What Is Insomnia?

Insomnia can be defined as the inability to fall asleep, stay asleep, or waking too early. Many people experience insomnia at some point in their lives because there are many causes, some of them temporary. If you develop chronic insomnia, you may be referred to a sleep specialist at Baptist Health.

Types of Insomnia

How do you know if you have insomnia? The main symptom of insomnia is the inability to go to sleep or stay asleep, but this can also lead to sleepiness during the day. Since sleepiness can be a symptom of many sleep disorders, it is important to talk to your doctor about all possible symptoms. Certain disorders like Periodic Limb Movement Disorder (PLMD) can occur during sleep without you being aware or waking up.

Insomnia can be classified as either a sleep disorder or as a side effect of another type of medical problem or disease:

• Primary insomnia: Primary insomnia is a sleep disorder that occurs independently of any other medical issue or condition.
• Secondary insomnia: Secondary insomnia refers to the sleeping problems that someone may experience while suffering from another medical condition, such as asthma, arthritis, acid reflux, cancer, or depression. Secondary insomnia is a symptom rather than a disorder.

A second means of classifying insomnia is based on frequency and duration:

• Acute insomnia: Acute insomnia is short-term insomnia, lasting from one night to a few weeks at a time.
• Chronic insomnia: Chronic insomnia is long-term insomnia, occurring at least three nights a week for periods of three months or more. The chronic form can stop suddenly and then reoccur at a later date.

There are other means of defining insomnia as well:

• Sleep-onset insomnia: If you have difficulty falling asleep on a regular basis, you may have sleep-onset insomnia.
• Sleep-maintenance insomnia: In this form of insomnia, you wake up frequently at night or too early in the morning.
• Mixed insomnia: Mixed insomnia combines difficulty falling asleep with difficulty staying asleep or waking too early.
• Paradoxical insomnia: Paradoxical insomnia is more perception than reality. It occurs when you think that you’re sleeping less than you actually are.

Symptoms

Insomnia can affect both your sleeping and waking hours. Symptoms may include:

• Trouble falling asleep
• Frequent waking during the night
• Waking too early in the morning, with an inability to go back to sleep
• Fatigue, sleepiness, or exhaustion during daylight hours
• Feeling grumpy or irritable
• Problems concentrating
• Becoming accident prone
• Feeling anxious about a persistent lack of sleep

Insomnia Causes

Insomnia is thought to be caused by the brain’s inability to regulate sleep and wake times. The sleep and wake cycles do not operate at the same time, it is one or the other. When your brain is unable to turn off the wake signals and turn on the sleep signals, insomnia is the result.

In addition to the brain being the cause of sleeplessness, there are other factors that can keep you from getting sleep.

• Medical conditions: Some other sleep disorders can cause disruptions in sleep, such as Restless Legs Syndrome (RLS) or Sleep Apnea. Other non-sleep specific causes also include asthma, arthritis, and chronic pain or sinus conditions.
• Medications: Some decongestants or cold medicines can cause difficulty sleeping as well as those taken for heart, thyroid, high blood pressure or depression.
• Sleep habits: Going to sleep and waking at irregular times each day and night, using electronic devices too close to bedtime, eating or drinking caffeine or alcohol in the evening.

Diagnosis

Most cases of insomnia can be diagnosed by symptom description to your doctor. A physical exam and detailed sleep history along with symptom description is sometimes all that is used to diagnose this disorder. If other factors are of concern your doctor may recommend you to a sleep specialist at Baptist Health where a sleep study can be performed in the lab or at home and the proper treatment can begin.

What Tests Are Used to Diagnose Insomnia?

There are no medical tests that can positively diagnose insomnia. Instead, your physician may order one or more tests with the goal of eliminating other possible diagnoses that are consistent with your symptoms. These tests include:

• Actigraphy: Actigraphy is a test for measuring a patient’s periods of activity and rest. The actigraph, the testing device, is shaped like a watch and is worn on the wrist or ankle throughout the day, for a period of up to two weeks. Your physician will use data collected by the actigraph to analyze patterns in your sleep-wake cycle.
• Sleep study (polysomnography): A sleep study is a test in which diagnostic devices are used to gather data from a number of bodily systems while you sleep. Included among the monitored systems are those associated with the brain, heart, and lungs. Sleep studies can be conducted in the patient’s home or at a medical facility. They’re used to diagnose a wide range of sleep disorders, which can provide or eliminate alternative diagnoses for the symptoms presented by the patient.
• Multiple sleep latency test (MSLT): A multiple sleep latency test is a variation on a sleep study, in which the patient spends the night at a medical facility and is tested again on-site in a series of naps during the following day.

