Up all night? You’re not alone. Sixty million other Americans have trouble sleeping, too. In fact, insomnia is the most common of all sleep disorders. A whopping third of the population complains of sleep trouble (probably because they’re not getting their 7-9 hours recommended by the National Sleep Foundation). But, only 10% of the population have what’s considered persistent and chronic insomnia, 40% of which are likely due to a psychiatric condition. For these insomniacs, every day means waking up feeling like they never slept at all. Just 24-72 hours of no sleep, for the average person, results in decreased motor function, focus and concentration problems, and in more extreme cases, hallucinations. Worse, the problem compounds as time goes on (one of the triggers for sleeplessness is a lack of sleep itself), creating a vicious cycle that, over time, can lead to other health problems.
People experiencing insomnia say they have at least one of the following:
- Trouble falling asleep
- Problems staying asleep
- Waking too early
- Unrefreshing sleep
Over time, these bouts of insomnia can lead to other undesirable symptoms, including:
- Mood changes
- Difficulty concentrating
So, doctors will often make a clinical diagnosis of insomnia if these criteria apply:
- Sleep difficulties that happen at least three times per week
- This goes on for a minimum of three months
- This is causing a person distress
- This person can’t function at school or work
There are lots of different sorts of sleep disorders. The most common include:
Sleep apnea can impair your breathing as you sleep (common among those with obesity, sinus trouble, etc)
Restless leg syndrome is characterized by discomfort, tingling, or pain in the legs that gets worse at night and is only relieved by movement
Circadian rhythm disorders are when one’s sleep patterns and internal clock is off
Parasomnias entail abnormal activities while sleeping such as walking, talking, and extreme nightmares
Excessive daytime sleepiness is when persistent drowsiness occurs during wakeful times either narcolepsy or another medical condition.
The type of sleeplessness you experience matters in determining the cause of your insomnia.
Short-term insomnia can last for a few days or weeks and may be caused by:
An upsetting or traumatic event
Changes to your sleep habits
Chronic insomnia lasts for at least three months and is often related to another problem or a combination of problems, including:
Medical conditions that make it harder to sleep, such as arthritis or back pain
Psychological issues, such as anxiety or depression
Substance use and abuse
People with certain risk factors are more likely to have insomnia, and they include:
- High stress or distress caused by a life event
- Emotional disorders, such as depression
- A sedentary lifestyle
- Changes in working hours, or night-shifting
- Hormone changes such as menopause
- Gender (insomnia is more likely to affect women than men)
- Certain medical conditions, such as obesity and cardiovascular disease
There are both pharmaceutical, and nonpharmaceutical treatments for insomnia. Your doctor can help guide you to what works best and is most effective for you.
At-home treatments include:
Sleep hygiene training can help change disruptive behaviors inadvertently impacting your sleep. The NSF’s recommendations are many, but include:
Avoiding caffeine, alcohol, and nicotine before bedtime
Exercising each day, if only for ten minutes—but not before sleep
Minimizing the time spent on your bed not sleeping (such as watching TV)
Over-the-counter (OTC) sleep medications such as antihistamines like Diphenhydramine/Benadryl, herbal formulations, melatonin, and others
Natural sleep aids like warm milk, herbal tea, and valerian root (see: CBD below)
If your insomnia persists even after OTC medications and improving your sleep habits, your doctor may go on to help you get to the bottom of your sleep troubles. This could mean:
Diagnosing and treating an underlying condition whether chronic pain, anxiety, sleep apnea, a psychological disorder, etc.
Prescription sleep medications that your doctor prescribes to promote or help extend the sleep, a few of which are:
- Eszopiclone (Lunesta)
- Zolpidem (Ambien)
- Halcion (triazolam)
- Trazodone (Desyrel)
- Estazolam (ProSom)
However, not all sleep aids are right for everyone. Sleep medications can have serious side effects, especially long term, and tend to get both overused and abused. It’s important to talk to your doctor before starting yourself on any OTC medication, drug, or supplement.
New, alternative therapies for insomnia include:
Cognitive-behavioral therapy (CBT). The American College of Physicians (ACP) recommends this as a treatment for persistent and chronic insomnia in adults.
CBD and other plant cannabinoids are showing much promise for treating insomnia, sleep apnea, narcolepsy, and other sleep-related disorders (though CBD taken with THC has been shown to improve sleep better than using CBD alone). The jury is still out on effectiveness but at least one double-blinded crossover study found that CBD did not hurt or disrupt the sleep-wake cycle of patients taking high doses.