overcoming insomnia

Tossing, turning, staring at the ceiling…we’ve all spent the occasional night battling insomnia. But when those sleepless nights turn into weeks or months, it becomes exhausting and frustrating.

Chronic insomnia affects up to 30% of adults at some point. If you’re longing for restful slumber night after night, know there are many ways to tackle insomnia for good.

This in-depth guide covers all things insomnia and sleep, from causes and risk factors to medical, behavioral, and natural remedies. Ready to say goodbye to counting sheep and finally get the sleep you need? Let’s dive in.

What is Insomnia?

Insomnia is difficulty falling or staying asleep that results in daytime fatigue, mood changes, and impaired work and social functioning. It involves both sleep quantity and quality issues.

Acute insomnia lasts from one night to a few weeks. It often stems from a short-term stressor like travel, grief, or illness. Chronic insomnia is difficulty sleeping at least 3 nights per week for 3 months or longer.

Insomnia symptoms include:

• Difficulty falling asleep at bedtime – lying awake for 30+ minutes
• Waking frequently and being unable to fall back asleep
• Waking too early and being unable to return to sleep
• Feeling unrested despite enough time spent sleeping
• Daytime drowsiness, fatigue, and irritability
• Difficulty concentrating and focusing
• Worrying about not sleeping perpetuates insomnia

Around 90% of people with insomnia also have a co-occurring medical, mental health, or sleep disorder. So other issues often underlie and exacerbate insomnia.

Now let’s look at what causes insomnia and who’s most at risk.

Causes and Risk Factors for Insomnia

Many factors can trigger insomnia or perpetuate sleep problems once they start:

Medical Conditions

Physical health issues including:

• Chronic pain – arthritis, headaches, neuropathy
• Respiratory conditions – sleep apnea, asthma
• Gastrointestinal problems – reflux, IBS
• Hyperthyroidism, renal disease, cancer
• Neurological disorders – Alzheimer’s, Parkinson’s

Mental Health Disorders

Psychiatric conditions such as:

• Anxiety, depression
• Bipolar disorder
• ADHD
• PTSD

Medications

Drugs that interfere with sleep including:

• Decongestants, steroids
• Blood pressure medications
• Antidepressants
• Stimulants for ADHD

Sleep Disorders

Issues like:

• Restless leg syndrome (RLS)
• Sleep apnea
• Circadian rhythm disorders
• Nighttime leg cramps, acid reflux

Habits and Behaviors

Lifestyle factors that affect sleep:

• Irregular sleep schedules
• Daytime napping
• Using electronic devices at bedtime
• Consuming caffeine, alcohol, heavy meals before bed
• Nicotine use
• Lack of physical activity

Life Stressors

Situations causing stress and worry such as:

• Work or financial problems
• Major life changes or trauma
• Grief and bereavement

In many cases, insomnia arises from a combination of biological, psychological, and behavioral factors. Understanding your personal triggers is key to finding the right treatment approach.

Risk Factors for Insomnia

Certain characteristics make people more predisposed to insomnia:

• Being female – women are 40% more likely to have insomnia
• Older age – sleep patterns change as we age
• Family history – insomnia has genetic factors
• History of mental health disorders
• Overactive, “turbo-charged” brain
• Tendency to worry and ruminate

Now that you know why insomnia happens, let’s look at how doctors diagnose it.

Getting an Insomnia Diagnosis

If sleepless nights are interfering with your daily life, see your primary care doctor or a sleep specialist. Here’s how insomnia is professionally diagnosed:

Sleep Study

Your doctor may recommend an overnight sleep study, or polysomnogram. You sleep at a clinic with sensors monitoring bodily functions, including:

• Brain waves (EEG)
• Heart rate (EKG)
• Breathing patterns
• Eye and leg movements
• Blood oxygen levels

This data helps pinpoint whether another sleep disorder like sleep apnea causes your insomnia. A sleep study can also assess how much time you actually spend asleep vs. awake.

Sleep Journals and Questionnaires

Keeping a sleep diary for 1-2 weeks tracks details like:

• What time you go to bed and wake up
• How long it takes to fall asleep
• Number and duration of nighttime awakenings
• Daytime mood, energy levels, and functioning

Sleep questionnaires help rate the severity of your insomnia and the extent to which it impacts daily life.

