From healthcentral.com
Occasional tossing and turning is one thing—but if you’re experiencing regular sleep disruptions at night and trouble functioning during the day, it could be a medical condition
You might toss around the term insomnia after hours of desperately staring at the ceiling but there’s a difference between a single sleepless night and a string of them (or even many months of them!) that typifies this sleep condition.
For sure, whether your restless nights are frequent or few and far between, it feels incredibly stressful when it happens. But there are differences when it comes to the long-term effects on your health. “One night of bad sleep will not destroy your life,” says Seema Khosla, M.D., the medical director of the North Dakota Centre for Sleep in Fargo, ND. But insomnia, she cautions, can have very deleterious effects, causing headaches, mood changes, and even contributing to chronic health issues like diabetes.
About 30% of adults have symptoms of insomnia, per the American Academy of Sleep Medicine, so sleeping is consistently difficult for you, you’re not alone. Here, we asked experts like Dr. Khosla what to know about insomnia, when to talk to a doctor, and how to get the sleep you so desperately need.
What Is Insomnia?
Insomnia is defined as either a short-term (acute) or longer-term (chronic) inability to get consistent sleep. Most adults need seven to nine hours of shuteye daily, though the right number for you can be highly individual. Insomnia is typically considered chronic when it happens at least three nights per week for three months or longer. However, Dr. Khosla notes that it’s worth talking to a doctor if your inability to get good sleep is consistently, negatively impacting your waking life, whether you meet an official definition or not.
Rather than clock-counting at night (which can hurt more than it helps) or relying on your smartwatch to track your sleep, she suggests people focus most of their energy on how they feel during the day. “Sometimes someone will come in who says they feel fine all day, but they’re concerned because their sleep tracker says they're only getting an hour of deep sleep,” she notes. Daytime impacts are the biggest tell-tale sign of an issue. Meanwhile, if you always feel tired and moody, and have a hard time waking up, Dr. Khosla says it’s worth talking to someone, even if your smartwatch says you’re getting a perfect eight hours each night.
Types of Insomnia
The International Classification of Sleep Disorders, 3rd edition (ICSD-III) now classifies most cases of insomnia into two main categories, per StatPearls:
Short-term insomnia. Insomnia that lasts under three months (also sometimes called transient or acute insomnia) fall into this category.
Chronic insomnia. Insomnia that lasts for three nights per week for at least three months is considered chronic.
Doctors used to categorise insomnia by its cause, the National Library of Medicine notes. It was usually divided into two categories:
Primary insomnia. This type of insomnia is not linked to medications, a health condition, or a specific problem.
Secondary insomnia. This refers to having trouble sleeping as a secondary issue to another health condition or issue (such as pain, restless leg syndrome, sleep apnoea, asthma, depression, anxiety, arthritis, cancer, or heartburn, a medication, or substance used).
Meanwhile, Dr. Khosla also breaks down chronic insomnia for her patients by how and when it impacts their sleep:
Sleep-onset insomnia: Trouble with falling asleep.
Sleep-maintenance insomnia: Problems staying asleep, a.k.a. waking up for long period in the night.
Mixed insomnia: Having issues with both falling asleep and staying asleep.
It can be hard to define what it means to have “trouble” falling asleep, as the amount of time that constitutes “trouble” can feel arbitrary, says Angela Holliday-Bell, M.D. a board-certified physician and certified sleep specialist in Chicago. But she says a good rule of thumb is that it should take about 10 to 20 minutes to fall asleep. Since you’re likely not aware of exactly how long it took you to drift off, how you feel during your waking hours may be the ultimate judge.
It’s entirely possible to believe you haven’t slept when you actually have. This is known as paradoxical insomnia, which falls under chronic insomnia but usually indicates poor quality sleep rather than wakefulness. People with paradoxical insomnia feel like they’re awake when they’re asleep, so they underestimate how many hours they slept and can feel like they’ve hardly slept despite logging a standard night’s sleep, according to The Sleep Foundation. “Sometimes there is a sensation of I'm awake,” Dr. Khosla explains. “You’ll tell your spouse you got 15 minutes of sleep, but they say you were snoring the second your head hit the pillow. There’s a disconnect between their subjective experience versus the objective experience and a lot of the time, it’s because they’re getting super light sleep, so the brain doesn’t feel like it’s asleep.” This can also be due to sleep apnea, Dr. Khosla cautions, so it’s important to seek help if this happens to you regularly.
