Insomnia
Insomnia means low-quality sleep. It is very common, with around one-third of people in the US suffering from it. Insomnia can occur in many different forms, from difficulties falling to sleep, staying asleep, waking up too early without being able to get back to sleep, or not feeling refreshed from sleep. It leads to significant symptoms in the daytime, such as tiredness, difficulties concentrating, and sometimes problems controlling your emotions. Because everyone is unique, the amount of sleep someone requires to function their best varies from person to person and also tends to decrease with age, so there are no set criteria to diagnose insomnia. The diagnosis is made from what a patient describes, the symptoms they experience, and their doctor's expertise and opinion.
The majority of adults need between 6 and 9 hours of sleep per night in order to function well in the daytime, and the average range of time taken to fall asleep is between 10 to 30 minutes. It is normal to wake up from time to time at night, so don't worry if you do, and try not to look at a clock, as worrying and clock-watching can make getting back to sleep harder.
Insomnia is more common in women and older people. The main causes are:
- Poor sleep routines or habits (known as sleep hygiene).
- A loud or bright sleeping environment.
- Stress.
- Substance abuse.
- Caffeine or alcohol use.
- Certain mental health or physical health conditions that can affect sleep.
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Classifying types of insomnia
Insomnia can be classified in different ways. The descriptions tend to be either by the length of time it has been occurring or by the cause of the symptoms.
If you have had difficulties sleeping for less than 3 months, then it is known as short-term (acute) insomnia, and if your symptoms continue beyond 3 months, it is described as chronic insomnia.
The reason for these terms is that acute insomnia tends to be due to a specific cause, such as a stressful life event, noise, having a newborn baby, or another environmental cause.
Chronic insomnia tends to be linked to other medical conditions, such as some mental health conditions or conditions that affect breathing.
This brings us to the second way of classifying insomnia which is by the cause. If the insomnia is linked to or caused by another medical condition, then this is known as secondary insomnia. If it is not, then it is known as primary insomnia.
Healthwords pharmacists' top tips
Fortunately, many people can minimize their insomnia by making simple changes at home. This is known as sleep hygiene, which is about optimizing the environment and bedroom routine to aid your sleep. This includes things you should do and things you should avoid.
On the to-do side of things, routine is key. Aim to go to bed and wake up at the same time every day where possible, as it will help with sleep quality and length. It's also important to set a daily pre-bed routine that you follow every night - this needs to include some wind-down time/relaxation (maybe try out the meditation section) so your body has the cues that it is winding down to sleep.
If you can't sleep after 20 minutes – get up and start the routine again. Optimize your sleep environment by trying to block out any light and noise as best as you can. It is important not to get too hot at night, so don't cover yourself in all the duvets. When asleep, your core body temperature naturally drops, which helps aid sleep. If you raise your body temperature in the night, it will disrupt and affect your sleep.
The things to avoid are caffeine past midday and then alcohol, smoking, large meals, or computer and phone use at night.
If sleep hygiene changes have not improved your symptoms and your insomnia is caused by something that is short-term, then you can speak with your pharmacist. They can recommend over-the-counter medications that can aid sleep. These usually contain natural ingredients or drowsy antihistamines that aid sleep. However, they are only to be taken for up to 2 weeks, so they are not a long-term solution. Longer-term treatment can include a talking therapy called cognitive behavioral therapy (CBT) and very rarely sleeping tablets that your doctor can prescribe.
Pharmacist recommended products
When should I see my doctor?
You should book an appointment to see your doctor if you have tried the sleep hygiene advice for 3 weeks or more and have not seen any improvement, if your day-to-day life is significantly affected due to insomnia symptoms, or if you feel insomnia may be caused by a mental or physical health problem.
What will my doctor do?
Your doctor will ask you about your medical history, your current symptoms, and any relevant family history. They may do some examinations to rule out a physical cause of your symptoms and may take some blood tests. They will also discuss your mental health and any other stressors or changes in your life. Often, a doctor will ask you to keep a sleep diary to record your sleep and symptoms. This helps the doctor get a better picture of what's going on. The doctor will then discuss sleep hygiene and any treatments available such as referring you for talking therapy.
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