Battling Insomnia: Diagnosis And Treatment

Insomnia is a sleeping disorder that can affect your physical and mental health. It’s currently the most common specific sleeping disorder in America, with 30% of adults¹ reporting short-term issues and a further 10% report suffering from chronic insomnia.

While sleep problems are common, many people delay seeking help, believing the issue will resolve on its own. Although some do, others become worse. Seeking medical advice and diagnosis early on can result in fewer disruptions to daily life and further complications.

Insomnia: definition

Insomnia is a common sleep disorder that interferes with the duration and quality of sleep. If you have insomnia, you can find it hard to fall asleep, stay asleep, or both. People who suffer from this condition often feel tired and irritated.

Acute insomnia

Acute insomnia (also called short-term or adjustment insomnia) typically lasts less than three months. It's often triggered by a stressful or traumatic life event, such as problems at work, the loss of a loved one, or a serious injury.

Once you learn how to deal with the underlying problem or identify the trigger, symptoms typically resolve. In some cases, acute insomnia can worsen and transition into chronic insomnia.

Chronic insomnia

A doctor is likely to diagnose chronic insomnia if you have trouble falling asleep or staying asleep more than three nights a week for at least three months.

Chronic insomnia may go away for a while, only to come back in a few weeks or months. Similar to acute insomnia, this condition can be triggered by stressful or traumatic situations. It is commonly linked to mental health issues, physical and neurological health problems, poor sleep hygiene, and other sleep disorders.

Doctors classify insomnia as:

• Primary – a separate issue, which isn't connected to other health problems.

• Secondary – resulting from another health issue.

• Mild – insomnia that leads to fatigue during the day.

• Moderate – insomnia that affects daily activities and functions.

• Severe – insomnia that significantly impacts the quality of life.

Insomnia is more prevalent in older adults and females. One in four women² in the United States has suffered from symptoms of insomnia. It can often be more pronounced before a menstrual cycle, pregnancy (especially the third trimester), and perimenopause.

How to diagnose insomnia

To diagnose insomnia, your doctor will ask you a series of questions, perform a physical exam, and run some tests.

• History and symptoms – the doctor will ask about your sleep history, sleeping schedule, health conditions, eating and drinking habits, and the presence of fatigue.

• Physical exam – the doctor will perform a physical exam to flag any medical problems that may be related to your insomnia.

• Blood tests – if your doctor suspects a medical condition may be present, they will request blood tests to aid diagnosis.

• Sleep study – to get additional information, your doctor may conduct a sleep study (also called polysomnogram test³). It involves spending the night at a sleep center with sensors attached to your scalp, face, chest, limbs, eyelids, and finger. These sensors will record your brain activity, oxygen levels, heart rate, and other markers to help identify the problem.

• Actigraphy test⁴– this test involves attaching a sensor to your wrist to monitor your sleeping patterns. You can perform the test at home.

To help your doctor make a diagnosis, consider keeping a sleep diary for a week or two prior to your appointment.

How to treat insomnia

Depending on the severity of your symptoms, medical history, and underlying conditions, your doctor may suggest different courses of treatment. They may include:

Cognitive-behavioral therapy (CBT-I)

CBT-I helps you recognize, address, and change perceptions that affect the way you sleep. It allows you to reduce and eliminate negative thoughts that may contribute to keeping you awake at night.

The behavioral aspect of CBT-I teaches you how to avoid behavior that may affect your sleep. It also helps you incorporate healthy sleeping habits.

Common types of CBT-I are:

• Stimulus control – helps you develop a positive response to getting into bed for sleeping.

• Sleep restriction – sets limits on the time you can spend in bed with the goal of helping you fall asleep faster.

• Relaxation training – teaches you how to relax your mind and body while in bed.

• Biofeedback – allows you to observe biological reactions in your body and learn deep relaxation techniques.

• Sleep environment – works on improving your sleep environment resulting in a more favorable and healthy sleep experience.

• Sleep hygiene training – addresses daily activities that could interfere with your sleep.

