Why Do I Have Insomnia?
Dr. Angel Rivera
Chronic sleep disorders are estimated to annually affect up to 70 million people in the United States according to the Centers for Disease Control and Prevention (CDC) and insomnia is one of the most common ones.
It can be caused by many factors, including stress, anxiety, depression, and medications, and can also be a symptom of other health conditions among many other factors.
If you are having trouble sleeping, you need to see your doctor for a diagnosis as there are many treatment options available for insomnia too that we will detail below.
What is insomnia?
Insomnia is a sleep disorder that can make it difficult to fall asleep, stay asleep, and cause you to wake up earlier than expected although it is also possible to have a combination of the three.
You may suffer from acute insomnia (short-term insomnia) or chronic insomnia (long-term insomnia), with acute insomnia being temporary and only lasting from a day to a few weeks while chronic insomnia is defined as having difficulty sleeping three or more days a week for at least three months.
You will likely not have to seek treatment for acute insomnia while chronic insomnia may require treatment.
Other forms of insomnia include primary insomnia, which is when sleep difficulties are not caused by another health condition, and secondary insomnia, which is when sleep difficulties are a symptom or side effect of another problem.
All types of insomnia can diminish your quality of life due to poor sleep and also lead to other risks for health problems such as heart disease, stroke, and diabetes.
A normal night for a healthy adult is seven to nine hours of sleep, but if you have insomnia you may have many sleep disturbances causing sleep loss or even have sleepless nights.
What are the causes of insomnia?
There are many potential causes of insomnia that range from psychological factors, physical factors, and environmental factors.
The most common causes of insomnia include:
Insomnia is often caused by stressful life events. When you have high-stress levels, your body's fight-or-flight response is triggered which releases hormones like adrenaline and cortisol making it harder to fall asleep and stay asleep.
Sources of stress can include work, school, medical situations, relationships, and finances.
Mental disorders such as post-traumatic stress disorder (PTSD) can also play a factor.
Anxiety and anxiety disorders can also make it difficult to fall asleep or stay asleep as your mind is racing with worry. You may have anxiety about an upcoming event, such as a presentation at work, or something from your past that is bothering you.
Depression is a common cause of insomnia as it can make it hard to fall asleep and stay asleep.
It can make you feel exhausted during the day which makes it difficult to fall asleep at night and you may also have negative thoughts that keep you up at night.
When you have chronic pain such as arthritis or fibromyalgia (widespread pain in your muscles) it can be difficult to fall asleep and stay asleep as the pain may wake you up or make it hard to get comfortable.
Two of the main causes of insomnia from sleep disorders are restless legs syndrome and obstructive sleep apnea.
Restless legs syndrome (RLS) is a condition where you have an urge to move your legs, usually due to an uncomfortable sensation that can make it hard to fall asleep as you feel the need to keep moving your legs.
Obstructive sleep apnea (OSA) is a condition where your breathing is interrupted during sleep which can cause you to wake up or make it difficult to stay asleep ruining your sleep cycle.
Irregular sleep schedules
If you have an irregular sleep schedule due to working odd hours or frequently traveling, it can make it difficult for your body to adjust and fall asleep.
Differing sleep schedules due to work can make it difficult to get into a sleep pattern or sleep routine while traveling which can disrupt your circadian rhythm due to frequently crossing back and forth over different time zones and causing jet lag.
Unhealthy sleep habits
Using the television, laptop, or mobile phone in bed can make it difficult to fall asleep as the bright screens can keep you awake.
Poor sleep habits also include working or doing other activities in bed that can also make it hard to sleep as your bed needs to be only associated with sleep and sex.
Consuming caffeine, nicotine, a large meal, or alcohol before bed can also make it difficult for you to fall asleep.
Your sleep environment can also play a role in insomnia. If your bedroom is too bright, noisy, or uncomfortable it can make it difficult to fall asleep or stay asleep.
Creating a dark, quiet, and cool environment with a comfortable mattress and sheets, and possibly using a sleep mask can help you fall asleep and stay asleep throughout the night.
There are many prescription drugs that can cause insomnia as a side effect. Some of the most common include:
- Blood pressure medications
- Asthma medications
The potential side effects of these medications can include difficulty falling asleep, waking up frequently during the night, or early morning awakening.
If you suffer from substance abuse you may also have difficulty falling or staying asleep when in withdrawal. Over-the-counter medications such as pain medications, cough and cold medications, and weight loss supplements may also contain caffeine or stimulants that can cause adverse effects.
There are many neurodegenerative diseases that can cause insomnia including Parkinson's disease and Alzheimer's disease.
