Insomnia: How can you overcome it?

What is insomnia, and what is it caused by?

Insomnia is characterized by insufficient sleep, whether in quantity or quality, despite favourable conditions for rest. It typically involves difficulty falling asleep, frequent nocturnal awakenings, or waking up too early in the morning, leaving individuals not feeling sufficiently rested.

There are various forms of insomnia. Episodic or transient insomnia is common and often linked to temporary factors or behaviours that disrupt sleep, such as stress, emotional distress, overeating, pain, or the consumption of stimulants. This type of insomnia lasts many nights but is usually resolved once the triggering factor is removed.

Chronic insomnia is diagnosed when sleep disturbances occur at least three times a week for a minimum of three months. It is influenced by three main factors:

• Predisposing factors: These include genetic susceptibility (e.g., being a light sleeper) or psychosocial factors (e.g., childhood trauma).
• Precipitating factors: Triggers such as significant stress, overwork, or life difficulties.
• Perpetuating factors: These include behaviours or thoughts that sustain sleep issues, such as spending excessive time in bed for non-sleep activities, anxiety about sleep, or obsessing over sleep quality.

Approximately 15% to 20% of the population is affected by insomnia, with 9% experiencing severe forms that significantly impact daily life. Women are more commonly affected than men, and the prevalence of insomnia increases with age due to factors such as declining sleep quality, sedentary behaviour, and daytime sleepiness.

Individual risk factors for insomnia include:

• Anxiety and depression, which increase the risk of chronic insomnia by 7 to 10 times.
• Social or lifestyle factors, such as unemployment, living alone, or having chronic illnesses like cardiovascular disease or chronic pain.
• Neurological disorders, including Parkinson’s disease and Alzheimer’s disease, which can disrupt circadian rhythms.

What are the consequences of insomnia?

Insomnia often leaves people feeling like their sleep is not restful or refreshing, impacting their daily lives with consequences such as:

• Fatigue
• Daytime sleepiness
• Nervousness or irritability
• Difficulty concentrating and remembering

The effects of insomnia extend beyond nighttime, impacting both personal well-being and societal aspects, such as increased absenteeism from work and a higher risk of accidents.

Long-term sleep deprivation also affects overall health, exacerbating conditions such as chronic pain, type 2 diabetes, and depression. It is associated with an increased risk of cardiovascular accidents, obesity, hypertension, and psychiatric disorders.

How can insomnia be managed and treated?

Effective management of insomnia begins with addressing lifestyle factors and treating any underlying conditions contributing to sleep disturbances.

Treating underlying health conditions

When the cause is identified, or if insomnia is linked to specific conditions, appropriate treatments are recommended. For example, in the following cases:

• Mental health issues (e.g., depression or anxiety disorders)
• Painful medical conditions
• Hyperthyroidism
• Sleep apnoea

Avoiding stimulants

If sleep is disrupted by substances like caffeine or recreational drugs, it is often recommended to stop their consumption.

Making lifestyle changes

Changes in daily habits can also promote better sleep, such as adjusting activity schedules that interfere with sleep quality (e.g., avoiding evening exercise), or improving the sleep environment (e.g., reducing noise or light).

Trying herbal remedies or prescription medication

If insomnia persists, a doctor may prescribe treatment tailored to the type and severity of the condition, using the lowest effective dose for the shortest duration possible.

For transient insomnia, a doctor or pharmacist may recommend a mild sedative, such as herbal remedies containing hawthorn, valerian, passionflower, or melatonin.

In more severe cases, prescription sleeping pills may be necessary, but these should be used for no more than four weeks due to the risk of dependency and withdrawal effects.

Psychotherapy

For chronic insomnia, psychotherapy, particularly cognitive-behavioural therapy (CBT), is highly effective in breaking the cycle of sleeplessness and unhelpful sleep habits.

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