It's important to understand that CBT-I requires several sessions to see positive benefits, as new habits take time to form in daily routines.

Medication

To help ease your symptoms, a doctor may prescribe sleeping pills. While they usually work quickly, sleeping medications do not fix the core problem. Taking them for more than a few weeks can result in unpleasant side effects, including tolerance to the drug.

You can also take advantage of over-the-counter sleep medication. However, just like prescription medication, these pills aren't intended for regular use. Your doctor can explain when and how these drugs should be administered for your specific needs.

Lifestyle changes

While several factors can cause insomnia, incorporating a few fundamental lifestyle changes can drastically improve your sleep patterns.

• Exercise – staying active relieves tension in the body, resulting in a deeper, more satisfying sleep. Vigorous activities or over-stimulation before bed can have the reverse effect and result in difficulty settling or falling asleep. 

• Plan a consistent sleep schedule – try going to bed and getting up at the same time every day. This will form a healthy rhythm your body will adjust to and eventually expect.

• Check your bed – your bedding, mattress, and pillows could be changed to find more comfortable alternatives. Additionally, some people prefer a cooler room to sleep in and heavy weighted blankets.

• Reduce caffeine – drinking tea, coffee, and other energy drinks in the evening could interfere with your sleep.

• Minimize daytime naps – if you take naps during the day, they could affect your ability to sustain a full night's sleep.

• Avoid large meals before bed – eating large meals before bed could trigger heartburn when lying down, resulting in restless or difficult sleep positions.

• Get out of bed – if you can't fall asleep, don't stay in bed. Get up and do something relaxing until you feel sleepy again.

If these lifestyle changes don't improve your quality or duration of sleep, it's essential to contact a doctor to discuss your next steps.

When to see a doctor

While a common condition, insomnia is often missed⁵ by primary care physicians. If your sleeping patterns are disrupted, it's imperative to share this information with your doctor, especially when you:

• Have difficulty falling asleep for more than a week.

• Have trouble remaining asleep during the night.

• Often wake up earlier than you plan to.

• Have problems falling asleep without pharmaceutical assistance.

• Feel fatigued throughout the day.

• Have difficulty concentrating or remembering details.

• Feel that you aren't performing daily tasks as well as you used to.

• Feel a lack of motivation.

• Make more errors when studying or working.

• You are not satisfied with the quality of your sleep.

If at least one of the statements above rings true, you should speak with your doctor. Ignoring these symptoms could have a variety of adverse consequences, including:

• The transition from acute to chronic insomnia.

• Mental health disorders (anxiety, depression, substance abuse).

• Higher risk of developing medical conditions⁶ (hypertension, cardiovascular disease, obesity, diabetes, and depression).

• Increased alcohol consumption.

Depending on the underlying causes of your condition, a specialist can help you learn how to treat insomnia and avoid accompanying health issues.

Which doctor treats insomnia?

No matter how severe your insomnia seems, the first doctor you should see is your primary care physician. If your child is having symptoms, you should visit a pediatrician. They will help diagnose the condition and, if necessary, refer you to other specialists.

• Sleep medicine specialist – professionals with experience in diagnosing and treating sleeping disorders.

• Neurologist – since neurological disorders can cause insomnia, you may need to speak with a neurologist if other causes are ruled out. If the cause of your insomnia turns out to be neurological, a neurologist will develop a course of treatment.

• Psychologist or psychiatrist – both experts can help identify and treat underlying mental health issues that could be causing or contributing to your insomnia.

When the cause of your insomnia is breathing difficulties (e.g., sleep apnea), your primary care physician can refer you to specialists such as a pulmonologist, an ENT (Ear, Nose Throat), and a dentist.

The lowdown

Insomnia is a highly treatable condition. If you feel you have insomnia, it's vital to alert your primary care physician.  After your doctor diagnoses insomnia and designs the best course of treatment, your quality of life could improve drastically in a short time frame. Lifestyle changes may also improve your conditions and general overall health.

Don't wait for a short-term sleep disorder to turn into a severe chronic condition. Speak to your doctor and learn how to treat insomnia as soon as possible.