Why can't I sleep? Dealing with Insomnia

What is the meaning of Insomnia?

Insomnia is a disorder where you have problems with sleep. This may include troubles falling asleep, staying asleep or both. Insomnia can occur for anywhere from a short period of time to long term, usually over a month. This can lead to some pretty serious effects, such as extreme sleepiness in the daytime, sleep deprivation and an increased risk of car accidents.

Shot of a concerned looking young man with insomnia sitting on a bed while his wife sleeps in the background

What are the symptoms of Insomnia?

There are many symptoms of Insomnia, with their severity increasing along with the gravity and length of the disorder. These include:

  • Difficulty falling asleep
  • Waking up multiple times at night 
  • Regularly waking up too early 
  • Poor sleep quality
  • Feelings of tiredness and fatigue
  • Irritability
  • Difficulty napping even when tired
  • Impaired concentration
  • Memory issues

This can lead to sleep deprivation if you consistently experience poor sleep. Deprivation can aggravate symptoms and lead to more serious issues. For example, depressed mood, a weakened immune system, cardiovascular disease, high blood pressure and impaired learning.

What causes Insomnia?

As sleep is a good indicator of overall health, there’s no surprise that Insomnia is caused by many different things. The most common causes are stress, anxiety and depression. A lack of sleep can make these issues worse, creating a self-reinforcing cycle. However, this can be a case of ‘chicken or the egg’. Contemporary research has concluded that sleep issues have a bidirectional relationship with other health problems. For example, anxiety may contribute to insomnia, but insomnia might trigger or worsen anxiety.

Environmental factors can also play a large role- including light, temperature and your bed.

A more recent common cause is too much screen time. Screens emit blue light which signals to our body that it’s daytime, disturbing our body clock if used too late. Having a ‘screen curfew’ can really help with settling into your sleep routine. Many devices also now have dimming options, or ‘night modes’ to reduce blue light.

Insomnia can also be down to your breathing if you’re affected by sleep apnea or UARS. Breathing issues during sleep can be a nasty wake-up call for many sufferers. Many wake up gasping for air as their breathing has stopped while they’re sleeping. Those that snore, sleepwalk or experience sleep paralysis may also wake themselves up. Regularly waking up in the night can disturb your circadian rhythm, aka. your body clock. This is a cycle of changes that we go through every 24 hours, including when we wake up and sleep.

Jet lag, unusual shifts at work and frequent changes in sleep patterns can disturb this. This cycle affects some important functions such as our hormones, bodily temperature and digestion. 

Drugs, especially stimulants like caffeine, nicotine and excessive alcohol, can also greatly affect your sleep. Prescription drugs such as beta-blockers and some antidepressants may also list this as a side effect. Insomnia can even be the result of withdrawal from many different drugs, even including alcohol.

Mental and physical disorders are also a very common cause of Insomnia. Chronic pain, gastrointestinal issues, PTSD and ADHD are all examples of issues which may be related. Those that are undergoing hormone changes may also be greatly affected. This might include menopause, puberty and pregnancy.

Is all Insomnia the same?

There are actually many different types of Insomnia. Each person experiences Insomnia in distinct ways. You can classify insomnia by how long it’s occurred for (transient, acute or chronic), or by the main symptom experienced:

  1. Sleep-onset insomnia
    • This refers to issues with falling asleep in the evening, associated with ‘tossing and turning’ in bed. Many shift workers experience this, as their ‘night time’ is different from naturally occurring circadian rhythms.
  2. Sleep-maintaining insomnia
    • This means the inability to stay asleep throughout the night. Those struggling with maintaining sleep may also have issues with getting back to sleep, decreasing quantity and quality.
  3. Early morning awakening
    • This concerns waking up much earlier than desired, and being unable to get back to sleep. This is very common in older adults, due to changes in circadian rhythm as you get older.

Some may also identify with the term ‘mixed insomnia’, which isn’t technically a formal term. This refers to a combination of the types described above. Classification is quite difficult as symptoms often change over time.

Close up of a doctor doing a medical exam while both him and the patient are wearing protective masks

How do you get diagnosed?

To be diagnosed with insomnia in the UK, it’s best to go to your GP. The NHS also has a quick sleep self-assessment, however this is not a substitute for a formal diagnosis. A sleep assessment carried out by your GP will include questions around potential causes, such as your medical history and lifestyle. 

Disorders like insomnia can also be detected through what’s called a polysomnogram. It’s a non-invasive assessment which involves recording video and audio of someone sleeping. Sensors are placed on the head, chest and legs, and blood oxygen level is also monitored. These are all connected with long wires to allow movement, and patients can communicate with doctors. Many different factors are analysed- such as brain waves, eye movement, breathing rate and movement.

What are the treatments for severe sleeping trouble?

There are a few common pieces of guidance which doctors will recommend to those with insomnia. This is often referred to as ‘sleep hygiene’. To see the difference small steps can make, changes such as these are trialled for at least 4 weeks,:

  • Relaxing before bed with a warm bath, music or reading
  • Ensuring you have a comfortable pillow, duvet and mattress
  • Having fixed sleeping hours
  • Making the room the most comfortable temperature, noise and light level
  • Avoiding daytime napping
  • Exclusively using one room for sleeping
  • Prohibiting clock checking 
  • Turning off any screens
  • Avoiding heavy or spicy foods before bed
  • Avoiding caffeine, alcohol and nicotine before bed
  • Exercising regularly throughout the day, more than 4 hours before bed

For more tips for a better night’s sleep, you can visit our very own Sleep Resource Centre.

If these steps do not work, another treatment option is to trial Cognitive Behavioural Therapy.

CBT is a form of psychological treatment which can alter your thoughts and behaviours around many issues, including sleep. A pharmacist can also provide you with sleeping aids, however, many of these have adverse side effects. Some can also make you drowsy when you wake up the next day. This is why many GP’s now steer clear from prescribing sleeping pills, unless your condition is severe. 

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