Insomnia

What is insomnia?

Insomnia is a condition where people struggle to fall or stay asleep. How common it is depends on the definition used. However, population studies have shown that around 30% of people worldwide have at least one or more insomnia symptoms.

It can have a huge impact on your day-to-day life, not just your sleep. This is especially true for people who have chronic insomnia.

What are the different types of insomnia?

Insomnia can be classified in several different ways. The main distinction is between acute and chronic insomnia.

• Short-term insomnia - symptoms last for 3 months or less.
• Long-term insomnia - symptoms occur at least 3 nights a week for 3 months or more.

It can also be defined by the types of symptoms and their cause.

• Sleep onset insomnia - difficulty falling asleep.
• Sleep maintenance insomnia - difficulty staying asleep.
• Early morning awakening insomnia - frequently waking up earlier than they intended (some experts classify this under sleep maintenance insomnia).
• Secondary insomnia - symptoms caused by another condition such as sleep apnoea, pain or acid reflux.

Understanding the type of insomnia you have will help your doctor find the cause and choose the best treatment for you.

What causes insomnia?

There is no single cause of insomnia. However, most experts believe that it is likely caused by hyperarousal.

This is where your body and brain are active when they don’t need to be, which disrupts your sleep pattern. This can include a raised heart rate, higher body temperature and higher levels of certain hormones (e.g. cortisol).

There are several potential causes of hyperarousal. In some rare cases, the cause isn’t clear.

Poor sleep hygiene

The simplest cause of insomnia is poor sleep hygiene. Sleep hygiene involves your habits and environment when you go to bed. For example, too much light or sound can stimulate your brain and keep you awake. Going to bed at different times or napping during the day can also affect your sleep.

Stress and anxiety

Another common cause is stress and anxiety. It can be triggered by general worries or more serious events (e.g., losing a job or a loved one).

This can cause you to stay awake worrying, which keeps your brain active. The problem then becomes cyclical as you start to worry about the lack of sleep and the original trigger.

Lifestyle factors

Your life and your habits can affect your sleep as well.

Stimulants like caffeine or nicotine can disrupt your sleep if regularly taken before bed. This includes coffee, cigarettes, energy drinks and any recreational drugs. An unhealthy diet can also cause you to sleep more poorly.

Another factor that can cause it is irregular sleeping patterns. If you do shift work or have jet lag from a long-haul flight.

Medical conditions

A range of physical and mental health conditions can cause insomnia.

Risk factors for insomnia include:

• sleep disorders (e.g. sleep apnoea, sleepwalking or night terrors)
• heart conditions (e.g. angina)
• respiratory conditions (e.g. asthma or COPD)
• conditions that cause chronic pain (e.g. fibromyalgia or arthritis)
• conditions that cause hormone problems (e.g. overactive thyroid)
• mental health conditions (e.g. depression or bipolar disorder)
• conditions that affect the bladder (e.g. urinary incontinence or enlarged prostate)
• neurological conditions (e.g. Alzheimer’s or Parkinson’s disease)
• menopause

The condition is common in pregnant women and the elderly.

Medication

It can also be a side effect of certain medications. Some examples include:

• certain antidepressants
• epilepsy medicines
• non-steroidal anti-inflammatory drugs (NSAIDs)
• steroids
• medicines for high blood pressure
• asthma medicines

Always check the patient information leaflet of any new medication you take to be prepared for any side effects.

What are the symptoms of insomnia?

The most notable sign of insomnia is sleep difficulties. Symptoms of insomnia include:

• have difficulty falling asleep
• struggle to stay asleep throughout the night
• wake up early in the morning when they don’t need to

Depending on the nature of your condition, you may experience one symptom or all.

What sets insomnia aside from acute sleeping problems is its impact on your daily life. This is because sleep is important for your body’s day-to-day functioning.

Daytime symptoms include:

• feeling tired during the day and after you wake up
• worse performance at school or work
• feeling irritable
• difficulty concentrating

Keeping a sleep diary will track your symptoms and how much sleep you have. This will help your doctor make a diagnosis.

How is insomnia diagnosed?

Most doctors can diagnose it by describing your symptoms. There are no direct tests for insomnia. However, you may need other tests to rule out other sleep conditions.

How do I treat insomnia?

