What Is Insomnia?
People with insomnia have trouble falling asleep, have disrupted sleep, or they awaken too early. As a result, they may get too little sleep or have poor-quality sleep. They don’t feel refreshed when they wake up.
Insomnia can be acute (short-term) or chronic (ongoing). Acute insomnia is common and often is brought on by situations such as acute stress at work or at home. Acute insomnia lasts for days or weeks and usually gets resolved along with the acute stress. We have all experienced a bad night’s sleep at one time or another.
Chronic insomnia means poor or disrupted sleep that lasts a few weeks or longer. Many cases of chronic insomnia are secondary to some other problem. Certain medical conditions, medicines, sleep disorders (like sleep apnea), and non-prescription drugs can cause secondary insomnia. Insomnia in such cases may be due to pain or discomfort, or to the emotional burden of having to deal with (and treat) a chronic disease. A less-frequent chronic form of insomnia is primary insomnia. Primary insomnia isn’t due to medical problems, medicines, or non-prescription drugs. It is its own distinct disorder, and its causes are not well known at present. Life or personal changes can sometimes trigger primary insomnia, including long-lasting stress and emotional upset.
Insomnia can cause daytime sleepiness and a lack of energy. It also can make people feel anxious, depressed, or irritable. People with insomnia may have trouble focusing on tasks, paying attention, learning, and remembering. These problems can affect work or school performance.
How Is Insomnia Treated?
For acute insomnia, solutions include fixing the acute stressor and lifestyle changes. Lifestyle changes can include better sleep habits, which often help relieve acute insomnia. Examples here include a regular bed-time, using the bedroom only for sleep or sex, and avoiding caffeine and other stimulants before bedtime.
For chronic insomnia, the first thing to determine is whether the sleep problem is primary, or secondary to something else. If it is caused by something else, treating the underlying cause may resolve or improve the sleep problem, especially if the problem is identified and addressed relatively quickly. For example, if caffeine or alcohol is causing your insomnia, stopping or limiting your intake might make the insomnia go away. If the insomnia is related to a medical or psychiatric condition, or to the treatment for the condition, speak with your doctor about what the medical options are. Once the medical treatments for the secondary insomnia are in place, or if instead the problem is primary insomnia, there are lifestyle and therapy options still available.
Lifestyle treatment options
All people with insomnia should try to avoid drugs that could make the problem worse, such as alcohol, caffeine, and nicotine. The sleep-disrupting effects of these substances can last 8 or more hours. The person with insomnia can also try to avoid over-the-counter drugs that can disrupt sleep (for example, some cold and allergy medicines). They can talk with a doctor about which medicines won’t further disrupt sleep. People with insomnia can also try to schedule their daily exercise at least 5 to 6 hours before going to bed. They can avoid being too hungry (or eating heavy meals or drinking a lot) shortly before bedtime. They can try to adopt bedtime habits that make it easier to fall asleep and stay asleep. For example, they can follow a routine that helps them to wind down and relax before bed. If necessary, they can leave the bedroom and read a book, listen to soothing music, or take a relaxing bath. They can make their bedroom more sleep-friendly. They can avoid bright lighting while winding down and try to limit possible bedroom distractions, such as a TV, computer, or pet. They can make sure the temperature of their bedroom is cool and comfortable. Their bedroom also should be dark and quiet. They should go to sleep around the same time each night and wake up around the same time each morning, even on weekends. If they can, they should avoid night shifts, alternating schedules, or other things that may disrupt their sleep schedule. If the lifestyle changes are not working, there are therapy options to consider.
Cognitive-Behavioral Therapy (CBT) options
CBT is effective for insomnia, and for the psychological causes of insomnia. CBT for insomnia targets the thoughts, feelings and actions that can disrupt sleep. This therapy encourages good sleep habits and uses several techniques to relieve anxiety or other negative moods that can disturb sleep. For example, relaxation techniques and biofeedback (monitoring the body’s reactions) are used to reduce anxiety, tension or anger. These strategies help people better control their breathing, heart rate, muscles, and mood. CBT also aims to replace sleep anxiety (or sadness or anger) with more positive thinking that links being in bed with being asleep. This method also teaches people what to do if they are unable to fall asleep within a reasonable time. CBT also may involve talking with a therapist one-on-one or in group sessions to help them understand and cope with the thoughts and feelings that disturb sleep (like depression, anxiety or personal or relationship difficulties). This method may assist people to describe and better cope with thoughts racing through their mind in terms of how they look, feel, and sound. For example, one goal might be for the mind and body to settle down and stop racing. CBT also focuses on limiting the time people spend in bed while awake. This method involves setting a sleep schedule. At first, people in the therapy will learn how to limit the total time in bed to the typical short length of time they are usually asleep. This schedule might make them initially even more tired because some of the allotted time in bed will be taken up by problems falling asleep. However, the resulting tiredness is intended to help them eventually to get to sleep more rapidly. Over time, the length of time spent in bed is increased until they get a full night of sleep. For success with CBT, patients may need to see a therapist who is skilled in this approach weekly over 2 or 3 months. Research shows that CBT works as well as prescription medicine for many people who have chronic insomnia, and may provide better long-term relief than medicine alone. For people who have insomnia and chronic depression, CBT combined with antidepressant medicines can help in relieving both conditions.
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