The CallonDoc Guide to Insomnia

Sleep is exceedingly important, it helps us heal from wounds, supports mental stability, and promotes positive health benefits across the board. However, a lack of it can lead to a reduced daily performance and a weaker immune system In many cases, prolonged lack of sleep is caused by what is called insomnia. 

Trouble sleeping is hardly a new phenomenon, but it isn’t something to take lightly. According to the Sleep Foundation, around 15% of Americans in the United States report being affected by a form of insomnia or other sleep disorder by a form of insomnia or other sleep disorder, about 50-70 million people. 

Symptoms: What are common insomnia symptoms?

Insomnia symptoms vary from person to person based on a variety of factors, including how a person sleeps at night. According to the National Heart, Lung, and Blood Institute, symptoms include sleeping in short periods, lying awake before sleeping, waking up too early, and not feeling the benefits of sleep.

Is insomnia a symptom of anything?

Insomnia can be a symptom of various underlying medical, psychological, or lifestyle conditions. For example, it can be a symptom of anxiety or depression, chronic pain, hormonal imbalances, or substance abuse. It can also be a side effect of certain medications. In some cases, insomnia may be a primary sleep disorder with no clear underlying cause.

According to WebMD, insomnia doesn’t include staying out or working late and getting too little sleep as a result but rather is defined as a person being incapable of falling asleep. Outside of primary insomnia, here are some examples where insomnia can be a symptom:

Allergies: According to the Sleep Foundation, those with allergies are more than twice as likely to suffer from insomnia. Allergy symptoms such as irritated skin, swollen/watery eyes, rhinitis, and other related reactions can contribute to causing insomnia.

Excessive stress: According to the Sleep Foundation, stress and insomnia often go hand in hand. On top of putting strain on the brain and heart, stress can release hormones that make sleeping difficult and amplify other problems. 

Grief: According to the Sleep Foundation, it is common for those grieving to suffer from insomnia.    Similar to stress, grief has a tendency to have negative impacts on your body and contributes to releasing hormones that keep the body in a more agitated state. 

GI disorders: According to Sleep Dysfunction and Gastrointestinal Diseases, insomnia and gastrointestinal diseases can be closely related. Accompanied by discomfort, conditions like IBS, acid reflux, inflammatory bowel, and will put enough strain on a person to keep them uncomfortable and awake. 

Irregular sleep patterns: Irregular sleeping patterns, such as frequently changing bedtimes or wake-up times, making it harder to fall asleep and stay asleep, and disrupting the body's natural circadian rhythm. The circadian rhythm is the body's internal 24-hour clock that regulates sleep-wake cycles, hormone production, and other biological processes. This can lead to insomnia and a host of other negative effects on physical and mental health.

Mental Illness: According to the National Alliance on Mental Illness, around half of insomnia cases are due to mental illness. More specifically, depression, anxiety, and others make sleep significantly more difficult. 

Pain: Chronic and regular pain can make it difficult to fall asleep and stay asleep, as the discomfort and physical sensations can keep the body and mind awake. This can result in a cycle of pain and insomnia, where the lack of sleep exacerbates the pain, and the pain further disrupts sleep, leading to chronic sleep deprivation and fatigue.

Pregnancy: The Sleep Foundation points to a common link between pregnancy and insomnia, with 60% of pregnant women suffering from insomnia. This can be due to the many features of pregnancy, like nausea, hormone changes, heartburn, physical discomfort, and more. 

Premenstrual syndrome: According to WebMD, there are varying reasons why someone with PMS might have insomnia as a symptom. Not just from the hormone change, but also from other symptoms like swelling, muscle pain, pelvic pain, mood changes, and more may contribute to a lack of sleep. 

Are there different types of insomnia?

Yes, according to Stanford Medicine, there are different types of insomnia. Insomnia can be classified five types:

• Transient: A brief and self-limiting form of sleep disturbance that typically lasts for a few days or weeks, often caused by stressful life events, environmental factors or changes in sleep routine.
• Short-term: Short-term insomnia is a sleep disorder that lasts for several weeks, often caused by a medical condition, medications, or emotional stress.
• Chronic: Chronic insomnia is a long-term sleep disorder that lasts for at least three nights a week for three months or more and can be caused by underlying medical or psychological conditions.
• Primary: Primary insomnia is a sleep disorder that is not caused by an underlying medical, psychiatric, or environmental condition, but rather, is a chronic condition that can return throughout a person’s life.
• Co-morbid: Co-morbid insomnia is a sleep disorder that occurs alongside another medical or psychological condition, such as anxiety or depression, chronic pain, or sleep apnea. In these cases, treating the underlying condition may also help alleviate insomnia symptoms.

Insomnia can also be classified based on the specific sleep-related symptoms experienced, such as difficulty falling asleep, difficulty staying asleep, or early morning awakenings. Understanding the type of insomnia a person is experiencing is important for identifying the underlying cause and determining the most effective treatment approach.

Causes: What is the main cause of insomnia?

According to the Sleep Foundation, insomnia can have various causes, and it is often a combination of factors that contribute to the development of the disorder. 

