Insomnia--difficulty falling or staying asleep--is a common response to stress, anxiety, depression, and other conditions. It may be short-lived and resolve quickly or become chronic and disturb your life and well-being if the underlying problem persists. Improvement in sleep comes from managing the cause of the insomnia.
Stress
Acute or chronic stress is a constant threat to human equilibrium, and normal sleep pattern is vulnerable to this threat. According to the National Sleep Foundation, stress causes insomnia by disturbing the normal sleep cycle. You can recognize the connection between your insomnia and stress if it started soon after a stressor began, which can include:
- Personal or family illness
- Death of a loved one
- Work or school-related stress
- Job or financial loss
- Family or relationship distress, or divorce
Acute stress leads to an increase in your stress hormones, such as cortisol and adrenaline, disturbing your sleep pattern. These hormones can stay chronically elevated and cause long-term insomnia as long as the stress continues. Insomnia itself can be a big source of stress and set up a chronic stress-insomnia cycle.
Management and Prevention
To prevent stress-related insomnia, actively manage your sources of stress by changing what you can. Otherwise, learn ways to cope with stress to improve your sleep quantity and quality.
Coping recommendations include eating right, adequate exercise, meditation, or other and stress management exercises, such as passive muscle relaxation and mindful deep breathing or visualization. A warm bath or yoga before bed can also reduce stress and help you sleep.
Anxiety
Anxiety is another common cause of insomnia. An underlying anxiety disorder might be the cause, or the anxiety might be a response to general stress. According to the Anxiety and Depression Association of America, anxiety can disturb sleep. On the other hand, chronic sleep deprivation can cause anxiety. Whatever the cause, people with anxiety may feel more anxious at night and have difficulty falling or staying asleep.
Management and Prevention
As with stress, you can help your anxiety by eating healthy foods and increasing your physical activities. Practice relaxation techniques to help reduce anxiety and prevent insomnia or other sleep disorders. Behavioral therapy or anti-anxiety medicines, if necessary, can also help you get better sleep.
Depression and Other Psychological Disorders
Depression and other psychological problems, such as bipolar disorder and post-traumatic stress disorder (PTSD), are also common causes of insomnia. According to Psychology Today, insomnia often accompanies depression, and insomnia can lead to depression or other psychological disturbances. As you lie awake thinking of your problems, you get into a cycle of further depression, anxiety, and insomnia.
Management and Prevention
Treatment of the underlying cause of the depression or psychological problem can help prevent or improve insomnia. Behavioral therapy or psychotherapy helps many people cope and sleep better. Others might be helped by adding an anti-depressant to the strategy.
Medical Conditions
A review in the journal Chest notes that many common medical conditions, such as the following, can disturb sleep quality, wake a person from sleep, and make it difficult to return to sleep, leading to chronic insomnia:
- Obesity, which can interfere with breathing
- Sources of chronic pain, such as arthritis, cancer, nerve pain from diabetes, or multiple sclerosis
- Heart disease, which can cause difficulty breathing, recurring chest pain, or anxiety
- Consequences of high blood pressure, such as fluid retention
- Lung problems, such as chronic obstructive pulmonary disease (COPD) and asthma
- Neurologic disorders, such as Parkinson's disease or Alzheimer's disease
- Heartburn from gastroesophageal reflux disease (GERD)
- Urinary frequency, which wakes you at night
Some of these problems cause sleep apnea, which disturbs sleep and can lead to insomnia.
Management and Prevention
Treatment and improvement of the underlying medical condition can help prevent insomnia. Some people may resort to prescription or over-the-counter (OTC) sleep medicine. Check with your doctor first before you take any OTC sleep aids or herbal preparations if you have a medical condition, such as high blood pressure or heart disease.
Medications
The book Principles and Practice of Sleep Medicine reviews the following medications that are associated with poor sleep and insomnia:
- Anti-depressants
- Blood pressure medicines
- Cholesterol-lowering drugs
- Allergy medicines and decongestants
- Prescription attention deficit hyperactivity disorder (ADHD) medicines, such as Adderall and Ritalin
- Steroids used to treat allergies, inflammation, hormone dysfunctions, and other problems
Management and Prevention
Before you take any medicine, make sure you understand the side effects. Do not take a bigger dose or take it more frequently than prescribed. If your insomnia is disrupting your life, you may need to to stop taking the medicine or use an alternative drug.
Habitual Use of Substances
Habitual use of common substances can cause insomnia, depending on the extent of use.
Stimulant Drinks
Caffeinated drinks, such coffee, tea, soda, or energy drinks are stimulants. They can cause insomnia and other disruptions in sleep quality, according to an article on caffeine and sleep by the National Sleep Foundation. For some people, this is even worse if they use these drinks close to bedtime.
Smoking
The nicotine in cigarettes and other tobacco products act as stimulants, which can disturb sleep. An analysis of multiple studies on nicotine and sleep published in Sleep Medicine Review supports this conclusion.
Alcohol
Although it is sedating, alcohol can disturb the quality of sleep and cause episodes of insomnia. In a study in the American Journal of Psychiatry on alcoholism and insomnia, more that 60 percent of alcohol users entering treatment reported insomnia. They were more likely to relapse to alcohol use than those without insomnia.
Management and Prevention
To prevent insomnia or improve your sleep quality and quantity, limit or avoid stimulant drinks, alcohol, and tobacco. If you continue these habits, limit or don't use these substances close to bedtime.
Abuse of Illicit Drugs
Abuse of illicit substances, such as heroin, opiates, and stimulant drugs like methamphetamines can disturb sleep and lead to insomnia. A small survey from the Cleveland Clinic on sleep disorders in substance abusers was reported in 2009 in the journal Psychiatry. Fifty-six of the study patients reported problems with insomnia.
