Both Pixie and I suffer from Insomnia Disorder. Pixie was diagnosed with chronic insomnia when she was 2 years old. She has never slept more than 4 hours at a stretch, unmedicated, and some days she goes without more than 2 hours sleep and appears fine. My insomnia is acute and I go through phases when I can’t sleep. If I am going through a particularly bad patch, I’ll take a sedative to help me fall asleep, however, I don’t like the way it makes me feel, so I don’t use these regularly.
What is Insomnia Disorder?
Insomnia is a sleep disorder that is characterized by difficulty falling and/or staying asleep. People with insomnia have one or more of the following symptoms:
* Difficulty falling asleep
* Waking up often during the night and having trouble going back to sleep
* Waking up too early in the morning
* Feeling tired upon waking
* Types of Insomnia
There are two types of insomnia: primary insomnia and secondary insomnia.
Primary insomnia: Primary insomnia means that a person is having sleep problems that are not directly associated with any other health condition or problem.
Secondary insomnia: Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition (like asthma, depression, arthritis, cancer, or heartburn); pain; medication they are taking; or a substance they are using (like alcohol).
What causes Insomnia Disorder?
Insomnia is most often associated with another problem. Insomnia that is not caused or worsened by other factors is rare. These factors may include:
This varies from relatively minor things like work or personal stress, to more severe changes such as death, divorce or job loss.
Other sleep disorders
Some sleep disorders can cause insomnia or make it worse. For instance, people with restless legs syndrome may have a hard time falling asleep.
Many physical illnesses can cause insomnia. People who experience pain, discomfort or limited mobility from medical problems may have difficulty falling asleep or staying asleep. Insomnia due to medical conditions is most common in older adults because people tend to have more chronic health problems as they age. Conditions such as pregnancy, particularly the third trimester, and menopause can cause sleep problems. The severity and duration of insomnia often varies with the related health condition.
The relationship between sleep and mental health is complex. Insomnia is sometimes caused by a mental health disorder. Often a mental health disorder will be found after a complaint of insomnia. Depression is one of the most common mental illnesses in the United States and a frequent cause of insomnia. People with depression often have trouble falling asleep or staying asleep. Difficulty falling asleep is also common in people with anxiety disorders. Other mood disorders such as bipolar disorder may also cause sleep problems.
Medication or substance use or abuse
Insomnia can be an unwanted side effect of many prescription or over-the-counter medications. Common cold and allergy medicines contain pseudoephedrine and can make it difficult to fall asleep. Antidepressants and medications to treat ADHD, high blood pressure or Parkinson’s disease can also cause insomnia.
Drinking alcohol before bedtime can cause frequent awakenings during the night. Insomnia also can occur if you suddenly stop using a sleeping pill.
Caffeine and other stimulants can prevent you from falling asleep. Stimulants also cause frequent awakenings during the night.
Some people are sensitive to certain foods and may be allergic to them. This can result in insomnia and disrupted sleep.
The environment where you sleep can cause insomnia. Disruptive factors such as noise, light or extreme temperatures can interfere with sleep. Sleeping with a bed partner who snores also can cause sleep disruption. Extended exposure to environmental toxins and chemicals may prevent you from being able to fall asleep or stay asleep.
Habits or lifestyles
Irregular sleep schedules (see shift work disorder) can cause insomnia in workers who try to sleep during the day.
What are the Risk Factors?
Nearly everyone has an occasional sleepless night. But your risk of insomnia is greater if:
You’re a woman. Women are much more likely to experience insomnia. Hormonal shifts during the menstrual cycle and in menopause may play a role. During menopause, night sweats and hot flashes often disturb sleep. Insomnia is also common with pregnancy.
You’re older than age 60. Because of changes in sleep patterns and health, insomnia increases with age.
You have a mental health disorder. Many disorders — including depression, anxiety, bipolar disorder and post-traumatic stress disorder — disrupt sleep. Early-morning awakening is a classic symptom of depression.
You’re under a lot of stress. Stressful events can cause temporary insomnia. And major or long-lasting stress, such as the death of a loved one or a divorce, can lead to chronic insomnia. Being poor or unemployed also increases the risk.
You work night or changing shifts. Working at night or frequently changing shifts increases your risk of insomnia.
You travel long distances. Jet lag from traveling across multiple time zones can cause insomnia.
How is Insomnia Disorder diagnosed?
A sleep specialist usually will begin a diagnostic session by asking a battery of questions about your medical history and sleep patterns. A physical exam may be conducted to look for conditions that may be causing insomnia. Similarly, physicians may screen for psychiatric disorders and drug and alcohol use.
If you’ve tried the insomnia self-help strategies and are still having trouble getting the sleep you need, a doctor or sleep disorder specialist may be able to help. Seek professional help for insomnia if:
* Your insomnia doesn’t respond to self-help
* Your insomnia is causing major problems at home, work, or school
* You’re experiencing scary symptoms like chest pain or shortness of breath
* Your insomnia occurs almost every night and is getting worse
How is Insomnia Disorder treated?
Some habits are so ingrained that you may overlook them as a possible contributor to your insomnia. Maybe your Starbucks habit affects your sleep more than you realize. Or maybe you’ve never made the connection between your late-night TV viewing or Internet surfing and your sleep difficulties. Keeping a sleep diary is a helpful way to pinpoint habits and behaviors contributing to your insomnia.
Adopting new habits to help you sleep
* Stick to a regular sleep schedule. Support your biological clock by going to bed and getting up at the same time every day, including weekends.
* Avoid naps. Napping during the day can make it more difficult to sleep at night. If you feel like you have to take a nap, limit it to 30 minutes before 3 p.m.
* Limit caffeine, alcohol, and nicotine. Stop drinking caffeinated beverages at least eight hours before bed. While alcohol can make you feel sleepy, it interferes with the quality of your sleep, and nicotine is a stimulant.
* Avoid late meals. Try to avoid heavy, rich foods within two hours of bed. Fatty foods can take a lot of work for your stomach to digest and spicy or acidic foods can cause heartburn.
* Get regular exercise. Regular exercise can improve the symptoms of insomnia, but it’s not a quick fix. It takes several months to feel the full effects. Aim for 30 minutes or more of activity on most days—but not too close to bedtime.
Develop a better bedtime routine
It’s not just what you do during the day that affects the quality of your sleep, but also those things you do to prepare your mind and body for sleep.
* Make sure your bedroom is quiet, dark, and cool. Noise, light, and heat can interfere with sleep. Try using a sound machine or earplugs to hide outside noise, an open window or fan to keep the room cool, and blackout curtains or a sleep mask to block out light.
* Avoid stimulating activity and stressful situations before bedtime. This includes vigorous exercise, big discussions or arguments, or catching up on work. Instead, focus on quiet, soothing activities, such as reading, knitting, or listening to soft music, while keeping lights low.
* Turn off screens one hour before bedtime. The light emitted from TV, tablets, smartphones, and computers suppresses your body’s production of melatonin and can severely disrupt your sleep. Instead of emailing, texting, watching TV, or playing video games, try listening to a book on tape, a podcast, or reading by a soft light.
If you, or someone you know, suffers from depression, or any other mental health issues, and needs help, please contact the South African Depression and Anxiety Group. SADAG is Africa’s largest mental health support and advocacy group. On this website you will find comprehensive mental health information and resources to help you, a family member or loved one.
Should you wish to share your story, please feel free to contact me by clicking on the green email icon on the top right side of the blog.