrounding this sleep disorder occur during the night or day. The worst type of RLS is during the night. Your legs can feel prickly, tingly, itching or burning. Most certainly, this can keep you awake at night. Or at least keep you from reaching the restful levels of sleep. For more on Restless Leg Syndrome, check out our RLS page here.

Don’t let insomnia increase your risk of debilitating diseases. Take steps to end the cycle.

Stress may affect your sleep patterns.

Stress can rev up your brain just like you can rev up a motorcycle. Sometimes you just can’t get stressful thoughts out of your mind no matter how hard you try. When you’re stressed out, your mind races with thoughts you can’t control and may affect many parts of your life such as memory, mood and even muscle repair.

Lack of sleep because of stress may also affect your energy the next day and if it continues could cause problems at your job or in a relationship. You may not feel like exercising, but this is one of the main habits you can develop to alleviate stress – and also get a good night’s sleep.

If the stress if temporary, you may be able to relieve it by changing your lifestyle. Exercise, dietary habits, caffeine and alcohol may be controlled so you sleep better at night.

Even though you may be getting enough sleep, stress may interfere with the quality of sleep you get. Fair or poor quality sleep patterns may lead to insomnia and other conditions which affect your lifestyle.

Most of the time, relaxation techniques and tweaking your lifestyle will work to help you get a good night’s sleep, but if the stress continues, you may need to consult a therapist or sleep expert for more targeted help.

Depression and sleeplessness.

One factor keeping you awake at night is depression. People who complain of fatigue during the day discover depression is keeping them from a good night’s sleep and exacerbating the depression during the day.

The link between depression and insomnia is complicated. Those people who have chronic insomnia are more likely to develop depression – and those who suffer from depression are more likely to develop insomnia.

So, the two disorders aren’t separate of each other, but overlap. Just because you get rid of the depression doesn’t guarantee the insomnia will go away – and vise-versa. Both disorders should be treated to be able to improve the quality of sleep and the quality of life.

Anxiety and depression go hand-in-hand, just like depression and insomnia. When you remain anxious about a problem or impending problem, it’s more likely you won’t get a good night’s sleep. If the condition persists, depression (and insomnia) may occur.

New statistics show that treating sleep problems such as insomnia and other related disorders, depression can be prevented. One study indicated over 500 patients who suffered from insomnia and depression improved when treated with an anti-depressant and sleep medication.

Lifestyle changes also make a big difference and should be considered in all cases of depression and insomnia.

Fibromyalgia linked to insomnia.

Painful and sometimes debilitating, fibromyalgia is a leading cause for insomnia. As with other sleeping disorders, sometimes fibromyalgia may occur after a long bout with insomnia. Restless sleep usually occurs with the pain of trying to rest with fibromyalgia and insomnia may occur.

Rather than popping a pill to ease the pain and other symptoms of fibromyalgia, the medical community usually suggests lifestyle changes along with medication. Any lifestyle change which can reduce stress, pain and fatigue to help you get a good night’s sleep may also help with the insomnia issue. Studies indicate when fibromyalgia patients improve their sleep patterns, their moods are lifted, fatigue is lessened and concentration improves.

Those who suffer from fibromyalgia or chronic fatigue may have depressed immune systems. Sleep can be a positive influence in keeping your immune system healthy and ready to ward off diseases which may affect your life in a negative manner.

Sleep apnea, breathing and respiratory problems, allergies and enlarged tonsils may also cause insomnia and lead to fibromyalgia unless corrected. It’s important to address any and all causes which may be affecting your lack of sleep and resulting in chronic fatigue or fibromyalgia.

The connection between obesity and insomnia.

Statistics linking obesity and insomnia are alarming. The Centers for Disease Control and Prevention states over 65% of Americans suffer from obesity and the percentage is likely to increase over the next few years. Besides caloric intake and less physical activity, lack of sleep can also be a contributor to obesity.

