The struggle with insomnia is real, and it can be hard to know what's causing it. Insomnia is a common problem for many adults, but it can also affect children. It's important to understand what causes insomnia before you try any solutions.

The sleeplessness caused by insomnia may cause sufferers to feel as though they are walking around in circles all day. It can also lead to feelings of depression or anxiety which are not good for health in any way. So what exactly IS insomnia and what causes it?

 

Insomnia defined:

Many people may think that insomnia is a condition that only impacts your ability to fall asleep. In reality, insomnia is a sleep disorder that causes you to have difficulty with falling asleep and/or staying asleep. It’s also a sleep disorder that can occur in short spurts (acute) or over a long duration (chronic). More specifically, acute insomnia sufferers struggle with sleep anywhere from one night to a couple of weeks. Chronic insomnia, however, is defined as occuring for at leat three nights a week for three months or more¹. Yikes.

 

What causes insomnia?

While there are two categories that describe duration of insomnia symptoms, there are actually two primary types of insomnia that people experience¹:

1. Primary insomnia
2. Secondary insomnia

Primary insomnia

Primary Insomnia is insomnia is a chronic sleeping disorder that’s not related lifestyle habits, medical conditions, or psychiatric causes. This type of insomnia usually lasts or recurs for years throughout a person’s life (oftentimes beginning in childhood).

There are three subtypes of primary insomnia: idiopathic, stress-related, and SSM.

Idiopathic primary insomnia is insomnia of unknown cause in the absence of anxiety.

Stress-related primary insomnia is insomnia that results from stress, such as rumination or other intruding thoughts throughout the night.

Sleep state misperception (SSM), also known as paradoxical insomnia is when a person is getting enough sleep and doesn’t suffer from daytime signs of sleep deprivation, however still feel as if they aren’t getting enough sleep.  Interestingly, people who have episodes of primary insomnia are also more likely to experience paradoxical insomnia. Paradoxical insomnia is thought to affect anywhere between 9%-50% of adults, but is more common among those who have primary insomnia².

 

Secondary Insomnia

Secondary insomnia (SI) is the most common form of insomnia. In the case of SI, sleep problems occur or worsen because of another medical or psychiatric disorder. Substance (whether alcohol or drugs) can also cause secondary insomnia. People who experience severe pain due to arthritis may experience secondary insomnia, for example. Psychiatric causes may include depression, panic disorders, anxiety, and adjustment disorders. When it comes to non-pain related medical conditions, literature has often pointed to diseases like heart disease, lung disease, asthma, renal disease, Alzheimer’s, and seizures as several of the common causes of SI³.

Seconday insomnia is more common than primary insomnia, however is more often viewed as being unresponsive to treatment⁴.  One study found that those with secondary insomnia had worse daytime functioning when compared to those with primary insomnia and those without insomnia⁴.

 

Getting tested for insomnia

Your physician may order a sleep disorder test to assist with diagnosing insomnia- particularly if Primary Insomnia (i.e. insomnia not caused by an underlying disease) is suspected. This could include a physical exam and a detailed medical and sleep history assessment.  Below is a list of common suggestions and tests medical providers may use to guide their assessment and diagnosis of insomnia:

• Sleep diary (A way to self-track your sleep patterns)
• Mental health exam (To further investigate possible depression, anxiety, or other mental disorders as an underlying cause of sleep disruption)
• Epworth Sleepiness Scale (A questionnaire validated to assess daytime sleepiness)
• Actigraphy (Using a small, wrist-worn device to measure sleep-wake patterns over time)
• Polysomnogram (A test that measures sleep activity during sleep)

If you are noticing difficulty with sleeping at night, be sure to discuss your symptoms with your physician!

Are there treatments for insomnia?

This depends on the type of insomnia you have. Whenever you hear a claim about certain drugs or interventions “curing insomnia,” question what kind of insomnia they’re referring to (and what the evidence is to back up their claims).

Targeted drugs, supplements, and behavioral interventions may be helpful for Primary Insomnia. Treatment for Secondary Insomnia, however, will typically be more focused on the primary disorder. For example, if you’re experiencing joint pain from arthitis that causes you to stay up all night (Secondary Insomnia), maybe pain medication your physician prescribes will help you get better sleep. The insomnia itself will only be targeted if other treatment options specific to the underyling causes don’t work.

Research has found that Primary Insomnia may respond well to psychological intervention³. Examples of psychological intervention include:

• Cognitive techniques (techniques to help reshape beliefs and attitudes about sleep)
• Cognitive behavioral (combines cognitive techniques with behavioral techniques, like relaxation or breathing, in order to target poor sleep behaviors)
• Relaxation (can be muscle relaxation, soothing imagery, or other relaxation techniques)
• Sleep restriction (improving sleep by restricting the time allotted for sleep at night)
• Stimulus control (A set of instructions that help to get rid of poor sleep habits)

 

If you’ve been struggling with insomnia for a long time, consult your doctor to find out the root cause of it. You may be able to treat your symptoms more effectively if you know what is causing them. Consult with your healthcare professional before trying any treatment plan as not all plans will work for everyone.

 

References:

1. https://www.webmd.com/sleep-disorders/insomnia-symptoms-and-causes
2. https://www.psychiatrictimes.com/view/primary-insomnia-lifelong-problem
3. https://www.med.upenn.edu/cbti/assets/user-content/documents/LichsteinSIreview.pdf
4. https://content.apa.org/record/2001-06652-008