Symptoms
Between 10% and 30% of adults have chronic insomnia, and many more deal with it from time to time. Here’s a look at some of the latest research on this condition, its causes, and treatments that may help. A new type of drug is giving doctors another option when it comes to prescription medication to treat insomnia. Orexin receptor antagonists.
Causes
Insomnia is a disorder characterized by persistent difficulty 1 with sleep onset, maintenance, consolidation, or quality. People who have insomnia struggle with sleep despite adequate opportunities for sleep, and also experience excessive daytime sleepiness and other dysfunctions when they are awake.
Prevention
Chronic insomnia is characterized by symptoms that occur at least three times per week for at least three months. Insomnia that lasts or less than three months is known as short-term insomnia.
Complications
Non-Medical (Cognitive & Behavioral) Treatments for Insomnia. Cognitive behavioral therapy (CBT) includes behavioral changes (such as keeping a regular bedtime and wake up time, getting out of bed after being awake for 20 minutes or so, and eliminating afternoon naps) but it adds a cognitive or "thinking" component.
What is the latest research on chronic insomnia?
What is insomnia and how is it treated?
What is the difference between short term and chronic insomnia?
What is the best non medical treatment for insomnia?
What is short term treatment of insomnia?
Melatonin. This over-the-counter (OTC) supplement is marketed as a way to help overcome insomnia. It's generally considered safe to use melatonin for a few weeks, but no convincing evidence exists to prove that melatonin is an effective treatment for insomnia, and the long-term safety is unknown.
How is insomnia Research treated?
Research has found it's particularly helpful with resetting your body clock if you work odd hours, like a night shift, or have jet lag. But it can also relieve insomnia....Nondrug Insomnia TherapiesCognitive restructuring. ... Stimulus control. ... Sleep restriction. ... Relaxation training. ... Sleep hygiene.
What is the most effective treatment for insomnia?
Cognitive behavioral therapy for insomnia, sometimes called CBT-I, is an effective treatment for chronic sleep problems and is usually recommended as the first line of treatment.
What does research say about insomnia?
Johns Hopkins researchers report that people with chronic insomnia show more plasticity and activity than good sleepers in the part of the brain that controls movement. "Insomnia is not a nighttime disorder," says study leader Rachel E.
What is the treatment for chronic insomnia?
A chronic insomnia treatment regimen typically includes at least one behavioral intervention, which often takes the form of cognitive behavioral therapy for insomnia (CBT-i); if therapy and other behavioral interventions are not effective, your doctor may recommend some form of sleep medication.
Who first discovered insomnia?
It is a disorder characterized by inability to sleep or a total lack of sleep. Being the first psychosomatic disorder to be described by Johann Heinroth in 1818, insomnia clinically presents as a subjective perception of dissatisfaction with the amount and/or quality of the sleep.
What is the first line treatment for chronic insomnia?
CBT-I is recommended as first-line treatment for chronic insomnia [1-4]. When used, medications should be part of a holistic approach that includes healthy sleep habits, adequate opportunity for sleep, treatment of relevant comorbidities, and CBT-I when appropriate and available.
Is commonly used to treat insomnia?
Benzodiazepine sedatives such as triazolam (Halcion), estazolam, lorazepam (Ativan), temazepam (Restoril), flurazepam, and quazepam (Doral) and non-benzodiazepine sedatives such as zolpidem (Ambien, Intermezzo), eszopiclone (Lunesta), and zaleplon (Sonata) are drugs that can help induce sleep.
Which of the following is the most effective agent to help a patient with insomnia that involves both difficulty falling asleep and maintaining sleep?
Nonbenzodiazepine GABA-A agonists (“Z-drugs” or “nonbenzodiazepines”) are effective for people with sleep-onset and sleep-maintenance difficulties, and they are among the drugs most commonly prescribed for insomnia.
What a insomnia means?
Overview. Insomnia is a common sleep disorder that can make it hard to fall asleep, hard to stay asleep, or cause you to wake up too early and not be able to get back to sleep. You may still feel tired when you wake up.
