Insomnia: Causes, Symptoms and Treatment DSM-5 780.52 (G47.00)

Insomnia is a sleep-wake disorder, where people have trouble initiating sleep, staying asleep and by waking up early in the morning and not being able to go back to sleep. Even when individuals with the disorder have ample opportunities to sleep, it is interrupted. The disorder causes people to feel tired or sleepy during the day—daytime fatigue–because of trouble sleeping at night. They experience inattention, irritability and difficulty concentrating. Many times, the disorder causes distress and difficulties in social groups and at work, and both of these areas suffer.

Symptoms of Insomnia Disorder

Some of the symptoms of insomnia include:

• Waking up several times in the night.
• Having difficulties falling asleep at night.
• Waking up early and not being able to fall back to sleep.
• Lying awake for long stretches of time.
• Feeling unrefreshed after sleeping.
• Having trouble paying attention to a task.
• Feeling tired/fatigued during the day.
• Feeling irritable.

Medical professionals don’t have a single way to test individuals for insomnia disorder. They are able to diagnose it based on the symptoms and ruling out other items. The following items are needed to reach a conclusion that the individual has insomnia.

1. The person is not happy with either the amount or the quality of sleep. It may be problems with waking up early and not being able to go back to sleep, having difficulties falling asleep or being unable to stay asleep.
2. Because of the disruption of sleep, the individual is distressed and is not able to function well. The areas that can be affected because of the distress are in the individual’s personal life or career, as well as his behavior and emotions.
3. The problem with sleep happens at least three times a week and lasts for at least three months.
4. There is enough opportunity for sleep, but the difficulties still remain.
5. There are no other physical, mental or sleep-wake disorders that can explain the problem.
6. The sleeping problems are not caused by the use of substances or medication.

Insomnia can occur with or as the result of another mental condition, such as major depressive disorder. In addition, it can be identified with another medical condition like pain. It can also reveal itself as a feature of a more prevalent mental disorder.

When insomnia continues, the individual is at risk for depression.

What Causes Insomnia Disorder?

While there isn’t a single cause of Insomnia Disorder, there are many components that can cause its onset. They include:

• Stress and anxiety can make sleeping problematic, because they cause tension, as well as feelings of worry and overstimulation.
• The individual may feel pessimistic toward sleeping over a period of time. This may make it harder to fall and stay asleep.
• Depression and other conditions may be contributing factors to spur insomnia. Changes in mood and the hormones can also contribute to insomnia and vice versa.
• There are many medical conditions that can lead to insomnia, including nasal allergies, chronic pain and arthritis. In addition, asthma, thyroid disorders and reflux can make sleeping uncomfortable and can cause an individual to have trouble sleeping and staying asleep.
• There are medicines for thyroid disease and high blood pressure that may cause insomnia as a result of taking them.

Predisposing Factors

A predisposition or an inclination toward insomnia can increase the chances of insomnia occurring. They can include a family history of troubled sleep, an individual who is a worrier or a track record of not being a good sleeper.

Precipitating Factors

There may be triggers that cause insomnia, such as a major change in lifestyle, moving to a new location or being elevated to a new position at work and the many responsibilities it brings.
A 2004 study found that 60 percent of patients with insomnia were able to identify a trigger for their disturbance of sleep. These triggers tended to be around family, work, school and health. The study supports the idea that precipitating factors have a role in insomnia, because the stress of these external factors, such as divorce, may have an effect on health. The result is not being able to sleep. (http://www.psych205.com/uploads/2/6/3/0/26304200/primary_insomnia.pptx)

Perpetuating Factors

There are factors that can cause insomnia to continue or even make it worse, such as heightened anxiety or developing depression. These can be obstacles in recovering from insomnia.

How do You Treat Insomnia?

Cognitive Behavioral Therapy (CBT) can help teach people to recognize and change beliefs that affect the ability to sleep. In CBT, individuals can control or eliminate negative thoughts and worries that prevent them from sleeping. It also helps in forming good sleeping habits and avoiding the behaviors that hinder sleep. The following are some of the CBT techniques used for insomnia.

• Stimulus control therapy helps remove the factors that cause the person to have trouble sleeping. A therapist may advise to set a consistent bedtime and wake-up time, to avoid naps and to use the bed primarily for sleep. In addition, a person should leave the bedroom if he is unable to fall asleep within 20 minutes and come back when he is sleepy.
• Sleep restriction is used for people who lie in bed when they’re awake. It becomes a habit that causes troubled sleep. The individual reduces the time he spends in bed, which causes a partial sleep deprivation—and he is more tired the next evening. When the sleep has become better, the amount of time spent is bed is lengthened little by little.
• Sleep hygiene is a method that includes changing habits that can cause loss of sleep. It may be smoking or consuming too much caffeine later in the day, drinking alcohol or not getting enough exercise. In addition, the individual will practice ways to wind down before going to bed.
• There are things people can do to make their sleep surroundings more comfortable. A few of the suggestions are to keep the bedroom dark, cool, quiet, as well as removing the television from the room and keeping the clock away from view.
• Relaxation training help people calm their minds and bodies using various techniques, such as meditation, muscle relaxation and imagery.
• Paradoxical intention or remaining passively aware means that an individual prevents any effort to sleep. Worry about not being able to fall asleep can keep people awake, so “letting go” of the worry can aid in relaxation and make it less difficult to go to sleep.

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