Insomnia – Causes, Symptoms & Treatments

What is Insomnia?

Insomnia is defined as the repeated difficulty with sleep initiation, duration, consolidation and quality of sleep. This means you have trouble falling asleep or staying asleep for long periods of time. For those effected by this condition, this disorder means much more. The inability to sleep impacts every aspect of your life. Insomnia is the most commonly reported sleep disorder in America. It’s likely, at some point in your life, you, or someone close to you will be affected. If you are one of the nearly 60 million people in America who annually report issues with sleeping, the consequences are considerable.

“The woods are lovely, dark and deep. But I have promises to keep, and miles to go before I sleep.”
– Robert Frost

This quote resonates louder today than ever before. Our busy work and social lifestyles leave little time for rest. Instead of making sleep a priority, it’s something we try to work into our schedule when time permits. Far too often, our days are filled with so much stress that by the time we go to bed, we’re too wired to nod off.

From time to time, we all have a restless night. However, prolonged sleep deprivation takes a serious physical and mental toll. Insomnia is more than a nighttime affliction. Daytime symptoms include fatigue, difficulty concentrating and moodiness. Insomnia is also linked to bouts of anxiety and depression. The degree and severity of the symptoms can vary and are caused by a variety of factors. For this reason, treatments will vary also. Possible alternatives can range from simple lifestyle changes to behavioral therapy or medications.  We’ll discuss the most common types of insomnia; their causes, symptoms and treatments. It’s important to understand every situation is different. The most effective treatments will vary depending on your unique circumstances. We recommend consulting a physician for any prolonged sleep issues.

Common Types of Insomnia

*Types of Insomnia are identified by the duration, severity and cause of the disorder.

• What Is Acute Insomnia?
• What Is Chronic Insomnia?
• What Is Comorbid Insomnia?
• What Is Onset Insomnia?
• What Is Maintenance Insomnia?

Treatments for Insomnia

*Depending on the severity of your condition, treatment can consist of  a combination of lifestyle changes, behavioral therapy, and medications. Those with severe sleep deprivation issues should always consult a physician for professional advice.

• Good Sleep Hygiene and habits
• Cognitive Behavioral Therapy
• ​Relaxation – Breathing Technique
• ​Progressive Muscle Relaxation
• ​Sleep Restriction Therapy
• Reconditioning Therapy
• Treating Gender Related Insomnia
• Meditation Therapy
• Medications for Insomnia

What is Acute Insomnia?

Acute insomnia is a short term sleep disorder.​ It’s typically brought on by a life altering event like an illness, job loss, divorce or change in sleep routine. Once temporary stress or pain subsides, normal sleep patterns usually return. As a result, Acute insomnia may not need any treatment at all. Simple behavioral changes and good sleep hygiene can help promote better sleep during this period.

Causes of Acute Insomnia

• Stress from life altering event – Job loss, death of loved one or divorce
• Short term injury or illness
• Medications – Some medicines, including cold or blood pressure medicines can cause sleeplessness.
• Environmental distractions – noise, light or temperature extremes
• Changes in sleep routine – Disruption of sleep schedule can upset circadian rhythm

Symptoms of Acute Insomnia

• Difficulty falling asleep
• Difficulty staying asleep
• Waking up early
• Daytime sleepiness
• Difficulty concentrating
• Mood swings

What is Chronic Insomnia?

Unlike Acute Insomnia, Chronic Insomnia is a long term affliction. It is typically categorized by sleep difficulties that occur three or more times a week for over a three month or longer period. Chronic Insomnia sufferers experience far more disruption to their day to day lives. Dangers associated with this disorder increase as symptoms worsen.

Causes Of Chronic Insomnia

• Anxiety and depression
• Anger
• Bipolar disorder
• Trauma
• Grief

Symptoms Of Chronic Insomnia

• Inability to concentrate and memory loss
• Lack of energy
• Chronic stress
• Chronic pain and discomfort
• Irritability
• Feeling sleepy throughout the day

What is Comorbid Insomnia?

