Insomnia is the inability to fall asleep and stay asleep. It is classified as a sleep disorder and people with this condition do not get enough sleep. They also do not get refreshing sleep after they do fall asleep. The condition may only last a short while, especially during times of emotional trauma, stress, or financial trouble. This is known as acute insomnia and usually clears up within a week or two. It can also be long-term as a symptom of something else going on. This is known as chronic insomnia and could be related to medication side effects, actual sleep disorders, substance abuse, and illness. Both acute and chronic insomnia can lead to disruptions in daily life. You may feel daytime sleepiness and be unable to pay attention, complete needed tasks, or experience problems with learning. It can also cause problems with driving or operating heavy machinery. Common symptoms of insomnia are:

• Sleepy during daytime hours
• Anxiety
• Unrefreshing sleep
• Early waking
• Headaches
• Stomach upset
• Irritable moods
• Depression
• Trouble thinking
• Accidents
• Excessive worry about sleep issues

There are two types of insomnia, primary insomnia, and comorbid insomnia. Primary insomnia occurs when a person has sleep problems not related to a health condition or problem. Comorbid insomnia is caused by an underlying or co-existing health condition. Common co-morbidities are depression, substance use (i.e., alcohol), a chronic health condition or disease ( i.e., asthma, cancer, arthritis, heartburn, etc.). Insomnia is also classified according to its psychophysiological association, or “mind-body” connection. People who have insomnia may not be able to relax their mind and worry excessively about not being able to fall or stay asleep. This causes insomnia to become a chronic condition for those people who may have recovered from the initial stress that caused acute insomnia. The stress of not being able to sleep initiates a cycle where the sleeplessness and difficulty sleeping causes a person so much worry that they are not able to relax his or her mind enough to fall asleep.

Insomnia can be due to several factors including:

Changes in routine. If you have been traveling across time zones, started working a night shift, or changed from a night shift to a day shift your body will not know when it is time to sleep. This usually only results in temporary insomnia.

Emotional upset. If you have had recent emotional trauma, you may be unable to sleep if you are thinking about the event.

Stress and anxiety. Anxiety and stress can make your thoughts race. Thinking about family, school, or work too close to bedtime may make it hard to fall asleep.

Depression. People with depression often feel tired and nap during the daytime hours. These naps can make it hard to fall asleep at night.

Environmental factors. Light, noise, and extreme temperatures (cold and hot) can interfere with your sleep.

Medication. Certain medications have stimulant side-effects that can interfere with sleep. These include allergy medication, heart medication, blood pressure pills, antidepressants, steroids, and decongestants.

Health conditions. Some medical problems make it hard to sleep such as pain, breathing trouble, frequent nighttime urination, and heartburn.

Sleep routine. If you look at your phone screen in bed or watch TV, you may be interfering with your sleep routine. Your bed should only be for sleep.

Using caffeine too late. Try not to drink too much caffeine in the afternoon or later in the day.

Eating too late. Going to bed with a full stomach can stall your sleep. Eat dinner early and keep bedtime snacks light.

Some factors increase your risk for insomnia including:

• Female gender
• Age over 60
• Travel across time zones
• Night shift work
• High stress
• History of depression or anxiety

 

If you are worried about having insomnia, make an appointment with your healthcare provider.

Unfortunately, no test can diagnose insomnia. Your doctor will take a medical history, give you a physical exam, and ask you questions about your sleep habits. You may be asked to keep a sleep diary for a set period in which you record your sleep patterns and symptoms. Some cases of insomnia are referred to a sleep center for tests that may diagnose underlying health conditions. Your physician may also order lab tests to see if there is a physical cause for your sleeping problems.

Before you try prescription medication for sleep, your doctor may recommend a few things that may help including:

• Cognitive-behavioral therapy (relaxation techniques, anxiety relief, therapy)
• Over-the-counter medications
• Lifestyle changes

If the above things do not work, your doctor may put you on prescription medication for insomnia short-term. They do have side-effects like sleepwalking, sleep-driving, and sleep eating. Some people do things in their sleep they don’t remember doing.

