Are you also having trouble sleeping at night? Let's talk about insomnia!

Today we are going to talk about a problem that many people have. That is, not being able to sleep properly at night. Sometimes you may not be able to fall asleep even after going to bed. Or you may wake up again even after sleeping for a while. This is what we simply call insomnia. While for some this is just a minor annoyance, for others it can have a major impact on their lives. So, why does this happen? Let's talk about this in more detail, shall we?

What exactly is insomnia, or sleeplessness?

Simply put, insomnia is when you don't get the sleep you want. This can mean that you can't sleep for long enough, you can't sleep well, you have trouble falling asleep, or you wake up in the middle of your sleep.

Think about it, sleep is very important for our bodies. In fact, scientists are still figuring out how important sleep is for us and why we need it so much. But one thing we do know is that not getting enough sleep can lead to sleep deprivation. This is a really unpleasant experience. Also, we can't function properly throughout the day.

Are everyone's sleep patterns the same?

No, it doesn't. Everyone's sleep habits and the amount of sleep they need can vary greatly. Because of these differences, experts say that a wide range of sleep characteristics can be considered "normal." Here are some examples:

• Early birds/early risers: There are some people who naturally like to go to bed early and wake up early.
• Night owls/late risers: Others like to go to bed late and wake up late.
• Short-sleepers: Some people need less sleep than others. Research suggests that there may even be a genetic cause for this.
• Learned sleep differences: Some people develop sleep habits for specific reasons, such as their profession. For example, those with combat experience in the military often learn to sleep very lightly because of the demands and dangers of their profession. Similarly, some people are accustomed to sleeping well no matter how noisy their surroundings are.
• Natural changes in sleep needs: Your sleep needs change throughout your life. A small baby needs about 14-17 hours of sleep a day. But adults (over 18 years of age) need about seven to eight hours a day.

Are there any types of insomnia?

Yes, experts divide this insomnia condition into two main types:

• Time: This can be short-term (acute) or long-term (chronic) . Long-term insomnia is called an insomnia disorder .
• By Cause: Primary insomnia is the inability to sleep for no other reason. Secondary insomnia is the inability to sleep as a symptom of another medical condition or event.

How common is this?

In fact, both short-term and long-term insomnia are very common. Roughly speaking, about one in three adults worldwide has symptoms of insomnia. Also, about 10% of adults can be identified as having an insomnia disorder.

What are the symptoms of insomnia?

Insomnia can have a variety of symptoms. They can be divided into several categories:

• Things you feel when you have trouble sleeping.
• Effects during the day.
• Symptoms of chronic insomnia.

Things you feel when you can't sleep

The way you find it hard to fall asleep is a key symptom of insomnia. This can happen in three main ways, and people often alternate between them:

• Difficulty falling asleep (Initial/sleep onset insomnia): This means that you have a hard time falling asleep when you go to bed.
• Middle/maintenance insomnia: This is when you wake up in the middle of the night, but then fall back asleep. This is the most common type. It affects about two-thirds of people with insomnia.
• Late/early waking insomnia: In this, you wake up early in the morning and cannot fall back asleep.

Effects during the day

Because sleep is essential for you to stay healthy, disorders like insomnia can cause various symptoms even when you're awake. These include:

• Feeling tired, lifeless, or sleepy.
• Slow response. Imagine, when you're driving a car, you can't react quickly.
• Difficulty remembering things.
• Slowed thinking, confusion, or difficulty concentrating.
• Mood changes, especially anxiety, depression, and irritability.
• Interference with your work, social activities, hobbies, or other daily activities.

Symptoms of Chronic Insomnia

The nature of your symptoms is also important. If your symptoms have certain characteristics, you may have chronic insomnia. These characteristics include:

• Conditions: To be diagnosed with chronic insomnia, you must have it without any specific reasons that interfere with your sleep (such as a change in work schedule, special life events). It is diagnosed when you have difficulty falling asleep despite having enough time and the right environment to sleep.
• Frequency: In chronic insomnia, you must have trouble sleeping at least three times a week .
• Duration: Chronic insomnia lasts for at least three months .
• Explanation: This insomnia cannot be caused by drugs or medications (both medical and non-medical) or other sleep disorders. Also, this insomnia cannot be completely explained by other physical or mental conditions.

Why do we not sleep like this? What are the reasons?

Experts still don't know exactly what causes insomnia. But based on current understanding, many factors can contribute to the condition. Some of these factors may be the cause, or may contribute to it. More research is needed to understand exactly how and why insomnia occurs.

Factors that may cause or contribute to this include (but are not limited to):

• Family history (genes): Sleep characteristics and conditions, including insomnia, seem to run in families.
• Changes in brain activity: The brains of people with insomnia may be more active, or chemical changes in the brain may affect sleep.
• Physical conditions: Your physical health can affect your sleep. This can include temporary illnesses like minor infections or injuries, or long-term illnesses like acid reflux or Parkinson's disease . Conditions that affect your body's natural sleep/wake clock, called circadian rhythm, can also cause sleep disturbances.
• Mental health conditions: About half of people with chronic insomnia have at least one other mental health condition, such as anxiety or depression.
• Life situations: Although stressful and difficult life situations are not a direct cause of insomnia, they are very common contributors to it.
• Life changes: Short-term changes like jet lag , sleeping in a new, unfamiliar place, and getting used to a new job (especially shift work ) often have an impact. Even long-term changes like moving to a new home can affect sleep.
• Your habits and routine: Your sleep habits (also called sleep hygiene ) can contribute to insomnia. This includes things like whether you take a nap during the day, what time you go to bed, and whether you drink things like coffee and when you do.