Sleep apnea is a serious sleep disorder and may affect people who are overweight. Insomnia may occur if you have sleep apnea because you’re being constantly awakened by breathing difficulties. And, since sleep disorders may cause over-eating, the problem becomes a vicious circle difficult to break.

The connection between obesity and insomnia becomes even more profound because of the hormones ghrelin and leptin. One (ghrelin) alerts you when it’s time to eat and the other (leptin) lets you know when you’ve eaten enough. If you’re tired from lack of sleep or whatever reason, ghrelin hormone levels increase and leptin hormones decrease.

This causes a serious disparity in the way you eat and leads to more caloric intake than you need. A good night’s sleep can help your hormones adjust back to normal and may even cause you to lose weight.

Natural Approaches to Curing Insomnia

Sleep Hygiene.

Practicing good sleep hygiene should be the first step in trying to cure insomnia. It does not require drugs or doctor's appointments, just some adjustments in your waking and sleeping habits. Certainly, if you still have trouble sleeping after practicing good Sleep Hygiene, you should seek higher levels of treatment, such as seeing your doctor.

There is a lot of Sleep Hygiene information on this website. Check out the blog for more in depth articles, but in the meantime, here are some sleep hygiene basics.

• Eliminate caffeine from your diet – especially drinking it before you go to bed.
• Deep breathing - deep breathing can help you create a scenario at night where you can practice a relaxing breath helping you fall asleep. Learn some Yoga breathing techniques help.
• Exercise - Cardio exercises during the day are also imperative in getting a good night’s sleep. Aerobic exercise stimulates the production of certain chemicals in the brain which will serve to help you sleep more soundly when you go to bed.
• Relax in the evening - Warm baths are great ways to relax your body and get in the mood to sleep. Try adding some lavender or other relaxing herb to further enjoy the bath and put your body at rest.

• Get comfortable – Are you sleeping on an uncomfortable mattress or pillow? Before you spend money on new sleep furniture and accessories, consult with an osteopathic physician who is proficient in osteopathic-manipulative therapy to see if a few sessions are in order and what might enhance your sleep patterns.
• White noise can help – If you live in a noisy house or apartment, and the noise is keeping you awake, invest in an inexpensive “white noise” generator which produces soothing sounds such as ocean waves, rain and other relaxing sounds.

Cognitive behavioral therapy is a viable insomnia treatment.

If you’re having trouble with insomnia and plan to visit a health care provider, chances are he or she will recommend cognitive behavioral therapy as a treatment. Cognitive behavioral therapy is a safe and effective treatment used to tread many disorders – without the use of drugs

Sometimes called CBT-i is a program helping you to recognize sleep preventing behavior patterns. Physicians believe is an effective treatment for insomnia. When you begin to recognize the problems, you can then replace the behaviors with positive patterns helping you overcome the real problems resulting in sleepless nights.

CBT-I encourages you to understand your sleep cycles identify how behaviors, beliefs and other factors may affect your sleep. A sleep therapist will likely assist you in your quest to cure insomnia. You will begin by keeping a detailed sleep diary for a couple of weeks.

Cognitive behavioral therapy for insomnia helps you control your thoughts and adjust your behavior so the things normally keeping you awake remain controlled or completely eliminated from your life.

While sleep medications may be a short-term solution to your insomnia problems, CBT-I is a way to address the underlying causes of the problem rather than simply masking the symptoms. With a little time and effort, CBT-I may be the best solution.

 

The benefits of cognitive behavioral therapy to treat insomnia.

More health care providers are recognizing that cognitive behavioral therapy may benefit many people who need to avoid drugs and other harsh methods of treatment.

CBT-I is especially beneficial for those who are suffering from age-related illnesses and disorders. Many people who have suffered from insomnia for years or who have taken many over-the-counter and prescription medications to ward off the effects of insomnia have found CBT-I very helpful in alleviating the problems.

Seniors often suffer from chronic pain and other physical and mental problems which accompany aging. These conditions contribute to insomnia and other sleeping disorders which older people often develop.

