About Sleep
Sleep Related Conditions
Sleep Disorders
Insomnia, also known as sleeplessness, stands out as one of the most prevalent sleep disorders among adults. It often leads to disruptive sleep patterns that impact daily life. Various factors, including stress, medications, and an individual’s sleep habits and environment, can contribute to the development of insomnia.
What is Insomnia?
Insomnia is a sleep disorder characterized by persistent trouble falling asleep, staying asleep, reduced sleep duration, disrupted sleep or waking up early, decreased sleep quality, and impaired daytime functioning despite adequate rest and an appropriate sleep environment. Typical symptoms of poor daytime functioning include fatigue, depression or irritability, difficulty concentrating, memory loss, limited social or occupational skills, and reduced learning ability.
Types of Insomnia
Insomnia manifests in two main forms:
- Primary insomnia refers to sleep difficulties unrelated to any other health condition.
- Secondary insomnia occurs when sleep is disrupted by underlying health conditions such as asthma, depression, arthritis, cancer, or heartburn, as well as factors like pain, medication, or substances such as alcohol.
Based on duration, experts classify insomnia as follows:
- Acute insomnia, with a sleep period of less than 6 hours for around less than one month.
- Sub-acute insomnia, with a 6-hour sleep period for around one month and to three months.
- Chronic insomnia, with a duration of more than three months.
What causes Insomnia?
Insomnia can be caused by various triggers and risk factors. The Spielman’s 3P Model of insomnia is a popular theory that describes how insomnia occurs and how acute insomnia becomes chronic insomnia. Among these, the individual susceptibility plays an important role.
Risk Factors of Insomnia
They include genetic susceptibility to insomnia or related factors associated with enhanced basal metabolic rate of an individual, hyper-responsiveness and sleep wakefulness-related alterations in the neurotransmitter system.
Moreover, psychological factors include a personality tendency to excessive worry or overthink about some issues. People with a high susceptibility to insomnia have a lower physiological threshold for stimulus events leading to insomnia. For instance, the stimulus may not cause insomnia in others but may trigger it in individuals with a high susceptibility to insomnia.
- Personality traits : Individuals with insomnia often share certain common personality traits, including excessive anxiety about health and sleep, well-being, or daytime functioning. These traits can lead to anxiety and addiction to activities that they think will help them sleep better.
- Negative emotions : Individuals with chronic insomnia disorder encounter internalizing problems such as depression and restless feelings. These adverse emotions may affect the normal psychophysiological process of sleep. The more individuals worry, the less they can sleep, while in turn, the less they can sleep, the more they worry. Consequently, it leads to a vicious cycle: negative emotions and irrational thoughts—negative emotions that exacerbate the irrational thoughts and negative feelings about insomnia.
5 Main Causes of Insomnia
1. Stressful life events
These events or “triggers” usually relate to stressful life events, including work stress, death of a beloved, pregnancy, divorce, job loss or other significant life events. These stressful events can lead to short-term or persistent sleep disorders.
2. Poor sleep hygiene
Staying up late and engaging activities like exercising or consuming coffee and alcohol close to bedtime can contribute to insomnia in adults. Additionally, irregular sleep schedules, prolonged time spent in bed, and inappropriate napping can further disrupt nighttime sleep. In children, resistance to sleep may manifest through behaviors such as climbing out of bed, speaking, crying, and seeking attention, often requiring specific actions like rocking, feeding, or parental presence in the bedroom to facilitate returning to sleep after waking up at night.
3. Environment
Environments with excessive noise, high or low temperature, low pressure, and lack of oxygen (i.e., plateau) can cause insomnia.
4. Diseases
Mental health conditions, especially mood disorders and anxiety disorders, can increase the risk of chronic insomnia. Likewise, many physical diseases, accompanied by pain (rheumatic diseases), dyspnea or orthopnea (cardiovascular or pulmonary diseases), nocturia (congestive heart failure use of diuretics, benign prostatic hyperplasia, untreated obstructive sleep apnea), and the adverse effects of drugs used in the chronic disease treatment, may cause sleep problems.
Medication
Insomnia may relate to the application or withdrawal of certain drugs or substances. Common drugs and substances that may cause insomnia include anticonvulsants, antianxiety and antidepressant medication, β-blockers, alcohol, narcotics, and marijuana.
Things That Make Your Insomnia Worse
These are behaviors performed by individuals to reverse or deal with sleep disorders like insomnia, but they might aggravate it instead of improving sleep.
