INSOMNIA: CAUSES, TYPES, SYMPTOMS, TREATMENT - ECONOMÍA - 2025

The insomnia is a sleep disorder characterized by difficulty in initiating sleep, waking up frequently or too early and did not get back to sleep, or sleep a number of hours but still feel tired.

Thus, insomnia generally refers to trouble sleeping, not just difficulty falling asleep. In reality, it is impossible not to sleep -except in some pathologies- and after about 40 hours without doing so, so-called micro-dreams are produced, which last several seconds.

Types of insomnia

Primary insomnia

Difficulty with sleep does not refer to other medical or psychiatric problems. However, insomnia can cause disorders such as anxiety; not sleeping causes anxiety, anxiety further disrupts sleep, which further increases anxiety.

Secondary insomnia

The person has sleep problems due to something else, such as illness (depression, asthma, arthritis, cancer, heart disease), pain, medications, or substances (alcohol, drugs).

Symptoms

The symptoms of insomnia can be:

• Difficulty falling asleep.
• Waking up during the night.
• Waking up too early.
• Not feeling well rested even if you fell asleep at night.
• Tiredness during the day.
• I dream during the day.
• Irritability, depression, or anxiety.
• Difficulty paying attention, concentrating, or remembering things.
• More mistakes or accidents.
• Tension and headaches.
• Stomach ache.
• Worries about sleeping.

Diagnosis

Diagnostic criteria for primary insomnia (DSM-IV)

A) The predominant symptom is difficulty starting or maintaining sleep, or not having a restful sleep, for at least 1 month.

B) Sleep disturbance (or associated daytime fatigue) causes clinically significant distress or impairment in social, occupational, or other important areas of individual activity.

C) Sleep disturbance does not appear exclusively in the course of narcolepsy, breathing-related sleep disorder, circadian rhythm disorder, or parasomnia.

D) The alteration does not appear exclusively in the course of another mental disorder.

E) The alteration is not due to the direct physiological effects of a substance or a general medical condition.

Causes

Common causes of insomnia can be:

• Stress: worries about work, health, school or family that can keep the mind active at night.
• Anxiety: daily anxiety or serious anxiety disorders like post-traumatic stress disorder can disrupt sleep. Worrying about being able to go to sleep or not can make the problem worse.
• Depression: You can sleep too much or have trouble sleeping if you are depressed.
• Other medical conditions: there are medical conditions that can worsen insomnia such as pain, breathing difficulties, the need to urinate frequently, arthritis, cancer, hyperthyroidism, Parkinson's, Alzheimer's…
• Changes in the school environment or schedule: travel or working late can disrupt circadian rhythms making sleep difficult.
• Poor sleep habits: bad sleep habits include irregular schedules, doing stimulating activities before sleeping, uncomfortable environment, using the bed for activities other than sex or sleeping.
• Medications: many drugs that are prescribed can interfere with sleep, including some antidepressants, medications for hypertension, stimulants, corticosteroids…
• Caffeine, nicotine, and alcohol: Coffee, tea, and beverages that contain caffeine are stimulants and can interfere with sleep if taken in the afternoon. Nicotine is another stimulant that can cause insomnia. Alcohol is a sedative, although it can prevent you from reaching deep stages of sleep and often causes sleep disruption at night.
• Eating too much for dinner: Eating too much for dinner can cause physical discomfort when lying down, making it difficult to fall asleep.

On the other hand, insomnia becomes more common with age. As the years go by, you can experience:

• Changes in sleep patterns: Sleep often becomes less restful with age, and sounds in the environment make it easier to wake up. With age, the internal clock tends to advance, which is equivalent to getting tired earlier in the afternoon and getting up earlier. However, older people generally need the same hours of sleep.
• Change in activity: With age, physical or social activity may decrease. This lack of activity can interfere with a good night's sleep. On the other hand, being less active can lead to more naps, which can interfere with nighttime sleep.
• Change in health: chronic pain, arthritis, stress, anxiety, or depression can interfere with sleep. Bening prostate hyperplasia in men causes the need to urinate frequently, interrupting sleep. Menopausal hot flashes can also be the same.
• Other sleep disorders: Sleep apnea or restless leg syndrome becomes more common with age.
• More medications: Older people tend to take more medications, which increases the likelihood of drug-induced insomnia.

Treatments

-Behavioral therapies

Behavioral therapies educate on new behaviors, habits and ways that improve the quality of sleep. These therapies are recommended as the first line of treatment and are usually as effective or more effective than medication.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) focuses on breaking the cycle of amnesia. Poor quality sleep leads to stress and anxiety, which makes sleep even worse, leading to more stress and more anxiety.

To try to solve the problem, the affected person can adopt poor habits such as taking sleeping pills, alcohol or taking long naps to regain sleep. This makes everything worse.

In addition to improving habits, CBT aims to change thoughts and feelings about sleep that can cause stress and contribute to insomnia. CBT does not have immediate results, it requires patience and persistence, although it is a safer and more effective treatment than medication.

At first, the situation may get worse if the therapist proposes sleep restriction therapy. In this, the time spent in bed is limited and as the efficiency of sleep increases, you begin to sleep earlier and get up later, until the ideal hours are reached.

Relaxation techniques

Progressive muscle relaxation, biofeedback, and breathing exercises can reduce anxiety at bedtime. These techniques help control breathing, heart rate, muscle tension, and mood.

In this article you have several detailed relaxation techniques.

Stimulus control

It is about controlling the time spent awake in bed and associating the bed and the room with sleep and sex.

Sleep restriction

This treatment decreases the time spent in the cape, causing partial sleep deprivation, which makes the person feel more tired the next night. When sleep improves, time in bed is gradually increased.