Medications can often exacerbate symptoms of insomnia and also interact with other drugs you may be taking. And, whereas drugs and some other methods are temporary solutions, cognitive behavioral therapy can help long-term. No evidence exist that CBT-I have any negative side effects.

Cognitive behavioral therapy may also help you with other disorders such as anxiety or depression. It’s a viable alternative for other techniques which may be harmful to your health.

You’ll also benefit from learning ways to change bad behaviors or habits for good ones. Gaining an understanding of yourself and what makes you tick can be life-changing and eventually help you set and reach goals which have eluded you.

Finding the best treatment for insomnia.

There are trained practitioners who specialize in Behavioral Sleep Medicine. Although the number of sleep specialists are limited, you can find treatment which suits your needs and schedule. To begin your search for a sleep specialist, try the following organizations:

• Society of Behavioral Sleep Medicine – You can find a directory of Behavioral Sleep Medicine practitioners.
• American Board of Sleep Medicine – You can gather information about sleep disorders and sleep medicine specialists.
• American Academy of Sleep Medicine – A search site for sleep centers such as the Mayo Clinic Center for Sleep Medicine.
• National Sleep Foundation – Find information about finding a sleep practitioner who might be association with particular hospitals.

Some methods of treatment involve group sessions while some work with individuals and the sessions may vary in time and how often you go to treatment. Before you make an appointment with a sleep practitioner, be sure to ask what his or her approach to insomnia is so you’ll know what to expect.

There are also media you can purchase on CDs and websites devoted to curing insomnia, but meeting with a sleep medicine specialist is the preferred treatment.

Your health insurance may cover treatments for insomnia

Medical Approaches to Curing Insomnia

Drugs which may help treat insomnia.

*I'd like to put a big disclaimer out there that I don't think medication is a great approach to resolving insomnia. Maybe as a last resort, and certainly under the direction of your doctor.

Your physician may deem a prescription or over-the-counter drug may be the best choice for you to beat insomnia. All of these medications should be taken just before bed time and you should not drive or engage in other activities which require focus. Some drugs your doctors may prescribe to help insomnia include:

• Sonata – Also known as zaleplon, this drug has a short span of making you feel sleepy. This is a good choice if you awake during the night and need a boost to help you go back to sleep.
• Ambien or Intermezzo (zolpidem) – This drug comes in a couple of different strengths – long-term for helping you get to sleep and short-term if you tend to wake in the middle of the night.
• Rozerem (ramelteon) – This is the only drug which doesn’t depress the central nervous system. Instead, your sleep-wake cycle is the target and you can take it without fear of abuse or dependence.
• Desyrel and Remeron (trazodone and mirtazapine) – These are drugs used to treat depression, but may also be effective in treating insomnia which stems from anxiety.
• Over-the-counter Antihistamines – These sleep aids are sold without a prescription and work well to help you get to sleep, but the drowsiness may last through the next day.

These drugs may make you extremely sleepy and should be used with good sleep choices such as comfort and environmental conditions.

 

Alternative methods your doctor may prescribe.

Rather than popping a pill for all your medical maladies, the medical community is discovering other methods work better in helping alleviate and cure disorders such as insomnia. You and your physician need to explore the best method for you. Some alternative methods may include:

• Stimulus control therapy – You may be coached to try this method if you’re having trouble getting to sleep. Remove all conditions in the sleep area which makes your mind resist sleep, avoid naps, use the bed strictly for sleep and sex and leave the bedroom if you can’t get to sleep within a few minute. Return only when you’re sufficiently sleepy.
• Relaxation training – Calming your mind and relaxing your body from the stress of the day may be just what the doctor ordered to help you sleep. Your physician may suggest imagery, muscle relaxation, meditation and other methods of relaxing.
• Biofeedback – This technique lets you monitor your biological functions such as muscle tension and heart rate. You’ll receive feedback on how to adjust them so you can relax and enjoy a good night’s sleep. You may need to see a sleep specialist who will provide a biofeedback device so you can record your patterns.

Your health care provider may use the above methods combined with other techniques to ensure your sleep patterns improve without the use of drugs.

 

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