Comorbid, is defined by the simultaneous presence of two or more chronic diseases or conditions. Comorbid insomnia is linked to cardiovascular issues, arrhythmia, high blood pressure, diabetes and sleep apnea. A strong correlation has also been shown to exist between insomnia and depression. Having a sleep disorder does not cause depression, but it can play a role a role in its severity. Lack of sleep caused by another medical illness or by personal problems can make depression worse.

For some time, the prevailing consensus has been that if you treat the comorbid condition, insomnia will resolve itself. Recent studies have shown results to the contrary. Evidence now supports that treating both conditions simultaneously is a more effective solution.​ The average American already sleeps just under the bare minimum of 7 hours per night recommended by the National Sleep Foundation. When you add depression or a serious physical condition, to the mix, the results can be dangerous.

Causes Of Comorbid Insomnia

• Psychiatric disorders
• Medical disorders
• Chronic pain
• Neurologic disorders
• Medications
• Circadian Rhythm disorders
• Sleep apnea

Symptoms Of Comorbid Insomnia

Symptoms of Comobrid Insomnia are similar to that of chronic Insomnia.  The presence of a secondary disorder can intensify these symptoms significantly. Insomnia can further aggravate secondary condition.

• Inability to concentrate and memory loss
• Lack of energy
• Chronic stress
• Chronic pain and discomfort
• Irritability
• Feeling sleepy throughout the day

What is Onset Insomnia?

For some, sleep difficulties occur at the beginning, or onset of the night. Once asleep, subjects can generally stay asleep. Onset Insomnia causes significant enough disruption to prevent a quality night’s sleep. Onset Insomnia can be acute or chronic depending on the duration of the disorder. The intensity of its symptoms can range from mild to severe.​

Causes Of Onset Insomnia

• Temporary or long term stress
• Medical issues
• Circadian rhythm issues
• Other sleep disorders
• Excessive amounts of stimulants; such as caffeine

Symptoms Of Onset Insomnia

• Inability to concentrate and memory loss
• Lack of energy
• Chronic stress
• Chronic pain and discomfort
• Irritability
• Feeling sleepy throughout the day
• Lack of sex drive

What is Sleep Maintenance Insomnia?

People with maintenance insomnia wake up frequently and have trouble returning to sleep. Unlike onset insomnia, Sufferers of this disorder have little difficulty getting to sleep. Staying asleep, in particular, waking too early is the biggest problem. Often times, frustration sets in and the stress of not being able to return to sleep compounds the problem​.

“Like when people say they slept like a baby. Do they mean they slept well? Or do they mean they woke up every ten minutes, screaming?”
– Lee Child, Killing Floor

Causes Of Maintenance Insomnia

• Medical issues such as chronic pain, sleep apnea or depression
• Alcohol use or abuse can cause you to fall asleep quickly but be restless through the night
• Menopause can be a large contributor to repeated wake ups.
• Anxiety or depression will cause symptoms to emerge or become more pronounced
• Worrying about not being able to stay asleep becomes a self fulfilling prophecy. The stress this disorder creates is a vicious circle.

Symptoms Maintenance Insomnia

• Early Morning awakenings – waking too early and not being able to return to sleep
• Waking up suddenly to a restless state
• Not being able to sleep longer than a few hours at a time
• Having the sense that you are still awake, even while sleeping

Treating Insomnia

Depending on the type and severity of the disorder, one or several different techniques may be used. Some recommendations are simple but effective lifestyle changes. Others should not be started without first consulting a physician.

*Information on this site is intended to be an informational guide and should not be interpreted as medical advice. Seek professional help for serious sleep disruption.

Good Sleep Hygiene and Habits

Maintaining proper sleep hygiene is essential to getting a good night’s rest.​  It involves creating the proper environment most conducive for sleep. It also means putting your body and mind in the right state of well being. Better health starts with making great sleep a priority.