Unsurprising to anyone who’s ever slept badly, insomnia can make you feel wretched. Per Mayo Clinic, symptoms include:
Brain fog
Fatigue or low energy
Feeling cranky, depressed or anxious
Feeling exhausted during the day
Having a hard time falling asleep (obviously)
Having a hard time focusing
Making more mistakes
Memory problems
Ongoing worries about sleep
Waking up during the night
Waking up too early
As someone who’s experienced insomnia herself, Dr. Holliday-Bell is empathetic toward those who are struggling with it. “Insomnia can include waking up with headaches, experiencing a lack of motivation, falling asleep when you’re not meaning to, feeling the need to nap, and craving multiple cups of coffee,” she adds.
Daytime Effects of Insomnia
How you sleep (or don’t) at night massively affects how you function during the day, explains Dr. Khosla. Some daytime impacts of insomnia include:
Decreased functioning or productivity in an academic or work setting
Difficulty with concentrating, brain fog, or impaired attention or memory
Impacts on interpersonal or social interactions
Susceptibility to errors and accidents
Getting to the root cause of an ongoing sleep issue can be the first step in scoring a better night’s rest. Researchers have identified the most common triggers.
Genetics
Research has shown that genetics play a major role in ongoing sleeplessness. “If both your parents have [experienced] insomnia, there’s a good chance you’ll have it [at some point],” Dr. Holliday-Bell notes. “Though there’s a higher tendency towards females having it than males.”
However, even if family history makes you prone to insomnia, it often takes a combination of factors—including lifestyle habits—to trigger it. “Things like stress or drinking lots of coffee to stay up and work will throw you over the threshold that's already lower just because of your genetics,” Dr. Holliday-Bell says.
Brain Activity Differences
Research in the last decade out of Johns Hopkins University of Medicine found that differences in brain functioning may also play a role in chronic insomnia. A study in Sleep found that the motor cortex in the brain of those with chronic insomnia tended to be more adaptable to change, while the neurons in that region were more “excitable.” This furthered research that showed that those who have insomnia may be processing information more constantly, which may interfere with sleep. “Insomnia is not a night time disorder. It’s a 24-hour brain condition, like a light switch that is always on,” according to study co-author Rachel E. Salas, M.D.
Medical Conditions
Beyond sleep apnoea, many other medical conditions can interfere with sleep. For example, “chronic pain is so hard because it may cause arousal that keeps waking you up,” Dr. Khosla says. Conditions that can steal your sleep include:
Acid reflux
Alzheimer’s
Asthma
Cancer
Diabetes
GERD
Overactive thyroid
Parkinson’s
“Historically, sleep is something that has been relegated to its own little corner in the outpatient world. We haven't fully grasped this idea that sleep trickles into everything,” Dr. Khosla says, adding that trouble with any organ system can have an impact on your sleep.
Medications or Substances
In addition to everyday culprits like alcohol and caffeine, the medications you take can impact your sleep, causing insomnia, Dr. Khosla explains. “If you have COPD or asthma, medications we use to treat those disorders can lead you to stay awake,” she says. “When we use beta blockers for heart failure or atrial fibrillation, those can cause nightmares that impact sleep.” Similarly, antidepressants, some pain, allergy or cold medications, and weight-loss drugs can disrupt sleep, per Mayo Clinic.
Mental Health Conditions
Anxiety and depression can be both symptoms and causes of insomnia. “There’s that ‘chicken vs. the egg’ relationship there,” Dr. Holliday-Bell says, noting that, in some people with both insomnia and anxiety, it can be hard to tell which came first. Similarly, post-traumatic stress disorder and other anxiety disorders can also impact sleep negatively. About 40% of adults with insomnia also had a diagnosable mental health disorder, most often depression, an article in The Journal of Clinical Sleep Medicine notes. If you’re struggling with your mental health and it’s impacting your sleep, talk to your doctor.