Medical Exam and History

Your doctor assesses your overall health to identify any underlying medical conditions or medications contributing to insomnia. Blood tests might check for thyroid dysfunction.

Mental Health Evaluation

A psychologist screens for psychiatric issues like depression, anxiety disorders, and PTSD that often co-occur with insomnia.

Putting all this data together paints a picture of your specific insomnia profile and causal factors. Accurate diagnosis guides treatment recommendations.

Treatments and Remedies for Insomnia

Many effective insomnia treatments exist from medication to therapy to lifestyle changes. Healthcare providers often recommend combining approaches for the best results.

Medications

Prescription sleeping pills serve a role in treating insomnia short term. Types include:

Benzodiazepine sedatives like lorazepam (Ativan), alprazolam (Xanax), and diazepam (Valium) reduce anxiety and promote sleep onset. But they lose effectiveness over time and carry a dependence risk.

Non-benzodiazepine hypnotics like zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta) help initiate sleep without antianxiety effects. Potential for tolerance and dependence still exists.

Melatonin receptor agonists like ramelteon (Rozerem) regulate the sleep-wake cycle by mimicking melatonin. Less habit-forming than other prescription sleep aids.

Off-label use sleep drugs like the antidepressant trazodone are sometimes prescribed for insomnia because of their sedating effects.

Most sleeping pills treat symptoms without addressing underlying causes. They work best short term paired with other behavioral interventions. Long-term use risks side effects like daytime drowsiness, nausea, and dependence.

Other medications that promote sleep include some antipsychotics, anticonvulsants, and allergy/cold medicine (doxylamine succinate). But always consult a doctor before trying new medicines.

Behavioral and Psychological Treatment

Cognitive-behavioral therapy for insomnia (CBTI) effectively treats chronic insomnia without drugs. A trained therapist helps change sleep-disrupting thoughts and behaviors.

CBTI components include:

• Sleep restriction limits time spent awake in bed to strengthen the body’s sleep drive. Bedtimes are gradually increased as sleep improves.
• Stimulus control instructions get you out of bed if unable to sleep after 20 minutes. This reassociates the bed with sleepiness not wakefulness.
• Cognitive restructuring identifies and alters anxiety-provoking thoughts about sleep.
• Relaxation practices like meditation and deep breathing counter racing thoughts.
• Regular rising times get your body into a consistent sleep-wake rhythm, even after poor sleep.

Multiple systematic reviews confirm CBTI matches or exceeds sleeping pill efficacy, often with sustained improvements. It’s recommended as first-line treatment for chronic insomnia.

Finding a qualified CBT therapist is key. Online CBTI programs like SHUTi are also proven effective and convenient.

Sleep Hygiene

Sleep hygiene refers to habits and environmental conditions conducive to quality slumber. Good sleep hygiene is essential for insomnia treatment and prevention.

Tips to optimize your sleep hygiene include:

• Keep a consistent bedtime and wake time, even on weekends
• Limit daytime napping to 30 minutes
• Establish a calming pre-bed routine like a warm bath or light reading
• Exercise regularly, but not too close to bedtime
• Avoid electronic screens for 1 hour before bed
• Make sure your sleep environment is cool, dark, and quiet
• Limit caffeine, alcohol, and heavy meals before bed
• Reduce liquid intake for fewer nighttime bathroom trips

Optimizing sleep hygiene lays the groundwork for insomnia improvement. But it’s most effective when combined with targeted medical and/or behavioral therapies.

Natural and Integrative Remedies

Many complementary approaches help initiate sleep without drugs’ side effects. Natural options include:

Supplements like melatonin, magnesium, and valerian root regulate sleep-wake cycles, reduce anxiety, and relax muscles.

Essential oils like lavender, chamomile, and vetiver promote relaxation when diffused before bedtime.

Meditation and sleep music quiet the mind from racing thoughts. Calm breathing synchronizes with alpha brain waves characteristic of early sleep stages.

Acupuncture may boost nighttime melatonin secretion and daytime alertness based on some studies.

