How Insomnia Works

Every insomniac knows the self-torture of looking at the clock throughout the night.
Every insomniac knows the self-torture of looking at the clock throughout the night.
© Karen Winton/iStock/Thinkstock

When you haven't been getting enough sleep, things can start to get a little weird. A little fuzzy. Your memory seems cloudy. You can't concentrate and you're irritable, tense and anxious. Above all, you're tired. And as any "Fight Club" fan knows, when you have insomnia, you're never really asleep and you're never really awake.

Between 50 and 70 million Americans live with a chronic sleep disorder, and the Sleep Health Foundation estimates that as many as 10 percent of adults are experiencing mild insomnia at any time, making it the most prevalent sleep problem among Americans [sources: Kolbert, Sleep Health Foundation]. Adults need, on average, between 7 and 9 hours a sleep every night. But according to a 2011 poll, more than 50 percent of Americans ages 13 to 64 admit they don't get the recommended amount because they have trouble sleeping every night.


Symptoms of insomnia -- which, aptly, means 'no sleep' in Latin -- include not only a difficulty falling asleep but also difficulty staying asleep [source: Neubauer]. Insomniacs may also have poor quality sleep because they wake up frequently throughout the night, sleep for too few hours a night, and as a result experience daytime exhaustion.

But that's not where it ends. Normally it should take a person no more than 20 minutes to fall asleep once her head has hit the pillow; insomniacs, in comparison, frequently need 30-45 minutes (or more) to fall asleep at night. Difficulty falling asleep may be how most of us would define insomnia (which makes sense as it's the most common symptom), but insomnia causes side effects that follow you throughout the day, such as fatigue, tension headaches, anger, depression and gastrointestinal distress, as well as anxiety and worry. And that's not just worrying about to-do lists and your job -- insomniacs also have increasing worry about their sleep. People who don't get enough sleep are also at a higher risk for chronic diseases such as type 2 diabetes, stroke and hypertension.

Insomnia may also increase your risk of accidents -- as many as 5 percent of adults admit they've fallen asleep while behind the wheel of their car at least one time during the last 30 days, and sleep deprivation is known to have been a factor in some major accidents such as the Exxon Valdez oil spill and the Chernobyl nuclear accident [sources: Kolbert, Peri].


Insomnia Causes and Risk

Not all insomnia is created equal -- there are different types of this sleep disorder, and there are differing durations, too.

There are two basic types of insomnia: primary or secondary. Primary insomnia means your problem sleeping (or staying asleep) isn't being caused by something else, like another health condition. Within this type of insomnia there are three main sub-categories: psychophysiological, idiopathic and paradoxical. Psychophysiological insomnia is based in worry -- specifically, worry about sleep, with anxiety increasing around (you guessed it) bedtime. Psychophysiological insomniacs may have a single sleepless night but worry themselves into several more of the same. Idiopathic insomnia stands apart because this type develops early in life and continues to be a lifetime sleep disorder that may (or may not) get worse with stressful events in your life. Paradoxical insomniacs are, as the name would suggest, a bit of a paradox, because this group experiences from severe sleeplessness without other symptoms such as daytime drowsiness.


While primary insomnia is its own manifestation, secondary insomnia is insomnia that's a symptom of another problem -- and about 80 percent of all insomnias are secondary [source: NHLBI]. Stressful events (such as a divorce or losing your job) may be to blame for some, as are jet lag and other shifts to your schedule. Individuals with low incomes and people who live sedentary lifestyles are also at higher risk. Additionally, insomnia may be caused by a mental health condition. Depression, anxiety and bipolar disorder, among others, are known to disturb many people's sleep patterns -- as many as 85 percent of people who have major depression also have insomnia [source: Cleveland Clinic].

Certain medications also may keep you up at night -- for example, common prescriptions known to cause insomnia in some people include drugs to treat allergies, cardiovascular disease, asthma, pain and depression, among others, and include alpha blockers (to treat high blood pressure), beta blockers (used to treat a variety of things from hypertension to migraines to heart disease), ACE inhibitors, ARBs, corticosteroids, H1 antagonists, glucosamine, statins and, ironically for those with depression-induced insomnia, SSRI antidepressants [source: Neel].

You're at risk for insomnia; we all are. One out of three adults has occasional bouts with acute insomnia, and one in 10 with chronic [source: NHLBI]. But some of us are more likely to experience sleeplessness than others. Women, for example, are more likely than men, infants and kids to have insomnia; hormonal shifts are thought to contribute to the problem. (In fact, during pregnancy, as many as 84 percent of women report symptoms of insomnia [source: Paul].) Seniors over age 60 also have an increased risk.


