Insomnia

Symptoms

The symptoms of insomnia depend on the type of sleeping problem that you have. A lack of sleep can affect your mood and cause tiredness and fatigue during the day.

It's thought that up to a third of people in the UK have symptoms of insomnia at some point in the year, which can include:

• lying awake for a long time at night before falling asleep
• waking up several times in the middle of the night
• waking up early in the morning and not being able to get back to sleep
• feeling tired and not refreshed by sleep
• not being able to function properly during the day and finding it difficult to concentrate
• being irritable

How much sleep do I need?

As every individual is different, it's difficult to define what ‘normal sleep’ is. Factors that influence the amount of sleep you need include your age, lifestyle, diet and environment.

For example, newborn babies can sleep for 16 hours a day, while school-age children need to have an average of 10 hours sleep.

Most healthy adults sleep for an average of seven to nine hours a night. As you get older, it's normal to find sleep more difficult to maintain, although you still need the same amount of sleep.

When to visit your GP

You should consider visiting your GP if a lack of sleep is affecting your daily life and you feel that it's a problem. Fatigue caused by insomnia can sometimes affect your mood and create problems within your personal relationships and work environment.

Read more about simple methods that may help prevent insomnia, in the self help section.

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Causes

Insomnia can be caused by many different things, including stressful events, psychiatric problems, underlying physical conditions, and drug and substance misuse. It can also be a side effect of certain medications.

Stressful events

Some people experience insomnia in response to a stressful event, and it continues even when the stress has been resolved. This is because they have learnt to associate the sleeping environment with being alert.

Worrying about work, money or health, a loved one becoming ill or dying, and even noise and light are all causes of Stress and are likely to keep you awake at night. 

Psychiatric problems

Underlying mental health problems can affect your sleeping patterns. They include:

• mood disorders, such as depression or bipolar disorder
• anxiety disorders, such as generalised anxiety, panic disorder or post-traumatic stress disorder
• psychotic disorders, such as schizophrenia

Physical condition

Insomnia can be caused by underlying physical conditions, including:

• heart disease 
• respiratory disease, such as chronic obstructive pulmonary disease or asthma
• neurological disease, such as Alzheimer's or Parkinson's disease
• hormone problems, such as an overactive thyroid
• joint or muscle problems, such as arthritis
• problems with the genital or urinary organs, such as urinary incontinence or an enlarged prostate
• sleep disorders, such as restless legs syndrome, narcolepsy or sleep apnoea
• chronic (long-term) pain

Drug and substance misuse

Alcohol and drug misuse, nicotine and drinking too much caffeine (contained in tea, coffee, energy drinks) can also affect your sleeping patterns.

Medication

Some prescribed treatments or medicines that are available over the counter can cause insomnia. These include:

• antidepressants 
• epilepsy medicine
• medication for high blood pressure (hypertension), such as beta-blockers
• hormone replacement therapy 
• non-steroidal anti-inflammatory drugs (NSAIDs)
• stimulant drugs, such as methylphenidate, which is often used to treat attention deficit hyperactivity disorder (ADHD) or modafinil, which is used to treat narcolepsy (a long-term sleep disorder that disrupts normal sleeping patterns)
• some medicines that are used to treat asthma, such as salbutamol, salmeterol and theophylline

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Diagnosis

You should consider visiting your GP if you're finding it difficult to get to sleep or to stay asleep and it's affecting your daily life.

Investigating the problem

You're likely to be asked about your sleeping routines, how much alcohol and caffeine you drink each day, and your general lifestyle habits, such as diet and exercise.

Your GP will also check your medical history for any illness or medication that may be contributing to your insomnia. 

Keeping a sleep diary (see below), can help you and your GP understand the pattern of your insomnia, which may help to decide the method of treatment. 

Read more about how insomnia is treated.

Keeping a sleep diary

You should keep a sleep diary for a minimum of two weeks. It should record information such as:

• the time you go bed
• the time it takes to get to sleep
• the number of times that you wake up during the night
• the time at which you wake up
• episodes of daytime tiredness and naps
• the times of meals, alcohol consumption and significant events during the day, such as exercise and stress

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Treatment

The first step in treating insomnia is to find out whether the problem is being caused by an underlying medical condition.

If it is, once the condition has been treated your insomnia may disappear without the need for further medical help.

Your GP should advise you on what you can do at home to help you sleep. This is often referred to as good sleep hygiene, and includes:

• establishing fixed times for going to bed and waking up (avoid sleeping in after a poor night's sleep)
• trying to relax before going to bed
• maintaining a comfortable sleeping environment (not too hot, cold, noisy or bright)
• avoiding napping during the day
• avoiding caffeine, nicotine and alcohol within six hours of going to bed
• avoiding exercise within four hours of bedtime (although exercise in the middle of the day is beneficial)
• avoiding eating a heavy meal late at night
• avoiding watching or checking the clock throughout the night
• only use the bedroom for sleep and sex

Read more about simple methods that may help prevent insomnia.

If you have long-term insomnia (lasting more than four weeks):

• your GP will advise you about good sleep hygiene
• your GP may recommend cognitive and behavioural treatments
• you may be prescribed a short course of sleeping tablets for immediate relief or to manage a particularly bad period of insomnia (although they aren't recommended for long-term use)
• If you're over 55 years old, your GP may consider prescribing melatonin.

Cognitive and behavioural treatments

Cognitive behavioural therapy (CBT) aims to change unhelpful thoughts and behaviours that may be contributing to your insomnia. CBT is usually recommended if you've had sleep problems for more than four weeks. It includes:

• stimulus-control therapy, which aims to help you associate the bedroom with sleep and establish a consistent sleep/wake pattern
• sleep restriction therapy – you limit the amount of time spent in bed to the actual amount of time spent asleep, creating mild sleep deprivation; sleep time is then increased as your sleeping improves
• relaxation training – this aims to reduce tension or minimise intrusive thoughts that may be interfering with sleep
• paradoxical intention – you try to stay awake and avoid any intention of falling asleep; it's only used if you have trouble getting to sleep, but not maintaining sleep
• biofeedback – sensors connected to a machine are placed on your body to measure your body’s responses, such as muscle tension and heart rate; the machine produces pictures or sounds to help you control your breathing and body responses

Sometimes, CBT is carried out by a specially trained GP. Alternatively, you may be referred to a clinical psychologist.

Reference: http://www.nhsdirect.wales.nhs.uk/encyclopaedia/i/article/insomnia/