Who studied insomnia?
Peter Hauri, Psychologist Who Focused on Insomnia, Dies at 79.
What is insomnia Pubmed?
Insomnia-the unwelcome experience of difficulty sleeping-is common and can be acute, intermittent, or chronic. Insomnia can be the presenting symptom for several common sleep disorders, but it also often occurs comorbidly with mental and physical health conditions.
How to treat insomnia?
Regardless of the type of therapy used, the treatment of chronic insomnia has two primary objectives: improving sleep quality and quantity , and improving daytime impairments . Initial approaches to treatment usually include at least one behavioral intervention, such as stimulus control therapy or relaxation therapy. Biofeedback therapy is also used. When pharmacotherapy is required, the choice of a specific drug within a class should be directed by: 1) symptom pattern; 2) treatment goals; 3) past treatment responses; 4) patient preference; 5) cost; 6) the availability of other treatments; 7) comorbid conditions; 8) contraindications; 9) concurrent medication interactions; and 10) potential adverse effects. 25
How long does insomnia last?
The Centers for Disease Control and Prevention further classifies insomnia as episodic (lasting at least one month but less than three months); persistent (lasting three months or longer); or recurrent (two or more episodes within one year).24
What is insomnia related to?
Associated insomnia is primarily related to an underlying mental or mood disorder, such as depression, dysthymia, cyclothymia, bipolar disorder, anxiety, or schizophrenia.17,20–23This form of insomnia may also be caused by inadequate sleep hygiene (i.e., habits that are inappropriate for good quality of sleep), such as psychologically stressful activities; the consumption of caffeine, nicotine, alcohol, or heavy meals; or vigorous physical activity near bedtime.17Other potential causes of associated insomnia include concomitant medical conditions (e.g., infections and metabolic diseases) and the use of substances or medications (e.g., alcohol, stimulants, and antidepressants).17
What is insomnia in the DSM-5?
According to the Diagnostic and Statistical Manual of Mental Disorders,fifth edition (DSM-5), insomnia is defined as dissatisfaction with sleep quantity or quality that results in clinically significant distress or impairment in social, occupational, or other important areas of functioning. Insomnia is associated with one or more of the following symptoms: difficulty initiating sleep (sleep-onset insomnia or initial insomnia); difficulty maintaining sleep (sleep-maintenance insomnia or middle insomnia); and early-morning awakening with the inability to return to sleep (late insomnia).4
What are the causes of insomnia?
Primary chronic insomnia may be caused by several predisposing (genetic and constitutional) factors, including hyperactivity of stress response mechanisms or of the HPA axis; anxiety and depression; and abnormalities in the circadian rhythm (circadian sleep-wakefulness control).12,14,17–19Precipitating and perpetuating factors, such as psychosocial features (e.g., fatigue and irritability), behavioral changes, and cognitive characteristics, also contribute to insomnia.13
How many people have sleep disorders?
An estimated 50 million to 70 million adults in the U.S. have chronic sleep and wakefulness disorders.5Insomnia is more common in women (25%) than in men (18%), and its prevalence increases with age, affecting approximately 50% of the elderly population.6Data from the years 2008 through 2010 from the National Health Interview Survey indicated that 62% of adults in the U.S. slept seven to eight hours and that 28% slept six or fewer hours in a 24-hour period.7In the National Health and Nutrition Examination Survey (2005–2010), approximately 4% of U.S. adults 20 years of age and older reported that they had taken prescription sleep aids during the previous 30 days.8
What are the two forms of sleep?
People experience two forms of sleep: rapid eye movement (REM) and nonrapid eye movement (NREM). Sleep typically begins with the NREM phase, which is followed by the REM phase. NREM sleep is subdivided into three stages in which brain activity, eye movement, and skeletal muscle tone progressively decrease, placing the individual in a deeper state of sleep. Later in the cycle, when the individual enters REM sleep, electrical activity in the brain increases, contributing to increased blood flow to the brain, changes in respiratory and cardiac rates, and dreaming.1REM sleep correlates with activities of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system in healthy humans.2
How long does insomnia last?
