Insomnia (sleep problems)

Insomnia that lasts for more than a few weeks is often associated with other health conditions including pain, menopause, depression and anxiety disorders.

Sleep disorders

Insomnia can be a symptom of a number of other sleep disorders that include:

Restless leg syndrome

This is characterised by the urge to move the legs and an uncomfortable burning or cramping feeling in the legs.

Periodic limb movement disorder

This involves involuntary movements of the lower legs during sleep and can lead to sleep interruptions.

Sleep apnoea

Sleep apnoea is a condition that results in short pauses in breathing during sleep. Obstructive sleep apnoea is a result of the throat walls coming together briefly during sleep, causing temporary shortness of breath.

Circadian rhythm disorders

This is a group of conditions that affect the timing of sleep.

Types

There are several different terms that are commonly used to describe insomnia. These are based on either the cause of the insomnia, or how long your sleep has been affected.

Primary insomnia

This term is used when the difficulty sleeping is not related to any other health problems.

Secondary insomnia

Insomnia that is related to another health condition. For example, pain, depression and anxiety disorders can all cause sleep problems. Secondary insomnia also describes insomnia that is related to the use of medications and other substances, such as alcohol or caffeine.

Short-term and long-term insomnia

Insomnia can also be classified on the basis of how long sleeping has been affected. Short-term (acute) insomnia is used to describe the condition when sleep has been affected for less than one month. Long-term (chronic) insomnia describes the condition when it lasts longer than one month.

Signs and symptoms

The main signs that are associated with insomnia are difficulty falling asleep at night and difficulty staying asleep. If you have insomnia you may also experience:

• Waking up early in the morning;
• Waking up many times during the night;
• Not feeling well rested after a night's sleep, and;
• Depression or anxiety.

Methods for diagnosis

To work out if you have insomnia, your doctor is likely to ask about your sleep patterns and habits, as taking a history is the main basis for diagnosing insomnia. They may also conduct a physical exam to see if you have any other conditions that may cause sleeping problems. You may be asked to keep a sleep diary, which involves recording the times when you go to bed, fall asleep, wake up, stay awake in bed and get up in the morning. In some cases your doctor may recommend more tests if there is concern that other medical conditions may be contributing to your sleep difficulties. These tests include:

Sleep study

A sleep study, or polysomnography, is usually done overnight in a sleep lab or can be done at home with mobile equipment. It measures your brain activity, eye movements, heart rate and blood pressure. This information can be used to work out if you have a sleep disorder that could be related to your insomnia, in particular sleep apnoea or a limb movement disorder.

Sleep study. 

Actigraphy

Actigraphy is a test that is sometimes performed to diagnose conditions that affect your sleep cycle. It involves wearing a small device on your wrist that can measure movement and provide information on how you sleep and your activity levels during the day.

Types of treatment

The type of treatment you need depends on the cause of your insomnia. Trying to get sleep naturally by using self-care methods is usually the first line of treatment for insomnia. In some cases your doctor may prescribe medication to help you return to a normal sleep pattern. It is also important to treat any underlying health conditions, such as sleep apnoea or depression, that may be contributing to your insomnia.

Self care

Self-care treatments are simple things you can do at home that may help you settle down before going to bed. Some common natural ways to help sleep include:

• Establishing a routine before going to bed;
• Going to bed and getting up at the same time each day, regardless of how much sleep you have or have not had, including on weekends and holidays;
• Getting regular exercise during the day, but avoiding late-night exercise;
• Avoiding alcohol, caffeine, energy drinks and smoking before bedtime;
• Avoiding sleeping during the day;
• Avoiding lights and watching television in the bedroom, including light from tablet devices, computer screens and phones, and;
• Relaxing before bedtime.

Medication

In some cases, if natural ways to aid sleep have not worked, your doctor may prescribe medication to help you sleep and return to a normal sleeping pattern. These medications can become less effective the more they are used, meaning that they need to be taken in higher doses to achieve the same effect. If taken for more than two weeks, these medications can lead to difficulty sleeping when the medication is stopped. Some of the common medications prescribed for insomnia include temazepam, zopiclone and zolpidem. These are generally recommended to only be used at the lowest effective dose and for the shortest amount of time needed.

Melatonin is a hormone that is found naturally is the body. It is important in the control of your circadian rhythm - the variation of the level of alertness or sleepiness throughout the day. Melatonin in tablet form can be used as a short-term treatment for insomnia.

Potential complications

Not getting enough sleep at night can affect how you function during the day. Sometimes this can lead to problems such as poor performance and trouble concentrating at school or work. Long-term insomnia can also lead to poor immune system function and mental health issues such as depression and anxiety. In extreme cases, being very tired from lack of sleep could lead to serious accidents.

Prognosis

Insomnia itself is usually not a very serious condition, but if sleep is affected for a long time it can have serious complications. It is important to treat the underlying cause of the insomnia to try and restore a normal sleep pattern. With proper treatment and lifestyle changes, most people will be able to overcome their difficulty sleeping.

Prevention

You may be able to prevent insomnia by identifying problems that could cause sleeping problems and dealing with them early. This might include managing any medical problems that could cause difficulty sleeping, such as depression, and reducing the amount of caffeine, alcohol and other stimulants you consume. Getting regular exercise and developing good sleeping habits, such as going to bed and getting up at the same time each day, may also help to prevent insomnia. Maintaining an environment that is conducive to sleep is also important, so reduce excess light, noise and temperature.

Maintaining a regular sleeping pattern may help with treatment of insomnia.