At a most basic level, insomnia is a persistent difficulty falling and/or staying asleep. Various worldwide studies have shown that symptoms of insomnia impact 10–30% of the population, with some studies concluding the number may be as high as 50–60%.
But while insomnia may be fairly easy to diagnose, it’s a challenging disorder to fully understand. The lines can be blurry around its causes and the issues that exacerbate it. This is why treating the symptoms of insomnia (not being able to get or stay asleep) can make it difficult to get to the root causes of insomnia.
If you or someone you know has been experiencing insomnia, this article can help you understand the common causes, popular treatment options, and the innovative Full Sleep program.
Sleep is a critical bodily function. It helps us fight disease and keeps our immune system working at optimal levels. It impacts how our body regulates our metabolism and manages chronic diseases and conditions. On top of that, it plays a significant role in our ability to be at our best both mentally and physically.
So when we’re deprived of sleep, it’s a big deal.
Unfortunately, insomnia has become a general label frequently applied to every sleep difficulty. This is often because of a tendency to think of insomnia as a symptom and not a disorder. Correctly understood, insomnia can be both a disorder and a symptom of another disorder. It’s important to understand that there is a technical definition for insomnia and criteria for diagnosing it.
A couple of nights of poor sleep isn’t necessarily insomnia. In fact, insomnia isn’t defined by the number of sleeping hours at all. When it comes to the amount of time people sleep, it’s helpful to keep in mind that some people function extremely well with 5–6 hours of sleep a night.
Because of the ways culture talks about insomnia, it can be a surprise to learn that many with insomnia regularly get “sufficient” amounts of sleep. The areas where people with insomnia differ from others have to do with:
The DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision) defines chronic insomnia as a sleep disorder associated with one or more of the following symptoms:
Along with these symptoms, a chronic insomnia diagnosis also requires that the sleep difficulty:
When it comes to insomnia, it’s important to think about it as a specific disorder, and not a catch-all term for anything that impacts one’s sleep.
There isn’t a one-size-fits-all version of insomnia. The symptoms associated with this sleep disorder can show up in different ways.
There are a number of reasons why someone could experience insomnia symptoms for a period of fewer than three months. It could be the result of loss or a stressful transition. For instance, if someone was going through a divorce or the loss of a loved one.
Bouts of short-term insomnia can also happen when you experience things like:
These forms of short-term insomnia tend to resolve themselves over time as we adapt to situations or conditions change. But sometimes the ways we attempt to accommodate acute insomnia or our anxiety around it can lead to chronic insomnia.
This form of insomnia is a condition that lasts longer than three months but can even continue for years. It may occur persistently or it may be recurring. And while it can be fairly easy to determine the causes and treat acute insomnia, the causes associated with chronic insomnia can be more challenging to figure out. Sometimes the condition is the result of a perfect storm of converging issues.
Traditionally, treatment for chronic insomnia has focused on modifying the behaviors and thought processes associated with the problem or pharmaceutical intervention. Many organizations and guidelines, including the American Academy of Sleep Medicine and the American College of Physicians, recommend a methodology known as cognitive behavioral therapy for insomnia (CBT-I) as a first-line treatment of this disorder.
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Sometimes insomnia can be linked to other conditions or behaviors. This is often referred to as “secondary insomnia.” For instance, someone who uses methamphetamine or someone experiencing migraines might struggle to get to sleep or stay asleep. When the symptoms of insomnia are related to other factors, it’s often referred to as secondary.
Occasionally, insomnia may exist alongside another condition. These conditions are comorbid, meaning conditions co-occurring in a person. For instance, you might have depression and insomnia. One condition isn’t necessarily causing the other, but they occur simultaneously and can exacerbate one another. Depression may make it harder to get to sleep at night, and the lack of sleep can negatively impact depression symptoms. But removing one won’t necessarily cure the other.
It’s important to recognize that the line between secondary and comorbid insomnia is a little blurry. Removing the primary condition or behavior causing secondary insomnia won’t always fix insomnia. And treating one comorbid condition can occasionally have a huge impact on the other, revealing more of a causal relationship than previously thought.
Insomnia is a complex disorder that might have a single source of origin, or it could be the culmination of a variety of compounding issues. A few of the common issues causing or exacerbating the condition might include:
These are just a few of the problems that can lead to or worsen insomnia, but these problems don’t need to be present for your sleep to be impacted. Primary insomnia can occur unrelated to your environment, or secondary physical or mental-health problems.
Individuals often try to find a solution for insomnia on their own before consulting a professional. So let’s look at some common home treatments before touching on professional responses to insomnia.
When people are struggling with sleep issues, they may or may not use the term insomnia in a colloquial sense. For instance, after a week’s worth of bad sleep, they might tell their spouse that they have insomnia. If they Google “home treatments for insomnia,” they’ll find a lot of material relating to sleep hygiene.
Sleep hygiene refers to behaviors and environmental factors that one could change to make their lifestyle more conducive to sleep. These might include things like:
The kinds of habits touched on by sleep hygiene are important, and can truly help people suffering with some sleep issues. And sleep hygiene plays an important part in methodologies like CBT-I. But on its own, it isn’t often an effective treatment for chronic insomnia.