People who develop physical dependence on their drug of abuse may also experience insomnia as part of the withdrawal syndrome when they abstain from their substance.
Management and Prevention
If drug abuse is affecting your sleep, your insomnia may improve after withdrawal, detox, and rehab. Long-term rehab treatment of the drug abuse or addiction using medications, behavioral therapy, and support services can help prevent chronic insomnia.
Change in Schedule
Sleep disturbance and insomnia can come from a change in your work, travel, or regular sleep schedule. These changes can disturb your body's internal clock (circadian rhythm), which is set to the natural day-night cycle. Prolonged exposure to bright, artificial light during the day or night because of a school or work schedule can also disrupt the normal sleep-wake cycle and cause insomnia.
Neurotransmitters in the brain such as melatonin, norepinephrine, and serotonin control the cycles of wakefulness and sleep. Changes in schedule likely cause disturbances in these hormones resulting in disrupted sleep and insomnia.
Management and Prevention
Over time, your internal clock may reset to match your new schedule and correct your insomnia. Otherwise you might need to adjust your schedule or to seek help for treatment. Light therapy to reset your sleep cycle to match your work or travel cycle can often help.
Poor Bedtime Habits
After a while, poor habits connected to your sleep establish a pattern that can lead to insomnia. These habits include:
- Going to bed too late or at variable times
- Getting up too early or too late, out of synch with your internal clock
- Watching the clock when you are awake
- Stimulating activities too close to bedtime including work, TV, computers, cell phones, and video games
- Large meals before bed
Management and Prevention
You can prevent insomnia and get better sleep each night by keeping a regular sleep schedule. Avoid stimulating activities and a big meal before bed. In addition, create a peaceful sleep environment, including having a comfortable bed. Relaxation habits such as deep breathing, meditation, self-hypnosis, or yoga can help wind you down for bed.
Exposure to Bright Screens at Night
Hours of looking at bright screens at night, such as a computer monitor, laptop, tablet, television, or cell phone, can make it difficult to fall asleep. It is thought that the blue light from the LED backlit screens mimics daylight and disrupts the natural transition of brain hormones that bring on sleep. This is also true for eReaders, as found in a Harvard study published in 2014 in the Proceedings of the National Academy of Science. The longer the exposure the more the disruption in sleep.
As noted by a Scientific American brief review, the primary cause of sleep problems that can lead to insomnia is the interference of this light with melatonin, the hormone of sleep. Melatonin release is pegged to the circadian, day-night/wake-sleep cycle and increases with the onset of darkness to induce sleep. Exposure to these sources of light can delay the onset of sleep by delaying the normal rise in melatonin at night and play havoc with your circadian rhythm and sleep pattern.
Management and Prevention
By understanding this connection between bright screens exposure and insomnia, you can take steps to decrease its effect on your sleep. Avoid or limit your exposure before bedtime by turning down the brightness on your screens so you can get sufficient sleep. If you wake up during the night, try to avoid using any devices with bright lights so it is easier to get back to sleep.
Female-Associated Insomnia
There are causes of insomnia associated with natural transitions in women only. The insomnia may or may not be linked to hormonal changes.
The Menstrual Cycle
WebMD notes some women complain of insomnia and other sleep disturbances especially just before and during their period. This is more common in women who have symptoms of the premenstrual syndrome, such as bloating and pelvic pain. Progesterone promotes sleep; however, it is not clear whether the sleep problems are related to the lower levels during those phases of the cycle.
Pregnancy
Insomnia is one of the sleep disorders of pregnancy. It may be related to hormonal, physiological, and physical changes during pregnancy. Insomnia may be more common in the late second and third trimesters as the discomforts of pregnancy worsen.
Menopause
During the transition to menopause (perimenopause), women may have episodes of insomnia according to the National Sleep Foundation. This is likely due to the hot flashes, flushing, or sweating caused by falling or fluctuating estrogen levels. As reviewed by the Journal of Clinical Sleep Medicine, lower progesterone levels and an increase in disordered breathing after menopause may also explain the sleep disruptions.
Management and Prevention
Exercise and activities that promote relaxation such as yoga, meditation, imagery, or self-hypnosis can help all three circumstances. Sleep disturbances during menopause can resolve with time or by using hormone replacement therapy or antidepressants to treat the hot flashes.
Aging
Sleep disturbance and insomnia are common in the elderly, according to a review in the American Journal of Medicine, and may or may not be a natural consequence of aging for some people. Changes in sleep pattern may be due to aging of the internal clock or multiple other factors in the elderly such as:
- Lack of activity
- Chronic pain
- Chronic illnesses
- Urinary frequency
- Multiple medications for illnesses
- Loneliness and isolation
Management and Prevention
Prevention of insomnia and improvement in sleep quality can come from increasing physical and mental activities, addressing underlying problems, and getting behavioral or social support.
Health Consequences of Chronic Insomnia
Like healthy eating, healthy sleep is essential to maintain optimum health. Insomnia, whatever the cause, can lead to physical and psychological distress and make you ill. The following are some of the problems that can occur as reviewed in the Journal of Clinical Sleep Medicine:
- Fatigue and desire for sleep the next day
-
Effect on memory and attention
- Poor performance at work or school
- Stress and tension headaches
- Mood disturbances such as irritability, anxiety or depression
- Psychosis if the insomnia is extreme and prolonged
- Affect appetite and nutrition leading to anorexia or overeating
- Weight loss, weight gain or obesity, diabetes
- High blood pressure and heart disease
- Depressed immune system
Ask for Help
If you are feeling stressed, anxious, depressed, and low on well-being, and sleep deprivation interferes with your ability to function, discuss your insomnia with your doctor. He can evaluate you for underlying causes and discuss helpful medical and behavioral solutions or prescribe a sleep aid if needed.
