Sleeping problems: what causes sleeping disorders and how to improve sleep quality

What is Insomnia?
Insomnia causes
Insomnia risk factors
Insomnia self-help. Tips to a better nights sleep.

What is insomnia?

Insomnia is a very common sleep disorder that probably affects most people at one time or another. Insomnia is more common among women and older adults but can occur in people of all ages and all social classes. Over the age of 65, 29% of men and 37% of women are affected.

Insomnia is an experience of inadequate or poor quality sleep characterized by one or more of the following problems: difficulty falling asleep, difficulty maintaining sleep, waking up too early in the morning and sleep that is not refreshing. Insomnia also involves daytime consequences such as fatigue, lack of energy, difficulty concentrating and irritability. Insomnia is not a serious medical condition but it can greatly affect the patient’s work and social life.

Periods of sleep difficulty lasting between one night and a few weeks are referred to as acute (transient) insomnia. Chronic insomnia refers to sleep difficulty occurring at least three nights per week for one month or more. Over 90 percent of people experience transient or short-term insomnia at some point during their lives, and up to 30 percent of the general U.S. population struggle with chronic insomnia.

Insomnia causes

There are many possible causes of insomnia. Sometimes there is one main cause, but often several factors interacting together will cause a sleep disturbance. Some conditions and situations that commonly lead to insomnia include:

Psychological Causes
- Anxiety, a condition in which individuals feel increased tension, apprehension, and feelings of helplessness, fear, worry, and uncertainty. Everyday anxieties as well as severe anxiety disorders may keep your mind too alert to fall asleep.
- Stress. Exposure to stress may contribute to the development or worsening of insomnia. Relationship problems, a chronically ill child, or an unrewarding career may contribute to sleep problems. If you suffer from these types of stresses, you should seek counseling to gain a new outlook on your troubles and more control in your life. Concerns about work, school, health or family can keep your mind too active, making you unable to relax.
- Depression, a mood disturbance characterized by feelings of sadness, despair, and discouragement. About 90% of people with depression have insomnia. This may be due to chemical imbalances in your brain or because worries that accompany depression may keep you from relaxing enough to fall asleep when you want to.
- Learned insomnia (also known as psychophysiological insomnia). Occurs when an individual worries so much about whether or not he/she will be able to go to sleep, that the person’s bedtime rituals and behavior actually trigger insomnia. The more the person worries about falling asleep, the harder it becomes. Some individuals with learned insomnia have trouble sleeping in their own beds yet may fall asleep quickly when they don't intend to - while reading the newspaper, sleeping away from home, or watching TV. Just a few nights of poor sleep during a month can be enough to produce a cycle of poor sleep and increase your worry about it. Treatment for learned insomnia aims to improve sleep habits and reduce unnecessary worry.
Hormonal changes in women. These include premenstrual syndrome, menstruation, pregnancy, and menopause.
- Menopause. Insomnia is frequently reported by women experiencing menopause. Insomnia can be a major problem in the first phases of menopause, when hormones are fluctuating intensely. Insomnia during this period may be due to different factors that occur. In some women, hot flashes, sweating, and a sense of anxiety can awaken women suddenly and frequently at night.
- Menstruation. Progesterone promotes sleep, and levels of this hormone plunge during menstruation, causing insomnia.
- Pregnancy. The effects of changes in progesterone levels in the first and last trimester can disrupt normal sleep patterns.
Decreased melatonin. The levels of melatonin, the hormone that helps control sleep, decrease as a person ages. By age 60, the body produces very little melatonin.
Medical conditions. These include allergies, arthritis, asthma, headache disorders, heart disease, gastroesophageal reflux, high blood pressure, restless legs syndrome, hyperthyroidism, Parkinson's disease. Such medical problems usually require the attention of a physician who can diagnose and treat the underlying condition. Treatment of the underlying cause of insomnia hopefully will result in improved sleep.
Pain. Pain and discomfort from a medical illness or injury often interfere with sleep.
Sleep related disorders. These include sleep apnea (in which one temporarily stops breathing during sleep) and periodic leg and arm movements during sleep (in which one's muscles excessively twitch or jerk). Severely disrupted breathing during sleep, known as sleep apnea, may affect people who breathe normally while they are awake. Breathing related sleep problems are most common in men, snorers, overweight people, and older adults.
Genetics. Problems with insomnia do seem to run in some families, although researchers have yet to identify how genetics play a role.
Jet lag. Air travel across time zones often causes brief bouts of insomnia. After long plane trips, one day of adjustment is usually needed for each time zone crossed. Traveling west to earlier times seems to be less traumatic than going east to a later time because it is easier to lengthen a circadian phase than to shorten it.
Working the night shift or long shifts. Individuals who work at night and those who work long shifts may have trouble adjusting their sleep habits. If you maintain later hours on weekends than during the week, you are more likely to experience sleep problems.
Medications. Insomnia can be a side effect of various medications, both prescription and over-the-counter. Such drugs include: antidepressants, high blood pressure medications, corticosteroid medications. Many over-the-counter medications, including some pain medication combinations, decongestants and weight loss products, contain caffeine and other stimulants. Antihistamines may initially make you groggy, but they can worsen urinary problems, causing you to get up more during the night.
Long-term use of sleep medications. Sleeping pills often become less effective over time. If a person suddenly stops taking or becomes tolerant of a long term prescription medication, insomnia may result. If you need sleep medications for longer than a few weeks, take them no more than two to four times a week, so they don't become habit forming.
Substance abuse:
- Caffeine. Caffeine (contained in popular drinks like coffee, tea and cola or foods such as chocolate) is a stimulant and may prevent you from getting the sleep you need. The National Sleep Foundation reports the effects of caffeine can cause problems falling asleep as much as 10-12 hours later in some people. Consider halting your caffeine intake earlier in the day to ensure you get quality sleep.
- Nicotine also stimulates the brain. Regular smokers often sleep very lightly and have reduced amounts of REM (rapid eye movement) sleep. They also tend to wake up after 3 or 4 hours of sleep due to nicotine withdrawal.
- Alcohol. You may think that having a glass of wine will help you sleep. However, while it may help you fall asleep quickly, alcohol consumption is likely to produce interrupted sleep. After we have had a few drinks, alcohol often causes drowsiness and lets us get off to sleep quite easily. Later in the night, however, when the alcohol level in our blood decreases, our body's arousal mechanism is stimulated and our normal sleep pattern is impaired. In addition, one of the effects of alcohol is to stimulate the pouring of adrenalin into the bloodstream, causing arousal, sweating and palpitations. This can result in waking up half-way through the night, or earlier than normal, with the heart pounding, making it quite difficult to get to sleep again.
Inactive behavior. People whose lifestyles are very quiet or restricted may experience difficulty sleeping at night.
Excessive computer work.
Environmental Factors. In one study, 20% of adults reported that light, noise, and uncomfortable temperatures caused their sleeplessness.
- Noise. Traffic, airplanes, television, and other noises can disturb your sleep even when they don't cause you to wake up.
- Light. It is well known that a person's biologic circadian clock is triggered by sunlight and very bright artificial light maintains wakefulness. Light affects your brain’s production of the hormones that regulate sleep rhythms. Too much light in the bedroom can keep your body from deep sleep. Insufficient exposure to light during the day, as occurs in some disabled elderly patients who rarely venture outside, may also be linked with sleep disturbances.
- Room temperature. Extreme temperatures and changes in the surrounding environment can contribute to sleepless nights. You will be restless if you are too hot or cold. A comfortable room temperature is best.
- Sleep partner or other family members. A sleep partner who snores, has sleep apnea, is very restless, gets up frequently, or has difficulty sleeping will affect your ability to sleep. Interruptions from other family members, such as a toddler or new baby, can also keep you up.

