Self Help

Insomnia is not a sleep disorder! Rather, insomnia is a complaint of difficulty falling asleep, difficulty staying asleep, or unrestorative sleep. The complaint of insomnia can be caused by multiple factors.

Transient Insomnia: Transient insomnia lasts only a few days and usually occurs in people who are otherwise healthy but are undergoing sudden stress (including positive stress such as getting ready for a wedding or a trip) or experiencing the onset of a medical or psychiatric illness, changes in medications, or jet lag. An example of transient insomnia would be trouble sleeping before on important exam or an important meeting.

Transient insomnia rarely is discussed in the doctor’s office since it usually gets better before the patient can get an appointment. Patients usually seek professional help after experiencing short-term insomnia, which can last up to 3 weeks, or chronic insomnia, which lasts more than 3 weeks.

Chronic Insomnia: Chronic insomnia often is a multi-level problem, reflecting multiple predisposing, precipitating, and perpetuating factors. For example, insomnia in an already anxious individual (predisposing factor) may result from nervousness about a new job (precipitating factor). This may lead to inappropriate use of alcohol and sleeping pills at night to induce sleep, as well as increased anxiety about sleep (perpetuating factors).

Causes of Insomnia: Insomnia usually is caused by either behavioral problems and bad sleep habits, medical problems, psychiatric problems, medications and drugs, circadian rhythm disorders, or sleep disorders (such as sleep disordered breathing or periodic limb movements in sleep).

The following may be related to the causes of insomnia: Behavioral, medical, psychiatric, drugs, circadian rhythm disturbances, and sleep disorders

No matter what originally caused the complaint of insomnia, behavioral problems often are the main perpetuating problem. The two more common behavioral conditions are psychophysiologic insomnia and poor sleep hygiene.

Psychophysiologic insomnia occurs when you are negatively conditioned to sleeping in your bed. For example, you experience some anxiety over an upcoming job evaluation. You go to bed and have difficulty falling asleep. The next night you tell yourself that you didn’t sleep well the night before, so you have to get some sleep tonight. You become so tense trying to sleep that you have difficulty sleeping the second night. On the third night the same thing happens.

Poor sleep hygiene means bad sleep habits. Bad sleep habits generally result from irregular sleep schedules, excessive daytime napping, overuse of alcohol and caffeine, poor sleep environments, or anxiety at bedtime. Both psychophysiologic insomnia and poor sleep hygiene can be treated by teaching the patient appropriate sleep hygiene rules. In fact, good sleep hygiene is the cornerstone of all insomnia treatments.