What is Insomnia?

Difficulty falling asleep or staying sleep is commonly called insomnia. It is considered chronic when it occurs on most nights for more than a month. It is estimated that one in two Australians have suffered from some form of insomnia, affecting their sleeping and waking hours, and leading to feelings of lethargy and a lack of alertness when at work.

What are the Symptoms?

1. Trouble falling asleep or staying asleep;
2. Waking up too early in the morning; and
3. Inadequate sleep

Types of Insomnia

Insomnia affects people of all ages, however, it is a problem more common in women and older adults. There are three main types:

TRANSIENT INSOMNIA – a mild form of insomnia that lasts several days, but no longer than four weeks. It is usually brought on by stress, anxiety or excitement. Examples of this include, sleeping poorly before an important occasion, such as a business meeting, or after a disagreement with a friend or family member. For jet lagged Australian travellers overseas who have whisked across numerous time zones, transient insomnia is common.

SHORT-TERM INSOMNIA – poor sleep, commonly caused by ongoing stress, anxiety or excitement for between 4 weeks and six months. When the stressful situation comes to an end, or when the sleeper becomes accustomed to it, sleep usually returns to normal. Marital discord or the death of a loved one are common examples of this.

CHRONIC INSOMNIA – poor sleep for more than six months. About half of chronic insomnia cases are caused by an underlying physical ailment such as involuntary leg movements and breathing problems.

What Causes Insomnia?

GENERAL INFLUENCES - include:

1. General anxiety and stress
2. Extreme temperatures
3. Psychiatric problems (i.e. depression)
4. Pain from arthritis or other diseases
5. Erratic work and sleep schedules

LIFESTYLE – include:

1. USE OF STIMULANTS – Caffeine near bedtime can trigger awakenings throughout the night. Nicotine is another common cause, with smokers generally taking longer to sleep than non-smokers. Many common drugs (including non-prescription drugs for weight loss, asthma and colds) can disrupt sleep also.
2. USE OF ALCOHOL – it is a common mistake for people to believe that wine can help you sleep. While it may help you get to sleep quicker, fragmented sleep throughout the night is not uncommon.
3. SHIFTWORK – working non-traditional hours such as nights or rotating shifts can lead to sleep problems. Maintaining a routine which includes sleeping regular hours is crucial to helping your body adapt.
4. INACTIVE BEHAVIOUR – leading a too quiet or restricted lifestyle can often lead to sleeping difficulties because of the inactivity during the day.
5. MISUSE OR OVERUSE OF SLEEPING PILLS – sleeping pills can provide a temporary solution in bringing about a sounder sleep and improving alertness the following day. However, most medical practitioners seldom prescribe its use for more than three weeks. Over-the-counter sleeping pills may cause restlessness in some people, and some prescription sleep medications may often cause grogginess in the morning. Sleeping pills do not cure insomnia and frequent use may eventually lead to decreased quality of sleep.

ENVIRONMENTAL FACTORS – include:

1. NOISE – excessive and disruptive noise such as passing traffic, airplanes, TV, and radio can disturb sleep even when they don’t cause you to wake up.
2. LIGHT – light coming through your eyelids even when your eyes are closed, can disrupt your sleep.

PHYSICAL/PSYCHIATRIC ILLNESS – other sleep disorders and physical illnesses may occur during sleep, disrupt sleep and produce symptoms that can easily be mistaken for insomnia. Note that these other disorders require medical attention and common treatments for insomnia will not help them.

1. PSYCHIATRIC PROBLEMS – insomnia is often a cause and/or effect of people’s depression. Treatment of the underlying problem, often including both medication and psychotherapy, can help improve sleep.
2. BREATHING DISORDERS – Obstructive sleep apnea which is characterized by snoring and repeated pauses in breathing during sleep, can wake a sleeper dozens or even hundreds of times a night. As the arousals each night are slight, they are often not remembered. However, they are sufficient, however, to produce restless sleep. The most effective form of treatment is continuous positive airway pressure (CPAP), where the breathing passages are held open via a steady stream of air flow through a mask worn over the nose during sleep. (Please refer to our ‘sleep apnea’ brochure for further information).
3. PERIODIC LEG MOVEMENTS – brief muscle contractions can cause leg jerks that last a second or two and occur roughly every 30 seconds (often for an hour or longer) several times a night. These movements can cause hundreds of brief interruptions of sleep each night, resulting in restless sleep. Periodic limb movements become more frequent and severe as we grow older. Treatment can include medication, evening exercise, a warm bath, or a combination of these. Iron replacement may be helpful for iron deficiency, especially if you also experience restless legs. (Please refer to our ‘Restless Leg Syndrome and Periodic Limb Movement Disorder’ brochure for further information).
4. WAKING BRAIN ACTIVITY THAT PERSISTS DURING SLEEP – monitoring of people’s sleep has shown that some people who complain of light or less restful sleep fail to sink fully into sleep.
5. GASTROESOPHAGEAL REFLUX (HEARTBURN) – back-up of stomach contents into the esophagus can awaken a person several times a night, causing pain or tightness in the mid-chest area. When reflux occurs during the day, a few swallows and an upright position will usually clear the irritating materials from the esophagus. During sleep, less frequent swallowing and a lying down position causes more reflux, making the sleeper wake up coughing and choking. If you experience this problem, try elevating your head or raise the head of the bed. Medications can also provide relief.

What Helps Insomnia?

1. Avoid the use of caffeine within six hours of bedtime;
2. Avoid alcohol when sleepy. Particularly while taking sleeping pills or other medications;
3. Keep in mind that one may experience lack of sleep but that eventually the condition will improve or subside;
4. Go to bed only when sleepy;
5. Exercise regularly - but not within four hours of bedtime;
6. Create a sleep ritual. Try to do the same thing each night just before going to bed - perhaps a few minutes of reading, a glass of milk or a warm bath;
7. Use the bedroom only for sleep and sex.

When to see the doctor

If your insomnia has disturbed your sleep for more than one month, and your lack of sleep interferes with your productivity and daily routine, you should contact your family doctor or ask for a referral to a sleep disorders specialist. Ask your bed partner to help identify your sleep habits, such as snoring or restlessness. Counseling may help those whose insomnia results from poor sleep habits. In other cases, medication or evaluation at a sleep disorders centre may be recommended.