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Insomnia Disorder

Kathryn Patricelli, MA

What is Insomnia Disorder?

A person with Insomnia Disorder has trouble falling asleep, staying asleep, or going back to sleep after waking up. Symptoms can include:

  • Not being satisfied with the amount or the quality of sleep because of one or more of the following:
    • Having trouble falling asleep
    • Having trouble staying asleep - you wake up a lot during the night or have trouble going back to sleep after waking up
    • Waking up early in the morning and being unable to go back to sleep
  • These sleep problems are causing a lot of stress or problems with school, work, relationships with others, or daily activities.
  • These sleep problems happen at least 3 times per week
  • These sleep problems have been happening for at least 3 months
  • The insomnia does not happen because of another sleep disorder, is not because of a medication or substance that was taken, or because of another medical or mental health condition that the person has.

The insomnia can be:

  • Episodic - problems last at least 1 month but less than 3 months
  • Persistent - problems last 3 months or longer
  • Recurrent - two or more episodes of insomnia happen during a 1-year period

How common is Insomnia Disorder?

Research has found that about 1/3 of adults report having some of these symptoms, but only about 6-10% have all the symptoms that result in a diagnosis of this disorder. Insomnia Disorder is the most common of all the sleep disorders. Females are almost 1.5 times more likely to complain of these symptoms than males. 40-50% of people with insomnia also have another mental disorder.

Insomnia can happen at any time, but usually happens for the first time in young adulthood (20s or 30s). It is more common in middle or older age. Younger people usually have more problems falling asleep and older adults have more trouble staying asleep. Women can also have insomnia before or during menopause.

What are the risk factors for Insomnia Disorder?

There are some risk factors to developing problems with sleeping, but it is even more likely when people have those risk factors and also are going through a major life stress (illness, separation, new job, death in the family, etc.) Most people will get through the sleep troubles after the stress has passed, but those that have the risk factors may continue to have problems.

These factors include:

  • a personality style where you worry or are anxious a lot or tend to hide your feelings.
  • noise, light, too high or low temperature in the sleeping room, and high altitude
  • being female or of advanced age
  • having a parent or sibling with insomnia
  • having poor sleep practices (drinking too much caffeine, not having regular sleep schedules, etc.)

What other disorders or conditions often occur with Insomnia Disorder?

Insomnia happens with many other medical conditions like diabetes, heart disease, arthritis, and pain disorders. Having a medical condition increases the risk of insomnia and having insomnia increases the risk of medical conditions happening.

People with insomnia also often have other mental health issues, especially depression, bipolar disorder and anxiety. People with insomnia may also misuse medications or alcohol to help them go to sleep, to deal with the anxiety that they feel, or to cope with the daytime sleepiness that they have. This not only makes the insomnia worse, but depending on the medication used can also lead to a substance use disorder.

How is Insomnia Disorder treated?

If you are having trouble falling asleep or staying asleep, you should first see a doctor who will look for any medical conditions that may be causing the problems. The doctor may suggest that you go to a sleep center for more tests to look at your sleeping patterns and what your body and brain are doing during sleep.

If there isn't a medical issue causing the problem, then the first type of treatment will be behavior therapy to work on your sleep habits. This could include setting regular times to go to sleep and to wake up and looking at the types of activities you do before bed that could be causing a problem (exercise, too much tv or screen time, eating or drinking, spending time in your bedroom other than when sleeping, etc.). Relaxation methods, such as breathing exercises, may also be helpful.

A technique called sleep restriction can be used where you limit the amount of time that you are spending asleep and reduce it a bit each night. This makes you more tired and can help make it easier to go to sleep. Once it works for a few nights, then you begin adding a bit more time in bed each night until you are getting a normal amount of sleep.

Cognitive behavior therapy can help you look at thoughts and feelings that may be making it hard for you to fall asleep or to stay asleep. This could be stress, worries that you are having about work or school, big things that have happened in your family recently (a death, marriage, new baby, etc.) The therapist will help you figure out what might be worrying you and then teach you how to change your thoughts, so that you can fall asleep and stay asleep.

Finally, your doctor may recommend that you take a sleeping pill medication, either over the counter (purchased in a store) or by prescription.