Who is most at risk for insomnia?

People with the following symptoms or conditions are more likely to develop insomnia:

• Light sleepers.
• People who use alcohol.
• People who feel unsafe in their home (for example, in cases of ongoing violence or abuse).
• People who have a fear or anxiety about sleep, for example, those who have sleep-disrupting problems such as nocturnal panic attacks or nightmare disorder .

What complications can occur if you don't sleep?

If insomnia is severe or lasts for a long time, it can lead to sleep deprivation . The main problem with sleep deprivation is daytime sleepiness. This is very dangerous when you are driving a car or doing other tasks that require you to be alert.

Sleep deprivation can also increase the risk of developing the following conditions:

• Depression
• Anxiety
• High blood pressure (Hypertension)
• Heart attack
• Stroke
• Obstructive sleep apnea
• Type 2 diabetes
• Obesity
• Psychosis-related diseases

How does a doctor detect this?

A doctor can diagnose insomnia by asking questions about your health history, personal circumstances, sleep habits, and symptoms. They may also recommend some tests to see if there are other medical conditions that may be causing or contributing to insomnia.

What tests are done?

There are no tests that can directly diagnose insomnia. Instead, tests are used to rule out other conditions that have similar symptoms to insomnia. The most common tests that can be done are:

• Testing for sleep apnea . This can be done using an overnight sleep study (polysomnography) in a sleep lab or an at-home sleep apnea screening device .
• Actigraphy.
• Multiple sleep latency test (MSLT).

Other tests may be done depending on your symptoms and other factors. Your doctor is best able to tell you which tests are recommended for you.

Is there a treatment for insomnia? Can it be cured?

There are many ways to treat insomnia. These treatments range from simple lifestyle and habit changes to various types of medications. The main methods of treating insomnia are:

• Establishing and practicing good sleep habits (sleep hygiene).
• Medications to help you fall asleep or stay asleep (especially ones that are not addictive or otherwise affect your sleep).
• Treatment for mental health.

Medications that help you sleep

There are many different types of medications that can help you fall asleep or stay asleep. Many of these are sedative or hypnotic drugs – both prescription and over-the-counter. There are also mental health medications, and some herbs and supplements.

• Sedative drugs: These reduce the activity of the nervous system.
• Hypnotic drugs: These make you sleepy.

In general, your doctor can best tell you about your treatment options and what is best for you. They are also the best source of information about possible side effects or complications with treatment.

Important: These are just examples of medications, not all treatments are available. Remember, medications for insomnia may not work for everyone. Some medications may interact with other medications, and your age and physical health may also play a role.

Also, it's important to remember that while medications may help you sleep, some medications can also negatively affect your sleep cycle. It's not just the quantity of sleep that matters, but the quality as well. That means you should use medications – even over-the-counter ones – with great caution.

Prescription drugs

There are several types of prescription medications available to treat insomnia. Depending on where you live, some medications may have legal restrictions due to the way they work or their side effects.

Controlled drugs:

• Benzodiazepines: Examples include estazolam , quazepam (Doral®) , temazepam (Restoril®) , and triazolam (Halcion®) .
• "Z-drugs": Although they have different names, experts often group them together because they have very similar properties to benzodiazepines. The most common are eszopiclone (Lunesta®) , zaleplon (Sonata®) , and zolpidem (Ambien®) .
• Dual orexin receptor antagonists (DORAs): Orexin is a chemical in your brain that helps you stay awake. Blocking orexin helps you feel sleepy. Examples include suvorexant (Belsomra®) , lemborexant (Dayvigo®) , and daridorexant (Quviviq®) .
• Antiseizure medications: These include gabapentin (Neurontin®) and pregabalin (Lyrica®) . These can help with conditions that can keep you awake, such as restless leg syndrome .

Non-controlled drugs:

• Sedating antidepressants: These include tricyclic antidepressants (TCAs) such as doxepin (Silenor®) and amitriptyline (Elavil® ), and trazodone .
• Melatonin and related drugs: Melatonin is a chemical your brain uses to tell you when it's time to sleep. It's available in strong prescription doses, as well as in low-strength over-the-counter medications.* There are also synthetic drugs that work similarly to melatonin, such as ramelteon (Rozerem®) .

*Note: Do not take more than the recommended amount of melatonin without talking to your doctor. Doses above 10 milligrams may be harmful.*

Nonprescription medicines

Antihistamines used to treat allergies can also make you sleepy. Examples include diphenhydramine (the active ingredient in medications like Benadryl®) and doxylamine (often known by the brand name Unisom®).