1, 2 Insomnia is classified as short-term if it persists less than 3 months and chronic if it persists at least 3 months and occurs at least three times per week. 1, 2 Similar essential features of insomnia are described in the American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and include dissatisfaction with sleep quantity or quality with complaints of difficulty initiating or maintaining sleep. 3 The sleep disturbance must also cause clinically significant distress or impairments in social, occupational, or other important areas of functioning and may occur independently or during the course of another mental disorder or medical condition. 3 For many, insomnia becomes a long-term and persistent condition. A recent longitudinal study based on annual survey data demonstrated that 37.5% of participants with insomnia disorder at baseline continued to report insomnia symptoms through 5 years of follow-up. 4
What are the different types of insomnia?
11–13 The main categories are difficulty falling asleep (sleep-onset insomnia), difficulty staying asleep (sleep-maintenance insomnia), early-morning awakenings coupled with an inability to return to sleep (terminal insomnia), and combined insomnia (more than one of these categories). 13, 14 Additionally, insomnia with objective short sleep duration (<6 hours by polysomnography) has also been identified as an important phenotype. 15 Identification of a patient’s specific insomnia phenotype (eg, sleep-onset versus sleep-maintenance insomnia) may help guide treatment. 14 It is critically important to recognize the dynamic nature of insomnia, and that the stability of a patient’s insomnia symptoms may vary over time. 13 A 4-month longitudinal study of general practice attenders found that only 17–51% of the patients reported the same sleep complaint (s) at follow-up. 12 Similarly, in a large, longitudinal community-based study of individuals with current or lifetime insomnia, approximately 60% retained the same insomnia symptom phenotype after 1 year; 40% had a different phenotype. 14 The demonstration in these studies that many patients have conversion of their insomnia symptoms 12, 14 highlights that ongoing assessment is needed to monitor for potential changes in the presenting insomnia symptoms.
How does sleep signaling work?
Wake/sleep signaling in the brain is driven by two competing sets of brain circuitry: one set of neurotransmitter pathways that promotes sleep and another set that promotes wakefulness. 60 Transitions between sleep and wake states are dependent on the relative strengths of the two opposing sets of circuits and the end result has been described as akin to a flip-flop switch. 60 Historically, the most common approach in the pharmacologic treatment of insomnia has been to increase the sleep signal, such as with medications that target the γ-aminobutyric acid (GABA)-A receptor. However, this may not be the best approach physiologically if the insomnia disorder is due to excessive wake signaling occurring at the time when the individual is expected to fall asleep and remain asleep. Decreasing the excessive wake signal has recently become a viable option for medication treatment now that orexin has been identified as a key central promotor of wakefulness.
How often do you get insomnia?
Chronic insomnia disorder, which affects 6–10% of the population, is diagnostically characterized by ongoing difficulties with initiating or maintaining sleep occurring at least three times per week, persisting for at least 3 months, and associated with daytime impairment. While chronic insomnia is often considered a condition primarily related to impaired sleep, the disorder can also adversely affect domains of physical and mental health, quality of life, and daytime function, which highlights the importance of treating the multidimensional sleep disorder. Owing to misperceptions about the safety and effectiveness of treatment options, many individuals with insomnia may not seek professional treatment, and alternatively use ineffective home remedies or over-the-counter medications to improve sleep. Some physicians may even believe that insomnia is remediated by simply having the patient “get more sleep”. Unfortunately, treatment of insomnia is not always that simple. The disorder’s complex underlying pathophysiology warrants consideration of different nonpharmacologic and pharmacologic treatment options. Indeed, recent insights gained from research into the pathophysiology of insomnia have facilitated development of newer treatment approaches with more efficacious outcomes. This narrative review provides a summary of the diagnostic criteria and pathophysiology of insomnia and its subtypes. Further, this review emphasizes new and emerging nonpharmacologic and pharmacologic treatments for chronic insomnia, including recent enhancements in approaches to cognitive behavioral therapy for insomnia (CBT-I) and the new dual orexin receptor antagonist (DORA) pharmacologics. These advances in treatment have expanded the treatment options and are likely to result in improved outcomes in patients with chronic insomnia.
