From self.com
The tossing and turning might be signalling a deeper problem
We’ve all been there: You can’t fall asleep, you get worried about not being able to fall asleep, and the vicious cycle begins. If you’re wondering what causes insomnia, the answer isn’t always simple, but all that tossing and turning often boils down to some type of stress.
From time to time, it’s common to struggle to fall asleep, battle frequent wake-ups throughout the night, or notice your mind starts running far too early in the morning. In fact, insomnia is the most common sleep complaint, affecting over one in three adults at any time, per the American Academy of Sleep Medicine (AASM).
But chronic insomnia usually isn’t a standalone issue. Rather, it’s an actual sleep disorder—and a possible sign of an underlying problem with your lifestyle, environment, or overall health.
“In my practice, sleep and insomnia are so important we often call this the ‘canary in the coal mine,’" Alex Dimitriu, M.D., a sleep physician double-board-certified in psychiatry and sleep medicine and founder of Menlo Park Psychiatry & Sleep Medicine in California, tells SELF. “If sleep is off for some time, there is usually something deeper worth looking into.”
While many of us are tempted to adjust to this lack of sleep with more coffee and naps, it’s important to take insomnia seriously. Over time, poor sleep can contribute to a slew of issues, ranging from chronic health conditions like diabetes and heart disease to serious accidents and injuries, per the Cleveland Clinic. Just how much sleep you need can vary, but most of us function best between seven to nine hours of shut-eye each night.
If you’ve been lying in your bed wide awake, keep reading to learn what could be causing your insomnia, when to bring up your sleep issues with a doctor, and what types of treatment can help get you snoozing soundly again.
What are the symptoms of insomnia?
First, a quick primer on what this sleep disorder actually does to your body and mind. Potential symptoms of insomnia may include:
- Struggling to fall asleep
- Waking up in the middle of the night or too early in the morning
- Feeling tired, sleepy or foggy during the day
- Having problems paying attention, concentrating, or remembering
- Moodiness, irritability, or depression
- Impulsive or aggressive behaviour
- Lower energy, motivation, or performance at work or school
- Being more prone to mistakes and accidents
- Feeling frustrated or worried about poor sleep
Are there different types of insomnia?
Experiencing short-term disturbed sleep is more common than chronic insomnia, per the U.S. National Library of Medicine. In this case, you may experience symptoms for days, weeks, or sometimes a couple of months due to a particularly stressful period at work or a traumatic life event, like losing a family member or going through a painful breakup.
Chronic insomnia, on the other hand, means you have trouble falling and staying asleep at least three times a week for three months or longer. It can also be triggered by things like never-ending stress, difficult emotions you haven’t worked through, or constant travel that’s throwing your schedule out of whack. However, this type of insomnia can present as a side effect to a deeper issue as well, like an underlying health condition, medication plan, or substance use.
What causes insomnia?
Let’s dive deeper into the most common reasons you may be missing out on sleep:
“In some ways, insomnia is like an anxiety disorder about not getting enough sleep," Jason Ong, Ph.D., director of behavioural sleep medicine at SleepCharge by Nox Health and adjunct associate professor of sleep medicine at Northwestern Feinberg School of Medicine, tells SELF. “Anxiety about sleep and the attempts to try and make sleep happen actually perpetuate the problem by inadvertently disrupting your body’s regulation of sleep.”
A common response is to try to fix the issue by trying harder to fall asleep. However, moves like hopping in bed when you believe you should be sleepy (but aren’t) just turn up the pressure. In turn, you tend to feel even more restless and awake.
If you’re a jetsetter travelling across time zones for work, for example, or a shift worker trying to sleep during the day, disturbed sleep could follow. The root of the problem is known as circadian misalignment, or trying to sleep at times that don’t match your internal body clock, which regulates your sleep-wake cycle, says Dr. Ong.
An overwhelming work schedule, looming debt, caregiving, the loss of a loved one—any number of stressful life events could trigger insomnia. That’s because chronic stress flicks on your fight-or-flight response, Ash Nadkarni, M.D., an associate psychiatrist at Brigham and Women's Hospital and an instructor at Harvard Medical School, tells SELF. This cues a flood of stress hormones like adrenaline and cortisol into your bloodstream. When your stress doesn’t subside and that “on” switch gets stuck, these hormones keep surging through your body at night to keep you alert, blocking your ability to relax and ease into sleep.