If you are unsure if you have a cause for concern or believe that you may have insomnia, use the Epworth Sleepiness Scale or Stop-BANG assessment to rate your symptoms.

What Age Groups Are Most Affected by Insomnia?

Insomnia affects different age groups differently. In general, the older you are, the more likely you are to experience some form of sleep deprivation.

Insomnia in Adults

Adults are more susceptible than children and teenagers to insomnia.

This is because of:

• Changing sleep habits: Changes in when, how long, and how well you sleep are often linked to changes in sleep habits. For example, going to bed and waking up earlier can sometimes impact the quality of sleep.
• Reduced physical activity: Adults tends to become less physically active with age, which makes it more difficult to enter a state of deep sleep. Ironically, increased nap-taking during the day also makes it more challenging to sleep at night.
• Increased health issues: Changes in physical health can also rob us of quality sleep. Being uncomfortable in bed because of lower back pain or having to use the bathroom in the middle of the night due to a urinary issue are examples of how a change in health can affect the ability to sleep.
• Prescription-drug usage: An increased likelihood of insomnia is a side effect of some prescription medications.

Insomnia in Children and Teenagers

Insomnia is less common among the young. In some cases, what appears to be insomnia – a desire to stay up late and then sleep well into the day – is more a developmental phase than a genuine medical issue.

Risk Factors

There are several risk factors associated with possible insomnia. These include:

• Age: Persons 60 years or older are more likely to experience insomnia than younger individuals.
• Sex: Women are more inclined toward insomnia than men.
• Stress: Stress is a well-known factor in causing sleeplessness.
• Health conditions: Both physical and mental-health issues can impact quality of sleep.
• Irregular schedules: Traveling across time zones, working odd hours, and changing shifts on a job can all interrupt your normal sleep-wake cycle.

Prevention

While there is no way to prevent insomnia there are some things you can do to relieve your symptoms and develop healthy habits for sleep.

• Avoid sugar, caffeine, alcohol, and nicotine at night.
• Exercise regularly.
• Nap at the same time each day for short periods to reduce daytime sleepiness.
• Sleep/Wake at the same time each night/day to set your internal clock.

There is a higher risk of developing insomnia if:

• You work a swing shift, night shift, or irregular hours.
• You are over the age of 60.
• You are female.
• You have a temporary or permanent stressor, like the unexpected loss of a job.
• You have a corresponding health condition that can affect sleep.

Prognosis

Insomnia is often temporary and should give you little cause for worry. The factors driving short-term insomnia will change over time. Chronic insomnia is more serious. While it cannot be cured, a chronic form of this condition can be managed with proper treatment by most people without interrupting their normal routine.

Insomnia Treatment and Recovery

For temporary cases of insomnia due to stress, such as an unexpected job loss, your doctor may recommend lifestyle changes surrounding sleep or medications if insomnia is not thought to be from another medical condition.

When insomnia becomes chronic and other treatments do not alleviate symptoms, cognitive behavioral therapy (CBT-I) may be needed for treatment and is oftentimes the first treatment as it has proven to be as effective, if not more effective, than medications.

Your doctor may recommend using specific strategies to help you reduce and eliminate worrisome thoughts and stresses, particularly those associated with falling asleep. When you have insomnia, even for a short period of time, you can develop a fear of not being able to fall asleep, which only furthers your inability to fall asleep. CBT-I can help eliminate those thoughts by using:

• Relaxation: Muscle relaxation techniques (where you tense up and slowly release the tense muscles one section at a time), breathing techniques, and biofeedback therapy (to help you control involuntary processes by watching monitors).
• Paradoxical intention: In order to reduce the anxiety of being afraid to fall asleep, paradoxical intention is like the reverse psychology of sleep in that you get into bed trying to stay awake, not trying to fall asleep.
• Modified sleep schedule: By decreasing the time spent in bed and eliminating naps for a short stint, sleep deprivation can make you more tired and able to sleep once you are in bed. Over time, the amount of time in bed can be stretched to a normal amount of required sleep.

Appointments can be made to speak with any of our physicians by calling the sleep center, however, you may need a referral to have a study or other tests performed, which can be obtained from your primary care physician.

Learn More About Insomnia from Baptist Health

Insomnia can be conquered. Start by scheduling an appointment with a Baptist Health primary care or sleep specialist today.

Why Choose Baptist Health for Your Health Care

Baptist Health is a leading healthcare provider in Kentucky and Southern Indiana. We offer comprehensive care through our network of medical facilities and affiliated physicians, nurses, technicians, and support personnel. Our sleep specialists are some of the most experienced in the region.