What is insomnia?

Insomnia is defined as habitual sleeplessness and is sometimes used to describe a disorder recognized by polysomnographic (sleep study) evidence of disturbed sleep. It can often be distinguished by a positive response to one of two questions: Do you have difficulty falling or staying asleep? Do you experience difficulty sleeping?

Insomnia may accompany other sleep, medical and psychiatric disorders. It is followed by functional impairment while awake and can occur at any age, but is most common in older adults. While insomnia may only last up to 3 weeks (short term) it can last for more than 3 to 4 weeks (long term) and can lead to memory problems, depression, irritability and an increased risk for heart disease.

Diagnosis

A thorough diagnosis will differentiate between either primary, secondary or comorbid insomnia. Primary insomnia is not attributable to a medical, psychiatric or environmental cause and is described as a complaint of prolonged sleep onset latency, disturbance of sleep maintenance or the experience of non-refreshing sleep.

However, almost half of all diagnosed insomnia is associated with a psychiatric disorder. For example, it is suggested that in depression, insomnia should be regarded as a co-morbid condition. Insomnia often predates psychiatric symptoms and it may represent a significant risk for a subsequent psychiatric disorder.

Sleep-onset insomnia — difficulty falling asleep at the beginning of the night — is often a symptom of anxiety disorders. However, delayed sleep phase disorder — causes a delay in sleep period that flows over into daylight hours — is often misdiagnosed as insomnia.

Nocturnal awakenings are another form of insomnia and are either when someone has difficulty falling back asleep after awakening in the middle of the night (middle-of-the-night insomnia) or when waking up too early in the morning (terminal insomnia). Middle-of-the-night insomnia may be a symptom of pain disorders or illness; terminal insomnia may be a sign of clinical depression.

While insomnia affects people of all age groups, it particularly affects those aged older than 60 years, those who have a history of a mental health disorder including depression, emotional stress, working late night shifts and those who travel through different time zones.

Treatment

Before treating insomnia, it is important to identify or rule out medical and psychological causes. Although pharmacological treatments have been used to reduce symptoms in acute insomnia, their role in the management of chronic insomnia remains unclear.

According to the National Institutes of Health, cognitive behavioral therapy (CBT) “has been found to be as effective as prescription medications are for short-term treatment of chronic insomnia. Moreover, there are indications that the beneficial effects of CBT, in contrast to those produced by medications, may last well beyond the termination of active treatment.”

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