Insomnia may be categorized according to its duration:
- Acute insomnia: short-lasting and generally self-limited, often is the consequence of life circumstances (stressful situation, or bad news).
- Chronic insomnia: disrupted sleep that lasts at least three nights per week and for at least three months. Causes of chronic insomnia are various and many. Changes in the environment, unhealthy sleep habits, shift work, other clinical disorders, and certain medications could lead to insufficient sleep. People with chronic insomnia may require some form of treatment to help them re-establish healthy sleep patterns. Chronic insomnia can be linked to another medical or psychiatric issue.
Insomnia can also be classified as primary or secondary:
- Primary insomnia: this entity is not a symptom and does not have an underlying medical condition. Its cause is poorly understood. Primary insomnia usually lasts for at least 1 month. The common triggers of primary insomnia include major or long-lasting stress or emotional upset. Travel or other factors, such as work schedules that disrupt your sleep routine, also may trigger primary insomnia. Addressing these issues does not always guarantee resolution of insomnia. Trouble sleeping can persist because of habits formed to deal with the lack of sleep. These habits might include taking naps, worrying about sleep, and going to bed early.
- Secondary Insomnia: is the manifestation of an underlying problem. This type of insomnia often is a symptom of an emotional, neurological, or other medical or sleep disorder.
- Emotional disorders that can cause insomnia include depression, anxiety, and posttraumatic stress disorder.
Many other disorders or factors also can cause insomnia, such as:
- Conditions that cause chronic (ongoing) pain, such as arthritis and headache disorders
- Conditions that make it hard to breathe, such as asthma and allergic rhinitis
- An overactive thyroid
- Gastrointestinal disorders, such as heartburn
- Sleep disorders, such as restless legs syndrome and sleep-related breathing problems
- Certain medications: certain asthma medicines, such as theophylline, some allergy and cold medicines, and Beta blockers can cause insomnia.
- Commonly used substances also can cause insomnia. Examples include caffeine and other stimulants, tobacco and other nicotine products, and alcohol and other sedatives.
• Have a lot of stress.
• Are depressed or have other emotional distress, such as divorce or death of a spouse.
• Have lower incomes.
• Work at night or have frequent major shifts in their work hours.
• Travel long distances with time changes.
• Have an inactive lifestyle.
1- Sleep hygiene is the number one lifestyle modification that an individual with insomnia of no obvious cause should follow. It is composed of a number of measures or habits necessary to maintain normal, refreshing, quality nighttime sleep and full daytime alertness.
Poor sleep habits are quite various, and these include staying up too late and getting up too early. Sleep interruption with drugs, chemicals and work, overstimulation with late-night activities, all lead to inadequate sleep quality and/or amount.
The primary and most crucial sleep hygiene measure is to maintain a regular wake and sleep pattern seven days a week. It is also important to spend an appropriate amount of time in bed, not too little, or too excessive. This is not the same for all people.
Good sleep hygiene practices include:
• Avoiding taking naps during the day. It can disturb the normal pattern of sleep and wakefulness.
• Fix a bedtime and an awakening time. The body regulates itself to falling asleep at a certain time, but only if this is relatively fixed.
• Avoiding stimulants such as caffeine (including chocolate), nicotine, and alcohol within 4-6 hours of bedtime. Alcohol is well known to accelerate the onset of sleep, yet it disrupts sleep in the second half as the body begins to metabolize the alcohol, causing arousal.
• Exercising: it can promote good sleep as long as no vigorous exercise is done near bedtime (it better be taken in the morning or late afternoon).
• Food: keeping away from large meals close to bedtime (i.e., within 4-6 hours around bedtime).
• Adequate exposure to natural light. This is essential for maintaining a healthy sleep-wake cycle.
• A regular relaxing bedtime routine.
• Associate your bed with sleep. Avoid eating in bed, or watching TV while in bed.
• The sleep environment should be pleasant and relaxing. The bed should be comfortable, no loud sounds (like loud music), the room temperature should be moderate, and no bright light should stay on while you sleep.
2- Cognitive-Behavioral Therapy (CBT)
CBT for insomnia targets the thoughts and actions that can disrupt sleep. This therapy encourages good sleep habits and uses several methods to relieve sleep anxiety.
One of the methods used in CBT is relaxation techniques and biofeedback that aim to reduce anxiety. These strategies help you better control your breathing, heart rate, muscles, and mood.
CBT also works on replacing sleep anxiety with more positive thinking that links being in bed with being asleep. This method also coaches the patient on ways to deal with the inability to fall asleep within a reasonable time.
CBT also focuses on limiting the time spent in bed while awake. This method involves setting a sleep schedule.
Many prescription medicines are used to treat insomnia. Some are meant for short-term use, while others are meant for longer use. These require a medical prescription and may be habit forming
Some over-the-counter (OTC) products claim to treat insomnia. These products include melatonin, L-tryptophan supplements, and valerian teas or extracts.