You ever had one of those nights where you just couldn’t seem to fall asleep? While that happens to everyone, once in a while, people with insomnia have to deal with these symptoms night after night. Some people with insomnia have trouble falling asleep, whereas others wakeup throughout the night and struggle to fall back asleep, and these disturbances typically happen at least 3 times each week. Acute insomnia lasts less than a month, whereas chronic insomnia lasts over a month.

Insomnia affects both the quality and the quantity of sleep, which makes it hard for individuals to reach the restorative levels of sleep which causes daytime sleepiness and fatigue, and overtime, feelings of irritability, anxiety and depression. This can lead to professional and personal problems, as well as day-to-day challenges like falling asleep while driving.

Causes
Although insomnia can happen without an underlying cause, it can also accompany and worsen other problems like pulmonary diseases, psychiatric conditions, and a whole variety of conditions that might cause pain. Insomnia is also a common side effect of stimulants like caffeine, as well as depressants like alcohol, which can both disrupt the regular sleep cycle. Insomnia can also be a result of daily stresses from work or relationships as well as environmental factors such as having to work a night shift or having a new born baby.

There are a number of biological factors associated with insomnia. Studies have shown that people with insomnia might have heightened levels of the stress hormone; cortisol, which plays a role in the process of waking up every morning. People with insomnia are also more sensitive to the effects of cortisol, typically waking at much lower levels of cortisol as compared to the general population. In addition, insomnia is also associated with reduced levels of estrogen and reduced levels of progesterone, which can happen during menopause.

Commonly, people with insomnia will self-medicate with alcohol and benzodiazepines, both of which can be extremely dangerous. Alcohol abuse can lead to a number of physical and psychological changes that can rapidly worsen the sleep-wake cycle and lead to dependence. Similarly, benzodiazepines, especially short-acting ones, can also create dependence and have a high abuse potential, which can actually worsen insomnia if someone tries to stop using them.

Treatment
One method of treatment is getting good sleep hygiene, which includes going to sleep and waking up the same time everyday including weekends, getting good exercise (but not right before bed), reducing alcohol intake, avoiding day-time naps, avoiding caffeine and smoking, and not going to sleep hungry.
Another potential treatment is stimulus control which includes using the bed only to sleep rather than a place to watch TV, text, or talk on the phone. It also helps to keep the environment calm by taking away bright lights; like a computer or phone screen, and minimizing noise. Sometimes though, these are unavoidable in which case eye-covers and ear-plugs can definitely help. It’s also not helpful to try to force sleep to happen, which means that people that can’t sleep after 20 minutes should simply leave the bed and then come back when they feel ready to sleep. These suggestions all help the person associate sleep and only sleep with the bedroom.

Also for treatment, there is behavioral therapy, which includes relaxation techniques as well as cognitive behavioral therapy to help better manage problems and life stressors. While these techniques are being used, sometimes medications like Melatonin Agonists, Non-benzodiazepine sedatives, and occasionally benzodiazepines might be prescribed to help with sleep. These medications can often have side-effects though, so they are generally used for less than 2 months, usually in combination with the behavioral therapy techniques.