Do you suffer from insomnia? Here's why it happens and what you can do

By Cristiano Antonino On May 23, 2023

Insomnia is a very common sleep disorder: it is difficult for the sufferer to fall asleep. But that’s not all: it is possible that the sufferer not only wakes up frequently during the night but may open his eyes before dawn and never fall back asleep again

It is more than just an annoying disorder: lack of sleep, or sleeping badly, can affect a person’s energy and mood but also damage their health, impairing their work performance and quality of life.

There is no standard number of hours of sleep needed to ‘feel good’, but it varies from person to person

However, it is believed that most people in adulthood need about 7-8 hours a night (but there are those who need only 5 hours to recover their energy and there are the long sleepers, who need 9 or 10).

Yet, there are many people who experience short-term (‘acute’) insomnia in their lives, lasting for days or weeks: it is usually the result of stress or a traumatic event.

However, there are also those who suffer from long-term insomnia (‘chronic insomnia’), which lasts at least months and often much longer.

Insomnia may be ‘primary’ and thus an isolated disorder, or it may be secondary to other medical conditions or the taking of certain medications.

Admitting to suffering from it is the first step to resolving it, and to returning to a good quality of life.

Insomnia: definition and what it consists of

The term insomnia derives from the Latin insomnia and means ‘lack of dreams’; a suggestive term to describe a sleep disorder that is as common as it is annoying.

From a clinical point of view, insomnia refers to an insufficient duration of sleep but also to its discontinuity: it is not enough to sleep a few hours a night to suffer from it, therefore, but it is necessary that these hours are not sufficient to maintain adequate social and work functions during the day.

Sometimes the disorder is primitive, but more often it is secondary to other pathological or physical conditions or bad habits (related to diet, physical activity and lifestyle in general).

Although 10% of the world’s population suffers from chronic insomnia, there is not just one type and indeed each patient manifests different symptoms.

Specifically, there are three types of insomnia

initial insomnia, when the subject has difficulty falling asleep
intermediate insomnia, when the subject wakes up during the night and struggles to fall asleep again
terminal insomnia, when the subject complains of early awakenings and struggles to fall asleep again

In any case, the quality of sleep is very low and the side effects various (difficulty in staying awake during the day, drops in concentration and memory, up to outright depression).

Moreover, to date there are not only no drugs that completely solve the disorder, but also no drugs that are suitable for all individuals.

Insomnia: the symptoms

Symptoms of insomnia may include:

difficulty falling asleep in the evening
waking up at night
waking up too early in the morning
not feeling well rested after a night’s sleep
daytime tiredness or sleepiness
irritability, depression or anxiety
difficulty paying attention, concentrating on tasks/work or difficulty remembering
increased frequency of errors (e.g. at work)
constant worrying about sleep

However, in order to consider a person to be truly suffering from a significant degree of chronic insomnia, certain criteria must be taken into account:

time to fall asleep or time to wake up at night equal to or longer than 30 minutes
episodes of sleep disturbance equal to or greater than 3 nights per week
duration of insomnia equal to or greater than 6 months

People suffering from sleep disorders complain of daytime sleepiness and a deterioration in their ability to work (Morin, 1993).

Those who suffer from insomnia, compared to individuals without insomnia, also report high levels of anxiety and depression.

Insomnia may therefore be a risk factor or causal factor for the development of certain psychiatric disorders (Harvey, 2001; Lichstein, 2000).

The causes of insomnia and how to prevent it

Although in some cases insomnia may be an isolated disorder, much more often it is actually associated with other physical and mental pathologies.

It is usually the result of stress, life events or habits that interfere with sleep.

Treating the underlying cause can resolve insomnia, although sometimes this disorder can last for years and become a full-blown pathology.