• Limit caffeine intake – especially later in the day. Caffeine stays in your system up to 6 hours
• Avoid big meals before bedtime
• Keep bedroom cool; but not cold
• Set a time curfew for TV and computer use. Excessive light stimulation plays havoc with sleep.
• Keep your room dark. This signals your body it’s time to sleep
• Maintain a healthy lifestyle that includes daily exercise.
• Create a clutter free comfortable sleep environment.
• Limit bedroom activity to sleep and sex.
• Keeping a regular sleep schedule (even on your days off) will help keep your circadian rhythm in check.

Cognitive Behavioral Therapy for Insomnia

​Cognitive Behavioral Therapy is considered a safe, effective alternative to medications that can have unwanted side effects.​ Recent clinical trials that included over 1,100 Chronic Insomnia sufferers showed great promise. On average, participants fell asleep almost 20 minutes faster and spent roughly 30 minutes less time awake compared to those not undergoing CBT. These results were significant when compared to other treatments. According to Harvard Health Publishing, results of this therapy were equal to or better than similar data reported on zolpidem (Ambien) and eszopiclone (Lunesta). That’s great news considering there is no risk of medical side effects. Participants also showed continued benefits up to 6 months after therapy ended. It’s important to note, the study excluded those with secondary, medical, sleep or psychiatric disorders.

CBT begins with meeting with a therapist who will help work out an individualized plan for dealing with your sleep deficiencies. They may recommend cognitive therapy, stimulus control, sleep restriction, sleep hygiene and relaxation. None of which involve medications. The goal is to find the underlying cause opposed to only treating symptoms. During a 6 – 8 week period, the patient will log all sleep activity while their therapist will continue to monitor progress. Cognitive Behavioral Therapy is not a cure for Insomnia. It is however, been proven to be a safe effective way to approach this disorder. Approaches to CBT incorporate at least 3 of the following: stimulus control, sleep restriction, sleep hygiene, relaxation or meditation. Ask your doctor for more information and proper counseling.

Relaxation – Breathing Techniques

When your mind is racing it’s difficult to sleep. Try shifting attention away from the pressures of the day and focus on your body. Breathing techniques can be a very effective way to disengage from your stress. Concentrate on each breath you take. Breathe deep and slowly into your lower abdomen rather than your chest. Now, hold that deep breath in briefly before exhaling and feel your body begin to relax. Breathing techniques may take a bit of practice to master. Once comfortable with this activity it’s quite an effective way to find sleep. Or as the case may be, relax and let sleep find you!

Progressive Muscle Relaxation

Progressive muscle relaxation has received a lot of attention recently. But, it’s hardly a new technique. It was first developed in Chicago over 100 years ago by Dr. Edmund Jacobson. Using this technique, you learn to systematically tense, then relax the various muscle groups of your body. The process promotes overall physical relaxation and has been widely used in the treatment of insomnia. The benefits of progressive muscle relaxation include reduced anxiety, lower blood pressure and a sense of well being.

​How To Do Progressive Muscle Relaxation

*IMPORTANT – USE CAUTION!

Doing these exercises should never be painful. Apply firm but gentle pressure. Avoid if you have pulled muscles or are healing from broken bones. Consult a physician prior to starting this program if you have a condition that limits physical activity.  

Step #1 Applying Tension

Take a deep breath and apply tension to a specific muscle group. You can start with something as simple as your facial muscles. As you breathe in, raise your eyebrows in hold the position for 5 – 10 seconds.

Step #2  Relaxing Tense Muscles

Breathe out fully while releasing applied tension. Allow tense muscles to go limp and relaxed. Take about 10 – 15 seconds to appreciate how relaxed these muscles are, then move on to the next muscle group Repeat the process while holding your eyes closed shut. Again, breathe out and release tension. You can slowly move onto larger muscle groups like the shoulders and biceps. It takes time to fully focus on specific muscle groups, but with practice, this technique can be very effective. The process relaxes the body and eases the mind in preparation for sleep.

