Insomnia is a large and important topic. Whole books are written about it. Within this article I will highlight what is most important to know about the problem and some steps towards overcoming it.
First of all, insomnia is more of a symptom than it is an illness. The word insomnia comes from the Latin In (not) + Somnus (sleep). It literally means “not sleeping”.
Be that as it may, most insomnia sufferers get some sleep. The problem is that the sleep is either too short or of poor quality.
Everyone experiences a sleepless night of tossing and turning once in a while. This is normal and is not outside of healthy sleep. However, when insomnia becomes a regular occurrence it is a sleep disorder. There are three categories of insomnia, ordered according to duration:
Categories of Insomnia
- Transient Insomnia – Lasts less than a week. This type of insomnia can usually be connected with some kind of stress
- Acute Insomnia – From one week to one month in duration. Acute insomnia does not mean the person has not slept at all for a month, but that sleep has been difficult to initiate or sustain, or that the quality of the sleep has been very poor and unrestful.
- Chronic Insomnia – More than one month of poor sleep. Additional effects caused by long term sleep disruption may include severe muscle fatigue, aches and pains, hallucinations, lack of concentration, mental fatigue and double vision.
Do I Have Insomnia?
To determine whether you are suffering from insomnia, try this three-question Test:
- Are you experiencing poor sleep?
- Does the problem occur even though you have opportunity for sleep and a good sleep environment?
- Does the poor sleep affect you adversely the rest of the day – fatigue, sleepiness, aches and pains, bad mood, lack of concentration, lack of energy or motivation, sleep anxiety
Unless you answered ‘Yes’ to all three of these you don’t have insomnia. In other words, insomnia, in order to be insomnia, is described as poor sleep not due to external factors that is adversely affecting you both physically and mentally.
Insomnia is Self-Perpetuating
One of the difficulties with insomnia is that our our response to poor sleep is often to do things that hinder us from getting back on track. We try to compensate by sleeping in late, which makes it harder to get to sleep the next night. Or, we drink alcohol right before bed which may get you to sleep more quickly, but the sleep will be more easily disrupted. Or we simply worry too much about whether we will be able to sleep, and this worry becomes a self-fulfilling prophecy.
By thinking, or even saying, “I probably won’t sleep well tonight” a person can set themselves up for failure. This creates a downward spiral that is difficult to break out of. The bedroom may become associated with anxiety and being awake, so that far from inducing sleep, getting in bed actually prevents sleep. This can be true of other sleep cues as well, such as brushing your teeth, locking up the house, or other activities that usually precede sleep.
Primary vs. Secondary Insomnia
Another way in which insomnia is categorized is to distinguish between primary and secondary insomnia.
With primary insomnia, there is no other obvious external cause. It may be that some bad habit was started in infancy. Or the person may naturally have a higher metabolic rate or a higher level of stress hormones.
With secondary insomnia, there is some other health problem that creates an insomnia that may continue even after the initial problem subsides. Examples of insomnia causes are disease, illness, depression, heartburn, medication, drugs/alcohol/caffeine/nicotine, to name a few.
The term secondary is used not because of a lower importance, but because it is caused by some other problem initially.
Treatment Strategies for Insomnia
Standard treatment strategies fall into three main categories: Behavioral treatments, medications, and alternative treatments. Since I am not a doctor I am going to focus on the behavioral side. I will touch briefly on the the types of medications and other methods used to inform you, but what I say should in no way be construed as recommending a particular course of action. As with any disorder, it is best to seek counsel from a medical professional, and under no circumstances should you begin taking a medication or using an alternative medicine treatment without consulting your physician.
Behavior Treatment Methods for Insomnia
Of all the ways to treat insomnia, the behavioral treatments are usually the best. They are certainly the most natural, and are usually more effective than medications, without all the side effects drugs can entail.
When dealing with insomnia one should always begin with behavioral treatments, and only try other methods when behavioral methods have been thoroughly tried and exhausted.
The first line of behavioral treatment is simply to practice good sleep hygiene. See my best sleep tips for an extensive list of ways to improve your sleep naturally.