Common causes of chronic insomnia include

Stress. Worries about work, school, health, finances or family can keep the mind active at night, making it difficult to sleep. Stressful life events or traumas, such as the death or illness of a loved one, divorce or job loss, can also lead to insomnia.
Shift work or travel Circadian rhythms act as an internal clock, driving aspects such as the sleep-wake cycle, metabolism and body temperature. Interrupting them can lead to insomnia. Main causes include jet lag from intercontinental travel, shift work with frequent changes or night shifts
Bad sleeping habits. Bad sleep habits include irregular bedtimes, daily naps, stimulating activities before bedtime, an environment in which one feels uncomfortable sleeping, and using the bed to work, eat or watch TV.
Computers, TV, video games, smartphones or other screens just before going to bed can interfere with the sleep cycle.
Eating too late at night. Having a light snack before bedtime is fine, but eating too much may make a person feel physically uncomfortable while lying down.
Caffeine, nicotine and alcohol. Coffee, tea, and other caffeinated beverages are stimulants: drinking them in the late afternoon or evening may prevent the patient from falling asleep at night. Nicotine in tobacco products is another stimulant that may interfere with sleep. Alcohol may help one fall asleep, but it prevents deeper stages of sleep and often causes awakening in the middle of the night.
Medications. Many medications can interfere with sleep, such as some antidepressants, painkillers, antihistamines, antihypertensives or asthma or cold medicines. Drugs used for weight loss, containing caffeine or other stimulants, may also disturb sleep
Mental health disorders. For example, post-traumatic stress disorder or depression
Pathologies: Examples of conditions related to insomnia include chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson’s disease and Alzheimer’s disease.

Insomnia and ageing

Insomnia becomes more common with age.

As we grow older, we may experience:

Changes in sleep patterns. Sleep often becomes less restful with advancing age, so noise or other disturbing elements in the environment are more likely to wake a person up; among other things, as people get older, they often get tired earlier, go to sleep earlier and wake up earlier in the morning. Older people generally need the same amount of sleep as younger people.
Changes in activity. Older people may be less physically or socially active and this predisposes them more to daytime naps that interfere with a good quality of sleep at night.
Changes in health. Chronic pain due to conditions such as arthritis or back problems, as well as depression or anxiety, can interfere with sleep. Problems that increase the need to urinate during the night, such as prostate or bladder disease, sleep apnoea and restless legs syndrome, do the same and become more common with advancing age.
Medications. Older people generally use more drugs than younger patients, and some of these may have insomnia as a side effect.
Sleep problems can also be a concern for children and adolescents, but this is mainly because they are more active and therefore want to go to bed later and sleep more in the morning.

That is why it is important for parents to programme sleep-wake cycle routines for them to adopt.

Insomnia: consequences

Sleep is as important to health as a healthy diet and regular physical activity, as it affects the individual both mentally and physically.

In fact, people with insomnia report a lower quality of life than people who sleep well.

The consequences of insomnia include:

lower performance at work or school
slower reaction time when driving with increased risk of accidents
mental health disorders such as depression, anxiety disorder or substance abuse
increased risk and severity of diseases or long-term conditions such as hypertension and heart disease

What treatments are useful to combat insomnia

Some good habits can help prevent insomnia and enable deep, restful sleep.

Below is a list of useful tips to follow to combat the disorder:

consistency is key: keeping the same times at which you go to sleep and wake up (even at weekends) can help regulate your sleep
stay active: regular activity helps promote a good night’s sleep
check that your daily medication does not contribute to insomnia
avoid or limit daytime naps
avoid or limit caffeine and alcohol and do not use nicotine
avoid large meals and drinks before bedtime
make the bedroom a comfortable place to sleep
create a relaxing bedtime ritual, such as taking a warm bath, reading or listening to soft music

In addition to these precautions to be taken as a preventive measure, those who already suffer from insomnia can talk to their doctor about possible cognitive-behavioural psychotherapy or drug therapy.

Cognitive-behavioural psychotherapy consists of the use of certain intervention techniques that can be used depending on the characteristics of the disorder in each patient.

The techniques are mainly:

Sleep hygiene education: the aetiological and maintenance factors of insomnia are explained to the patient according to the cognitive-behavioural model.
In addition, sleep physiology (sleep stages, internal and external clock, individual differences) is clarified in order to improve sleep quality.
Sleep restriction: allows the time spent in bed by the patient to be matched with the time actually spent sleeping.
Stimulus control: aims to eliminate any associations between the bed or bedroom and activities incompatible with sleep.
Cognitive restructuring: procedure to change dysfunctional beliefs and expectations about sleep.
Relaxation and imaginative distraction techniques.

With regard to drugs, hypnoinductive drugs tend to be used in elderly patients, whereas hypnotic drugs or anxiolytics with a hypnotic function (benzodiazepines) are not recommended for prolonged use, as they have numerous side effects and lead to a high degree of habituation.

Moreover, a drastic attempt at withdrawal can lead to a bloody return of insomnia, psychomotor agitation, anxiety and tremors (Gillin, Spinwerber and Johnson, 1989).

This prompts the insomniac to take the drug again, creating a vicious circle.

Long-term treatment of the insomnia disorder therefore requires the use of antidepressant-sedating drugs and melatonin.

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