Insomnia risk factors

The following factors may increase an individual's risk for insomnia:

Age. As people grow older, sleep changes in most older people. Elderly people are more likely to be sedentary than younger adults. Medical conditions that cause pain or nighttime distress are common in the elderly. Neurologic diseases in the elderly, such as Parkinson's, Alzheimer's, and other forms of dementia, can cause nighttime disorientation, confused wandering, and delirium. Older people often take a number of prescription drugs whose side effects include insomnia. The elderly are also prone to grief, depression, and anxiety, the handmaidens of sleeplessness. Older people are more sensitive to environmental disruptions, such as light, noise, or jet lag. Subtle and dramatic hormonal shifts also occur, including reductions in melatonin and growth hormone and increases in stress hormones, creating an imbalance that may reduce all stages of sleep.
Psychiatric problems. The strongest risk factors for insomnia are psychiatric problems, particularly depression, and physical complaints, such as headaches and chronic pain, that have no identifiable cause (called somatic symptoms). About 90% of people with depression have insomnia. In addition, insomnia and depression often coincide with somatic symptoms, particularly chronic pain. In fact, insomnia worsens chronic pain even in people who are not depressed. Headaches that occur during the night or early in the morning may actually be caused by sleep disorders.
Negative Thinking. Negative thoughts and attitudes toward events can be significant factors in insomnia, however they do not cause insomnia in everyone.
Gender Factors. Insomnia is more common in women than men. In women, a number of hormonal events can disturb sleep, including premenstrual syndrome, menstruation, pregnancy, and menopause. After childbirth, most women develop a high sensitivity to the sounds of their children, which causes them to wake easily. It is possible that many women never unlearn this sensitivity and continue to wake easily long after the children have grown. Older women who are not bothered by sleeplessness tend to have longer and better sleep than noninsomniac men their own age.
Woking during night. Shift workers are at considerable risk for insomnia. Workers over 50 and those whose shifts are always changing are particularly susceptible to insomnia, although night-shift workers also have a high rate of sleeplessness.
Childhood fears. One study found that people who had experienced long-term insomnia had been prone to nightmares and fear of the dark as children.