Sleep Restriction Therapy

“If you can’t sleep, then get up and do something instead of lying there and worrying. It’s the worry that gets you, not the loss of sleep.”
-Dale Carnegie

Sleep Restoration Therapy was developed by Arthur Spielman, co-director of the Center for Sleep Medicine at Cornell Medical College. This technique is intended to reduce the amount of time awake after sleep disruptions, thus increasing the quality and efficiency of sleep.

Sleep restriction therapy limits the actual time spent in bed to time spent sleeping. The process begins by calculating the average amount of time slept over the past 7 nights. It does not count time awake in bed; only actual sleep time. This is important because many people who suffer from insomnia can spend 10-12 hours in bed but only be asleep for half of that time. That average sleep time becomes the allotted time for bed. The period must be at least 5.5 hours, even if the patient’s actual average was less.

This mild form of sleep deprivation is designed to encourage deeper more productive sleep. After the first week, quality of sleep during this period should increase substantially. At this point, the amount of time in bed is increased by 15 – 30 minute intervals. This duration will continue to increase as long as sleep efficiency improves; usually in one week intervals. Therapy is complete once the patient has attained the amount of quality sleep necessary for daytime functions.

Recondition Therapy for Insomnia

This process reconditions how patients perception of what their bedroom is. The basic prevailing philosophy here is that the bedroom is for sleep and sex only. That said, only go to bed when you are sleepy. If you you find yourself restless and frustrated, get out of bed and return when you feel ready for sleep. If you return still can not nod off, repeat the process. Read a book, listen to music and relax, let sleep come to you instead of chasing it. The goal is to change your perception of the bedroom from frustrating to comforting.

During this process it’s important to keep a set sleep schedule and wake at the same time daily. If you are sleepy during the day, resist the temptation to nap. This will help make going to bed a more welcoming experience.

Treating Gender Related Insomnia

Adjusting to hormonal changes during menstrual cycle or during menopause start with a commitment to some simple lifestyle adjustments.​

When Insomnia is caused by hormonal fluctuations and hot flashes, keeping your room temperature cool is very important. As you drift of to sleep, your body temperature naturally drops. Doing whatever you can to help this process will go a long way towards improving sleep. Don’t just think in terms of turning up the air conditioner. Choosing the right mattress will make a big difference. Natural materials such as latex, cotton and wool, breathe better and sleep cooler than most synthetic foams and fabrics. Bamboo sheets and pillow cases have a natural wicking action that help keep you cool and dry. Make certain your mattress protector is breathable too. The cooler and more comfortable you are, the better you’ll sleep.

For insomnia during pregnancy, try using multiple pillows in various positions around your body. Between your legs, under your arms or behind your back or anywhere that makes you more comfortable. Although it’s important to maintain your fluid intake during pregnancy, avoid drinking too much later in the evening. If Insomnia is also accompanied by depression, your doctor should be contacted ASAP. There are relaxation exercises known to help, but we recommend starting with a medical evaluation.

Meditation Therapy

The 1970’s brought about a term called “Mindful Meditation”. The process was designed to counteract the body’s response to stress and is still being used today. Meditation therapy involves diverting attention from daily tensions by focusing on breathing patterns or soothing sounds. Combined with good sleep hygiene practices, this routine is considered safe and effective.

Medications for Insomnia

Pharmacological sleep aids  include benzodiazepines (Restoril) and non-benzodiazepines such as Ambien or Lunesta. These are powerful prescription drugs that have documented side effects. All prescription sleeping pills have risks. Especially vulnerable, are people with liver or kidney disease.  Always talk with your doctor before trying a new treatment for insomnia. Always discuss any alternative options with your Doctor before using these medications. Most sleeping pills are meant to treat symptoms, not the underlying causes of insomnia. Cognitive behavioral therapy is widely viewed as a more effective (and safer) long term solution to sleep disorders.