When a person has been suffering from insomnia for a lengthy amount of time they will often establish negative associations with the sleep environment and sleep cues (as mentioned above). Things that normally contribute to a state of sleep preparation may be triggers for anxiety and alertness. The darkening sky, brushing your teeth, putting on pajamas, and getting into bed all become objects of frustration rather than relaxation.
Recondition is a step by step process meant to train a person to break those negative associations between the sleep environment and feelings of wakefulness, anxiety, fear and frustration so that they once again become triggers for sleepiness and rest.
Sleep restriction therapy is a process whereby you begin with a limited (restricted) amount of time in bed in order to train your body and mind to make maximum use of the sleep time. Only after this adjustment has been made do you start to gradually add 15-30 minutes of sleep at a time until you get to the desired or correct amount of nightly sleep.
Insomnia self-perpetuates by causing sufferers to experience anxiety and worry regarding sleep. By learning to release that anxiety during a pre-sleep routine one can begin to approach the sleep environment and time period in a proper state of relaxation.
There are several techniques for relaxation – progressive muscle relaxation; deep breathing exercises; yoga; meditation; visualization; and biofeedback are the most common.
Cognitive therapy involves retraining the mind to think about sleep in new ways, or with a new attitude. You learn to get rid of negative and inappropriate ways of thinking and replace the bad patterns of thought with positive and appropriate patterns of thinking. Cognitive Therapy is used in a variety of kinds of mental health situations with good success.
Treating Insomnia with Medications
Again, I am not a doctor and cannot prescribe any drugs. I can not in good conscience advise anyone to take over-the-counter drugs, either. I only wish to inform you about what is available and what you could expect from such drugs so you can make your own decision.
Again, no one should pursue medical treatment for any sleep disorder until behavioral methods have been exhausted, and anyone considering taking any type of drug to treat insomnia or other sleep problems should consult their physician or a sleep specialist doctor first.
With many kinds of drugs, including sleep-inducing drugs, you should keep in mind the following: Tolerance, rebound, dependence, safety and side effects.
Most OTC sleep medications contain an antihistamine as the active ingredient. Although usually used to treat allergies, antihistamines also block the wake-enhancing effect of histamine in the sleep-regulating centers of the brain, which promotes drowsiness. This is why most allergy medicines warn of causing drowsiness.
These are reasonably effective for a single night, but they have limited long-term usefulness. Most people build up a tolerance to the sleep-inducing effects in just a few days. Plus they may have side effects such as nausea, dizziness, dry mouth, and impaired coordination that are not worth the benefits, and may actually end up impairing rather than aiding sleep.
In treating insomnia, prescription drugs tend to be more effective than OTC medicines and they have fewer drawbacks. They must be prescribed by a physician.
A pill is not a silver bullet solution to insomnia. Too many doctors are willing to prescribe such drugs without doing a thorough evaluation of the patient. Underlying problems are not resolved and the best treatment is not found. The best use of medications is in conjunction with behavioral methods of treatment. For example, when undergoing reconditioning to reestablish a positive connection between sleep cues and sleepiness a medication may be used to induce drowsiness while experience such cues, in order to create that connection.
Alternative Treatment Methods
When considering an alternative treatment for any health issue keep these points in mind:
- Is there any potential danger. Check online for any accounts of problems people have experienced. For example, you could type into your browser search engine the phrase “valerian side effects” to find websites that discuss these issues.
- Use the treatment in conjunction with standard medical or behavioral methods, not instead of
- keep your doctor informed. If you feel like you need to keep it secret from your doctor it is not a good idea.
Alternative treatment methods include herbal supplements, over the counter melatonin and acupuncture.
Herbal supplements – The most commonly used herbal supplements for sleep inducement are valerian, lavender, chamomile and passionflower. These are believed to cause drowsiness or relaxation. Chamomile tea has been in use for centuries as a sleep aid. Taken in low dosage these all appear to be pretty safe and have a mild sedating effect.
OTC Melatonin – Even though melatonin is a naturally produced hormone associated with sleep, synthetic varieties sold over the counter have been found in multiple studies to have little beneficial effect. There is a small subset of the population that appears to benefit from it, but most get no help from it at all.
Acupuncture – Not many studies have been done to study the effects of acupuncture, and those that have been done have been quite small. What has been observed would indicate there is a good potential for strong benefits from acupuncture for insomniacs, but more study is required to make that determination.