Insomnia

The National Sleep Foundation defines insomnia as difficulty falling or staying asleep. It can be a single night of restlessness or months or even years of sleep disturbances. There are many types of insomnia and many causes, but fortunately, there are also many solutions.

Insomnia Symptoms Can Hide in Plain Sight

While the symptoms of insomnia may seem obvious, many people do not realize the things that they experience, like typical nightly restlessness, could in fact be a symptom of insomnia. According to the Mayo Clinic, these symptoms can include:

– Not being able to fall asleep despite trying and lying awake in bed
– Being awake for a large part of or all of the night
– Having a sleep schedule that is “off” where you may fall asleep during the day
– Waking up earlier than you intend to and not being able to get back to sleep
– Being a “light sleeper” or only being able to stay asleep for short periods
– Feeling tired, rundown, irritable or not refreshed in the mornings

The Mayo Clinic further recommends that when these symptoms begin to disrupt your life, physical health or mental well-being in a significant way, it is time to consult with your doctor. A doctor can assess your sleep and may diagnose one of several types of insomnia, each of which has different treatments.

The Types of Insomnia

In addition to the occasional restless night, the National Sleep Foundation also delineates five different types of insomnia, each with different causes and consequences.

1. Onset Insomnia – This form of sleeplessness involves the difficulty or inability of initially falling asleep. In other words, it is when you can’t get to sleep at the beginning of your night.

2. Maintenance Insomnia – This form involves a difficulty in staying asleep. It is also sometimes called “sleep maintenance insomnia.” Your sleep may be deep or light, but you struggling to sleep through the entire night and have trouble getting back to sleep if you awake. Another term for this form is “morning insomnia.”

3. Acute Insomnia – This type of insomnia is short-lived and lasts between one and a few nights. Its causes include stress from work or family, other worries, a change in schedule, or travel, sometimes called “jet lag.” This form of insomnia usually requires no treatment. Self-help solutions can include doing meditation, engaging in relaxing activities at the end of your evening or simply waiting it out. It usually resolves itself, but a periodic treatment such as a prescription or over-the-counter sleep aid may be recommended.

4. Chronic Insomnia – This more serious variation of insomnia can persist for months or even years. To have chronic insomnia, you must have experienced it at least three nights a week for three consecutive months or longer. While chronic insomnia can have many causes, which are discussed below, many people with this condition have a history of prior sleep problems, including past insomnia. It is often treated with meditation, psychotherapy, or prescription or over-the-counter medication.

5. Comorbid Insomnia – While the term “comorbid” may sound scary, in this case, comorbidity simply means that your insomnia is accompanied by or related to another health problem or disorder, such as sleep apnea. It can be a result of psychological disorders like anxiety, obsessive-compulsive disorder or depression. Discomfort that includes back pain, arthritis or an injury can also contribute to comorbid insomnia. Also, medications that you are prescribed, including diuretics, stimulants and many others, can lead to comorbid insomnia.

The Centers for Disease Control defines a sixth type of insomnia called chronic psychophysiological insomnia. This is a type of insomnia in which a person becomes psychologically conditioned not to fall asleep due to one or more stresses and a resulting fear of not being able to sleep.

Insomnia Statistics and Trends

The CDC states that adults over the age of 18 need at least seven hours of solid sleep per every 24 hours to satisfy their sleep needs. The CDC also tracks current statistics on insomnia.

Over 35% of American adults aged 18 or older have reported significant sleep deprivation, which is sleeping less than seven hours consistently. Among women, it is 34.8%. Among men, it is 35.5%. Researchers have also noted that African Americans, Asian Americans and First Americans have significantly more sleep problems than white Americans, varying between 1% and 12.4%.

The National Sleep Foundation further breaks down by age the percentages of people who have insomnia symptoms:
– Adults aged 18 to 29: 68%
– Adults aged 30 to 64: 59%
– Adults aged 65 and older: 44%

In general, this means that more than 60 million Americans suffer from at least some form of sleep disruption if not outright insomnia. As shown below, these problems with sleep disrupt productivity, reduce well-being and put people at risk of injury and long-term, chronic medical and psychological conditions.

The Short- and Long-Term Effects of Insomnia

In the short term, insomnia can affect your ability to function effectively in your daily life. Medically reviewed literature shows that even acute insomnia can increase the chance of being in a car or other accident. Your performance at work or in school may suffer. Judgment can be impaired. You may also notice negative changes in mood, energy and sex drive.

In the long term, people with chronic insomnia are at a higher risk of developing medical conditions. These can include asthma, diabetes, heart disease, hypertension and high blood pressure, seizures and stroke. In terms of mental health, there is a higher likelihood among insomniacs of developing anxiety and depression. Other long-term effects can include higher pain sensitivity, inflammation and a weakened immune system.

It is important to remember at this point that insomnia is a treatable condition. Consulting with a doctor when symptoms first develop is your first and best defense in preventing these long-term effects.