Try an herbal remedy. If your doctor gives the okay, the following herbal remedies have been shown to help promote good sleep:

Melatonin.  This hormone is made by the pineal gland- a very small gland located deep in the middle of the brain. The pineal gland secretes melatonin in response to daylight and darkness. In the daytime, melatonin levels are low. In a natural setting without artificial light exposure, the pineal gland will secrete high levels of melatonin in the absence of light. Melatonin helps to dictate the timing of your 24-hour internal clock, circadian rhythm. Low levels of melatonin have been shown to cause insomnia and research has shown that melatonin may help promote sleep in people dealing with insomnia. More importantly, regulating your exposure to artificial light may help to reset circadian rhythms in your body, thus allowing the secretion of an appropriate amount of melatonin to promote a good night’s rest.

L-tryptophan. Research shows that this amino acid may decrease the amount of time it takes for an insomniac to fall asleep and helps to reduce waking episodes. L-tryptophan was also shown to lift the mood and increase energy due to it being used in the serotonin uptake system.

Valerian root. Extract from the root of this flower may help improve sleep quality without the side effects that accompany many over the counter and prescribed sleep aids. The root bark can be taken as a tea or in supplement capsule form.

Chamomile. This pretty little white flower is a timeless herb that has been used for centuries to help relax the mind and promote sleep. Many different teas contain chamomile, or you can drink it on its own. You can also grow chamomile in your garden and collect the flowers for a fresh infusion.

Kava. A sleep study has shown that kava (combined with valerian) helped to reduce anxiety-caused insomnia symptoms in patients who were under significant stress. Participants stated that their stress severity was relieved and poor sleep symptoms improved after using both supplements for six weeks. Some participants of the study experienced vivid dreams, and a few stated they had gastric discomfort and dizziness after using kava.

Note: Herbal remedies can have side effects and sometimes severe drug interactions. Make sure you tell your doctor everything you are taking including herbs and check to see they are okay to use first.

Caffeine, tobacco, and other stimulants. The effects of these substances can last as long as 8 hours.

Certain over the counter and prescription medicines can disrupt sleep. For example, some cold and allergy medicines. Talk with your doctor about which medicines won’t disrupt your sleep.

Avoid alcohol. Alcohol may help you go to sleep easier, but you will sleep lighter. People who drink alcohol before bed often find they wake up in the middle of the night.

Have a good sleep routine. A bedtime routine can help you fall asleep and sleep better during the night. Do things like; bathe, meditate, read, or turn on nature sounds music. Do not exercise before bedtime as endorphins can be stimulating.

Make your room comfortable and NO television in your room. Keep your room around 68 degrees. Use table lamps instead of overhead lighting and avoid television or loud music in your room.

Keep the same bedtime. Start going to sleep at the same time every evening. If you have insomnia, avoid working night shifts. Keep your wake time the same every day too, even on your days off work.

Eat your way to good sleep. Make sure you are eating enough carbohydrates to help your body make enough serotonin/melatonin. These are natural chemicals in your body that promote good sleep. Try eating a bowl of cereal or a granola bar in the evening. Also, make sure you are getting enough vitamins and minerals in your diet.

Avoid stimulants late in the day.

If insomnia is just temporary, it should get better in a few days to weeks. Insomnia that is severe or chronic may take longer and need treatment. Understand that using prescription sleeping pills can encourage dependence on them, so lifestyle modifications should always be tried first.

The complications of insomnia can be serious. If you suffer from severe insomnia, make sure you are okay before driving, doing dangerous activities, or even taking care of others. Complications include:

• Car accidents
• Falling
• Inability to think quickly and respond to danger
• Poor learning
• Weight gain
• Irritable moods

These complications may be preventable with early intervention. If you have symptoms of insomnia lasting more than a few days, see your doctor.

Cleveland Clinic Writing Staff. (2021). Insomnia. Retrieved from: https://my.clevelandclinic.org/ccf/media/files/Neurological-Institute/sleep-disorders-center/insomnia.pdf

Costello, R. B., et al. (2014, November 07). The effectiveness of melatonin for promoting healthy sleep: a rapid evidence assessment of the literature. Nutrition Journal, 13(106). Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4273450/

Mayo Clinic Staff. (2016, October 15). Insomnia. Retrieved from: https://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167

Roth, Thomas. (2007, August 15). Insomnia: Definition, prevalence, etiology, and consequences. Journal of Clinical Sleep Medicine, 3(5 Suppl), S7-S10. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978319/

Silber, B. Y. & Schmitt, J. A. (2009, September 2009). Effects of tryptophan loading on human cognition, mood, and sleep. Neuroscience and Behavioral Reviews, 34(3), 387-407. Retrieved from: https://www.researchgate.net/publication/26775546_Effects_of_tryptophan_loading_on_human_cognition_mood_and_sleep