What are some causes of insomnia?

I can't sleep more than 3-4 hours without waking up!

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A:

Most causes of insomnia are psychological; "most", not all.

What causes insomnia?

Insomnia may be independent of other healthcare problems. However, it also may be a symptom of another problem, much like a fever or a stomachache. It can be caused by a number of factors.

Psychological Factors

Vulnerability to insomnia
Some people seem more likely than others to experience insomnia, just as some people tend to get headaches or upset stomachs. Simply knowing that you may experience insomnia and that it will not last too long can be helpful in dealing with it when it occurs.

Persistent stress
Exposure to stress may contribute to the development or worsening of insomnia. Relationship problems, a chronically ill child, or an unrewarding career may contribute to sleep problems. If you suffer from these types of stresses, you should seek counseling to gain a new outlook on your troubles and more control in your life.

Learned insomnia (also known as psychophysiological insomnia)
If you sleep poorly, you may worry about not being able to function well during the day. You may try harder to sleep at night, but unfortunately this determined effort can make you more alert, set off a new round of worried thoughts, and cause more sleep loss. Doing activities in and around the bedroom-changing into your night clothes, turning off the lights, pulling up the blankets- can become linked with the sleep problems that follow. Through repetition these bedtime activities can then trigger over-arousal and insomnia. Some individuals with learned insomnia have trouble sleeping in their own beds yet may fall asleep quickly when they don't intend to-while reading the newspaper, sleeping away from home, or watching TV. Just a few nights of poor sleep during a month can be enough to produce a cycle of poor sleep and increase your worry about it. Treatment for learned insomnia aims to improve sleep habits and reduce unnecessary worry.

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Lifestyle Factors

Use of stimulants
Caffeine near bedtime, even when it doesn't interfere with you falling asleep, can trigger awakenings later in the night. Nicotine is also a stimulant, and smokers may take longer to fall asleep than non-smokers. Be aware that the ingredients in many common drugs, including nonprescription drugs for weight loss, asthma, and colds, can disrupt your sleep.

Use of alcohol
You may think that having a glass of wine will help you sleep. However, while it may help you fall asleep quickly, alcohol consumption is likely to produce interrupted sleep.

Erratic hours
If you do shift work (work non-traditional hours, such as nights or rotating shifts), or maintain later hours on weekends than during the week, you are more likely to experience sleep problems. Maintaining regular hours can help program your body to sleep at certain times and to stay awake at others. Establishing a routine is important.

Inactive behavior
People whose lifestyles are very quiet or restricted may experience difficulty sleeping at night.

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Environmental Factors

Noise
Traffic, airplanes, television, and other noises can disturb your sleep even when they don't cause you to wake up.

Light
These factors should be considered if you find yourself feeling tired, even when you think you slept soundly all night.

These factors should be considered if you find yourself feeling tired, even though you think you slept soundly all night.

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Psychiatric/Physical Illness

Other sleep disorders and physical illnesses may occur during sleep, disrupt sleep, and produce symptoms that can easily be mistaken for insomnia. These other disorders require medical attention and common treatments for insomnia will not help them.

Secondary Insomnia
When insomnia is caused by a psychiatric disorder (most often depression) or a medical disorder (most often chronic pain), it is termed secondary insomnia. Secondary insomnia may be relieved by successful treatment of the primary psychiatric/medical disorder. Alternatively, behavioral methods (link) target the sleep disturbance itself and may quite beneficial.

Psychiatric problems
Insomnia, especially with awakenings earlier than desired, is one of the most frequently reported symptoms of depression. Insomnia is also associated with anxiety disorders, post-traumatic stress disorders, dementia (such as Alzheimer's disease, and other conditions. If you suffer from a psychiatric disorder, you may sleep poorly. Treatment of the underlying disorder, often including both medication and psychotherapy, can help improve your sleep. However, additional and specific treatment for the insomnia often is warranted.

Medical problems
Medical illnesses can disrupt sleep and produce symptoms of insomnia. For example, arthritis, headache disorders, benign prostatic hypertrophy, and other conditions can cause or worsen the problem of insomnia. Such medical problems usually require the attention of a physician who can diagnose and treat the underlying condition. Treatment of the underlying cause of insomnia hopefully will result in improved sleep. However, it is possible that a specific treatment for insomnia also will be needed.

Sleep-related breathing disorders
Certain disorders can cause repeated pauses in breathing during sleep. This can wake a sleeper dozens or even hundreds of times during the night. Pauses can be as short as 10 seconds and may not be remembered in the morning. They are sufficient, however, to produce disturbed and restless sleep. Severely disrupted breathing during sleep, known as sleep apnea, may affect people who breathe normally while they are awake. Breathing-related sleep problems are most common in men, snorers, overweight people, and older adults. Loud snoring that is interrupted by gasps, snorts, or other unusual sounds may be a warning sign of a sleep-related breathing disorder.

Severe cases of sleep apnea often benefit from a treatment known as positive airway pressure (PAP). This treatment keeps the breathing passages open with a steady stream of air flowing through a mask worn over the nose and mouth during sleep. Other treatments also are available, such as weight loss, surgery, or the use of dental appliances that help to improve breathing during sleep.

Sleep-related 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. In almost all cases the individual is totally unaware of the limb movements. 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, discontinuing medication, evening exercise, a warm bath, elimination of caffeine, or a combination of these. Iron replacement may be helpful if you have an iron deficiency, especially if you also experience restless legs.