These factors include the following three aspects of behaviors and sleep habits:
- Things not to do in the bedroom: Reading, watching TV, using a smartphone and listening to music, or lying awake in bed for a long time. The result is disrupting the connection between the person and the bedroom.
- Things not to do when trying to sleep: Excessive worrying about sleep, forcing oneself to sleep, frequently checking the time, tossing and turning in bed, playing with a smartphone, and using alcohol to aid sleep—can turn occasional insomnia into a chronic condition or worsen insomnia and dreaminess.
- Your attitude towards sleep: Having unrealistic sleep expectations, it is thinking you must get a perfect eight hours of sleep every night for your studies or work the next day. Worrying too much about bad things that haven’t happened yet can also make insomnia worse. Some people feel they can’t sleep without pills and worry about the side effects. Connecting sleep to life events, bad moods, the sleep environment, or changes in behavior can worsen insomnia as well.
These irrational thoughts may lead to excessive worrying about the adverse effects of insomnia, increase pressure, trigger anxiety, disrupt the normal sleep process, and make insomnia and dreaminess worse, resulting in a vicious circle.
Symptoms of Insomnia
Insomnia can affect daytime functions and lead to fatigue and cognitive impairment. Insomnia can also lead to other physical diseases, such as cardiovascular diseases, metabolic and endocrine abnormalities, etc. Furthermore, long-term Insomnia may also impact survival time. Therefore, individuals with these issues should immediately seek medical help.
Individuals should cautiously recall the beginning and development of insomnia, including the triggers, treatment and response and the medications they have been taking in the past month. They should provide information about the condition relating to physical discomfort or disease, previous consultation experience, test results and treatment, and any history of drug allergy.
Diagnosis of Insomnia
Sleep specialists should obtain a comprehensive medical history of sleep habits and practices for dealing with insomnia and other abnormal sleep behaviors. Similarly, they should investigate the dream enactment behaviors, any uncomfortable sensations, and spontaneous movements of the limbs before and during sleep.
Disease Diagnosis
The following clinical symptoms can diagnose insomnia:
- Insomnia manifests as difficulty falling asleep and taking more than 30 minutes to fall asleep.
- Declined sleep quality, sleep maintenance disorders, no less than two awakenings throughout the night, and waking up early.
- Decreased total sleep time, usually less than six hours concomitant daytime functioning impairment. Sleep-related daytime functioning impairment includes:
- Fatigue or discomfort
- Difficulty in concentrating, or memory loss
- Declined learning, work, and/or social skills
- Mood swings or irritability
- Daytime sleepiness
- Loss of passion and energy
- Increased tendency to make mistakes at work or while driving
- Nervousness, headaches, drowsiness, or other physical symptoms associated with sleep deprivation
- Excessive anxiety about sleep
Differential Diagnosis
- Delayed Sleep Phase Disorder
- Advanced Sleep Phase Disorder
- Difficulty in Falling Asleep due to Sleep Environment Problems
- Sleep Deprivation Syndrome
- Insomnia symptoms in other sleep disorders—such as sleep apnea or Restless Legs Syndrome (RLS)
- Chronic Insomnia can coexist with certain physical or psychological disorders.
What is the Treatment of Insomnia?
Once insomnia diagnosed, individuals should use professional Cognitive-Behavioral Therapy (CBT) and psychological counseling or medication to help improve sleep quality. They should not excessively worry about sleep, focus on whether daytime functioning is impaired. Excessive worrying may worsen insomnia increasing psychological stress and making it harder to recover from the disorder. Many studies demonstrate that after systematic CBT, the insomnia symptoms of nearly half of individuals can improve substantially.
1. Cognitive-behavioral Therapy for Insomnia (CBT-I)
A combined non-pharmacological treatment of cognitive psychotherapy, stimulus control, and sleep restriction—combined or not with relaxation therapy—is equally essential as the pharmacological treatment of insomnia.
Psychotherapy generally includes psychological counseling, explanation, and guidance, where patients can learn basic knowledge about sleep and reduce needless anticipatory anxiety. They should correct misperceptions change poor sleep habits, and wrong behaviors in dealing with insomnia.
- Stimulus control therapy can reduce or eliminate the fear of the sleep environment of an individual, reconstruct the benign association between the person and the bedroom, and improve sleep.
- Relaxation therapy refers to scientific relaxation training before bedtime, and it can help relieve stress, eliminate distractions, and induce individuals to fall asleep.
