Insomnia is a prevalent sleep disorder characterised by difficulties in initiating sleep, maintaining sleep, or experiencing both. Temporary episodes of sleep difficulties, referred to as acute insomnia, are frequent occurrences. Acute insomnia typically lasts for a few days or weeks and tends to manifest during periods of heightened stress or significant life transitions. When struggling to fall asleep or stay asleep for more than three nights per week, persisting for a duration of three months or longer, it is classified as chronic insomnia. This condition is also recognized as chronic insomnia disorder.

Types of chronic insomnia

Chronic insomnia can be classified into two primary categories: primary and secondary.

Primary insomnia, still not comprehensively grasped by researchers, is not associated with underlying medical conditions or medications. Current studies suggest that primary insomnia may be linked to alterations in specific brain chemicals, but further research is needed to establish a definitive understanding.

On the other hand, secondary insomnia arises as a result of other prevailing conditions or circumstances. It manifests as a symptom accompanying various medical issues, including emotional stress, trauma, persistent health problems, specific lifestyle patterns, or the usage of certain drugs and medications.

Symptoms 

• Difficulty falling asleep
• Waking up multiple times throughout the night
• Struggling to stay asleep or experiencing difficulty returning to sleep
• Early morning awakenings
• Experiencing daytime sleepiness or grogginess
• Not feeling refreshed after a night's sleep
• Irritability
• Mood changes, such as feelings of depression
• Difficulty concentrating
• Problems with memory
• Increased frequency of mistakes and accidents

Causes of chronic insomnia

Chronic insomnia can stem from various factors, often associated with an underlying medical condition. Lifestyle habits, medications, and stimulants can contribute to the development of chronic insomnia.

Underlying medical conditions

Persistent insomnia can be attributed to several long-term medical conditions, such as:

• Respiratory conditions, including asthma, chronic obstructive pulmonary disease (COPD), sleep apnea, and congestive heart failure
• Metabolic disorders like diabetes and acid reflux
• Hyperthyroidism, fibromyalgia, and chronic pain
• Restless leg syndrome and menopause-related sleep disturbances
• Urinary incontinence
• High levels of stress, both physical and emotional
• Anxiety, depression, bipolar disorder
• Neurodegenerative diseases like Alzheimer's and Parkinson's disease

Medications and stimulants that can trigger chronic insomnia

Chronic insomnia can be triggered in certain individuals by specific medications and stimulants. These substances may include:

• Alcohol
• Antidepressants
• Beta-blockers
• Caffeine
• Chemotherapy drugs
• Cold and allergy medications containing pseudoephedrine
• Diuretics
• Illicit drugs, like cocaine and other stimulants
• Nicotine
• Stimulant laxatives

Lifestyle habits

Certain lifestyle habits can contribute to chronic insomnia. These habits include:

• Engaging in rotating shift work
• Frequently travelling across multiple time zones, resulting in jet lag
• Being physically inactive
• Taking frequent daytime naps
• Lacking a consistent waking and sleeping routine
• Having a poor sleeping environment

Managing chronic insomnia

There are various treatment approaches, both self-administered and supervised by professionals, that can be employed to address chronic insomnia. The choice of treatment will be contingent upon the underlying cause of your insomnia and could involve medication or therapy aimed at tackling the root condition.

In addition to addressing any underlying issues, your healthcare provider might suggest a combination of treatment options to effectively manage chronic insomnia.

• Cognitive behavioural therapy (CBT), particularly CBT for insomnia (CBT-I), has been proven through research to be equally or even more effective than sleep medications in treating chronic insomnia. This approach involves providing education about sleep and promoting healthy sleep habits, while also addressing and modifying the thoughts and behaviours that hinder your ability to sleep.
• Restricting stimulus influence - This involves modifying behaviours that reinforce your mind's resistance to sleep. Implementing a consistent sleep and wake schedule is a key aspect of this approach.
• Sleep limitation - This therapy revolves around reducing the amount of time you spend in bed, which includes avoiding daytime naps. The objective is to deliberately limit your sleep duration, making you sufficiently tired by bedtime. As your sleep quality improves, the time spent in bed gradually increases.
• Techniques for relaxation - To achieve a state of relaxation, various methods such as breathing exercises, yoga, guided meditation, and other techniques can be employed. These approaches aim to alleviate muscle tension, regulate breathing, and stabilise heart rate, facilitating a calm and relaxed state.
• Medications - There exists a variety of prescribed medications and over-the-counter sleep aids designed to assist with falling asleep or maintaining sleep. Although these remedies can be effective, medical professionals generally advise against prolonged use of sleeping pills due to their potential side effects. These may include daytime drowsiness, memory issues, sleepwalking, difficulties with balance, and an increased risk of falling. Moreover, specific categories of sleeping pills have the potential to lead to dependency.

Conclusion

Insomnia is a prevalent issue that can stem from various factors, encompassing both physical and mental health. Some instances may be linked to environmental conditions or lifestyle choices, like working night shifts or consuming caffeine and alcohol. Sleep deprivation can give rise to a range of issues, varying from mild fatigue to long-term health conditions. People facing persistent difficulties with sleep, which negatively impact their daily functioning, are advised to consult a doctor. Medical professionals can identify the underlying cause and provide suitable recommendations for a resolution.