What causes 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.
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.
Lifestyle Factors
Use of stimulants
Caffeine near bedtime, even when it doesn't interfere with you 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 your sleep.
Use
of 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.
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.
Noise
Traffic, airplanes, television, and other noises can disturb your
sleep even when they don't cause you to wake up.
Light
These factors should be considered if you find yourself feeling
tired, even when you think you slept soundly all night.
These factors should be considered if you find yourself feeling tired, even though you think you slept soundly all night.
Other sleep disorders and physical illnesses may occur during sleep, disrupt sleep, and produce symptoms that can easily be mistaken for insomnia. These other disorders require medical attention and common treatments for insomnia will not help them.
Secondary
Insomnia
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. Alternatively, behavioral
methods (link) target the sleep disturbance itself and may quite
beneficial.
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, dementia (such as Alzheimer's disease, and other conditions.
If you suffer from a psychiatric disorder, you may sleep poorly.
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, headache disorders, 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 of insomnia hopefully will result in improved
sleep. However, it is possible that a specific treatment for insomnia
also will be needed.
Sleep-related
breathing disorders
Certain disorders can cause repeated pauses in breathing during
sleep. This can wake a sleeper dozens or even hundreds of times
during the night. Pauses can be as short as 10 seconds and may not
be remembered in the morning. They are sufficient, however, to produce
disturbed and restless sleep. 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. 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 keeps the breathing passages open with a steady stream of air flowing through a mask worn over the nose and mouth during sleep. Other treatments also are available, such as weight loss, surgery, or the use of dental appliances that help 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 roughly every 30 seconds (often for an hour or
longer) several times a night. 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 sleep. 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 you
have an iron deficiency, especially if you also experience restless
legs.
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 fail to sink fully into sleep. 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.
If you experience this problem, try elevating your head, or raise
the head of the bed (headboard) onto 6- to 8-inch blocks. Medications
can also provide relief.