- Hypnotherapy is a professional treatment that uses hypnotic induction to put individuals into a hypnotic state. Experts treat physical and psychological disorders, including treating insomnia.
It’s worth noting that there are various commercially available CBT insomnia apps on the market. We have meticulously curated a list of the best ones, tested through scientifically valid methods to ensure their efficacy.
2. Sleep Medication
Due to individual differences, there is no absolute best, fastest, and most effective medication. In addition to commonly used over-the-counter medications other medications should be prescribed under medical supervision.
First, individuals should take sleeping pills under the guidance of a professional sleep physician. Second, it is vital to understand the timing of sleeping pills taking effect and acting after oral administration. For example, they can take fast-acting drugs such as zolpidem and zaleplon after lying on the bed and slow-acting drugs 30-60min before bedtime. Likewise, they may take melatonin 1.5-2 hours before bedtime too. The action duration of drugs is generally shorter than the expected sleep time, but some individuals may take them late at night or early in the morning. As a result, the drug is still effective when waking up, which may impair daytime functioning.
Family or caregivers should administer older people taking sleep pills—especially those with muscle relaxation effects—to prevent falls at night or during the day.
See also:
Can you die from lack of sleep?
Tips to Calm Insomnia
It is essential to improve the surrounding environment and poor sleep hygiene habits, maintain a balanced diet to treat insomnia. Moreover, it is vital to exercise moderately to relax the body and relieve stress, downplay or ignore unhappy factors, and reduce excessive anxiety about private or public events.
1. Maintain Comfortable Sleep Environment
Maintaining a room temperature of about 20℃ may help individuals sleep better. In addition, a quiet environment can be conducive to improving sleep quality. Adjust the bed, bedding, and pillow to make it comfortable and satisfying and create an excellent sleeping ecosystem. Taking a bath before going to bed is vital. A hot bath before bedtime can help the body and mind to relax. Lying in bed after a hot bath when body temperature returns to normal can help to fall asleep.
2. Keep a Balanced Diet
- Intake a balanced diet with moderate protein and plenty of vegetables and fruits.
- Drink a glass of hot milk before bedtime, as the tryptophan in milk has a sleep-promoting effect.
- Drinks or foods before bedtime can suppress the cerebral cortex and induce postprandial somnolence, which may help individuals sleep better. But they should not drink alcohol, coffee, tea and other drinks with excitatory effects within six hours before bedtime.
3. Do Moderate Exercise
- After waking up, outdoor exercise with morning sunlight can help individuals sleep better.
- Do not do strenuous exercise before bedtime, but moderate stretching exercises, including yoga and Ba Duan Jin, are great benefits.
4. Monitor Your Sleep Daily
Under the guidance of a physician, individuals should keep their sleep diary to record their bedtime, wake-up time, practical sleep time factors affecting sleep, medication, and subjective feelings and scores of sleep. It allows the physician to estimate an individual’s sleep latency time, sleep maintenance, and sleep routine.
We recommend integrating a dedicated sleep-tracking app to enhance this monitoring process. ShutEye® App is a prime example of such a tool. It proves to be an ideal solution not only for tracking sleep but also for detecting patterns associated with insomnia, offering a more comprehensive approach to sleep management.
Lifestyle Changes: Things You Can Do to Avoid Insomnia
From the perspective of preventing the disease, individuals should try the following home remedies and lifestyle changes to avoid insomnia:
- Individuals should not go to bed without feeling sleepy. If they cannot fall asleep after 30 minutes lying on the bed and feel agitated, they should leave the bed temporarily.
- They should avoid napping or limit it to 30-60 minutes daily.
- Individuals with insomnia may consider removing the clock from the bedroom.
- In general, the bedroom should be dark to promote sleep, but moderate lighting is vital for older people to prevent them from falling when they get up at night.
- People should not overeat before bed, especially for individuals with reflux esophagitis. Some snack is allowed when one finds it difficult to fall asleep due to hunger.
- Individuals with insomnia should avoid intense workouts before bedtime.
- Individuals should avoid alcohol, caffeine, tea, cigarettes, and other stimulants before bedtime.
Summary
Insomnia is a pervasive sleep disorder affecting millions worldwide. However, by understanding its causes and symptoms, we can arm ourselves with the tools to reclaim our restful sleep. From Cognitive Behavioral Therapy to lifestyle changes, a variety of strategies exist to combat Insomnia.
Remember, the journey to improved sleep begins with awareness and proactive steps towards change!
