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Understanding Insomnia: Types, Causes, Symptoms, & Treatment

What is Insomnia?

Insomnia is a common condition in which you experience difficulty with sleep. The average amount of nightly sleep that an adult needs is between 7 and 8 hours, with some people needing less sleep and others needing more. The person with insomnia may experience difficulty falling asleep, frequent awakenings, waking too early, or non-restful sleep. Some people experience a combination of these difficulties.

Chronic insomnia is associated with increased risk for cardiac disease, ischemic stroke, glucose intolerance, weight gain, poorer quality of life, poor cognitive functioning, increased mental illness, and increased use of the health care system.

Symptoms associated with insomnia

People who experience sleeplessness frequently report a number of the following symptoms.

  • Difficulty falling asleep
  • Waking up frequently during the night
  • Difficulty returning to sleep
  • Waking up too early in the morning
  • Sleep that does not provide a feeling of being rested or refreshed
  • Daytime sleepiness
  • Inability to focus
  • Low energy levels
  • Irritability

Types of Insomnia

Insomnia can be grouped according to the cause of the sleep problem, frequency, and duration of the problem, or how sleep disturbance is experienced.

Primary insomnia is when you have difficulty sleeping that is not caused by another condition, such as illness, a drug, food, or drink.

Secondary insomnia is a sleep disturbance that is caused by another problem such as pain, caffeine, or tobacco. Most people who have insomnia have secondary insomnia. This type of insomnia usually goes away when you treat the condition causing sleeplessness.

Insomnia can be:

  • transient (for a short period)
  • intermittent (periods of poor sleep alternating with periods of good sleep)
  • chronic (occurs at least three nights per week for a month or more)

It may be experienced as:

  • Difficulty getting to sleep
  • Waking up frequently
  • Waking up too early in the morning
  • Waking up tired because sleep is not restful

Sleep apnea is said to occur when the sleeping person’s breathing is interrupted, thus interrupting the normal sleep cycle. This may cause the person to complain of sleepiness during the day and in some cases, the sleeping individual cannot continue breathing until he or she wakes up.

Restless legs syndrome forces the sleeping person to continually shift and move legs in order to avoid an unpleasant tingling sensation while sleeping.

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Parasomnia refers to different kinds of disruptive sleep events such as nightmares, sleepwalking, violent behavior while sleeping, and REM behavioral disorder in which the sleeping person moves their body parts in response to dream events.

Repeated exposure to jet lag, stress, caffeine, tobacco and other situations that cause sleep disturbance can lead to chronic insomnia. However, chronic insomnia is generally caused by more complicated factors such as physical and mental illness. One of the most common causes of chronic insomnia is depression.

Problems that can cause secondary insomnia are:

  • Illnesses such as lung, heart, or kidney disease, Parkinson’s disease
  • Hyperthyroidism
  • Other sleep disorder such as sleep apnea, narcolepsy, restless legs syndrome
  • Pain, anxiety, and depression
  • Medicines that have side effects that cause sleep disturbance Decongestants, Beta-blockers, Antidepressants, Alcohol, Bronchodilators, Pain medicine with caffeine, Stimulants such as Ritalin, Corticosteroids; and Thyroid hormone replacement.
  • Smoking before going to bed
  • Poor sleep environment, i.e. noisy, too hot or cold, uncomfortable
  • Change in sleep routine
  • Side effects of a medication such as those taken for colds and allergies, high blood pressure, heart disease, thyroid disease, birth control, asthma, pain, and depression, especially SSRI antidepressants.
  • Change in the sleep environment (hotel, camping)
  • Stress
  • Jet lag
  • Blindness-inability to detect light and darkness can disrupt the biological clock
  • Night shift work


Health care providers diagnose insomnia using your sleep and medical history. If you are experiencing difficulty sleeping you should keep a sleep diary. Write approximately how long it takes to fall asleep, the number of times you wake up, how long it takes to fall back to sleep, how early you wake up in the morning, how refreshed you are and symptoms of tiredness you experience throughout the day. Record caffeine intake, nap times, and events that may impact sleep. Information from your bed partner about your sleep habits, sleep movements, and quality and quantity of sleep may also be helpful.

For patients who suffer from other sleep disorders in addition to insomnia, specialized tests may be carried out as part of the diagnosis. These tests may be performed in sleep labs or at home with portable testing equipment. One such test is called a polysomnograph. Electrodes are placed on the skin and scalp to record brain waves (EEG), electrical activity of muscles, eye movement, breathing rate, blood pressure, blood oxygen levels, and heart rhythm.

There are two states of sleep: non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. Normally a person experiences four to five cycles of these two stages per night, with each cycle lasting about 90 minutes. A polysomnogram can show if there are disturbances in either or both of these stages of sleep, as well as the nature and severity of the disturbance.

Treatments of Insomnia

Short-term and intermittent insomnia may not require treatment. Practicing good sleep habits and avoiding external circumstances that interrupt sleep may be enough to cure insomnia that is not chronic.

The best approach of treatment of lack of sleep depends on the underlying cause and the type of insomnia, but some available options include:

  • counseling
  • cognitive behavioral therapy, or CBT
  • prescription medications
  • over-the-counter sleep aids
  • melatonin, which is also available for purchase online

However, there is not enough strong evidence to prove that melatonin helps with sleep.

Alternative Medicine

There are alternative medicines that may help certain people sleep. It’s important to know that these products are not required to pass through the same safety tests as medications, so their side effects and effectiveness are not as well understood.


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