What is insomnia?

Insomnia is a term used to describe poor quality or inadequate sleep.  It is the most common sleep complaint affecting between 33% to 50% of the adult population at any time.  When the sleep difficulty resolves within a few weeks it is referred to as acute insomnia. 1 in 10 people suffer from chronic insomnia, which is defined as persistent sleep dissatisfaction, for more than a month.

Insomnia is not defined by the number of hours asleep, as people vary considerably with regards to their sleep needs. It is classified according to whether there is difficulty getting to sleep (initial insomnia), problems staying asleep (sleep maintenance insomnia), waking up too early (late insomnia) or not feeling refreshed from the night’s sleep.

It is more common in women, people over 65 years of age, and those with chronic medical or mental health conditions such as depression and anxiety.  Other factors that can disrupt sleep include acute stress, alcohol and certain medications.

Impact of insomnia

Everyone has the occasional bad night’s sleep, but when the problem persists it can be very distressing for the individual and impact on their quality of life. The consequences of insomnia include excessive tiredness, low energy, poor concentration, irritability and low mood. Research has shown that individuals suffering from chronic insomnia are also four times more likely to become depressed than good sleepers.

What causes insomnia?

Insomnia can develop due to a number of different reasons. These include medical and psychiatric conditions, biological, lifestyle, behavioural and/or environmental factors. Other sleep disorders can masquerade as insomnia including obstructive sleep apnoea syndrome (OAS), snoring, periodic limb movement during sleep and circadian rhythm disorders.

Acute insomnia is often triggered by a significant life stress such as a bereavement, work stress, moving house.  Once the stressful event improves, the insomnia should also start to resolve.  However where the sleep difficulty persists, there may also be another underlying factor at play.  Scientific studies have demonstrated that individuals with chronic insomnia are more prone to the hyperarousal state.  This means they are more physically and emotionally tense than good sleepers, due to an increased amount of neuro-chemicals released by the brain.  This biological effect may explain why some people suffer with insomnia, where no other underlying cause is found.

How can insomnia be treated?

Insomnia is the most common sleep disorder, but few people seek medical help and it remains a very under-treated problem. While prescribed sleeping medication can provide relief from insomnia as a short term intervention, it is not advisable to continue these medications long term.

When insomnia is due to an underlying medical or psychiatric condition (co-morbid insomnia), it is important to treat this first and see whether the insomnia resolves.  If there is a suspicion of another sleep disorder causing symptoms of insomnia, the individual should be referred for further investigations at a specialist sleep clinic.

Chronic non co-morbid insomnia responds very well to a psychological treatment called Cognitive Behavioural therapy (CBT).  Unlike medication, which only works as long as it is taken, CBT gives the individual life long skills to achieve good quality sleep with sustained results.