Article

Insomnia

Insomnia, also known as sleeplessness, is the most common sleep disorder. It is characterized by difficulty falling asleep, staying asleep, or waking up too early, and is often followed by daytime sleepiness, low energy, irritability, and a depressed mood. Women are more likely than men to experience insomnia, especially during periods of hormonal change (menstruation, pregnancy, menopause). [This observation lacks specific citations; consider researching relevant studies for inclusion if available.] Chronic insomnia can increase the risk of depression, anxiety, cardiovascular disease, and impaired cognitive function.

Symptoms

  • Difficulty falling asleep (sleep onset insomnia)
  • Difficulty staying asleep (sleep maintenance insomnia)
  • Waking up too early
  • Non-restorative sleep — waking up feeling as tired as before going to bed due to poor sleep quality.
  • Daytime fatigue, irritability, or difficulty concentrating

Explanation of 'Non-Restorative Sleep'

'Non-restorative sleep' refers to a condition where an individual wakes up after sleeping but still experiences exhaustion, mental fatigue, and impaired performance. This type of insomnia is often linked to underlying health issues such as depression or chronic stress. For example, someone with non-restorative sleep might spend eight hours in bed but wake feeling unrested because their sleep was fragmented by frequent awakenings due to nightmares or anxiety.

Causes and Risk Factors

  • Hormonal fluctuations (menstrual cycle, pregnancy, menopause)
  • Stress and anxiety
  • Poor sleep hygiene (irregular schedule, excessive screen time)
  • Medical conditions: Chronic pain can lead to difficulty staying asleep due to discomfort. Hot flashes associated with menopause cause night awakenings.
    • Mechanism for chronic pain: Pain disrupts the ability to initiate or maintain sleep through increased arousal and altered sleep architecture.
    • Mechanism for hot flashes: These sudden episodes of heat increase core body temperature during sleep, triggering an awakening response as the body attempts to cool down. Hot flashes are also linked to hormonal changes (estrogen fluctuations).
  • Medications: Stimulants can delay sleep onset by increasing alertness and arousal. Some antidepressants may initially cause insomnia but could improve sleep quality in long-term treatment.
    • Mechanism for stimulants: These substances increase neuronal firing, especially in areas like the locus coeruleus that regulate wakefulness.
    • Mechanism for some antidepressants: SSRIs (Selective Serotonin Reuptake Inhibitors) can interfere with sleep initially by delaying REM onset or increasing wake time. However, over weeks they may improve overall sleep quality as depression symptoms lessen.
  • Caffeine, nicotine, and alcohol use
  • Working night shifts

Insomnia can be short-term (lasting days or weeks) or long-term (lasting more than a month). It can occur independently or as a result of another problem. Diagnosis is based on sleep habits and examination for underlying causes; a sleep study may be done to look for other sleep disorders.

Prevention and Management

  • Maintain a regular sleep schedule
  • Avoid caffeine, nicotine, and heavy meals before bedtime — Consider adding guidance, such as avoiding caffeine after 2 PM.
  • Practice relaxation techniques (meditation, deep breathing, progressive muscle relaxation)
  • Cognitive behavioral therapy for insomnia (CBT-I) is the most effective long-term treatment. This approach addresses maladaptive sleep behaviors through structured sessions over several weeks and helps establish sustainable sleep habits without relying on medication.
    • Mechanism of CBT-I: It targets thoughts and behaviors that worsen sleep, such as irregular sleep schedules or excessive worry about not sleeping. Through techniques like stimulus control, sleep restriction therapy, cognitive restructuring, and relaxation training, CBT-I teaches the patient to fall asleep faster, stay asleep longer, reduce morning fatigue, and maintain these improvements independently.
  • Medication may be used short-term if needed, but should be monitored by a healthcare provider
  • Address underlying medical or mental health conditions

Related Topics

See also: Mental health, Nutrition, Exercise, Physical activity