Insomnia is a common sleep disorder that can make it difficult for someone to fall asleep, stay asleep or both. According to the Cleveland Clinic, insomnia affects up to 70 million people in the United States annually. One third to one half of adults have symptoms of insomnia and 10 to 15 percent of people have chronic insomnia. Chronic insomnia occurs more than three days a week for at least three months. Although no tests are needed for the diagnosis, they may be done to rule out other conditions, such as a sleep study to rule out sleep apnea. Not only does insomnia affect your sleep, but it can also cause fatigue and irritability, as well as affect your ability to concentrate during the day. This can affect home, work and school life, including relationships with others. Insomnia can also have a negative impact on drivers, making them sleepy and in the worst case, causing an accident.
According to the National Institute of Health (NIH), some risk factors for insomnia include:
- Age - insomnia becomes more prominent with older age
- Genetics - insomnia is more prevalent in families
- Occupation - including shift or night work
- Environment – noise or light exposure during the night, too warm or too cool temperatures, changing time zones
- Lifestyle - not getting enough physical activity, napping during the day, using substances (caffeine, elicit substances, nicotine, alcohol), getting up frequently with a baby
- Stress – grieving, anxiety about work, school, health, finances or getting enough sleep
- Gender - women are more likely to have insomnia, especially during pregnancy and menopause
- Cleveland Clinic also notes that pain (due to arthritis, fibromyalgia or other conditions), heartburn, neurological disorders (such as Alzheimer’s or Parkinson’s) may also lead to insomnia
According to Mayo Clinic, insomnia may be more common with age due to several changes:
- Sleep patterns - older people get tired earlier in the evening and wake up earlier in the morning (sleep tends to be less restful as you age)
- Activity changes - both physical and social activity may decrease with age; older people are more likely to nap during the day as well
- Health conditions - pain from arthritis or back problems, urinary issues (bladder or prostate conditions), restless legs
- Medications - generally older people take more medications than younger populations
Why is insomnia important? According to the NIH, insomnia increases your risk of:
- Cardiovascular conditions - heart disease, hypertension, stroke
- Mood disorders - anxiety, depression
- Worsened chronic pain
- Decreased immunity
- Decreased metabolism – weight gain leading to increased risk of obesity, metabolic syndrome and diabetes
So what can you do if you have insomnia or prevent insomnia if you don’t have it? There are sleep hygiene tips that I often give to my patients.
- First and foremost, I recommend regular exercise. This is not only good for insomnia but has many other health benefits as well. Exercise should not be done right before bedtime.
- While exercise is not recommended before bed, I do recommend other activities to relax your body and mind in preparation for sleep. This can include meditation, taking a warm bath, or listening to relaxing music.
- I also recommend avoiding stimulation from bright lights, large meals, caffeine, tobacco, alcohol in the evenings and outside noises. A fan for white noise and blackout curtains to reduce light exposure are beneficial.
- Avoid drinking fluids right before bed and use the restroom immediately before bed so the urge to urinate does not wake you from sleep.
- Bedrooms are meant for sleeping and sex only - no televisions, video games, phones, etc.
- Getting out of bed at the same time every morning, no matter what time you fell asleep, will help keep your body on a circadian rhythm. Avoiding naps during the day will also make you more ready for bed that evening.
If the above tips fail, you may benefit from cognitive behavioral therapy (CBT) which can be done by a therapist. According to the Cleveland Clinic, CBT is “a brief, structured intervention for insomnia that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep.” This is one of the first-line recommended treatments for insomnia. However, some patients do require medication therapy. There are over-the-counter treatment options (such as melatonin or antihistamines) as well as various prescription medications. I recommend speaking to your doctor prior to starting these medications, as they can have side effects, especially in older patients.
If you are one of many people suffering from insomnia, try using the tips above. You may schedule an appointment with your doctor to discuss. Keeping a sleep journal --what time you fall asleep, what time you wake up, any naps, etc. -- may be helpful to take with you to that appointment. Insomnia can affect your mental and physical health along with relationships and work, and it is not worth losing sleep over!