Life Circumstances and Habits
The circumstances and stressors in your life are going to play a major role in your insomnia Dr. Khosla says. For instance, if you have a super important project coming up at work or school, you might experience short-term insomnia. Likewise, if you have a new baby in the house, or you’ve recently moved, or you’ve changed time zones, these can all lead to sleeplessness, typically short-term.
Meanwhile, your daily habits also have an impact, Dr. Khosla adds. If you’re scrolling on TikTok, basking in blue light before bed, it might negatively impact your sleep. If you’re super inconsistent on what time you hit the hay, you might also have more issues with insomnia.
Risk Factors for Insomnia
Several risk factors predispose you to chronic insomnia, per The Journal of Clinical Sleep Medicine, including:
Age (older folks are more prone)
Gender (cis-women are more likely to have insomnia)
Having comorbid medical or mental health conditions
“The biggest danger of insomnia is an acute complication—say, falling asleep at the wheel,” says Dr. Holliday-Bell. “A lot of traffic accidents are due to drowsy driving or falling asleep while driving. If you operate heavy machinery at work, you're more prone to accidents if you have insomnia.”
But insomnia can also jeopardize your health over the long haul. “Chronic insomnia increases your risk of significant longer-term conditions like cardiovascular disease, high blood pressure, stroke, and diabetes,” Dr. Holliday-Bell adds.
The National Library of Medicine notes that complications of insomnia can include:
Cardiovascular disease
Dependence on sleep medications or similar drugs
Hypertension
Mood-impacting disorders such as anxiety and depression
Type 2 diabetes
Dr. Holliday-Bell notes that no one test that reveals insomnia—it’s a clinical diagnosis made by your doctor. You also might do a sleep study where you’re hooked up to an EEG machine while you stay overnight in a clinic, so doctors can study your patterns and help figure out what’s happening.
Treatment and Prevention of Insomnia
Some approaches to treating insomnia are more effective long term than others. Let’s look at the most popular options.
Cognitive Behavioral Therapy (CBT)
Dr. Holliday-Bell says CBT is the “gold standard” for treating insomnia. “It’s a therapeutic process that focuses on the underlying cause of insomnia,” she says. “It’s unpacking and addressing the roots—the maladaptive thoughts surrounding sleep that ultimately lead to sleep anxiety. It addresses the cognitions and then the behaviours that have resulted in insomnia.”
Medications
Supplements like melatonin and magnesium are options but you should always talk to your doctor before trying them and know that results are mixed on many of them. “It’s not uncommon for a doctor to give a prescription for a sleep aid short-term, as someone starts to try behavioral therapy, but it’s with the ultimate goal of weaning off of sleep medications,” Dr. Khosla says.
Habit Changes
Dr. Khosla says changing your habits may help, although even with a change in behaviour, for some people, insomnia persists. For example, getting into bed at the same time each night, eliminating screens an hour (or even two) before bedtime, adjusting your phone settings to eliminate blue light-specific exposure after sunset, nixing your afternoon coffee, or working out in the morning instead of at night can help. You also might try meditating before bed.
Stop Overthinking It
Sleep is having a major moment right now in the wellness tech space. You can buy blue-light shielding glasses. You can track your shuteye with your smart phone or myriad other devices. You can even order an actual bed to tuck your phone into to stop you from the blue light exposure.
Dr. Khosla thinks a lot of modern wellness tools are causing folks to overthink their sleep routines. “With all of these wearables, a lot of people have been a little bit more focused on sleep, which, in some ways, is great—except for when it becomes a problem,” she says. A hyper-focus on sleep, she notes, can ironically stoke the anxiety that keeps people awake.
Outlook
The vast majority of people experience the occasional sleepless night, and as many as one in three adults have varying degrees of insomnia. Given how common it is, perhaps it’s no surprise that there are multiple effective strategies to combat it.
If you get prompt treatment and intervention, especially with shorter-term insomnia, the prognosis is quite good. As Dr. Khosla says, if insomnia is impacting your waking life, it’s worth reaching out and getting help. Feeling tired all day isn’t normal and retreating to bed for a nap isn’t necessary—you have more important things to do, and with the right interventions, you’ll be on your way.
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