Cannabidiol (CBD) shows potential for reducing insomnia and anxiety at bedtime. More research is needed on appropriate dosing.

Cognitive behavioral therapy apps like Sleepio use CBTI principles in convenient app formats with virtual sleep coaches.

Weighted blankets apply gentle, calming pressure that may release sleep-inducing serotonin.

Always consult your healthcare provider before trying supplements to ensure safety and proper use. Natural remedies work best alongside other lifestyle changes.

Tips for Preventing and Managing Insomnia

Alongside professional treatment, you can take control of your sleep by optimizing daily habits for better nightly rest:

Address sources of pain or discomfort. Get health issues checked out and manage chronic conditions proactively. Upgrade your old mattress or pillows if needed.

Examine your medication list. Ask your doctor whether any prescriptions or OTC drugs could affect sleep. Discuss options like taking them earlier.

Cut back on alcohol and nicotine. Both disrupt sleep quality and cycles, especially in the latter part of the night.

Limit napping. Short morning naps of 20-30 minutes can help offset insomnia fatigue without interfering with nighttime sleep.

Exercise daily but not before bed. Regular physical activity improves sleep, but finish workouts at least 2-3 hours before bedtime.

Wind down before bed. Establish a relaxing pre-sleep routine like reading, gentle yoga, or light stretches.

Save your bed for sleep and sex. Watch TV, work, and browse your phone somewhere else so your brain associates bed with sleepiness.

Get daylight first thing. Exposure to sunlight in the morning helps regulate your circadian rhythm.

Manage stress and worries. Jot down a worry list during the day so you’re not ruminating at night. Practice relaxing skills like deep breathing, meditation, or prayer. Seek counseling for excessive anxiety.

Keep weekends on a schedule. Try to maintain your regular sleep-wake times within 1-2 hours even on days off. This sustains your body’s sleep-wake equilibrium.

Talk to your doctor. If self-help strategies and natural remedies don’t improve your insomnia in 4-6 weeks, seek professional treatment. Both medication and CBT offer lasting help for stubborn insomnia.

Don’t struggle night after night with ineffective home remedies. Seek help from your healthcare provider to identify underlying causes and get evidence-based treatment.

When to See a Doctor About Insomnia

If you’ve had insomnia nearly every night for over a month with no relief, it’s time to get medical support. See your primary care physician or a local sleep specialist.

Get evaluated promptly if insomnia is accompanied by:

• Excessive daytime sleepiness and fatigue
• Signs of depression or anxiety
• Cognitive difficulties like poor concentration
• Unexplained changes in sleep patterns or behavior
• Worsening chronic medical conditions
• Fear of going to bed or inability to function normally

Tell your doctor how long insomnia has bothered you, frequency of symptoms, and the steps you’ve tried at home. Bringing your sleep diary helps with diagnosis.

Be open about any other conditions and medications that may relate to your sleep troubles. Your doctor can check for underlying contributors and the best treatment options.

Left untreated, chronic insomnia takes a cumulative toll on physical and mental health. Seeking help sooner improves your chances of getting back on track with restorative sleep.

The Link Between Insomnia and Mental Health

Insomnia commonly co-occurs with psychiatric issues like depression, anxiety, and PTSD. The relationship goes both ways:

Mental Health Disorders Can Lead to Insomnia

Factors like ruminating thoughts, excessive worry, agitation, emotional distress, and medication side effects impair ability to fall and stay asleep.

Up to 90% of people with major depression experience insomnia during depressive episodes. Anxiety also perpetuates the racing thoughts and tension that disrupt sleep.

Insomnia Can Exacerbate Mental Health Symptoms

Sleep deprivation from chronic insomnia worsens mood, concentration, and coping abilities. It erodes psychological resilience.

Without enough sleep, parts of the brain linked to mood and behavior regulation are impacted. Insomnia makes existing mental health conditions worse.

Treating One Can Improve the Other

Since insomnia and psychiatric issues often feed each other, treating both is important for full symptom relief.

Improving sleep quality through CBTI and sleep hygiene helps mental health symptoms. And medications or therapy for mood disorders and anxiety can reduce insomnia.

Talk to your mental health professional about the relationship between your insomnia and psychological symptoms. Integrated treatment provides the best chance for improvement.