Also, if your child is on the autism spectrum, they may have difficulty falling asleep or staying asleep due to their condition.
During pregnancy, it is common to have difficulty falling asleep or staying asleep due to the many changes happening in your body, including hormone changes and an increase in getting up at night to use the bathroom.
Other medical conditions
Chronic pain, pregnancy, and neurological problems are not the only health conditions that can cause insomnia. Others include:
- Gastroesophageal reflux disease (GERD)
- Heart disease
- Overactive thyroid
Please see your doctor or health care provider if you believe your insomnia may be caused by another health condition and discuss treatment options.
What are the risk factors for insomnia?
There are many factors that can increase your risk of developing insomnia. Some of the most common include:
- Health issues whether they are mental health disorders or physical health conditions
- Irregular sleep schedule
- Age (being 60 or older)
- Gender (being female)
You are more likely to get insomnia as a woman due to hormonal changes such as menopause and premenstrual syndrome (PMS).
Being older than 60 is also a risk factor due to possible changes in your sleep schedule, taking more medications, and a lack of physical activity.
What are the symptoms of insomnia?
The symptoms of insomnia can vary from person to person but the most common insomnia symptoms include:
- Difficulty falling asleep
- Waking up frequently during the night
- Waking up early in the morning
- Memory troubles or cognitive impairment
- Feeling tired during the day and having daytime sleepiness
- Difficulty concentrating or focusing
- Increased chances of motor vehicle accidents or risk of falls
If you have these symptoms and have not received a diagnosis of insomnia please see your doctor so they can help develop a treatment plan that is catered for you.
How is insomnia diagnosed?
If you believe you suffer from insomnia please see your doctor. During your appointment, they will ask about your medical history, sleep habits, and how long you have been experiencing symptoms.
They may also ask about any medications you take, mental health conditions, and physical health conditions.
Your doctor will then conduct a physical exam to look for other possible causes of your insomnia and they also may ask you to keep a sleep diary to get a better grasp of your sleep disturbances. In some cases, your doctor may also order a sleep study to be conducted overnight that is monitored by a sleep expert in a sleep lab.
There are also now at-home sleep tests that you can use in the comfort of your own home if you are not comfortable spending the night in a sleep lab.
What are the treatment options for insomnia?
The treatment options for insomnia vary depending on the cause of your insomnia and how severe it is. Some of the most common treatments include:
Cognitive behavioral therapy for insomnia (CBT-I)
Cognitive behavioral therapy is a type of therapy that helps you change the thoughts and behaviors that are keeping you from sleeping and is one of the most common treatments for insomnia.
Common examples of CBT-I include using relaxation techniques such as meditation, deep breathing exercises, progressive muscle relaxation, biofeedback, and also using light therapy for your circadian rhythm.
CBT-I may also ask you to change your habits such as avoiding naps, using your bed for sex and sleep only, and stimulus control therapy using artificial light.
There are many medications that can be used to treat insomnia including:
- Benzodiazepines, which are also called benzos or BZDs and include such prescription medications as alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan)
- Non-benzodiazepines, which are also called Z drugs and include zolpidem, eszopiclone, and zaleplon
- Over-the-counter medicines such as antihistamines or a melatonin supplement
These medications are only meant to be used for a short period of time due to the possibility of developing a dependence on them, especially benzodiazepines.If you and your doctor feel that medications are the best treatment option for you they will help you find the lowest possible dosage for the shortest amount of time to minimize any risks.
If your insomnia is due to a lifestyle factor such as an irregular sleep schedule, too much caffeine, or stress, then making some changes to your lifestyle can help. Some common lifestyle changes that can help improve insomnia include:
- Sticking to a regular sleep time and wake-up time even on the weekends
- Limiting caffeine intake and avoiding it hours before bedtime including in the afternoon and evening
- Avoiding alcohol before bedtime
- Exercising regularly but not right before bedtime
- Creating a relaxing bedtime routine that may use soothing music, a warm bath, or reading a book
- Limiting screen time before bedtime
- Reducing stress with relaxation techniques such as yoga, meditation, and deep breathing exercises
Insomnia is a common sleep disorder that can make it hard to fall asleep, stay asleep, or both which can affect your sleep quality and overall health.
There are many different causes of insomnia which we go into detail above.
The symptoms of insomnia can vary from person to person but some common ones include feeling tired during the day, trouble concentrating, irritability, and mood swings.
The treatment options for insomnia vary depending on the cause of your insomnia and how severe it is but some common ones include cognitive behavioral therapy for insomnia, medications, and lifestyle changes.
If you think you may be suffering from insomnia or have sleep issues please talk to your doctor or health care provider.
References, Studies and Sources:
National Sleep Foundation