Insomnia and Addiction

Insomnia can be one of several causes behind a substance use disorder or addiction. Alternatively, insomnia can be the result of alcohol or drug use or addiction. In either case, insomnia is more difficult to resolve when the sufferer has a history of substance use or addiction.

The Diagnostic and Statistical Manual of Mental Disorders states that insomnia is comorbid with a substance use disorder or addiction if it is “beyond the immediate substance use,” meaning it occurs both before and after the person has stopped using.

Whether or not insomnia is comorbid with an addiction, the fact that a history of substance use exists increases the likelihood that some classes of prescription sleep aids will be abused. Certain prescription sleep aids may also trigger an increase in other substance use or a relapse into addiction.

Why Are Some Sleeping Pills Potentially Dangerous for People With Addictions?

The problem with most prescription sleep medications is how they work in the brain. There are four categories of prescription sleep medication, each of which has both advantages and drawbacks.

1. Benzodiazepines: Often called “benzos,” these were developed to treat anxiety, which can be one of the major causes of onset insomnia. These have a high instance of dependency and can therefore lead to a further substance use disorder or addiction. Medications like clonazepam in Klonopin, alprazolam in Xanax, and triazolam in Halcion are in this category.

2. Z-Drugs: These are also called hypnotics or soporific drugs. Most are slightly newer medications than most of the benzodiazepines. While they appear to have high efficacy and general effectiveness, they are also known to be habit forming, lose their potency with long-term use and can create dependency that leads to addiction. These medications can also cause problems with heart rhythm and suppress respiration, so they are not recommended for elderly patients.

3. An emerging class of drugs affect the sleep-wake cycle. These include ramelteon in Rozerem and suvorexant in Belsomra. These are reportedly less likely to create dependency over time. However, they can cause dizziness, headaches, drowsiness during the day, sleep walking and worsening of depression. They can also affect the patient’s ability to function well the following day.

4. Orexin Receptor Agonists: Orexins are a class of neurochemicals that increase wakefulness and attention while hindering sleep. Some of the newest sleep medications block orexins. They work in different parts of the brain than the benzodiazepines and Z-drugs. This newer class of medication is thought to have fewer side effects. However, these medications also have a slight potential to be habit-forming.

It is extremely dangerous to mix prescription sleeping pills with certain substances that someone with an addiction may be abusing. These include:

– Painkillers, including narcotics like opioids
– Benzodiazepines, which are used to treat anxiety
– Antidepressants
– Alcohol

Given these dangers, a doctor or therapist may be unwilling to recommend most prescription sleep medication since it can be dangerous when combined with substances being abused and potentially lead to an additional addiction. However, there are still options for people suffering from both an addiction and insomnia.

Insomnia Treatment Options for Those With an Addiction

While many prescription medications may not be an option when the sufferer has a history of addiction, there are many other interventions, both medical and psychology, that are available.

A doctor may recommend a periodic dose of a supplement called melatonin, which has many benefits and few drawbacks. This sleep-assisting substance is naturally generated by the body when it begins to get dark outside, but production is often blocked by artificial light. Melatonin begins its cycle roughly two hours before you go to bed. While effectiveness varies, melatonin has no known dependency risks. It is available both as a prescription and over-the-counter medication.

Antihistamines are another option that doctors may recommend for those with an addiction. These proven over-the-counter medications include diphenhydramine, which is the active ingredient in Benadryl, and doxylamine succinate, which is usually under the brand name Unisom. Valerian root supplements, though not definitively proven to promote sleep, appear to reduce anxiety and decrease wakefulness during the night. All three of these, according to the Mayo Clinic, have little to no risk of dependency but have potential side effects that include drowsiness, constipation and urinary retention.

There are also psychological interventions that have proven effective in alleviating insomnia. These can treat the root cause of psychologically comorbid insomnia by attempting to alleviate anxiety and depression. When done weekly, cognitive behavioral therapy for insomnia has been proven effective and safe. CBT for insomnia may include keeping a “sleep diary” and working to change your sleep habits and nighttime bed rituals.

Meditation and yoga are also recommended and proven ways of improving insomnia. Yoga helps to stretch and relax the body while reducing pain. This allows the body to prepare for and get to sleep more effectively while limiting pain. Meditation, especially what is called “mindfulness meditation,” helps to quiet the mind, enhance problem-solving and reduce sleep-hindering anxiety.

While most types of meditation can be effective in helping with insomnia, a psychologist or psychiatrist may recommend a clinical version known as mindfulness therapy. Another variant of this is an eight-week program called Mindfulness Based Stress Reduction, or MBSR. This type of meditation seeks to reduce the long-term stresses that are often at the root of insomnia.

While managing both insomnia and addiction can be difficult, there are many options available that are scientifically proven to reduce insomnia safely.

NFA Behavioral Health offers treatment for addiction. The staff focuses on the problems that are both the causes and effects of addictive behavior. These include insomnia. Using integrative, multi-approach interventions, treatment at NFA Behavioral Health could increase your chances of better, more consistent sleep while improving your chances of long-term sobriety.