What is secondary insomnia?
The International Classification of Sleep Disorders, Third Edition and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition also describe several secondary insomnias, which arise from co-occurring primary or causative conditions including mental disorders (eg, major depressive disorder), medical conditions (eg, pain), substance use, or another sleep disorder (eg, breathing-related sleep disorder). 1, 3 Despite these insomnia subtypes, it is often difficult to differentiate between them clinically due to substantial symptom overlap between primary and secondary insomnia. Additionally, it is often difficult to assign causation to any single factor or establish the precise nature of the relationship between insomnia and a co-occurring condition. 3 Indeed, insomnia frequently persists despite resolution of other conditions and often requires independent treatment. 5, 6 Some studies have shown that cotreatment of insomnia and co-occurring conditions yield more rapid improvement of both conditions compared with independent treatment of only the co-occurring condition, supporting the treatment of insomnia as an independent condition in patients considered to have the “secondary” condition due to a primary medical or mental cause. 7, 8 Other than the different treatments required for distinctive comorbidities, effective treatments for insomnia generally are the same across “primary” or “secondary” insomnia. 1, 2, 9, 10 It is important to note, however, that for some of the more recent insomnia treatments (eg, dual orexin receptor antagonists [DORAs]), less is known about their effectiveness in patients with insomnia and comorbidities as these newer agents are relatively new and studies of those that have become commercially available have not yet been conducted to evaluate their efficacy specifically in insomnia patients with co-occurring disorders.
How does insomnia affect quality of life?
The consequences of insomnia extend even further in that it can also reduce quality of life (QOL), impair neurocognitive functioning, 31 and pose economic and public health burdens through increased health care utilization, sick leave, and decreased work productivity. 32, 33 An international cross-sectional survey comparing health-related QOL among sufferers of chronic insomnia with good sleepers found that people with insomnia reported significantly reduced health-related QoL as assessed using the 36-Item Short-Form Health Survey. 34, 35 Likewise, the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012–2013) found that the annual loss of quality-adjusted life-years associated with insomnia was significantly greater than other medical conditions assessed, including arthritis, depression, and hypertension. 36
How many people have insomnia?
In industrialized nations, chronic insomnia disorder is estimated to occur in 5–10% of the general population, although some studies suggest that the rate is as high as 33% of the adults. 2, 37 Despite the large percentage, a relatively low proportion consult a health care provider about their sleep. 38–40 The low consultation rate may be due to limited knowledge among the general population about the safety and availability of insomnia treatments that can be offered by clinicians. Self-treatment with over-the-counter sleep aids, as well as alcohol, is not unusual. 41 Owing to this low rate of consultation about insomnia, health care providers may not consistently recognize and diagnose the condition, 39 which likely contributes to undertreatment of insomnia. 13, 39, 42
What is insomnia prevention?
Tips for Preventing Insomnia. According to the American Academy of Sleep Medicine’s ICSD-3 manual, insomnia is defined 1 as “persistent difficulty with sleep initiation, duration, consolidation or quality.”. Insomnia has many potential contributing factors and symptoms, but its diagnosis hinges on two essential components: sleep difficulties ...
How long does insomnia last?
Insomnia that lasts or less than three months is known as short-term insomnia. In rare cases, patients may exhibit insomnia symptoms without meeting the criteria for short-term insomnia and may warrant some form of treatment. This is known as other insomnia.
How to prevent insomnia?
Tips for Preventing Insomnia. Chronic insomnia may necessitate prescription medication, cognitive-behavioral therapy, and other types of formal treatment. For some people, practicing healthy lifestyle habits and good sleep hygiene can alleviate insomnia symptoms and help them sleep more soundly.