According to the Clinical Practice Guideline for Chronic Insomnia from the American Academy of Sleep Medicine, “Although all patients with chronic insomnia should adhere to rules of good sleep hygiene, there is insufficient evidence to indicate that sleep hygiene alone is effective in the treatment of chronic insomnia. It should be used in combination with other therapies” (Schutte-Rodin, Broch, Byusse, Dorsey, and Sateia, 2008, p.488).
The next step for many is to introduce substances that can help them relax and fall asleep. This includes over-the-counter medications and/or alcohol and CBD products. Here are a few of the most common ones.
Initially, a drink or two can seem like an easy way to solve problems sleeping. It is a depressant, meaning that it reduces arousal and stimulation (generally speaking). A glass of wine before bed can act like a sedative, but people can quickly develop a tolerance to its sedating effects—requiring someone to drink more in order to have the same impact. Some studies suggest that self-treating sleep issues with alcohol can lead to problem drinking.
Currently, the research around using cannabis for treating sleep issues is mixed. It can appear to be helpful in the short term but a lot more research is needed to truly understand its impact. It’s important to keep in mind that the goal of treating insomnia is to promote the body’s natural wake/sleep cycle. Some research suggests that it’s easy to become reliant upon the influence of cannabis products on sleep.
Ryan Vandrey, professor of psychiatry and behavioral sciences at John Hopkins University, says, “What commonly happens is people get into a pattern of using cannabis—whether it’s a high THC or high CBD hemp product—on a daily basis for an extended period of time. Then, when they go one night without it, they can’t sleep.”
In order to maintain our circadian rhythm (the 24-hour clock that regulates our sleep/wake cycle), our body produces a hormone called melatonin. This hormone can be purchased as a supplement, and evidence suggests that it can promote sleep and is safe for short-term use.
When it comes to treating insomnia, there may be underlying issues that melatonin can’t touch. If you’re having difficulties falling asleep, staying asleep, or waking up too early, you may need to look beyond hormonal supplements to compensate.
Beyond melatonin, there are a number of sleep aids that one can purchase. For the most part, all of the pills available without a prescription have the same sleep-inducing active ingredients: diphenhydramine and doxylamine.
Both of these medications are antihistamines and can be helpful for most people short term. If sleep issues continue, it’s wise to consult your physician. Overuse of these medications can lead to dependence and rebound insomnia (a re-emergence of the symptoms that led you to take the sleep aids in the first place).
If you look for intervention from a medical professional, treatments will tend to focus on the psychological or pharmacological. Their first line will be to address the thought patterns, behaviors, and environmental factors impacting sleep. They may also prescribe medications to help you fall asleep faster and rest through the night.
One of the first-line treatments offered is cognitive behavioral therapy for insomnia (CBT-I). CBT-I is a therapeutic approach that is fairly short in length, lasting about six sessions or less. It’s a methodology comprised of proven techniques for helping people get to sleep faster, sleep more efficiently, and stay asleep longer.
CBT-I helps to reframe the way a person with insomnia thinks about sleeping and bedtime. Because they can’t sleep, they tend to lie in bed scrolling through their phone, flipping through the TV, or worrying about whether they’ll get enough sleep tonight. This trains the brain to associate their bed with behaviors other than sleep. CBT-I helps to re-associate the bedroom with sleeping, even encouraging people to get out of bed if they’ve been lying there awake for longer than about 20 minutes.
Another essential CBT-I element is sleep restriction. This focuses on limiting the amount of time spent in bed not sleeping, so that your bed becomes strongly associated with sleep. It’s easy for people struggling with insomnia to increase the time they spend in bed awake, developing negative thought patterns around sleeping. The CBT-I specialist helps develop a specialized sleep schedule that is based around your personal needs and sleep efficiency score. You can learn more about this in our introduction to CBT-I article.
It also focuses on giving the person some tools to help them modify the negative thought patterns around sleep, and calm their mind and body at night.
CBT-I is highly regarded as a critical first step in dealing with insomnia. If you’re interested in learning more about this methodology and how Full Sleep uses CBT-I techniques, please check out “[insert name of CBT-I article].”
There are a number of medications your physician can prescribe for sleep, but they’re usually considered second-line treatment. A physician will typically consider them a short-term stop-gap measure. The reason medication isn’t as effective as other first-line measures like CBT-I is because they’re only effective while you’re taking them. So it’s essential that sleep prescriptions are not abused, but followed to the letter.
Full Sleep leverages the proven techniques of CBT-I in a comprehensive, personalized sleep program to help troubled sleepers. Along with a customized experience and sleep coach, Full Sleep’s bedside sleep tracker monitors your sleep via radar technology and helps you stay on track, even reminding you to get up if you’ve been lying awake too long.
The 6–8-week program offers lessons and tips to help you reevaluate your relationship with sleep, cut down on worries surrounding bedtime, and make your slumber more productive and efficient. A personalized sleep schedule and coach equip you with the tools you need to remove the obstacles that negatively impact how you think about and experience sleep.
Full Sleep’s science-based solution brings the sleep clinic into your bedroom with a non-invasive program for insomnia.