Waking brain activity
Waking brain activity can persist during sleep. Sleep monitoring during the night has shown that some people who complain of light or less restful sleep fail to sink fully into sleep. Individuals with persistent pain may experience this non-restorative type of sleep.

Gastroesophageal reflux
Back-up of stomach contents into the esophagus can awaken a person several times a night. This reflux is commonly known as heartburn because of the pain or tightness it produces 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 (headboard) onto 6- to 8-inch blocks. Medications can also provide relief.

What causes insomnia?

Many people have insomnia, or trouble sleeping. People who have insomnia may not be able to fall asleep, may wake up during the night and not be able to fall back asleep or may wake up early in the morning.

Insomnia isn't a disease. It's the body's way of saying that something isn't right. Many things can cause insomnia - stress, too much caffeine, depression, changes in work shifts and pain from certain medical problems, such as from arthritis.

Is insomnia a serious problem?

30 - 40% of adults have some amount of insomnia in any given year. The rate of insomnia increases with age and is more common in women. Insomnia can become serious. It can make you feel less able to do your work and can make you feel tense and anxious. People who have insomnia may feel tired, depressed and irritable. They may also have trouble concentrating. Insomnia causing drowsiness may lead to motor vehicle accidents and other health risks or problems.

How much sleep do I need?

Most adults need about eight hours of sleep each night. You know you're getting enough sleep if you don't feel sleepy during the day. Some people may need only six hours of sleep a night. Others may need 10 hours.
Sleep patterns change with age. For example, older people may take naps during the day and sleep less at night. In general, how much sleep you need as an adult will probably stay about the same.

What can my doctor do to find out why I'm not sleeping?

Your family doctor may ask you and your bed partner (if possible) some questions to find out why you aren't sleeping. These questions may concern your sleep habits (such as when you go to bed and when you get up), the medicine you take, the amount of caffeine and alcohol you drink, and if you smoke or chew tobacco.

Your doctor may also ask about events in your life that may be upsetting you and making it hard for you to sleep. These questions may involve your work or your personal relationships.

Other questions may include how long you've been having insomnia, if you have any pain, such as from arthritis, and if you snore or jerk your legs while you sleep. If the cause of your insomnia is still not clear, your doctor may suggest that you fill out a sleep diary. The diary will help you keep track of when you go to bed, how long you lie in bed before falling asleep, how often you wake during the night, when you get up in the morning and how well you slept.

How is insomnia treated?

The treatment of insomnia can be simple. Often, once the problem that's causing the insomnia is found and taken care of, the insomnia goes away on its own. The key is to find out what's causing the insomnia so that it can be dealt with directly.
If your insomnia is related to stress, you may need to reduce your stress or learn how to manage it. If you're depressed, your family doctor may suggest counseling or give you medicine to treat the depression.

Will sleeping pills help?

Sleeping pills can help in some cases but can also make insomnia worse. They're only a temporary form of relief, not a cure. They're best used for only up to a few weeks. Regular use can lead to rebound insomnia. This occurs when a person quits taking sleeping pills and the insomnia comes back. So instead of being a cure, sleeping pills can become a cause of insomnia.

Drugs you buy without a prescription often don't work very well, and prescription drugs may change normal sleep patterns and may make you groggy the next day. Because sleeping pills don't work as well over time, higher and higher doses are needed. For these reasons, you shouldn't use sleeping pills for long periods.

Sleeping pills can also be unsafe if your insomnia is caused by certain health problems. Your doctor can tell you if sleeping pills would be helpful and safe for you.

What can I do to improve my sleep habits?

Here are some things you can do to help you sleep better:

Go to bed and wake up at the same time every day, even if you didn't sleep enough during the night. This will help train your body to sleep at night.
Do the same thing every night before going to bed to help your body get ready for sleep. You might try taking a warm bath, reading or doing some other relaxing activity every night before going to bed. Soon you'll connect these activities with sleeping, and they'll help make you sleepy.
Use the bedroom for sleeping. Don't eat, talk on the phone or watch TV while you're in bed.
Make sure your bedroom is quiet and dark. If noise is a problem, use a fan to mask the noise or use ear plugs. You may hang dark blinds over the windows or wear an eye mask if needed.
Avoid trying to fall asleep. The more you try to fall asleep, the more trouble you may have. Don't watch the clock. Turn it away so you can't see the time.
Lying in bed and not being able to fall asleep can be frustrating. If you're still awake after 30 minutes, get up and go to another room. Sit quietly for about 20 minutes before going back to bed. Do this as many times as you need to until you can fall asleep.

Tips to help you sleep

Avoid or limit your use of caffeine (coffee, tea, colas, chocolate), decongestants, alcohol and tobacco.
Exercise more often, but don't exercise within a few hours before going to bed.
Don't start worrying about things when you go to bed. Set another time aside just for worrying. For example, you could spend 30 minutes after dinner writing down what's worrying you and what you can do about it.
Try eating a light snack before going to bed, but don't eat too much right before bedtime. A glass of warm milk or cheese and crackers may be all you need.
Don't nap during the day if naps seem to make your insomnia worse.

What is sleep apnea?

Some people feel tired not because they can't fall asleep but due to the way they sleep. Snoring and pauses in your breathing during your sleep with daytime tiredness can be caused by sleep apnea. Talk to your doctor if you think this might be a problem for you.


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