Insomnia Disorder

Learning Objectives

  • Describe symptoms and health consequences of insomnia
A person sitting up in bed in the middle of the night unable to fall asleep.
Figure 1. Insomnia is often accompanied by feelings of anxiety and frustration.

Insomnia

A person with insomnia has a consistent difficulty in falling or staying asleep and is the most common sleep disorders. Individuals with insomnia often experience long delays between the times that they go to bed and actually fall asleep. In addition, those with insomnia may wake up several times during the night only to find that they have difficulty getting back to sleep. As mentioned earlier, one of the criteria for insomnia involves experiencing these symptoms for at least three nights a week for at least one month’s time (Roth, 2007).

It is not uncommon for people suffering from insomnia to experience increased levels of anxiety about their inability to fall asleep. Insomnia becomes a self-perpetuating cycle because increased anxiety leads to increased arousal, and higher levels of arousal make the prospect of falling asleep even more unlikely. Chronic insomnia is almost always associated with feeling overtired and may be associated with symptoms of depression.

Watch It

Watch this video to learn more about the causes, symptoms, diagnosis, and treatment of insomnia.

You can view the transcript for “Insomnia – causes, symptoms, diagnosis, treatment & pathology” here (opens in new window).

Etiology

There may be many factors that contribute to insomnia, including age, drug use, exercise, mental status, and bedtime routines. Not surprisingly, insomnia treatment may take one of several different approaches. People who suffer from insomnia might limit their use of stimulant drugs (such as caffeine) or increase their amount of physical exercise during the day. Some people might turn to over-the-counter (OTC) or prescribed sleep medications to help them sleep, but this should be done sparingly because many sleep medications result in dependence and alter the nature of the sleep cycle, and they can increase insomnia over time. Individuals who continue to have insomnia, particularly if it affects their quality of life, should seek professional treatment.

Treatment

Treatment for insomnia includes both pharmacological and non-pharmacological treatment approaches. Common pharmacological treatment for insomnia includes Benzodiazepines; however, there also may be a withdrawal syndrome with rapid eye movement (REM) rebound. In addition, there are two newer benzodiazepine-like agents, zolpidem and zaleplon, which have fewer side effects, but good efficacy. Other agents for insomnia include sedating antidepressants and over-the-counter sleep products (sedating antihistamines).[1]

Dig Deeper: Use of Sleep-aid medication

While sleep-aid medication may be effective in treating insomnia, it is essential to be cautious and careful about your treatment plan involving this medication. It is important to consider all forms of treatment and consult with your doctor for treatment of sleep disorders. Read this article about “How to use sleep aids safely.”

An understanding of the electrophysiologic and neurochemical correlates of the stages of sleep is useful in defining and understanding sleep disorders. Excessive daytime sleepiness is often associated with obstructive sleep apnea or depression. Medications, including amphetamines, may be used to induce daytime alertness. Parasomnias include disorders of arousal and of REM sleep. Chronic medical illnesses can become symptomatic during specific sleep stages. Many medications affect sleep stages and can thus cause sleep disorders or exacerbate the effect of chronic illnesses on sleep.[2]

Some forms of psychotherapy, such as CBT, can help sufferers of insomnia. CBT focuses on cognitive processes and problem behaviors. The treatment of insomnia likely would include stress management techniques and changes in problematic behaviors that could contribute to insomnia (e.g., spending more waking time in bed). CBT has been demonstrated to be quite effective in treating insomnia (Savard, Simard, Ivers, & Morin, 2005; Williams, Roth, Vatthauer, & McCrae, 2013). Cognitive therapies for insomnia can help a patient to identify disruptive thought patterns, examine their validity, then replace harmful thoughts using strategies such as shifting attention, decatastrophizing, or reappraisal.[3]

Dig Deeper: Sleep Disorder Medication Dosage and Women

Read this article to learn about how FDA approval may not mean that the proper dosages are recommended for all groups of people, especially in the treatment of sleep disorders.

Solutions to support healthy sleep

Many college students struggle to get the recommended seven to nine hours of sleep each night. However, for some, it’s not because of all-night partying or late-night study sessions. It’s simply that they feel so overwhelmed and stressed that they cannot fall asleep or stay asleep. One or two nights of sleep difficulty is not unusual, but if you experience anything more than that, you should seek a doctor’s advice.

Here are some tips to maintain healthy sleep:

  • Stick to a sleep schedule, even on the weekends. Try going to bed and waking up at the same time every day to keep your biological clock in sync so your body gets in the habit of sleeping every night.

  • Tea being poured from a teapot into a cup.
    Figure 2. Compared to caffeinated drinks, herbal teas may be more affective in helping you achieve a good night’s sleep.

    Avoid anything stimulating for an hour before bed, including exercise and bright light from devices.

  • Exercise daily.

  • Avoid naps.

  • Keep your bedroom temperature between 60 and 67 degrees. People sleep better in cooler temperatures.

  • Avoid alcohol, cigarettes, caffeine, and heavy meals before bed. It may feel like alcohol helps you sleep, but it actually disrupts REM sleep and leads to frequent awakenings.

  • Heavy meals may make you sleepy, but they can also lead to frequent awakenings due to gastric distress.

  • If you cannot fall asleep, leave your bed and do something else until you feel tired again.

  • Train your body to associate the bed with sleeping rather than other activities like studying, eating, or watching television shows.

Key Takeaways: Insomnia

Try It

Glossary

insomnia: a consistent difficulty in falling or staying asleep

sleep aids: prescribed and over-the-counter medication that helps people fall asleep

 

  1. Pagel, J. F., & Parnes, B. L. (2001). Medications for the Treatment of Sleep Disorders: An Overview. Primary care companion to the Journal of clinical psychiatry, 3(3), 118–125. https://doi.org/10.4088/pcc.v03n0303 ↵
  2. Pagel, J. F., & Parnes, B. L. (2001). Medications for the Treatment of Sleep Disorders: An Overview. Primary care companion to the Journal of clinical psychiatry, 3(3), 118–125. https://doi.org/10.4088/pcc.v03n0303 ↵
  3. Abad, V. C., & Guilleminault, C. (2003). Diagnosis and treatment of sleep disorders: a brief review for clinicians. Dialogues in clinical neuroscience, 5(4), 371–388. ↵

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Insomnia Disorder Copyright © by Meredith Palm is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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