Insomnia (sleeplessness)

General | Effects of insomnia | Functional insomnia| Insomnia related to a somatic or mental disease or illness | How is insomnia treated | Medication of insomnia | When should you seek help?| For further information |

General  

Insomnia, or sleeplessness, is a usual complaint in adults of all ages; more than two thirds of the adult population experience occasional insomnia and 4 to 10 per cent suffer from long-term insomnia. At FSHS, sleep troubles are one of the top 15 causes for visiting a doctor. Insomnia is the most common sleep disorder, and it comprises difficulties in falling asleep, waking up recurrently during the night and waking up too early in the morning. Sufficient sleep cannot be defined by the number of hours you sleep each night. If you wake up refreshed and alert and capable of assuming your daily duties, you have got a good night's sleep.

Effects of insomnia

The amount of sleep an individual needs varies, and we all sleep poorly from time to time. An occasional sleepless night or a night of poor sleep is not dangerous and does not usually influence your daytime functioning in any way. However, if sleep problems occur repeatedly or persist for weeks, they result in sleep deficit and subsequent fatigue and impaired quality of life. In such a situation, the person is less alert, and there is a higher risk of accident or injury in traffic and in other exacting tasks. If you have irregular working hours and need to be awake during the night, it is not advisable to drive a car after a night shift. For instance, it has been found that doctors tend to fall asleep while driving a car more often after a night on duty than at other times.

Continued insomnia leads to:  

  • irritability 
  • reduced resistance to diseases 
  • disturbances in memory, concentration and learning
  • increased risk of accident or injury
  • predisposition to mental health problems.

Functional insomnia  

Functional insomnia is the most common type of insomnia, and the most usual sleep disorder as well. Functional insomnia is not related to any disease or health problem. Instead, stress, worrying, sudden life changes or other external factors prevent you from falling asleep in the evening or wake you up too early in the morning.

The ever accelerating changes in society, as well as individual pressures associated with studies, work, leisure activities or personal relationships, increase the risk of functional insomnia. Unfortunately, "having a sufficient amount of sleep" is not often a priority when we arrange our lives and use of time.

In addition to the above, the following factors expose us to functional insomnia: 

  • working irregular shifts 
  • recurrent waking during the night for a longer period of time (e.g. when parents are woken up by their baby)
  • excessive physical activity (sports and exercise!) late in the evening 
  • hormonal changes (for instance, menopause in women) 
  • abundant use of coffee, tea or cola drinks.

Temporary sleeplessness in connection with significant life changes or stress is natural, and there is no reason to be concerned. It is simply one way in which your body reacts to change, and it normally subsides when the situation involving change or stress settles down.

Insomnia related to a somatic or mental disease or illness  

Long-term (chronic) insomnia may be a symptom of an underlying disease or illness that must first be diagnosed and treated in order to deal with the sleep disorder.

The following diseases or illnesses may cause insomnia:

  • depression 
  • anxiety 
  • fibromyalgia 
  • chronic pain 
  • sleep apnoea (cessation of breathing during sleep) 
  • abundant use of alcohol, alcoholism and drug addiction.

How is insomnia treated?

To promote a good night's sleep, or to treat a mild form of insomnia, you should try to ensure that your sleeping conditions and habits are optimal. The following self-help measures for better sleep, or good "sleep hygiene" practices, have been issued by a national "Rohto" project in Finland. They are recommended to anyone suffering from sleep problems.

Self-help measures  

Good sleeping habits are the key in the treatment of functional insomnia:

  •  Avoid using your bed for anything other than sleep (and sex). 
  • Do not go to bed until you feel sleepy. 
  • Try to get up at the same time each morning (also at weekends). 
  • Avoid napping during the day, but if you absolutely need to take a nap, do it at the same time every day and do not sleep more than an hour.

Tips to help you get to sleep:

  • Do not drink alcohol less than two hours, or coffee, tea or other drinks containing caffeine less than six hours before going to bed. 
  • Avoid smoking for a number of hours before bedtime. 
  • Try to relax and calm down: avoid physical exercise, excitement, noise and entertainment showing violence. 
  • Make sure your bedroom is ideal for sleeping (correct temperature, soft lights, low noise level, a good bed). 
  • Eat a light, high-carbohydrate snack (such as bread and milk) before you go to bed. If you wake up during the night, however, do not eat anything. 
  • If you do not fall asleep in less than half an hour, get up and go to another room to do something quiet and relaxing. Do not go back to bed until you feel sleepy. 
  • Reading in bed for a while may help you fall asleep (especially if the text is boring).

Learning effective relaxation techniques may help you fall asleep. For instance, listening to a relaxation tape or music or stretching to relax muscles may be of help.

Medication of insomnia (sleeping pills)  

Use of sleeping pills has increased significantly during the past 15 years in Finland. Although sleeping pills are much safer today than they used to be, there is no sleep aid or sleeping pill that would be completely risk-free. All sleeping medicines involve a risk of inducing addiction or dependence and, as any drug, they may have adverse effects. If functional insomnia does not subside by itself, or if the cause of insomnia cannot be treated or influenced, short-term medication should be considered to break the circle of insomnia. Long-term use of sleeping pills is rarely necessary.

The national "Rohto" project has issued guidelines for the use of sleeping pills.

Sleeping pills may help but they are not a permanent solution to the problem.


What you should know about sleeping pills:

 Stick to the above self-help measures even during the medication. 

  • Sleeping pills are meant for temporary, short-term use only. 
  • The efficacy of sleeping pills often begins to decline after four weeks of use. 
  • You can take sleeping pills intermittently (for instance, three nights a week). 
  • Take the sleeping pill at the time you go to bed, but do not take any sleeping pill after midnight. 
  • Never take more than one sleeping pill per night.
  • All sleeping pills may have adverse effects, including daytime tiredness, memory disturbances, confusion and waking up in the early morning hours and, especially in elderly people, balance disorders. 
  • If you have used sleeping pills regularly for a longer period, do not stop using them abruptly. Halve the dose one or two nights before you stop taking the sleeping pill.

When should you seek help? 

It is advisable to consult a nurse, general practitioner or psychologist if:

  • insomnia has continued for several weeks or months, and your own sleep-promoting efforts do no have the desired effect; 
  • insomnia clearly interferes with your ability to function and carry out your daily activities; 
  • long-term insomnia is accompanied by other symptoms, such as depression, anxiety, narcolepsy (falling asleep during the day) or continuous pain.

For further information:
Insomnia

Literature (in Finnish):
Potilasohjeet unettomuuden hoitoon, Guidelines for treatment of insomnia issued by the national "Rohto" project
Nukkuu - vai nukkuuko, Hyvä Terveys 12/2000
YKT-lääkärin tietokanta, Database issued by Duodecim
Härmä & Sallinen, Univaje terveysriskinä, Duodecim 20/2000

 The article is made by: Dr Johanna Castren


Key words: Insomnia