Herbs and supplements

There are many herbs and supplements that can help treat insomnia. While many of these are common, it's not a good idea to assume that any herb or supplement is safe for you. You should definitely talk to a doctor before taking any of these. This will help you avoid any potential side effects or interactions, especially if you have other medical conditions or are taking other medications.

Mental health help

Because your mental health can have a big impact on your sleep, mental health treatment is a very effective way to improve your sleep, either directly or indirectly. A doctor is the best person to tell you more about your options and resources for receiving such care.

Can insomnia be prevented and the risk reduced?

Some of the things that cause insomnia can be prevented. But some of them may be caused by factors that are not fully understood. While insomnia cannot be completely prevented, there are many things you can do to help you sleep better (see the "How can I take care of myself?" section for more information).

What happens if I can't sleep? What is the outlook for this condition?

Insomnia is usually not a big problem. Many people who experience insomnia may feel a little tired or not at their best the next day. However , getting good, quality sleep often improves that feeling. However, long-term insomnia is a life-threatening condition. Although it is not usually dangerous, it can negatively affect your life in many ways.

If you notice that you are experiencing symptoms of sleep deprivation, it's a good idea to talk to a doctor. They can help you find out what's causing your sleep problems. They can also provide you with guidance and treatments to help you sleep better.

Short-term insomnia means it lasts less than three months. Chronic insomnia lasts more than three months. Because insomnia can have many causes, the amount of time you have insomnia may vary from time to time. Your doctor can tell you more about your insomnia and what you can do to limit how it affects you.

How do I take care of myself? (Sleep Hygiene)

Some of the most important things you can do to help your insomnia – and your sleep in general – revolve around sleep hygiene . These include (but are not limited to):

• Establish a sleep schedule and stick to it: For most people, the best thing they can do for their bodies and their sleep needs is to have a consistent routine. Set a bedtime and stick to it as much as possible, including weekends and holidays. Don't rely on naps during the day, and avoid naps in the late afternoon or evening, as these can disrupt your sleep cycle.
• Give yourself time to calm down: Put aside as much of the day's worries as possible before bed. Create a buffer time between when you finish your work for the day and when you go to bed. This will help you get into a good mood for sleep. If you can't sleep, try doing something calm and relaxing instead of lying in bed.
• Get comfortable: Comfort is essential for quality sleep. So create your sleeping environment accordingly – including lighting, noise, and temperature. Some people like to sleep with a sound generator that plays a specific sound spectrum, and you can try this too.
• Put that phone and tab away: Electronic devices often use light to trick your brain into thinking it's not nighttime. This can interfere with the release of chemicals that tell your brain and body that it's time to sleep.
• Think about what you eat and drink: Eating/drinking a lot in the evening, or eating/drinking late at night, can affect your sleep. Eating/drinking certain things can also affect your sleep – especially things that contain nicotine, or things that contain caffeine or alcohol.
• Stay active: Physical activity, even just walking, can help you get better quality sleep.
• If you're having trouble falling asleep, talk to your doctor: Your family doctor is a great resource to help you understand why you're having trouble sleeping and to help you improve your sleep. They can also help you figure out if there are other health problems that might be affecting your sleep.

When should I see a doctor?

If you notice that you have insomnia for more than a few days and it is starting to affect your daily activities, you should talk to a doctor (especially a family doctor). Also, talk to them if you notice any of the following:

• If you experience uncontrollable drowsiness while you are awake.
• If you have sudden episodes of sleepiness (called microsleeps) during your waking hours, especially if it happens while you are working or driving.
• If you have other medical conditions, mental health conditions, or problems that affect the amount or quality of your sleep.

What questions should you ask the doctor?

• Does my physical health affect my sleep? Could I have symptoms or other medical conditions that are preventing me from sleeping?
• How do the medications I take (if you take any) affect my sleep?
• What can I do if I feel like my mental health is affecting my sleep?

Does sleep affect pregnancy?

Yes, being pregnant (and the medical conditions you develop while you're pregnant) can have a significant impact on your sleep. During pregnancy, your body goes through a lot of changes – including physical, hormonal, and psychological changes. These can affect your sleep routine and make it harder to get enough quality sleep. If you're having trouble sleeping while you're pregnant, it's important to talk to your doctor. They can often help you better understand why you're having trouble sleeping and what you can do to help.

Can COVID-19 cause insomnia?

Yes, COVID-19 can affect the way you sleep. But experts still don't know exactly how or why. Researchers are still looking into exactly how COVID-19 affects your brain and body. They think that the general stress associated with the COVID-19 pandemic may also be contributing.

Finally, things to remember

Sleep is something that people often overlook until they're not getting enough of it. However, sleep is a critical part of your health. Not getting quality sleep can have a big impact on your overall health.

If you're having trouble falling asleep, it's a good idea to talk to your doctor. They can often help you improve your sleep, or refer you to another doctor or professional who can help. That way, you can put your sleep-related worries aside and wake up refreshed and ready to go.

` Insomnia, sleep problems, sleep patterns, sleep habits, mental health, sleep medication