Paradoxical intention

It aims to reduce worries and anxiety about being able to fall asleep. It is about trying to stay awake - paradoxical intention - instead of worrying about the ability to sleep.

Light therapy

If the affected person falls asleep too early and then wakes up too early, you can use light therapy to set the internal clock back.

-Medication

Prescription drugs such as zolpidem, eszopiclone, zaleplon, or ramelteon can help you fall asleep. Taking sleeping pills for more than a few weeks is not recommended, although some drugs are approved for long-term use.

According to the American Association of Retired Persons, the following drugs can cause insomnia:

• Corticosteroids: used in patients with allergic reactions, gout, lupus, rheumatoid arthritis, and for muscle inflammation. Examples are: prednisone, triamcinolone, methylprednisolone, and cortisone.
• Statins - Medicines used to treat high cholesterol levels. They can be simvastatin, rosuvastatin, lovastatin, and atorvastatin.
• Alpha blockers: used to treat hypertension and benign prostatic hyperplasia. Examples are terazosin, silodosin, alfuzosin, prazosin, doxosin, and tamsulosin.
• Selective serotonin reuptake inhibitors - Used for depression. Examples are fluxetine, paroxetine, escitalopram, sertraline, and fluvoxamine.
• Cholinesterase inhibitors: used to treat memory loss and other symptoms in patients with dementia. Examples are rivastigmine, donezepil, and galantamine.
• Glucosamine / Chondroitin Sulfate: Dietary supplements used to decrease the symptoms of joint pain to reduce inflammation.

-Allerative medicine

Many people fail to visit a professional and manage to overcome insomnia on their own. Although in some cases there is no research on safety and effectiveness, there are options such as:

• Melatonin: The body naturally produces melotonin, releasing it into the bloodstream. The release increases during the evening and decreases during the morning. Older people appear to have greater benefits from melatonin, although there is no evidence to prove that it is effective. It is generally considered safe for a few weeks, but its long-term safety is not known.
• Valerian: This is a supplement that is sold as an aid to sleep better. It has a moderate sedative effect, although it has not been well studied. It is advisable to consult with your doctor before taking it.
• Acupuncture: This is the placement of small needles at specific points on your body. There is evidence that this practice can benefit some people with insomnia, although more research is needed.
• Yoga: Some studies suggest that regular yoga practice can improve the quality of sleep.
• Meditation: some studies suggest that meditation along with conventional treatment can improve the quality of sleep. In addition, it has benefits such as reducing stress or blood pressure.

-Lifestyle and habits

Often the best solution to insomnia is to change your routines during the day and before going to sleep. Good sleep habits promote good sleep quality and energy and alertness throughout the day.

Basic tips are:

• Check medications: if you take drugs regularly, check with your doctor which ones may be affecting your sleep
• Exercise and stay active - Physical exercise promotes quality sleep. Get 30 minutes of physical exercise a day at least 4-5 hours before bed.
• Avoid or limit naps - Naps can make it harder to sleep at night. If you need them, try to spend no more than 30 minutes in the siesta and no later than 3:00 p.m.
• Avoid or limit caffeine, alcohol, and nicotine: Coffee, tea, and beverages that contain caffeine are stimulants and can interfere with sleep if taken in the afternoon. Nicotine is another stimulant that can cause insomnia. Alcohol is a sedative, although it can prevent you from reaching deep stages of sleep and often causes sleep disruption at night.
• Set a schedule: Keep your wake-up and wake-up times consistent, including weekends.

Before sleep:

• Avoid long meals and drinks before bedtime: Avoid eating too much before bedtime to reduce the likelihood of GERD and improve sleep quality.
• Use the bed or room only for sleeping or sex: avoid reading, working or eating in bed. Also watch TV, use the smartphone or laptop, play video games or any type of screen.
• Make your room comfortable to sleep in: close your room and keep it quiet. Keep the temperature comfortable, usually cooler than during the day, and keep it in the dark.
• Turn off clocks: set your alarm to get up, but turn off other clocks, including your smartphone, so you don't worry about what time it is.
• Relax: you can relax before bed with relaxation techniques, relaxing music, massages or baths.
• Get out of bed if you don't sleep: get what you need to rest and then get out of bed. If you can't sleep, get out of bed for 20 minutes, do something relaxing, and then try sleeping again.
• Don't try too hard to sleep - the more you try to fall asleep, the more awake you'll be. Do something in another room until you feel sleepy and then try to sleep again.

When to seek professional help?

If you have tried the treatments described above and are still having trouble sleeping, a specialist can help you.

Seek professional help if:

• Your insomnia does not respond to your strategies.
• Your insomnia causes major problems at home, work or school.
• You experience symptoms like chest pain or shortness of breath.
• Insomnia happens every night and is getting worse.

Risk factor's

The risk of insomnia is higher if:

• Being a woman: women are more likely to experience insomnia. The hormonal changes of the menstrual cycle and menopause play a role.
• Being older than 60 years: due to changes in sleep patterns.
• Having a mental disorder: Disorders such as depression, bipolar disorder, anxiety, or post-traumatic stress disorder can disrupt sleep. Waking up early in the morning is a classic symptom of depression.
• Stress: having stressful events can lead to insomnia. Examples are the deaths of relatives, the breakup of a couple, loss of employment…
• Change schedules or work nights.
• Traveling long distances (jet lag).

Complications

Sleep is as important to your health as having a proper diet and exercising. Whatever the cause, it can have negative consequences in all areas of life and on mental and physical health.

Complications can be:

• Lower productivity at work or school.
• Less reaction time when driving.
• Psychiatric problems such as anxiety or depression.
• Irritability.
• Greater chances of contracting diseases or conditions such as hypertension, diabetes or heart disease.
• Substance abuse.
• Overweight or obsessive.

And what experiences do you have with insomnia?