• Psychological factors, such as anxiety, depression, and stress, are common causes of insomnia. These conditions can lead to racing thoughts, worry, and an inability to relax, making it difficult to fall asleep and stay asleep. 
• Medical conditions, such as chronic pain, respiratory problems, and gastrointestinal disorders, can also interfere with sleep and cause insomnia. Poor sleep hygiene, such as irregular sleep schedules, consuming caffeine or alcohol before bed, or excessive screen time, can also disrupt sleep and cause insomnia. 
• Environmental factors, such as noise, light, and extreme temperatures, can also interfere with sleep. 
• Certain medications, such as stimulants or antidepressants, can interfere with sleep and cause insomnia. 
• Hormonal factors, such as fluctuations in hormones during menopause or menstrual cycles, can also disrupt sleep and cause insomnia. 
• Insomnia can also run in families and may have a genetic component.

Is insomnia a mental illness or physical?

Insomnia is generally not considered a mental illness or a physical illness on its own, but rather a symptom of an underlying condition or set of conditions that affect a person's ability to fall asleep or stay asleep. More often than not, it is not an isolated condition, being a sign of a greater problem that should be addressed. 

Diagnosis: How is insomnia diagnosed?

According to the National Heart, Lung, and Blood Institute, insomnia can be diagnosed when you “have difficulty falling or staying asleep for at least 3 nights a week…and lasts for 3 months or longer.” 

Tests that check for insomnia will check for whether you have conditions like sleep apnea or study your circadian rhythm. Other tests run in relation to insomnia may not necessarily be directly for insomnia, like blood tests, but will provide you with more information about underlying problems. 

At what point is insomnia severe?

The severity of insomnia can vary widely depending on the individual and their specific symptoms. Insomnia is generally considered severe when it significantly impacts a person's daily functioning and quality of life.

For example, if a person is unable to fall asleep or stay asleep for more than three nights a week, for three months or longer, and experiences daytime fatigue, difficulty concentrating, and mood changes, then the insomnia is considered severe. Severe insomnia can have a significant impact on a person's ability to function at work or home, as well as their overall health and well-being.

Additionally, if insomnia is caused by an underlying medical or mental health condition, or if it is accompanied by other symptoms such as chronic pain or sleep apnea, it may be considered more severe and require additional treatment.

If you are experiencing symptoms of insomnia that are impacting your daily life, it is important to talk to your doctor to determine the underlying causes and develop an appropriate treatment plan.

Treatment: What is the most prescribed treatment for insomnia?

Outside of melatonin and CBT therapy, there are many medications a person has to choose from for regular insomnia treatment. Such medications offered by CallonDoc can include:

• Doxepin
• Hydroxyzine
• Ramelteon
• Trazodone

Additionally, the goal of insomnia treatment is to improve the quantity and quality of a person's sleep and to address the underlying causes of the condition. That would mean suggesting lifestyle changes around when a person goes to sleep. Such changes include setting a sleep schedule, changing a diet, practicing stress management, and more. 

Management: What are the coping mechanisms for insomnia?

There are several coping mechanisms that can help individuals manage insomnia and improve their sleep habits. Here are a few examples:

• Maintain a consistent sleep schedule: Go to bed and wake up at the same time every day, even on weekends or days off. This helps regulate your body's clock and can help you fall asleep and stay asleep.
• Create a relaxing bedtime routine: Engage in relaxing activities such as reading a book, taking a warm bath, or listening to calming music before bed. This can help signal to your body that it's time to wind down and prepare for sleep.
• Practice good sleep habits/environment: Make sure your sleep environment is cool, quiet, and comfortable. Avoid using electronic devices in bed, as the blue light emitted from screens can interfere with your body's production of melatonin.
• Limit caffeine and alcohol intake: Both caffeine and alcohol can disrupt sleep, so it's important to limit your intake, especially in the hours leading up to bedtime.
• Manage stress and anxiety: Stress and anxiety can make it difficult to fall asleep and stay asleep. Try relaxation techniques such as deep breathing, meditation, or yoga to help manage stress.
• Get regular exercise: Regular exercise can help promote better sleep, but be sure to avoid vigorous exercise in the hours leading up to bedtime.
• Consider therapy: Talking to a therapist or counselor can help address any underlying mental health conditions that may be contributing to your insomnia.

Can insomnia go away on its own?

In some cases, insomnia may resolve on its own without treatment. For example, transient insomnia, which is short-term insomnia lasting less than a week, may resolve without any intervention once the underlying cause has been addressed.

However, for other types of insomnia, such as chronic insomnia, it is less likely to resolve on its own without intervention. Chronic insomnia is defined as having difficulty falling or staying asleep for at least three nights a week for three months or more. Without treatment, chronic insomnia can have negative effects on a person's overall health and quality of life.

It's important to note that while these natural remedies may be helpful for some people, they may not be effective for everyone. If you are experiencing persistent difficulty falling or staying asleep, CallonDoc can provide a treatment plan to get you back to a normal sleep routine. If you're reading this during a time you should be sleeping, you can start a visit now and pick-up your prescription first thing in the morning when your pharmacy opens.

Source: 

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8. Pacheco, Danielle. “How Grief and Complicated Grief Affect Sleep.” Sleep Foundation, 10 June 2022, https://www.sleepfoundation.org/mental-health/grief-and-sleep.
9. “Sleep Disorders.” NAMI, https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Sleep-Disorders
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11. “Insomnia - Diagnosis.” NHLBI, 24 March 2022, https://www.nhlbi.nih.gov/health/insomnia/diagnosis.
12. Lie, Janette D et al. “Pharmacological Treatment of Insomnia.” P & T : a peer-reviewed journal for formulary management vol. 40,11 (2015): 759-71.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634348/.