Will You Ever Sleep Again? Transient, Acute and Chronic Insomnias

Short-term insomnia can usually be treated with tweaks to your sleep habits.
Short-term insomnia can usually be treated with tweaks to your sleep habits.
© monkeybusinessimages/iStock/Thinkstock

Most of the time when we talk about our insomnia we talk about its duration, going on about another sleepless night. Insomnia doesn't last for any specific length of time, and it may come and go or visit you just once in a lifetime. The length of your insomnia can be transient, acute or chronic -- and you might experience any or all of these types throughout your life. Transient insomnia is a sleep disturbance that lasts only a few days at a time. An upcoming deadline at work or school may keep you awake for a few nights prior; this is a classic example of transient insomnia. Acute insomnia is another short-term type of the sleep disorder, but instead of losing sleep over the course of a few nights during this manifestation, a person could have bouts of sleepless nights over the course of three weeks at a time.

And then there are those who seem like they never sleep; when you aren't able to sleep for more than six hours a night on at least three nights a week for at least 30 days, you have chronic -- that's long-term -- insomnia. About a quarter of all chronic insomniacs are diagnosed with primary insomnia.


Most insomnia will respond well to treatment. Short-term insomnias are often best treated with lifestyle and behavioral changes, including a change in what's called your sleep hygiene -- your personal sleep habits. Maintaining a regular bedtime and wake time, for example, may help improve your sleep, as does keeping your bedroom dark, quiet and at a cool temperature. Reschedule your day so you're not eating within a few hours before your planned bedtime, and cut back on caffeine, nicotine and other stimulants -- as well as alcohol -- which are known to keep even the best of sleepers from quality sleep.

Insomnia that lasts longer than a just a few nights may need more powerful treatment, in addition to making lifestyle and bedtime habit changes.


Behavioral Therapy, Hypnotics and Over-the-counter Treatments

Prescription medicines may be used to treat insomnia if sleep habit changes don't help.
Prescription medicines may be used to treat insomnia if sleep habit changes don't help.
© Annie-Claude Bédard/iStock/Thinkstock

Nineteenth-century novelist Emily Brontë is said to have walked herself to sleep, she was so desperate for rest; whether that's fact or fiction, what we do know is that insomniacs will try all sorts of things (nope, counting sheep isn't thought to work) to nod off.

It's important to wind down before bedtime -- which probably won't include walking in circles like Brontë. In fact, exercise, especially moderate-to-vigorous exercise, isn't recommended during the three to four hours before your bedtime because of its energizing effect. Instead, try yoga as part of a healthy bedtime routine, and stick to the morning spinning class.


In addition to making some changes to the bedtime routine, The American Academy of Sleep Medicine recommends insomniacs try cognitive behavioral therapy, used to help control worries and anxiety about sleep and considered to be one of the most successful treatments. Relaxation techniques such as mindful meditation and controlled breathing, too, offer strategies to relieve sleep anxiety as bedtime approaches. Other behavior therapies include retraining yourself in how you think about your bed. For example, restricting the amount of time you spend in your bed (and gradually increasing the duration) may help reduce anxiety about going to sleep; others may benefit from a temporary treatment where the individual lies in bed without trying to fall asleep.

When behavior and lifestyle changes don't help, though, medications may.

Over-the-counter remedies, such as melatonin, tryptophan and valerian supplements, may work for some insomniacs. Melatonin, for instance, has shown to be effective treatment for sleep disorders caused by circadian rhythm problems (such as jet lag), and is considered to be key in managing how well the body handles its day-night cycle. Alternative remedies aren't regulated by the U.S. Food and Drug Administration (FDA), though, and some may contain ingredients such as antihistamines; follow a health professional's advice when trying at-home sleep aids.

Some insomniacs, acute and chronic, may need prescription medication to find relief. Prescription medicines used to treat insomnia are sedative-hypnotics, such as zolpidem (prescribed as Ambien) and eszopiclone (prescribed as Lunesta), and while they may work, they may also be habit forming and are usually only taken for short periods of time. Primary insomnia may also be treated with prescription medications such as benzodiazepine receptor agonists (BzRAs), as well as with ramelteon, a melatonin receptor agonist that works like melatonin in the brain. Low-dose antidepressants may be prescribed to help insomniacs with depression or anxiety.


Lots More Information

Author's Note: How Insomnia Works

During my research I discovered Tony Wright, the man who stayed awake for 11 days and nights -- I believe that he experienced slurred speech and mild visual hallucinations, but what I don't believe it that he figures the hardest part was remaining in one place to prove he wasn't sneaking naps. I believe the hardest part was staying awake. The next time I'm watching the clock at 3 a.m., I'll have to remind myself that at least it hasn't been 11 wakeful nights.

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More Great Links

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