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Insomnia
can be caused by psychiatric and medical conditions, unhealthy sleep
habits, specific substances, and/or certain biological factors.
Recently, researchers have begun to think about insomnia as a problem of
your brain being unable to stop being awake (your brain has a sleep
cycle and a wake cycle—when one is turned on the other is turned
off—insomnia can be a problem with either part of this cycle: too much
wake drive or too little sleep drive). It's important to first
understand what could be causing your sleep difficulties.
Medical Causes of Insomnia
There are many medical conditions (some mild and others more serious)
that can lead to insomnia. In some cases, a medical condition itself
causes insomnia, while in other cases, symptoms of the condition cause
discomfort that can make it difficult for a person to sleep.
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Examples of medical conditions that can cause
insomnia are:
Nasal/sinus allergies
Gastrointestinal problems such as reflux
Endocrine problems such as hyperthyroidism
Arthritis
Asthma
Neurological conditions such as Parkinson's disease
Chronic pain
Low back pain
Medications such as those taken for the common cold and nasal allergies,
high blood pressure, heart disease, thyroid disease, birth control,
asthma, and depression can also cause insomnia.
In addition, insomnia may be a symptom of underlying sleep disorders.
For example, restless legs syndrome—a neurological condition in which a
person has an uncomfortable sensation of needing to move his or her
legs—can lead to insomnia. Patients with restless legs syndrome
typically experience worse symptoms in the later part of the day, during
periods of inactivity, and in the transition from wake to sleep, which
means that falling asleep and staying asleep can be difficult. An
estimated 10 percent of the population has restless legs syndrome.
Sleep apnea is another sleep disorder linked to insomnia. With sleep
apnea, a person's airway becomes partially or completely obstructed
during sleep, leading to pauses in breathing and a drop in oxygen
levels. This causes a person to wake up briefly but repeatedly
throughout the night. People with sleep apnea sometimes report
experiencing insomnia.
If you have trouble sleeping on a regular basis, it's a good idea to
review your health and think about whether any underlying medical issues
or sleep disorders could be contributing to your sleep problems. In some
cases, there are simple steps that can be taken to improve sleep (such
as avoiding bright lighting while winding down and trying to limit
possible distractions, such as a TV, computer, or pets). While in other
cases, it's important to talk to your doctor to figure out a course of
action. You should not simply accept poor sleep as a way of life—talk to
your doctor or a sleep specialist for help.
Insomnia & Depression
Insomnia can be caused by psychiatric conditions such as depression.
Psychological struggles can make it hard to sleep, insomnia itself can
bring on changes in mood, and shifts in hormones and physiology can lead
to both psychiatric issues and insomnia at the same time.
Sleep problems may represent a symptom of depression, and the risk of
severe insomnia is much higher in patients with major depressive
disorders. Studies show that insomnia can also trigger or worsen
depression.
It's important to know that symptoms of depression (such as low energy,
loss of interest or motivation, feelings of sadness or hopelessness) and
insomnia can be linked, and one can make the other worse. The good news
is that both are treatable regardless of which came first.
Insomnia & Anxiety
Most adults have had some trouble sleeping because they feel worried or
nervous, but for some it's a pattern that interferes with sleep on a
regular basis. Anxiety symptoms that can lead to insomnia include:
Tension
Getting caught up in thoughts about past events
Excessive worrying about future events
Feeling overwhelmed by responsibilities
A general feeling of being revved up or overstimulated
It's not hard to see why these symptoms of general anxiety can make it
difficult to sleep. Anxiety may be associated with onset insomnia
(trouble falling asleep), or maintenance insomnia (waking up during the
night and not being able to return to sleep). In either case, the quiet
and inactivity of night often brings on stressful thoughts or even fears
that keep a person awake.
When this happens for many nights (or many months), you might start to
feel anxiousness, dread, or panic at just the prospect of not sleeping.
This is how anxiety and insomnia can feed each other and become a cycle
that should be interrupted through treatment. There are cognitive and
mind-body techniques that help people with anxiety settle into sleep,
and overall healthy sleep practices that can improve sleep for many
people with anxiety and insomnia.
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Insomnia & Lifestyle
Insomnia can be triggered or perpetuated by your behaviors and sleep
patterns. Unhealthy lifestyles and sleep habits can create insomnia on
their own (without any underlying psychiatric or medical problem), or
they can make insomnia caused by another problem worse.
Examples of how specific lifestyles and sleep
habits can lead to insomnia are:
You work at home in the evenings. This can make it hard to unwind, and
it can also make you feel preoccupied when it comes time to sleep. The
light from your computer could also make your brain more alert.
You take naps (even if they are short) in the afternoon. Short naps can
be helpful for some people, but for others they make it difficult to
fall asleep at night.
You sometimes sleep in later to make up for lost sleep. This can confuse
your body's clock and make it difficult to fall asleep again the
following night.
You are a shift worker (meaning that you work irregular hours).
Non-traditional hours can confuse your body's clock, especially if you
are trying to sleep during the day, or if your schedule changes
periodically.
Some cases of insomnia start out with an acute episode but turn into a
longer-term problem. For example, let's say a person can't sleep for a
night or two after receiving bad news. In this case, if the person
starts to adopt unhealthy sleep habits such as getting up in the middle
of the night to work, or drinking alcohol before bed to compensate, the
insomnia can continue and potentially turn into a more serious problem.
Instead of passing, it can become chronic.
Once this happens, worry and thoughts such as, "I'll never sleep,"
become associated with bedtime, and every time the person can't sleep,
it reinforces the pattern.
This is why it's important to address insomnia instead of letting it
become the norm. If lifestyle and unhealthy sleep habits are the cause
of insomnia, there are cognitive behavioral techniques and sleep hygiene
tips that can help. If you have tried to change your sleep behaviors and
it hasn't worked, it's important to take this seriously and talk to your
doctor.
Insomnia & Food
Certain substances and activities, including eating patterns, can
contribute to insomnia. If you can't sleep, review the following
lifestyle factors to see if one or more could be affecting you:
Alcohol is a sedative. It can make you fall asleep initially, but may
disrupt your sleep later in the night.
Caffeine is a stimulant. Most people understand the alerting power of
caffeine and use it in the morning to help them start the day and feel
productive. Caffeine in moderation is fine for most people, but
excessive caffeine can cause insomnia. A 2005 National Sleep Foundation
poll found that people who drank four or more cups/cans of caffeinated
drinks a day were more likely than those who drank zero to one cups/cans
daily to experience at least one symptom of insomnia at least a few
nights each week.
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Caffeine can stay in your system for as long as eight hours, so the
effects are long lasting. If you have insomnia, do not consume food or
drinks with caffeine too close to bedtime.
Nicotine is also a stimulant and can cause insomnia. Smoking cigarettes
or tobacco products close to bedtime can make it hard to fall asleep and
to sleep well through the night. Smoking is damaging to your health. If
you smoke, you should stop.
Heavy meals close to bedtime can disrupt your sleep. The best practice
is to eat lightly before bedtime. When you eat too much in the evening,
it can cause discomfort and make it hard for your body to settle and
relax. Spicy foods can also cause heartburn and interfere with your
sleep.
Insomnia & The Brain
In some cases, insomnia may be caused by certain neurotransmitters in
the brain that are known to be involved with sleep and wakefulness.
There are many possible chemical interactions in the brain that could
interfere with sleep and may explain why some people are biologically
prone to insomnia and seem to struggle with sleep for many years without
any identifiable cause—even when they follow healthy sleep advice.
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