What is Insomnia?

“Insomnia” is a general term, indicating a problem with sleep. It may be easiest to think about the sleep issue in one of three ways:

Term Definition
Prolonged sleep latency Difficult to fall asleep
Fragmented sleep Wake up several times throughout the night
Wake after sleep onset Difficulty going back to sleep after awakening in the middle of the night

You may have all three kinds of insomnia complaints, but sometimes it is easier to rank your complaints and attack them individually.

  • Falling asleep. It is important to make sure that other sleep disorders are not interfering with sleep onset (e.g. restless leg syndrome, circadian rhythm disorders, or sleep apnea). If these disorders are excluded, or have been adequately treated, then evaluation involves analyzing the sleep environment and behaviors around sleep. Is the bedroom cool and dark to allow for sleep? Is the environment calm and stress-free, or inundated with a lot of noise, pets, and bright lights? Has there been caffeine, nicotine, or alcohol usage in the evening? Are electronics in the bedroom? How much does stress and anxiety contribute with the inability to shut off the mind? Are bedtimes and wake times fairly regular?
  • Staying asleep. Analysis of fragmented sleep revolves around what is waking you up in the first place? Substances, like caffeine or alcohol, can wake you up in the middle of sleep, as can certain medications. Even herbal and vitamin supplements taken in the evening can contribute to awakenings. A sleep evaluation with a trained professional is a good way to answer these questions.
  • Falling back to sleep in the middle of the nightIf the main issue is inability to fall back asleep, the evaluation may be focused on two areas: what woke you up in the first place (e.g. do you have another sleep disorder?) and the behaviors during the time when you can’t fall back asleep. The answer may then involve both medical and behavioral treatments.

Why do I have Insomnia?

Sleep is dependent on 2 basic premises: the homeostatic drive and circadian timing. The homeostatic drive is the build-up of sleep pressure. The longer you stay awake, the higher the sleep pressure is. After about 16-hours of wakefulness or sleep pressure, the brain naturally wants to go to sleep. However, optimal sleep also depends on the timing of sleep. Once that 16th hour hits its peak, it should coincide with the internal timing of sleep, or this circadian rhythm of sleep. This sleep timing differs from individual to individual.

Insomnia typically occurs when something interferes with the build-up of sleep or interferes with the timing of sleep. Poor sleep habits may develop that lead to continuation of the insomnia. For example, if you can’t fall back asleep in the middle of the night, do you get up and start working? Do you use electronics? Clean the house? These activities can wake up the brain to the point where it is now entrained to wake up during sleep hours. It is then very difficult to get back to sleep.

What are the consequences of untreated insomnia disorder?

Over time, insomnia and sleep deprivation can lead to adverse health and medical consequences including mood issues, cardiovascular problems, metabolic issues, and neurological consequences. Talk to your doctor to start your evaluation!

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