What causes insomnia?
Insomnia is believed to originate due to a state of hyperarousal that can impact sleep-onset and sleep maintenance. Hyperarousal can be mental, physical, or a combination of both. Environmental, physiological, and psychological factors can all play a role in insomnia 3. These include the following: 1 Ingestion or consumption of substances that negatively affect sleep. These include alcohol, nicotine, and other drugs, as well as caffeine. Certain medications can also hinder sleep, such as diet pills and cold remedies. People may also experience sleep-onset or sleep maintenance issues as their bodies acclimate to new medications or cope with withdrawal from medications after finishing use. 2 Health problems. Physical pain and discomfort can make it harder to fall and/or remain asleep, leading to daytime impairments. Conditions that necessitate frequent trips to the bathroom at night, such as pregnancy or an enlarged prostate, can also cause insomnia symptoms. The same is true of sleep apnea, a disorder characterized by irregular breathing episodes known as apneas that occur throughout the night. Chronic pain, restless leg syndrome, heart, and lung diseases are also associated with insomnia. 3 Behavioral and mental health disorders. Insomnia is a common symptom of depression. Stress and anxiety can also contribute to insomnia, which in turn may exacerbate stressful and anxious feelings. Mental health disorders like bipolar disorder can cause insomnia, as well. Excessive worrying about sleeplessness is known to cause insomnia.
Why do older people have insomnia?
This may be attributed to chronic medical conditions, social isolation, and higher use of prescription medications, as well as factors like unhealthy sleep habits and stress that cause insomnia across all age groups.
How many people have insomnia?
Some conservative estimates show that 10% to 30% 4 of adults live with chronic insomnia. For other studies, this figure is closer to 50% to 60%. Insomnia is more prevalent in certain demographic groups, as well. Studies have shown insomnia affects 30% to 48% of older people 5.
What are the factors that contribute to insomnia?
Hyperarousal can be mental, physical, or a combination of both. Environmental, physiological, and psychological factors can all play a role in insomnia 3. These include the following: Ingestion or consumption of substances that negatively affect sleep. These include alcohol, nicotine, and other drugs, as well as caffeine.
What is the most common sleep disorder?
If you have trouble falling asleep or staying asleep, you may have insomnia, the most common sleep disorder. Between 10% and 30% of adults have chronic insomnia, and many more deal with it from time to time. Here’s a look at some of the latest research on this condition, its causes, and treatments that may help.
What is the drug that blocks the action of a brain chemical that keeps you alert called?
Orexin receptor antagonists. Some of the latest sleep medications are known as orexin inhibitors. They block the action of a brain chemical that keeps you alert, called orexin. Two of these drugs include:
What is CBT I?
CBT-I. The AASM put out new guidelines in early 2021 strongly recommending cognitive behavioral therapy for insomnia (CBT-I). When you do CBT-I, you meet with a therapist to learn how to change thoughts and behaviors that may be keeping you from getting a good night’s sleep. It involves several techniques that you may try one at a time or in combination.
What is cognitive restructuring?
Cognitive restructuring. The therapist will help you identify and change unhelpful thoughts and feelings that may be affecting your sleep, like anxiety about insomnia or unrealistic expectations.
What can a therapist do to help you calm your mind?
Relaxation training. Your therapist can teach you relaxation techniques like breathing exercises and meditation that may help calm your mind.
How does light therapy work?
When that cycle is thrown off, artificial light that mimics sunlight can help, a practice called light therapy. You sit in front of a special box that puts out an intense light at the specific time of day and for the length of time your doctor prescribes. Research has found it’s particularly helpful with resetting your body clock if you work odd hours, like a night shift, or have jet lag. But it can also relieve insomnia.
Is melatonin good for insomnia?
Melatonin supplements are often sold as a treatment for insomnia. But both the American Academy of Sleep Medicine (AASM) and the American Academy of Physicians don’t recommend it, saying there isn’t enough evidence it actually works.