Insomnia self-help. Tips to a better nights sleep

Behavioral techniques can actually cure chronic insomnia and studies have reported that between 70% and 80% of those who are treated with non drug methods experience improved sleep. Furthermore, studies report that 75% of those who have been taking drugs are able to stop or reduce their use.

Guidelines for better sleep:

Establish a regular routine. Go to bed and wake up at the same time each day. Getting your body used to a schedule can help regulate your sleep cycle. Avoid sleeping late on weekends to keep your schedule consistent and make it easier to wake up on Mondays. Don’t oversleep to make up for a poor night’s sleep - doing that for even a couple of days can reset your body clock and make it hard for you to get to sleep at night.
Incorporate bedtime rituals. Listening to soft music, sipping a cup of herbal tea, etc., cues your body that it's time to slow down and begin to prepare for sleep.
Don't spend too much time in bed. Your time in bed should be about the same as the amount of time you can actually sleep during the night. You can't force yourself to sleep by spending more time in bed.
Food and drink. Bedtime snacks can help. An amino acid called tryptophan, found in milk, turkey, and peanuts, helps the brain produce serotonin, a chemical that helps you relax. Try drinking warm milk or eat a slice of toast with peanut butter or a bowl of cereal with bananas before bedtime. Plus, the warmth may temporarily increase your body temperature and the subsequent drop may hasten sleep. Avoid taking very rich foods and alcohol before bed time. Avoid drinking large amounts of liquids before bedtime.
Caffeine. Discontinue caffeine intake four to six hours before bedtime and minimize total daily use. Caffeine is a stimulant and may disrupt sleep.
Nicotine. Avoid nicotine, especially near bedtime and on night awakenings. It is also a stimulant.
Alcohol. Avoid the use of alcohol in the late evening to facilitate sleep onset. Alcohol can cause awakening later in the night.
Relax before going to bed. A warm bath, reading, listening to soft music, or meditation can help you unwind from the day and get ready for sleep.
Worry time. It can be very helpful to set aside a period of time at night to review the day and to make plans for the next day. The goal is to avoid doing these things while trying to fall asleep. Write a personal diary before sleeping, or simply note down some things to remember for tomorrow. It's a way to clear the mind. It's not easy going to sleep with unfinished business on the mind, so find a way to note it and finish it until tomorrow, when you'll be far better able to deal with it anyway.
Sleep environment. Temperature and lighting should be controlled to make the bedroom conducive to falling asleep. A comfortable or uncomfortable bed can affect a person significantly, though it may not be immediately noticeable. Isolation from loud noise or pets is also a sensible way of ensuring sound sleep.
Associate your bed and bedroom with sleep. Use your bed only for sleep and sex. Establish the bedroom as a place for sleep and sexual activity only, not for reading, watching television, or working. Often, doing other activities in bed like watching TV, paying bills, or working only serve to initiate worries and concerns. Let your mind associate the bed with sleeping, relaxing, and pleasure.
Go to bed when you are sleepy. Stay up until a reasonable bedtime even if you feel sleepy earlier. Go to bed only when you are feeling really tired and sleepy. If you can't sleep, get up and only go back to bed when you're really sleepy again. If you are not asleep within 15 - 20 minutes go into another room, read or do a quiet activity using dim lighting until feeling very sleepy. (Don't watch television or use bright lights.) Don’t lie in bed awake for more than 15 minutes. This can make you anxious and worsen insomnia.
Body Heating and Sleep. Body-heating can have a very different effect from a warm room during sleep. Some studies suggest that soaking in hot water (such as a hot tub or bath) before retiring to bed can ease the transition into a deeper sleep. This may be due to a temperature shift (core body temperature drops after leaving the tub, which may signal the body it's time to sleep). Or the sleep improvement may be related to the water's relaxing properties, which may also have sleep promoting effects.
Nap. If you suffer from insomnia, try not taking a nap. If the goal is to sleep more during the night, napping may steal hours desired later on. If you're a regular napper, and experiencing difficulty falling or staying asleep at night, give up the nap and see what happens. However, napping can help promote short-term alertness, for example, to prepare for driving or in the middle of a long car trip.
Noise - a common cause of sleeplessness! Use earplugs if it's noise you can't do anything about - or change your attitude towards it. People can sleep through high levels of noise - it's not so much the level of noise but how you feel about it that keeps you awake. Use relaxation exercises to calm yourself and take your mind off it. Keep a radio/tape player by your bed and use it to mask other noise.
Do not look at the clock. Avoiding looking at the clock; this promotes anxiety and obsession about time.
Try not to be rigid about when and how much you sleep. Worrying about a sleep schedule can just make it harder to fall asleep.

Sometimes insomnia does go away on its own. Usually this happens with short-term insomnia that is due to some temporary stress in your life. When it persists, however, it may be a sign of another illness, such as anxiety or depression, and you should seek treatment.

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