Insomnia is the most commonly experienced sleep disorder. People who have insomnia experience difficulty falling asleep and staying asleep and a poor quality of overall sleep. However, insomnia is considered to be a symptom rather than a specific disorder.
There is a wide range of causes for insomnia and this makes it particularly hard for physicians to treat. In addition, there is never any clinical evidence of insomnia in patients, so it is even less likely for patients to be diagnosed and treated properly. Sometimes assessment of insomnia is dependent upon sleep diaries, conversations about sleep, sleep questionnaires, and sleep interviews. When these subjective impressions are relied upon for diagnosis, it is hard to tell the difference between someone with a sleep disorder and someone with normal sleep habits. One's subjective impression of their sleep is usually inaccurate and not very helpful. For this reason, many people are misdiagnosed with insomnia and this can lead to harmful consequences such as being on medication unnecessarily.
In order to someone to be diagnosed with a clinically significant case of insomnia, one of the following statements must be true (Coren, 1996):
For someone who really has insomnia these symptoms should lead to noticeable effects in daily life, such as sleepiness during the day, and their occurrence should be relatively consistent.
In many cases the underlying problem causing insomnia is psychological. Anxiety and stress have been shown to influence quality of sleep. Another cause of insomnia is age; sleep patterns become less constant as age increases. Even lifestyle factors have been shown to cause insomnia. Eating and exercising too close to bedtime and using alcohol, nicotine, and caffeine have all been shown to disrupt sleep. Another of the many possible causes of insomnia is an inability to shut off the parts of the brain that control thinking and feeling. Insomnia can also be induced by trying too hard to fall asleep and as a result causing a rise in energy levels.
About a third of all insomnia cases are caused by a bad sleeping environment. If a mattress is too soft, there is too much light or sound, or the temperature is too high or low the sleep pattern will be interrupted. Another easily resolved condition that can cause sleep problems is associating the bedroom and bed with activities other than sleep. If a person spends time on the bed doing non-sleep activities like watching tv or reading, the brain becomes confused about what it is supposed to be doing because it is conditioned to associate the bed with arousal instead of sleep. Sometimes people even condition themselves to sleep in places other than their bed, like on a couch or a chair. As a result they can sleep in these places without experiencing the insomnia. One way to avoid this is to use the bed only for sleep. Then, when a person gets into bed, the mind will make the correct association with sleep.
One of the most important causes of insomnia is actually sleeping medication. Unfortunately, even though insomnia is usually caused by things that can be treated without drugs, medication is often prescribed unnecessarily. People who use medication tend to develop a tolerance to it, and because the original cause of the insomnia was never dealt with in the first place, the medication can do nothing helpful for the patient. In fact, once that person tries to sleep after having developed a tolerance to the medication, they will experience even more severely disrupted sleep than before. When the patient then tries to take higher doses of the medication, it is called drug dependency insomnia. This turns into a horrible cycle, only making the insomnia worse. Therefore, whenever possible, doctors should use effective techniques to deal with the underlying problem causing the symptom of insomnia instead of resorting to prescribing medication.
One of these non-pharmacological treatments is developing one's sleep hygiene. This concept includes things like not spending excessive time in bed, never forcing oneself to sleep, hiding all bedroom clocks, and avoiding exercise too late at night. Another approach to insomnia is called stimulus control. It outlines four rules to help develop good sleep habits:
The use of these rules usually gives the patient a feeling of control over their sleep patterns. One additional way to treat insomnia is to tackle the issue of hyper-arousal with relaxation (Pallesen, 2001).
Therefore, although insomnia is a problem that plagues many, medication should be used only as a last resort. There are many other effective techniques such as visualizations, muscle relaxation, and sleep hygiene that help to combat insomnia without harming the body or making sleep problems even worse.