As we need oxygen to live and water to survive so do, we need sleep to refresh ourselves and reset ourselves for the next day. Every day brings with itself something new and what is more satisfying than beginning a new day with a good night’s sleep?
Good quality sleep plays a major role in improving the quality of life. It allows your body to reset and perform some essential maintenance on your memory, hormones, your immune system, and other critical functions. It improves the brain’s ability to learn, helps the body fight infections, and allows your heart to rest by lowing your blood pressure.
The amount of sleep someone needs is highly individual. Over the day, you build sleep pressure, you may find yourself nodding off and feeling tired. This is your body’s way of saying that you need sleep. But this is not the case for all. Sometimes you may find it hard to fall asleep.
Do you frequently wake up in the middle of the night? Do you tend to wake up early and are unable to go back to sleep? If the answer to these questions is yes, you may be suffering from a sleeping disorder called insomnia. In this article, we will answer all your questions regarding what is it that is keeping you awake night after night.
What is Insomnia?
Insomnia is defined as difficulty in falling asleep, staying asleep, or waking up too early at least three times per week for at least 3 months (1). It is a heterogeneous complaint reflecting poor sleep quality and/or lack of restful sleep that causes distress and impairment in daily functioning. The sleep quality component may include difficulty in falling asleep as well as maintaining a sound sleep (frequent awakenings, waking early, difficulty resuming sleep) (2).
Here we should understand that insomnia is different from sleep deprivation. Sleep deprivation occurs when an individual does not have the opportunity to get a full night of sleep. A small percentage of people who have trouble sleeping are short sleepers who can function normally on only five hours of sleep or less (3).
Insomnia is considered a chronic disease, because it interferes in the professional, family as well as social life of an individual, making it unable for them to respond to external stimulation. This causes difficulty in concentration and precluding numerous activities of daily routine which ultimately leads to a decrease in the quality of life (4).
Insomnia affects approximately 30% of adults. About 10% of adults have insomnia that is severe enough to cause daytime consequences (3). Studies have also shown that throughout the world, across cultures and all ages, more women than men have difficulty getting to sleep and staying asleep. Healthy women report longer sleep times (by 15–20 minutes) than men, suggesting a gender difference in sleep needs.
Women tend to be larks (morning types) rather than night owls. They may awaken more easily than men and may also have greater difficulty in falling back to sleep when their sleep is disturbed (5).
What are the Different Types of Insomnia?
Broadly there are two types of insomnia – primary and secondary (3).
Primary insomnia is sleeplessness that cannot be attributed to an existing medical, psychiatric, or environmental cause (such as drug abuse or medications).
Secondary insomnia is when symptoms of insomnia arise from a primary medical illness, mental disorders, or other sleep disorders. It may also arise from the use, abuse, or exposure to certain substances.
Causes of Insomnia (3)
Insomnia is considered a disorder only when it causes a significant amount of distress or anxiety, or when it results in daytime impairment. The International Classification of Sleep Disorders, 2nd Edition, documents the following types of insomnia based on the causes.
This is also called acute insomnia or short-term insomnia. It is usually caused by a source of stress and tends to last for only a few days or weeks. It can occur at any age and is seen more commonly in women than men.
Behavioural Insomnia of Childhood-
This type of insomnia occurs during childhood when a child, associates falling asleep with an action (being held or rocked), object (bottle), or setting (parents’ bed), and is unable to fall asleep if separated from that association.
Insomnia that begins in childhood and is lifelong and it cannot be explained by other causes.
Inadequate Sleep Hygiene-
This form of insomnia is caused by bad sleep habits that keep you awake or bring disorders to your sleep schedule.
Insomnia due to Drug or Substance, Medical Condition, or Mental Disorder-
Symptoms of insomnia often result from one of these causes. It is associated more often with a psychiatric disorder, such as depression, than with any other medical condition.
A complaint of severe insomnia occurs even though there is no objective evidence of a sleep disturbance.
Insomnia that is caused due to an excessive amount of anxiety and worry regarding sleep and sleeplessness is called psychophysiological insomnia. It is more frequent in women than in men.
Is Insomnia More Common in Women? (5,6)
There are many gender biases even today in our society and unfortunately, insomnia also seems to prefer the female gender. Yes! Women indeed suffer more from insomnia than men and higher rates of insomnia have consistently been reported for women than men. This sex difference in insomnia prevalence is evident after puberty and becomes even more pronounced at older ages (the mid-50s to mid-70s) (5). Let us explore the why behind this question.