What is insomnia treatment?
Insomnia Treatment. Insomnia is when someone is unable to sleep as much as they would like to, and there is no discernible cause. This can be a very frustrating situation, as the lack of sleep’s effects can worsen as sleep debt increases over time. 1 There are a number different insomnia treatments, some of which are behavioral ...
How to treat insomnia?
One method of insomnia treatment involves trying to eliminate some insomnia risk factors. Sources of stress can make it difficult to get to sleep, stay asleep, or return to sleep if you wake during the night or morning. Obviously not all sources of stress can be eliminated, but learning to manage stress with relaxation techniques may reduce the incidence of insomnia.
How to get rid of insomnia without drugs?
There are a few ways to alleviate insomnia without the use of pharmaceuticals. Making sure you only get into bed when you are going to sleep, and getting out of bed if you are unable to fall asleep within twenty minutes, can help establish good sleeping habits. 4 There are also two methods which are somewhat paradoxical in how they work. Sleep restriction, whereby you actively avoid sleeping as much as you would like, can make you tired enough to quickly fall asleep and stay asleep. You can also try to stay awake in bed, and the focus on staying awake can relieve you of the anxiety of being unable to sleep.
What is sleep hygiene?
Sleep hygiene encompasses practices meant to establish good sleeping habits. For example, if you watch television, read, or use a smartphone or tablet in bed, your body may learn to associate the bed with activities other than sleeping. A good sleep hygiene practice would be to only use the bed when sleeping.
How to fall asleep fast?
If you want to learn how to fall asleep fast, you should establish sleep hygiene, or good sleep habits. If you often do things other than sleep when in bed, your body and brain may have learned that going to bed doesn’t always mean going to sleep. By limiting your activities in bed to simply sleeping, you can break this association. If you find yourself lying in bed unable to sleep for at least twenty minutes, you should rise and do something else before returning to bed.
How long does insomnia last?
If the difficulty sleeping occurs for at least three nights a week and continues for at least three months, and is not the result of another mental illness, then it is likely to be classified as insomnia. 2. One method of insomnia treatment involves trying to eliminate some insomnia risk factors. Sources of stress can make it difficult to get ...
What medications are approved for long term use?
There are prescription drugs which are approved for long-term use by the United States Food and Drug Administration, such as zolpidem, zaleplon, ramelteon, and eszopiclone. Any use of a prescription sleeping pill should be under the care of a practicing medical doctor. 3.
What is Insomnia?
Insomnia is a sleep disorder characterized by difficulty falling or staying asleep. Insomnia is considered one of the most common sleep disorders. The Cleveland Clinic reports that 70 million U.S.
What Types of Insomnia are There?
There are two types of insomnia, acute and chronic. We list these insomnia types in detail below.
What are the Causes of Insomnia?
The causes of insomnia include stress, lifestyle habits, irregular sleep schedules, mental health issues, pain, illness, medications, neurological problems, and other sleep disorders. We list these causes in detail below.
Who is most at risk for Insomnia?
The people most at risk for insomnia are women, those over 60, individuals with mental health conditions, people experiencing a lot of stress, and folks with irregular sleep schedules. We will detail these risk groups below.
What are the Symptoms and Signs of Insomnia?
The symptoms and signs of insomnia are trouble falling asleep, waking up during the night, the inability to fall back asleep, waking up too early, daytime fatigue, irritability, depression, impaired memory, and difficulty concentrating. We list these symptoms and signs in detail below.
What are the Statistics about Insomnia?
The statistics about insomnia reveal that this is the most prevalent sleep disorder. The Cleveland Clinic reports that 70 million U.S. adults experience insomnia every year. Acute insomnia is more common than chronic insomnia.
What are the Risks and Complications of Insomnia?
The risks and complications of insomnia include worse job or school performance, increased risk for accidents, bad personal and professional relationships, long-term health problems, and less physical energy.