Daytime Effects of Insomnia

Missing out on quality sleep night after night takes a toll on how you feel and function during the day. Common daytime effects of insomnia include:

• Fatigue, low energy, sleepiness
• Difficulty concentrating and impaired memory
• Irritability and mood swings
• Increased proneness to stress, anxiety, and depression
• Lack of motivation
• Sensitivity to pain
• Headaches, dizziness, stomach upset
• Increased errors and accidents
• Weakened immune system

Studies show insomnia impairs productivity, performance, and concentration as much as alcohol intoxication. It triples your risk of having to take sick days from work.

Daytime drowsiness and fogginess from insomnia pose dangers like increased risk of car accidents. Lack of sleep disrupts every body system.

If you regularly feel unrested during the day despite adequate sleep opportunity, seek help. You don’t have to tolerate poor sleep forever.

Long Term Consequences of Untreated Insomnia

Letting chronic insomnia go untreated isn’t a harmless long-term strategy. Consistent poor sleep takes a major toll on your mental and physical health.

Potential risks and complications include:

Weakened immune function – Not getting enough sleep leaves you more prone to frequent colds and flu. Vaccines are also less effective when sleep deprived.

Weight gain and diabetes risk – Insomnia deregulates hormones that control hunger and appetite. It’s linked to weight gain, obesity, and higher diabetes risk.

Cardiovascular disease – Ongoing insomnia is associated with increased heart disease, heart attack, and stroke. Stress hormones are higher when sleep deprived.

Accelerated skin aging – Collagen production needed for skin renewal mostly happens during deep sleep. Insomnia can lead to premature wrinkles and aging.

Dementia and cognitive decline – Chronic sleep deprivation contributes to plaque buildup in the brain linked to dementia and Alzheimer’s disease.

Earlier mortality – One study found people with chronic insomnia had a 25-45% greater risk of dying prematurely compared to those sleeping over 6 hours nightly.

Higher pain sensitivity – Disrupted sleep homeostasis amplifies inflammatory pathways that increase sensitivity to chronic and acute pain.

Don’t wait until insomnia starts negatively affecting your health. Seek help early to get your sleep back on track. Consistent good sleep is essential for physical and mental well-being.

Better Sleep for Shift Workers and Parents

Insomnia remedies often target normal sleep-wake cycles anchored around nighttime hours. But some groups need to sleep outside conventional times. Two common examples are:

Shift Workers

People who work evening, night, or rotating shifts struggle to sync their sleep schedule with duties. Sleeping during the day poses challenges like noise, light, and family obligations.

Tips for shift workers to get better sleep:

• Strategically use blackout curtains, sleep masks, earplugs, and white noise machines to create an optimal sleep environment during daylight hours.
• Ask your employer if you can work consistent rather than rotating shifts to stabilize your schedule.
• Try to keep the same sleep and wake times on workdays and days off.
• Be rigorous about sleep hygiene – avoid alcohol, large meals, and electronics before bedtime.
• Talk to your doctor about using melatonin or light therapy to help reset your circadian rhythm.
• Prioritize stress management and healthy lifestyle habits to compensate for irregular sleep patterns.

Parents of Newborns and Young Children

Frequent night wakings to care for babies and children derail continuous consolidated sleep. Sleep training kids doesn’t guarantee parents smooth sailing either.

Strategies for parents to get better rests include:

• Nap when the baby naps during the day to make up needed sleep. But limit catnaps to 30 minutes to preserve nighttime sleep drive.
• Take turns waking up with the baby rather than both parents interrupted all night.
• Use white noise machines and blackout curtains to dampen disruptive noises and light.
• Go to bed early to bank more sleep opportunity before inevitable wakings.
• Schedule parent getaways without the kids to “catch up” on sleep. Enlist trusted family or friends for
  

  Sleeping Pills: Weighing the Pros and Cons

  Sleep medications like Ambien, Lunesta, and Sonata are commonly prescribed for stubborn insomnia. But are they safe and effective long-term treatments? Here are some pros and cons to consider if your doctor suggests sleep aids:

  Potential Benefits

  • Can provide rapid short-term relief for severe insomnia
  • Quickly re-establish normal sleep patterns disrupted by acute stress
  • Enable sleep when pain, medical conditions, or mental health issues would otherwise prevent it
  • Can be used alongside other therapies like CBT-I for added sleep benefits

  Potential Risks

  • Develop tolerance over time requiring higher doses to work
  • Dependence and withdrawal symptoms if stopped suddenly after regular use
  • Residue sleepiness, cognitive impairment, dizziness the next day
  • Complex sleep behaviors like sleep walking, eating, driving while not fully awake
  • Increased risk of falls, injuries, and car accidents
  • May exacerbate breathing problems in those with sleep apnea
  • Not intended for long-term insomnia treatment due to habit-forming potential

  Talk to your doctor about whether short-term judicious use of sleep medications could help in your situation. But pursue behavioral approaches like CBT-I whenever possible for sustained improvement without drug risks.

  Fighting Insomnia-Induced Fatigue

  One of the toughest daytime side effects of chronic insomnia is constant exhaustion and sleepiness. How can you combat insomnia fatigue?

  Get moving – Regular exercise reduces fatigue and boosts alertness hormones. But avoid vigorous workouts near bedtime.

  Soak in sunlight – Daytime light exposure keeps circadian rhythms on track for optimal nighttime sleep.

  Limit naps – Short 20-30 minute power naps relieve drowsiness without affecting nighttime sleep.

  Caffeinate wisely – Coffee and tea boost energy but impair sleep if consumed too late in the day.

  Try supplements – Magnesium, B vitamins, ginseng, and acetyl-L carnitine may combat tiredness.

  Treat other conditions – Fatigue often stems from untreated medical issues like anemia or hypothyroidism.

  Practice good sleep hygiene – Cool, dark quiet rooms, no electronics before bed, and a consistent sleep schedule all help reduce insomnia and subsequent fatigue.

  Talk to your doctor – Excessive persistent daytime sleepiness may indicate another health problem requiring diagnosis and treatment.

  Insomnia-related exhaustion can make daily activities feel daunting. Be proactive about managing fatigue while also pursuing the root cause of your sleep disorder.

  Ideal Nap Length and Timing

  Napping gets a bad rap as counterproductive when you’re trying to fix insomnia. But when done right, short daytime naps can relieve sleep deprivation without hindering nighttime rest.

  The ideal nap length is 10-30 minutes. This provides restorative benefits without entering deep slow wave sleep from which you’ll wake up groggy.

  The best nap timing is generally:

  • Between 1-3pm when we hit an afternoon energy slump
  • Right after lunch when food tends to make people sleepy
  • Within about 6-7 hours after waking up

  Avoid napping after 3pm, as it’s harder to fall asleep at night after sleeping in the late afternoon or evening. Limit naps to 30 minutes max.

  Allow time after your nap to shake off residual drowsiness before any activities requiring alertness like driving.

  Not everyone can nap effectively. If you wake from naps feeling more sluggish than restored, it’s better to skip your nap and focus on improving nighttime sleep consistency.

  Ways to Use CBT-I Techniques Solo

  Cognitive behavioral therapy for insomnia is highly effective but not always accessible or affordable. Can you use CBT principles on your own?

  While working directly with a therapist is ideal, there are ways to implement parts of CBT-I solo:

  • Follow stimulus control instructions like getting out of bed after 20 minutes of sleeplessness.
  • Maintain a regular sleep-wake schedule 7 days a week.
  • Keep a thorough sleep log to identify patterns and dysfunctional thoughts about sleep.
  • Read about cognitive restructuring techniques to reduce anxiety about sleep.
  • Listen to audio recordings of relaxation exercises and visualization practices.
  • Use mobile apps like CBT-i Coach with interactive CBT-I components.
  • Join online CBT-I support groups and forums to learn from others’ experiences.
  • Read self-help CBT-I books and workbooks with sleep diaries and written exercises.
  • Watch videos from CBT-I experts explaining the therapy principles and steps.

  While a DIY approach has limits, utilizing CBT-I tools on your own can still move you towards better sleep habits. But consult your doctor if self-help efforts don’t resolve chronic insomnia within a month or two.