Overview
Insomnia is the inability to get enough quality sleep due to difficulty falling asleep, frequent awakenings, or waking up early. About 30% of adults experience occasional insomnia, and 10% experience chronic insomnia.
It can be short-term (acute) or last longer than 3 months (chronic). It significantly affects quality of life, work performance, and overall health.
Symptoms
- Difficulty falling asleep
- Frequent awakenings during the night
- Waking up early and unable to fall back asleep
- Not feeling rested upon waking
- Daytime fatigue, weakness
- Irritability, mood changes
- Concentration, memory problems
- Distractibility
- Increased risk of mistakes, accidents
- Excessive preoccupation with sleep
- Intolerance
- Anxiety
- Headache, stomach complaints
Causes
Medical conditions:
- Chronic pain
- Asthma, COPD
- Reflux
- Thyroid problems
- Parkinson's, Alzheimer's
- Restless leg syndrome
- Sleep apnea
- Diabetes, heart disease
Mental disorders:
- Anxiety
- Depression
- Stress
- Post-traumatic stress disorder
- Bipolar disorder
Lifestyle:
- Irregular sleep pattern
- Shift work
- Jet lag
- Excessive caffeine, alcohol, nicotine
- Heavy meal late at night
- Screen use
- Inactivity
Medications:
- Antidepressants
- Blood pressure medications
- Corticosteroids
- Diuretics
- Asthma medications
- Cold medications
Environmental:
- Noise, light
- Excessive heat/cold
- Uncomfortable bed
Risk Factors
- Being female
- Over age 60
- Stressful life
- Shift work
- Irregular life
- Mental health problems
- Medical illnesses
- Social isolation
Complications
- Decreased work, school performance
- Traffic, work accidents
- Increased risk of depression, anxiety
- High blood pressure, heart disease
- Weakened immunity
- Increased risk of obesity, diabetes
- Chronic pain
- Substance use
- Significant decrease in quality of life
When to See a Doctor
- Insomnia lasting more than 3 weeks
- If it affects daily life
- Excessive daytime sleepiness
- Snoring, breathing pauses (sleep apnea)
- If depression, anxiety accompany
- Constant need for sleeping pills
- Traffic accident risk
Diagnosis and Treatment
Diagnosis:
- Detailed sleep history
- Sleep diary
- Sleep scales
- Medical examination
- Polysomnography (suspicion of sleep apnea)
- Actigraphy
- Thyroid, blood tests
Treatment:
1. Cognitive behavioral therapy for insomnia (CBT-I):
- First-line treatment
- Most effective long-term method
- Sleep hygiene, stimulus control, sleep restriction
- Relaxation techniques
2. Sleep hygiene:
- Go to bed and wake up at the same time every day
- Use the bedroom only for sleep
- Dark, quiet, cool room
- Avoid screens 1 hour before sleep
- Limit caffeine, nicotine, alcohol
- Do not eat heavy meals before sleep
- Regular exercise (at least 3 hours before sleep)
- Limit daytime naps (20-30 min)
- Relaxation routine (bath, book, meditation)
3. Medications (short-term, careful):
- Melatonin (especially in the elderly)
- Z-group sleep medications: Zolpidem, eszopiclone
- Benzodiazepines: Lorazepam, alprazolam (short-term)
- Antidepressants: Trazodone, mirtazapine, doxepin
- Orexin receptor antagonists: Suvorexant
- Antihistamines (over-the-counter, limited efficacy)
- Should be used carefully due to dependence risk
4. Treatment of accompanying conditions:
- Treatment of depression, anxiety
- Sleep apnea treatment
- Pain management
- Treatment of hormonal problems
Prevention and Lifestyle
Sleep routine:
- Consistent bedtime and wake time
- Do not change it on weekends
- Use the bedroom only for sleep
- 30 minutes of relaxation before bed
Lifestyle:
- Regular exercise (at least 3 hours before sleep)
- Healthy nutrition
- Manage stress (meditation, breathing exercises)
- Participate in social activities
- Get natural sunlight (in the morning)
Bedroom:
- Dark, quiet, cool (18-20 °C)
- Comfortable mattress, pillow
- Do not keep screens
- Do not watch the clock
To avoid:
- Evening caffeine (stop 6 hours before)
- Alcohol (disrupts sleep)
- Smoking
- Heavy meals before sleep
- Screens before sleep
- Long daytime naps
- Trying to fall asleep (get up if you cannot sleep)