Three common explanations for the gender difference in the prevalence of insomnia include mood disorders, sociological factors, and physiological influences.
There is evidence that the higher rates of anxiety and depression in women is likely contribute to their higher prevalence of insomnia. In women however the reverse is also especially true that insomnia predicts the beginning of depression.
Contribution of Family and Social Roles-
Balancing obligations between work and family may contribute to sleep difficulties. Women may be more prone than men to have ongoing thoughts and concerns that lead to a cycle of arousal and sleep impairment.
Women report increased sleep disturbances at particular phases of the menstrual cycle,
during pregnancy and the postpartum period, and menopause.
During the menstrual cycle, women find it difficult to sleep due to changes in the levels of the hormones progesterone and oestrogen that can lead to menstrual symptoms such as cramping, moodiness, cravings, and irritability.
Women tend to have a poor quality of sleep in the late stages of pregnancy. The general pregnancy symptoms may also lead to a decrease in the amount of deep sleep during this phase. While postpartum, the responsibilities that come with the new-born change the sleeping habits of the mother.
During menopause, women have decreased deep sleep and increased night time awakenings. Changes in oestrogen levels can result in hot flashes, night sweats, headaches, and palpitations, which can directly affect sleep.
Insomnia- Treatment, and Management
Various treatment modalities have been prescribed for insomnia. You are strongly advised to see your physician before starting any of the treatments. Your physician or any other specialist who he recommends will ask you a detailed history and evaluate your sleep patterns and habits. They may then prescribe the treatment best suited for you.
In general, the treatment modalities are as follows
- Cognitive-Behavioral Therapy (CBT)
CBT can have beneficial effects that last well beyond the end of treatment. It involves combinations of the following therapies
- Cognitive therapy- Changing attitudes and beliefs that hinder your sleep.
- Relaxation training- Relaxing your mind and body.
- Sleep hygiene training- Correcting bad habits that contribute to poor sleep.
- Sleep restriction- Severely limiting and then gradually increasing your time in bed.
- Stimulus control- Going to bed only when sleepy, waking at the same time daily, leaving the bed when unable to sleep, avoiding naps, using the bed only for sleep and sex.
- Over-the-Counter Products
Most of these sleep aids contain a chemical compound called an antihistamine. They can help you sleep better, but they also may cause severe daytime sleepiness. Other products, including herbal supplements, have little evidence to support their effectiveness.
- Prescription Sleeping Pills
Prescription hypnotics can improve sleep when supervised by a physician. They are typically prescribed for only short-term use.
- Unapproved Prescription Drugs
Drugs from a variety of classes have been used to treat insomnia without FDA approval. Many of these medications involve a significant level of risk and should not be consumed.
In this everyday stressful and hectic life, it is common to go through phases of insomnia. If you are suffering from insomnia, you need to understand that this condition is treatable and you can enjoy a sound sleep at night if you try working towards it. Asking for help if you cannot deal with the condition, is the best option.
So, don’t let your thoughts burden your eyelids and aim to have a good quality sleep every night.
Hope you found this article useful. Let us know your thoughts in the comments section below.
Author: Dr Pooja Nilgar (Content writer and editor)
- Kwak, A., Jacobs, J., Haggett, D., Jimenez, R. and Peppercorn, J., 2020. Evaluation and management of insomnia in women with breast cancer. Breast cancer research and treatment, 181(2), pp.269-277.
- Bardwell, W.A., Profant, J., Casden, D.R., Dimsdale, J.E., Ancoli‐Israel, S., Natarajan, L., Rock, C.L., Pierce, J.P. and Women’s Healthy Eating & Living (WHEL) Study Group, 2008. The relative importance of specific risk factors for insomnia in women treated for early‐stage breast cancer. Psycho‐oncology, 17(1), pp.9-18.
- Newton, J. (2011) ‘Sleep deprivation’, Journal of Clinical Sleep Medicine, 7(3), pp. 45–47.
- Tessaro, M. and Navarro-Peternella, F.M., 2015. Sleeping effects in the quality of life of women with insomnia. Fisioterapia em Movimento, 28, pp.693-700.
- Driver, H.S., 2012. Sleepless women: insomnia from the female perspective. Insomnia Rounds, 1(6), pp.1-6.
- Rajagopal, A. et al. (2018) ‘Women and sleep’, American Journal of Respiratory and Critical Care Medicine, 197(11), pp. P19–P20. doi: 10.1164/rccm.19711P19.