Insomnia Disorder
Insomnia, the most common sleep disorder, involves problems getting to sleep or staying asleep. About one-third of adults report some insomnia symptoms, 10-15 percent report problems functioning during the daytime and 6-10 percent have symptoms severe enough to meet criteria for insomnia disorder. An estimated 40-50 percent of individuals with insomnia also have another mental disorder. 1
Symptoms and Diagnosis
To be diagnosed with insomnia disorder, the sleep difficulties must occur at least three nights a week for at least three months and cause significant distress or problems in work, school or other functioning. Not all individuals with sleep disturbances are distressed or have problems functioning.
To diagnose insomnia, a physician will rule out other sleep disorders (see Related Conditions below), medication side-effects, substance misuse, depression or other illness. Some medications and medical conditions can affect sleep.
A comprehensive assessment for insomnia or other sleep problems may involve a patient history, a physical exam, a sleep diary and clinical testing (a sleep study). A sleep study allows the physician to identify how long and how well you’re sleeping and to identify specific sleep problems. A sleep diary is a record of your sleep habits to discuss with your physician. It includes information such as when you go to bed, get to sleep, wake up, get out of bed, take naps, exercise and consume alcohol and caffeinated beverages.
Sleep problems can occur at any age but most commonly start in young adulthood. The type of insomnia problems often vary with age. Problems getting to sleep are more common among young adults. Problems staying asleep are more common among middle-age and older adults.
Symptoms of insomnia can be
- Episodic (with an episode of symptoms lasting one to three months)
- Persistent (with symptoms lasting three months or more)
- Recurrent (with two or more episodes within a year)
Symptoms of insomnia can also be brought on by a specific life event or situation.
Treatment and Self-help
Sleep problems can often be improved with regular sleep habits. (See list of healthy sleep tips below.) If your sleep problems persist or if they interfere with how you feel or function during the day, you should seek evaluation and treatment by a physician.
Sleep disorders should be addressed specifically regardless of mental or other medical problems that may be present. Chronic insomnia is typically treated with a combination of sleep medications and behavioral techniques, such as cognitive behavior therapy. Several types of medications can be used to treat insomnia and help you fall asleep or stay asleep. Most of these can become habit-forming and should only be used for short periods under the care of a doctor. Some antidepressants are also used to treat insomnia.
Most over-the-counter sleep medicines contain antihistamines, which are commonly used to treat allergies. They are not addictive, but they can become less effective over time.
Many people turn to complementary health approaches to help with sleep problems. According to the National Institutes of Health some may be safe and effective, others lack evidence about effectiveness. Some raise safety concerns.
- Relaxation techniques, used before bedtime, can be helpful for insomnia.
- Melatonin supplements may be helpful for people with some types of insomnia. Long-term safety has not been investigated.
- Mind and body approaches, such as mindfulness/meditation, yoga, massage therapy and acupuncture lack evidence to show their usefulness, but are generally considered safe.
- Herbs and dietary supplements have not been shown to be effective for insomnia. There are safety concerns about some, including L-tryptophan and Kava.
There are safety concerns about some, including L-tryptophan and Kava. Let your health care provider know about any alternative medicines or supplements you are taking. Let your health care provider know about any alternative medicines or supplements you are taking.
Healthy sleep tips to address problems sleeping include:
- Stick to a sleep schedule – same bed time and wake up time even on the weekends
- Allow your body to wind down with a calming activity, such as reading away from bright lights; avoid electronic devices
- Avoid naps especially in the afternoon
- Exercise daily
- Pay attention to bedroom environment (quiet, cool and dark is best) and your mattress and pillow (should be comfortable and supportive)
- Avoid alcohol, caffeine and heavy meals in the evening
Source: National Sleep Foundation