What is Chronic Insomnia (Longterm difficulty falling or staying asleep)?
Insomnia, the most common sleep problem in the U.S., impacts roughly a third of the population. As classified by the third edition of the International Classification of Sleep Disorders (ICSD-3), insomnia involves difficulties falling asleep, remaining asleep, or experiencing quality sleep. This happens even when there is enough time and the right environment for sleep, and it leads to problems during the day. Long-term insomnia can harm your health and quality of life, hinder academic achievement, increase the likelihood of car accidents, reduce work productivity, cause irritability and increase daytime fatigue. Furthermore, insomnia can contribute to other health issues like heart diseases, chronic pain, depression, anxiety, diabetes, obesity, and asthma.
According to the ICSD-3, insomnia is categorized in three ways:
Chronic Insomnia Disorder
When sleep disturbances happen at least three times a week and have been present for the last three months.
Short-Term Insomnia Disorder
When sleep disturbances have persisted for more than three months.
Other Insomnia Disorder
When there is difficulty falling asleep or staying asleep which doesn’t fit the description of either chronic or short-term insomnia disorder.
What Causes Chronic Insomnia (Longterm difficulty falling or staying asleep)?
Those who struggle to manage stress or who are typically light sleepers are more prone to chronic insomnia. Insomnia is often associated with mental health conditions such as depression, anxiety, and post-traumatic stress disorder. Other medical problems, such as restless legs syndrome, constant pain, acid reflux, breathing problems, and lack of mobility, can also increase the risk of chronic insomnia.
Childhood issues, like separation anxiety, can put a child at risk of developing sleep problems. Additionally, individuals with certain personality qualities, such as perfectionism, ambition, tendency towards worry and depression, and low sociability (extraversion), tend to have a higher chance of developing insomnia over time.
Insomnia is also more common among those dealing with stressful life events such as family disruptions, divorce, loss of a spouse, or alcohol or substance abuse.
Risk Factors and Frequency for Chronic Insomnia (Longterm difficulty falling or staying asleep)
Insomnia is a common sleep problem affecting 10% to 15% of people. In the United States, around 5.5 million doctor visits in 2010 were because of sleep issues. While insomnia can affect anyone, it’s often more common in women going through menopause and in older adults.
- Insomnia affects 10% to 15% of people.
- About 5.5 million doctor’s visits in the US in 2010 were because of sleep issues.
- It can impact anyone, but is more common in women going through menopause and older adults.
Signs and Symptoms of Chronic Insomnia (Longterm difficulty falling or staying asleep)
If you’re dealing with chronic insomnia, your treatment plan should begin with a thorough evaluation. This includes documenting any disturbances in your sleep, identifying any health issues or medicines that may contribute to the insomnia, as well as finding out if you have other disorders that are related to sleeping.
It’s all about the details when it comes to your sleep history. Your doctor needs to determine if your insomnia is due to problems falling asleep, staying asleep, or both. For example, if you’re dealing with depression, you might find yourself waking up too early in the morning. Your doctor will want to ask about your habits before bed, such as if you drink alcohol or caffeinated beverages at night, use electronic devices before sleep, and how often you nap during the day. All of this information helps to figure out ways to improve your sleep.
Beyond that, your doctor should also check for other sleep-related disorders that might be causing fragmented sleep. These may include restless leg syndrome, sleep apnea, periodic limb movements, or nocturnal leg cramps. Each of these could be contributing to your sleep disturbances, and knowing about them would be important for treatment.
Testing for Chronic Insomnia (Longterm difficulty falling or staying asleep)
If a doctor suspects you’re struggling with insomnia, they might run some tests to check for underlying health conditions that may be causing it. Initial tests could include imaging of your thyroid, blood count check, liver and kidney function tests, and tests for blood sugar levels. These laboratory tests offer valuable insights into your overall health.
Doctors also use questionnaires to understand your sleep quality and disturbances. The most commonly used questionnaires are the Epworth Sleepiness Scale, which measures daytime sleepiness (with a score over 15 indicating severe sleepiness), and the Pittsburgh Sleep Quality Index, which assesses the quality of your sleep (a score more than 5 indicates poor sleep quality).
