Causes of Insomnia

What Causes Insomnia | Psychological Factors | Lifestyle Factors
Environmental Factors | Psychiatric/Physical Illness

What causes insomnia?

Insomnia may be independent of other healthcare problems. However, it also may be a symptom of another problem, much like a fever or a stomachache. It can be caused by a number of factors.

Psychological Factors

Vulnerability to insomnia
Some people seem more likely than others to experience insomnia, just as some people tend to get headaches or upset stomachs. Simply knowing that you may experience insomnia and that it will not last too long can be helpful in dealing with it when it occurs.

Persistent 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.

Learned insomnia (also known as psychophysiological insomnia)
If you sleep poorly, you may worry about not being able to function well during the day. You may try harder to sleep at night, but unfortunately this determined effort can make you more alert, set off a new round of worried thoughts, and cause more sleep loss. Doing activities in and around the bedroom-changing into your night clothes, turning off the lights, pulling up the blankets- can become linked with the sleep problems that follow. Through repetition these bedtime activities can then trigger over-arousal and insomnia. 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.

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Lifestyle Factors

Use of stimulants
Caffeine near bedtime, even when it doesn't interfere with falling asleep, can trigger awakenings later in the night. Nicotine is also a stimulant, and smokers may take longer to fall asleep than non-smokers. Be aware that the ingredients in many common drugs, including nonprescription drugs for weight loss, asthma, and colds, can disrupt sleep.

Use of alcohol
A glass of wine may help you fall asleep quickly, however, alcohol consumption is likely to produce interrupted sleep beginning a few hours after falling asleep.

Erratic hours
If you do shift work (work non-traditional hours, such as nights or rotating shifts), or maintain later hours on weekends than during the week, you are more likely to experience sleep problems. Maintaining regular hours can help program your body to sleep at certain times and to stay awake at others. Establishing a routine is important.

Inactive behavior
People whose lifestyles are very quiet or restricted may experience difficulty sleeping at night.

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Environmental Factors

Noise
Traffic, airplanes, television, and other noises can disturb sleep even when they don't cause the individual to wake up.

Light
Exposure to bright light prior to sleep can delay sleep onset, while light entering the bedroom can shorten sleep.

All of these environmental factors should be considered if you find yourself feeling tired, even when you think you slept soundly all night.

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Illness and Secondary Insomnia

Other sleep disorders, psychiatric and physical illnesses may disrupt sleep, and produce symptoms that can easily be mistaken for insomnia. These other disorders require medical attention and common treatments for insomnia alone will not help.

When insomnia is caused by a psychiatric disorder (most often depression) or a medical disorder (most often chronic pain), it is termed secondary insomnia. Secondary insomnia may be relieved by successful treatment of the primary psychiatric/medical disorder. Additionally, behavioral methods (link) that target the sleep disturbance itself and may quite beneficial especially if some sleep disruption remains after effective treatment of the underlying disorder.

Psychiatric problems
Insomnia, especially with awakenings earlier than desired, is one of the most frequently reported symptoms of depression. Insomnia is also associated with anxiety disorders, post-traumatic stress disorders, and other conditions. Treatment of the underlying disorder, often including both medication and psychotherapy, can help improve your sleep. However, additional and specific treatment for the insomnia often is warranted.

Medical problems
Medical illnesses can disrupt sleep and produce symptoms of insomnia. For example, arthritis, headaches, benign prostatic hypertrophy, and other conditions can cause or worsen the problem of insomnia. Such medical problems usually require the attention of a physician who can diagnose and treat the underlying condition. Treatment of the underlying cause will result in improved sleep. However, in some cases specific treatment for insomnia also will be needed.

Sleep-related breathing disorders
Sleep-related breathing disorders such as sleep apnea can cause repeated pauses in breathing during sleep. This can wake a sleeper dozens or even hundreds of times during the night. Pauses in breathing can be as short as 10 seconds and may not be remembered in the morning. However, they are sufficient to produce disturbed and restless sleep. Severely disrupted breathing during sleep 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. Loud snoring that is interrupted by gasps, snorts, or other unusual sounds may be a warning sign of a sleep-related breathing disorder.

Severe cases of sleep apnea often benefit from a treatment known as positive airway pressure (PAP). This treatment involves wearing a mask over the nose during sleep that is connected by a tube to a machine that blows room air into the nose to keep the airway open with a steady stream of air flowing through a mask worn over the nose and mouth during sleep. Other treatments, such as weight loss, surgery, or the use of dental appliances may help some individuals to improve breathing during sleep.

Sleep-related periodic leg movements
Brief muscle contractions can cause leg jerks that last a second or two and occur repeatedly about every 20-40 seconds for varying periods of time throughout the night (often for an hour or longer). In almost all cases the individual is totally unaware of the limb movements. These movements can cause hundreds of brief interruptions of sleep each night, resulting in restless or non-restorativesleep. Periodic limb movements become more frequent and severe as we grow older. Treatment can include medication, discontinuing medication, evening exercise, a warm bath, elimination of caffeine, or a combination of these. Iron replacement may be helpful if there is an iron deficiency, especially if restless legs is also present..

Waking brain activity
Waking brain activity can persist during sleep. Sleep monitoring during the night has shown that some people who complain of light or less restful sleep show waking brain (EEG) activity occruing simultaneously with sleep activity. Individuals with persistent pain may experience this non-restorative type of sleep.

Gastroesophageal reflux
Back-up of stomach contents into the esophagus can awaken a person several times a night. This reflux is commonly known as heartburn because of the pain or tightness it produces in the mid-chest area. When reflux occurs during the day, a few swallows and an upright position will usually clear the irritating materials from the esophagus. During sleep, less-frequent swallowing and a lying-down position causes more reflux, making the sleeper wake up coughing and choking. Elevating the head, or raisinge the head of the bed (headboard) onto 6- to 8-inch blocks may help. Medications can also provide relief.

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