Insomnia is defined as difficulty in falling asleep, difficulty staying asleep, or waking up early in the morning and not being able to return to sleep. In general, people with insomnia sleep less or sleep poorly despite having an adequate chance to sleep. Poor sleep may lead to trouble functioning during the daytime.
Insomnia is not defined by the number of hours slept because “sufficient sleep” can vary from one person to another. Sleep requirements may also decrease with age.
Insomnia is the most common sleep complaint. While almost everyone has an occasional night of poor sleep, approximately 10 percent of adults have long-term or chronic insomnia.
This information will review the symptoms, causes, diagnosis of insomnia, and the treatment for insomnia.
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For many people, the symptoms of insomnia interfere with personal relationships, job performance, and daily function. People with insomnia may have small differences in memory and problem solving compared with people without insomnia. However, they seem to have similar abilities on tests of general cognitive function, perception, verbal ability, attention, and complex thinking.
People with insomnia have an impaired sense of sleep. You may feel that you have not slept, even if testing shows that you have. You may also feel more fatigued than individuals without insomnia, even if testing indicates that you are less sleepy. This impaired sense of sleep may be related to a problem with the body’s sleep-arousal system, which normally helps you feel awake after sleeping and feel tired before going to bed.
One result of poor sleep is that you may become concerned that you will be sleep-deprived and will suffer from serious consequences of lost sleep. This concern may grow as you are unable to sleep, which in turn makes it increasingly difficult to fall asleep. It is important that you not get caught in this cycle and understand that you are sleeping more than it seems.
Short-Term Insomnia lasts less than three months and is usually associated with stressors. Possible stressors include the following:
Short-term insomnia often resolves when the stressor resolves
Situations that disrupt your normal sleep cycle can also cause insomnia. Some examples of this include:
Long-term insomnia (or chronic) insomnia lasts longer than three months and occurs at least three nights per week. Insomnia often occurs with other conditions, including:
Insomnia is frequently confused with short sleep requirement and sleep restriction:
If you seek help for insomnia, your doctor or nurse will start by asking you how many hours you slept and what problems you have had with sleep, over a typical 24-hour period. Your bed partner or caregiver can help to answer these questions because you may not be aware of what happens while you sleep.
You may be asked to keep a daily sleep log, which is a record of sleep times for one to two weeks.
Your doctor or nurse may ask other questions to determine the cause of your insomnia. A physical examination may be performed to determine if there are medical or neurologic conditions causing or worsening your sleep problems.
Laboratory tests may be recommended to help identify underlying medical or sleep disorders, although this is not required for everyone with insomnia. Laboratory tests may include polysomnography or actigraphy:
Circadian rhythms are changes in body functions, such as temperature regulation and sleep cycles, which occur for 24 hours. People with circadian rhythm disorders may experience insomnia and daytime sleepiness because their circadian rhythms follow an abnormal pattern.
Shift work sleep disorder – People who work late night shifts can have difficulty sleeping during the daytime. This is especially true for people who work rotating or permanent night shifts, who often revert to sleeping at night on days o to maintain contact with their family. Treatment often includes adopting a consistent daily sleep routine seven days per week.
Delayed sleep phase syndrome – Some people have a sleep-wake rhythm that is longer than 24 hours. These people want to go to bed later and sleep later every morning. However, this is usually not practical because of school or work requirements. Treatment usually includes trying to wake at an earlier, consistent time each day.
Advanced sleep phase syndrome – This is the opposite of delayed sleep phase syndrome and is more common in middle age and older adults. A person with this disorder may go to sleep in the early evening and wake much earlier than they wish. Attempts to stay up later do not always allow the person to wake later in the morning. Sleep can be normal if the person is willing to accept the early bedtime and wake time.