Recording your sleep patterns and habits in a sleep log or diary is another effective way to understand sleep issues. These logs typically cover 2 to 4 weeks and include information like alcohol and caffeine intake, bedtime routines, and daytime napping. Through analyzing your sleep logs, the doctor can get a sense of your total sleep time, how often you wake after falling asleep, your sleep efficiency, and potential disruptions in your natural sleep cycle. However, the accuracy of sleep logs depends largely on the reliability and correctness of the information you provide.
An actigraphy device worn on the wrist can also be used to analyze your sleep patterns and daytime activity. This device records your general movement and helps to examine your total sleep duration, time taken to fall asleep after waking up, and frequency of daytime naps. However, an actigraphy device has its limitations – it isn’t capable of detecting sleep disorders involving abnormal breathing or restless leg syndrome. For these instances, a sleep study, also known as polysomnography, would be required.
Polysomnography is a preferred method for detecting multiple sleep disorders, like sleep apnea, sleep-related breathing problems, and parasomnia. However, it’s not usually the first method used if the doctor suspects you have primary insomnia, unless other sleep disorders are also suspected.
Treatment Options for Chronic Insomnia (Longterm difficulty falling or staying asleep)
When it comes to non-drug treatment for sleep problems, there are several approaches. One is sleep hygiene, which involves teaching patients about lifestyle changes like limiting daytime naps, avoiding late-night meals or alcohol, and exercising regularly. It also means keeping a consistent sleep schedule. But it’s important to note that while good sleep hygiene can help promote healthy sleep, it’s generally not sufficient on its own to treat long-term insomnia. It’s usually most effective when combined with other, cognitive behavior therapy techniques.
Sleep restriction therapy is another treatment. Although it may initially increase daytime sleepiness because it involves reducing the amount of time you spend in bed, the goal is that it will help trigger a more robust desire for sleep and result in a more consolidated sleep. Over time, the amount of sleep a patient is allowed can gradually be increased.
Stimulus control therapy teaches the patient to avoid behaviors that disrupt sleep, such as eating or using electronic devices in bed. The patient should go to bed to sleep only when they’re very sleepy.
Relaxation therapy involves regular practice of breathing exercises, meditation, or yoga. These can help improve sleep patterns and reduce stress and anxiety.
Cognitive Behavioral Therapy for insomnia (CBTi) is a very effective option in managing sleep problems. It can significantly improve sleep latency (the time it takes to fall asleep), the amount of wakefulness after initially falling asleep, and total sleep time. Plus, studies have shown that CBTi is even more effective than medication for managing insomnia. It’s typically delivered in 6 sessions over a 6 to 8 week period by a healthcare professional. The sessions include sleep education, relaxation techniques, sleep restriction therapy, stimulus control therapy, and cognitive and behavioral therapy.
CBTi can be delivered in group sessions or even via telehealth or internet-based programs. However, these have two main limitations: self-motivation is required to follow the program regularly, and there is a shortage of effective therapists along with limited financial support, which further restricts patient access to the benefits of the program.
When it comes to drug treatment, there are a variety of options that act on different systems in the brain. Some drugs work on the GABA-A receptors, some on the melatonin receptors, and others target the orexin receptors or histamine-1 receptors. Prescribers will choose which drug is most appropriate based on the patient’s specific symptoms and needs.
There are some drugs that are not officially labelled for sleep disorders treatment, but are often prescribed off-label to manage insomnia. This includes certain types of antidepressants, atypical antipsychotics, and anticonvulsants.
What else can Chronic Insomnia (Longterm difficulty falling or staying asleep) be?
- Central sleep apnea, a condition where breathing repeatedly stops and starts during sleep
- Cheyne-Stokes breathing pattern, an abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing
- Depression, a serious mood disorder that impacts how you feel, think, and handle daily activities
- High altitude periodic breathing, a breathing disorder that can occur at high altitudes typically during sleep
- Jet-lag disorder, a temporary sleep problem that can affect anyone who quickly travels across multiple time zones
- Medication-related insomnia, a sleep disorder where a person has trouble falling asleep or staying asleep due to the side effects of certain medications
- Obstructive sleep apnea (OSA), a common sleep disorder in which a person’s breathing stops and starts due to throat muscle relaxation
- Periodic limb movement disorder, a disorder characterized by jerking or twitching movements of the limbs during sleep
- Restless legs syndrome, a disorder that causes an irresistible urge to move your legs, often accompanied by uncomfortable sensations
- Sleeplessness and circadian rhythm disorder, a disruption of the natural sleep-wake cycle, leading to difficulties in falling asleep, staying asleep, or waking up