How to know if you have insomnia and what you can do to treat your sleep troubles

From insider.com

Insomnia is a common sleep disorder affecting about 30% of US adults. It's more serious than just having occasional sleep troubles.

But with the proper treatment, it is also a condition that can be easily managed — and potentially even cured — as many people are able to improve their quality and quantity of sleep.

Here's what you need to know about the main symptoms, causes, and treatments for insomnia.

What is insomnia?

People who have insomnia consistently have trouble falling asleep, staying asleep, or both. With insomnia, your sleep issues will start to affect your daily life.

"Everyone has trouble sleeping sometimes," says Nate Favini, MD, medical lead of Forward, a preventive primary care practice. "It's really when the sleep difficulties start impacting other areas of your life that it becomes insomnia."

Signs and symptoms

Warning signs that you may have insomnia include: 

• Lying awake for a long time before falling asleep
• Frequently waking up during the night 
• Waking up early and not being able to fall back asleep

The longer these sleep troubles persist, the more they will carry over to cause health problems throughout the day. Common symptoms of insomnia include:

• Difficulty paying attention, focusing, or remembering
• Lower levels of energy or motivation 
• Irritability, depression, or anxiety
• Headaches, body tension, or gastrointestinal problems

If you always feel tired, and your sleep troubles are negatively affecting your ability to work or maintain healthy relationships, you should talk with your primary care doctor.
To diagnose insomnia, your physician will ask about your medical history and sleep troubles. They may also refer you to a sleep specialist, who can conduct further sleep studies, if necessary.

Types of insomnia

Depending on the duration of your insomnia, it can be diagnosed as one of two main types:

• Acute insomnia is often brought on by a specific event, such as stress or jet lag, and only lasts for several days or weeks. 
• Chronic insomnia is usually tied to another physical or mental health condition, and occurs for a longer period of time — at least three times per week for three months. 

Research has found that about 25% of Americans develop acute insomnia each year, but about 75% of those cases resolve without turning into chronic insomnia. 

Causes 

The causes of insomnia are classified as either primary or secondary. The main difference between primary and secondary insomnia is that secondary insomnia is a side effect of another health condition or medication whereas primary insomnia is the main illness.

Primary insomnia

Primary insomnia isn't related to any other health condition and is most commonly associated with acute insomnia. Usually, primary insomnia is caused by one, or a combination, of the following:

• A stressful life event. This could include a big job interview or upcoming test, as well as a major life change, such as the death of a loved one or a relationship break-up. 
• Uncomfortable sleeping conditions. For example, the temperature in your room might be too hot, making it difficult for you to stay cool at night. It might also be too bright or noisy to get restful sleep.  
• An irregular sleep schedule. This is often caused by poor sleeping habits, like if you don't wake up and go to sleep at the same time each day. Any change in your sleep routine could cause temporary insomnia, including jet lag. 

These factors will likely resolve on their own, and you won't need to seek medical attention.

Secondary insomnia 

Secondary insomnia is when your sleep troubles are the result of an underlying health condition, substance use, or the side effects of a medication.
The following causes often lead to chronic insomnia and require extensive medical attention:

• Sleep disorders. Research has found that insomnia occurs in about 38% of people with sleep apnea, and as much as 60% for those with restless leg syndrome. 
• Long-term illnesses. Physical ailments that can make it consistently difficult to sleep include asthma, acid reflux, chronic pain, hormone or thyroid disorders, and neurological disorders like Parkinson's disease. 
• Pregnancy. Research has indicated that about 78% of people experience insomnia during pregnancy. It's most common during the third trimester, as your belly gets bigger and the stress over having a newborn builds. 
• Mental health. While stress can cause temporary sleeping troubles, anxiety disorders and depression can cause insomnia that will likely require the help of a therapist. 
• Substance use. Excessive intake of caffeine, nicotine, or alcohol can make it difficult to sleep and pose long-term health risks. 
• Medications. Insomnia is a known side effect for common medications like SSRIs for anxiety, alpha or beta blockers for high blood pressure, and steroids for arthritis. 

Treatment

To figure out how to get better sleep, it's important to talk with your doctor, who can help you design a treatment plan for insomnia.

First, your doctor will have to determine what's causing your insomnia. If it's secondary, you may need further medical attention to address the underlying health condition.

But improving your overall sleep habits is also important. Most of the time, you'll need a combination of therapy, lifestyle changes, and natural remedies to treat insomnia and effectively resolve your sleep troubles. Here are the most common treatments for insomnia: 

Cognitive behavioural therapy 

Cognitive behavioural therapy for insomnia (CBT-I) is one of the most effective treatment methods for improving sleep.
Essentially, CBT-I helps you learn how to get better sleep. A trained therapist will teach you relaxation techniques, stress reduction strategies, and how to manage your sleep schedule. 
Research has found that CBT-I is effective at reducing the time it takes to fall asleep and the amount of time spent awake during the night — and the improvements in sleep quality are often maintained well after therapy sessions end.

Light therapy 

Light therapy is most commonly used when insomnia is caused by irregular circadian rhythms. These are natural rhythms in your body that respond to light and darkness and prepare your body for sleep.
Light therapy treatment involves sitting near a light box — which mimics bright outdoor light — for a set amount of time each day. This can help regulate your circadian rhythms and reset your body's sleep and wake cycles.

Usually, light therapy would only be used if CBT-I doesn't work at first, but you can talk with your doctor to see if it might be right for you. You should only try light therapy with medical supervision, as incorrectly timed light therapy can make insomnia worse.

Natural remedies 

There are also many effective natural remedies for insomnia, including lifestyle changes you can make to improve your sleep:

• Practice good sleep hygiene. Sleep hygiene refers to the act of adopting optimal sleep habits, such as sticking to a sleep routine and choosing relaxing activities to wind down for bed, like drinking a cup of chamomile tea instead of looking at your phone. 
• Exercise regularly. Research has found that getting at least 30 minutes of exercise five days a week can improve sleep quality. 
• Meditate. Mindfulness meditation can help relieve stress and wind down before bed. You can follow our guide on how to meditate to get started. 
• Try CBD. Some research has indicated that CBD, a compound found in hemp plants, can be effective at treating insomnia — but the results are not yet proven and you should ask your doctor before trying CBD for sleep. 
• Take a melatonin supplement. Melatonin is a hormone that your body produces naturally. It helps regulate your sleep-wake cycle. You can also purchase over-the-counter melatonin supplements. Research has found that taking melatonin supplements can help some people fall asleep at night more easily. but talk to your doctor about the proper dosage. 

Medication

Most of the time, doctors will not recommend medication for insomnia. If they do, it will only be on a short-term basis, as this medication can have serious side effects like sleepwalking, dizziness, or prolonged drowsiness that impacts your ability to function. 
Sleeping pills, or hypnotics, are considered safe, but only when you take the medication exactly as prescribed, and diligently check in with your doctor about potential risks or side effects.
If these other treatment methods aren't working to resolve your insomnia, you can ask your doctor about medication, but be advised that it is a far riskier option, where the costs often outweigh the benefits.

This article was medically reviewed by Alex Dimitriu, MD, psychiatrist and founder of Menlo Park Psychiatry and Sleep Medicine. 

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