How you treat your symptoms will depend on what's causing them. For some, it may be as simple as improving your sleep habits with home remedies. For others, it may require prescription treatment.

Good sleeping habits

One of the simplest ways to improve and prevent insomnia is to have a good bedtime routine and sleeping environment. These tips and tricks will help your mind and body feel more prepared to sleep.

The first part of good sleep hygiene is a consistent sleep schedule. This ensures you get the right amount of sleep each night. Most adults need 7-9 hours each night.

A sleep schedule will also help with consistency and help you fall asleep more naturally.

You should:

• wake up and go to bed at the same time every day when possible
• make gradual adjustments to your schedule in 1-hour increments to give your body time to adjust to a new sleep schedule
• limit naps - if you want to nap, keep it short and have it no later than early afternoon

Another part of good sleep hygiene is your bedtime routine. It will help you wind down and feel ready for sleep.

You should:

• try to keep a consistent routine - following the same steps in the same order each night will help reinforce to your brain that it’s time to sleep (e.g. brushing your teeth or putting on your pyjamas)
• allow 30 minutes each night to wind down by listening to soft music, stretching, drinking decaffeinated tea or reading
• dim your lights - this will trigger the production of melatonin, the hormone that signals sleep
• stop using electronics 30-60 minutes before bedtime - they can overstimulate your brain and disrupt your sleep, and the blue light will also reduce melatonin production
• if you’re struggling to get to sleep, don’t toss and turn - get up and do something relaxing for 20 minutes and try again

The final part of good sleep hygiene is optimising your bedroom.

Make sure your room is at the right temperature - a cooler is best.

Use a comfortable mattress and pillows.

Limit light exposure using heavy curtains or an eye mask.

Drown out any noise by using earplugs or white noise.

Use calming scents like lavender.

Choose the right bedding for you.

Lifestyle changes

Your lifestyle can also significantly impact your sleep. Some factors include:

• lack of daylight exposure - getting enough daylight during the day will help reinforce your circadian rhythms
• little physical activity - regular exercise has many benefits, but it can also make it easier to sleep at night
• smoking - nicotine in cigarettes acts as a stimulant, which may cause you to feel more awake at night when you shouldn’t
• alcohol - the effects of alcohol may disrupt your sleep (e.g. nausea)
• caffeine - like smoking, drinking caffeinated drinks too late will stimulate your brain and make you feel wired
• eating certain foods or heavy meals - eating too soon before bed will mean your body is still digesting, which can cause discomfort and distract your sleep
• using your bed for other activities besides sleep and sex - your brain will associate your bed with stimulating activities which may keep you awake

Limiting many of these activities will help improve your sleep and contribute to a healthier lifestyle overall.

Therapy

If changing your lifestyle and sleep habits hasn’t helped, your GP may be able to refer you for a specific kind of therapy.

It is a type of cognitive behavioural therapy called CBT-I. It involves using cognitive techniques to help you sleep. It can include sleep restriction therapy and relaxation training. Therapy may be carried out in small groups or one-to-one sessions.

Other types of therapy may be beneficial if you have other mental health conditions such as anxiety, bipolar disorder or depression.

Medication

Your doctor may prescribe you sleeping pills if other treatments have not worked or your symptoms are severe. Benzodiazepines, hypnotics and Z-drugs (e.g. zopiclone) are all prescribed for sleeping problems.

However, these sleeping tablets should only be used in the short term as they can cause side effects, become addictive and mask the underlying problem.

There are several over-the-counter sleeping pills available. These include antihistamines or herbal options like valerian root extract. Yet, these are not generally recommended for insomnia. There is little evidence that they help.

A safer alternative is Melatonin (Circadin). It regulates your sleep cycle. It can be used for longer than other sleeping pills and has a lower risk of side effects.

Can I buy insomnia medication online from HealthExpress?

You can order Melatonin online at HealthExpress.

Melatonin is only licenced for use by those over 55. Evidence suggests that it is less effective for those younger than 55, as the cause of their insomnia is generally not a lack of melatonin.

However, it is still available as an off-label medication for anyone younger and is effective in treating insomnia in those age groups.

You must complete a consultation, which will be reviewed by one of our UK-registered doctors. Your treatment will then be dispensed and dispatched to your door as early as the next day.