Insomnia is a symptom of many psychiatric disorders, including depression, anxiety, obsessive-compulsive disorder (OCD), bipolar disorder, and post-traumatic stress disorder (PTSD), per the National Alliance on Mental Illness (NAMI). While the relationship is complicated and more research is needed, researchers hypothesize the link is due to changes like a heightened stress response, issues with neurotransmitters or chemical messengers like serotonin, norepinephrine, and dopamine, plus associated problems with the internal body clock and sleep cycle, says Dr. Nadkarni.
This brings us back to that “canary in the coal mine” comment: Insomnia may stem from numerous health problems including other sleep disorders like restless legs syndrome, narcolepsy, or sleep apnoea, chronic pain due to conditions like arthritis or headaches, cancer, gastrointestinal disorders such as heartburn or GERD, hormone fluctuations during your period or due to thyroid disease, or even neurological disorders like Parkinson’s disease, per the Cleveland Clinic.
Insomnia can also be an unwanted side effect of certain medications or drugs. Stimulants, for example, cause a release of certain neurotransmitters, which in turn may disrupt your ability to fall and stay asleep, says Dr. Nadkarni. Others cause a change or reduction in sleep quality.
Common culprits include:
- Stimulants like caffeine and nicotine
- Some medications used to treat depression, ADHD, high blood pressure, or Parkinson’s disease
- Alcohol or other sedatives
- Some asthma medications such as theophylline
- Decongestants and allergy and cold medications that contain pseudoephedrine
- Some steroids like prednisone
- Drugs such as marijuana, LSD, and ecstasy
Poor sleep hygiene—or habits that wreck your ability to doze off—can also contribute to insomnia. Staying in bed for long periods of time (hello, revenge bedtime procrastination) or taking naps, for instance, often sets you up for more sleep disturbances at night, says Dr. Ong. If you’re not getting enough exercise, working late, going to bed at different times each night, or using your phone or watching TV in bed, you could also be making good sleep harder to come by, according to the U.S. National Library of Medicine.
While it’s typically not the root cause for insomnia, issues with your sleeping environment could also make it harder to get a good night’s rest, says Dr. Nadkarni. Think: bright street lights illuminating your bedroom, noisy neighbours, a snoring sleeping partner, or a mattress or comforter that traps too much heat.
When should you see a doctor about insomnia?
“Anyone that consistently gets less than six hours of sleep per night or experiences significant next-day symptoms of fatigue, low mood, or sleepiness, should consider speaking with a doctor,” says Dr. Dimitriu.
Generally, if it’s been a few weeks and your lack of sleep is really interfering with your day-to-day life and ability to function, it’s a good idea to seek professional help, Dr. Ong agrees.
Start by reaching out to a primary care doctor. Since insomnia can be caused by so many different health issues, they can help identify whether it’s necessary to refer you to a sleep specialist or psychiatrist, says Dr. Nadkarni.
What does insomnia treatment look like?
Treatment for insomnia typically includes addressing the underlying cause, making lifestyle changes to improve sleep hygiene, going to therapy, and/or taking medication.
If you have disturbed sleep, step one is to improve your sleep habits. A few quick tips:
- Go to bed and get up at the same time every day, even on weekends.
- Exercise more during the day, ideally outside if you can.
- Avoid large meals, too many fluids, and stressful discussions before bed.
- Limit naps and don’t snooze in the late afternoon.
- Cut down on alcohol and nicotine intake, and avoid “nightcaps.”
- Keep your bedroom dark, quiet, and cool—ideally between 60°F to 67°F for a peaceful snooze.
- Create a wind-down routine before bed with relaxing self-care activities like a long bath or meditation.
- Schedule a digital curfew at least 30 minutes before bedtime.
- If you can’t stop intrusive thoughts, try writing out your worries.
- If it’s been about 20 to 40 minutes and you can’t fall asleep, get out of bed and go do something relaxing—like reading a book—until you’re sleepy.
For chronic insomnia, the first-line treatment is cognitive behaviour therapy for insomnia (CBT-I), which lasts for about five to eight sessions with a licensed therapist in person or virtually. “This is a specific type of psychotherapy that uses cognitive and behavioural strategies based on the science of sleep to help patients regain their ability to regulate sleep,” says Dr. Ong. The key is to target anxiety and behavioural problems surrounding sleep issues with stress-reduction practices, relaxation, and healthy sleep habits.
If CBT-I is unavailable to you or simply not working fast enough, you can also try sleep medications like zolpidem (Ambien) or eszopiclone (Lunesta), provided that your doctor recommends them for your situation, says Dr. Ong. Keep in mind it’s important to take these under close medical supervision, as they do come with risks such as dizziness, brain fog, and possible dependence.
Bottom line: Whether your insomnia is short-lived or long-lasting, you shouldn’t have to just deal with it. With the proper help, you can have better sleep and start living well again.
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