Insomnia: The causes

Insomnia in its most disabling form - meaning several consecutive sleepless nights - affects 10-15% of Americans. This problem has been a boon for the sleep aid industry - millions are taking medications for insomnia, and the number is increasing all the time. In the past five years there has been a 100% increase in use of sleeping pills. Higher rates of insomnia are seen in older people and women. Usage of sleeping pills in the elderly is even more worrisome than in younger people. Between 5-33% of individuals over the age of 60 are prescribed a sleeping pill in the form of a z drug or a benzodiazepine.

Primary insomnia is the most common cause of insomnia, and unrelated to any other disorder or illness. Patients with primary insomnia are anxious and restless in bed, and feel pressure to go to sleep. They develop negative attitudes and expectations about their ability to go to sleep and may sleep better away from bed (e.g., in a comfortable chair or sofa watching TV or listening to music). There are multiple other common potential causes of insomnia, including:

• Poor sleep habits (doctors call it "sleep hygiene") including staying up too late or getting up too early, eating and drinking late at night, illness, or over-stimulating ourselves with work, worry, stress or late night TV watching.
• Sedentary lifestyle (people who exercise regularly, but not late at night, sleep better and more deeply than those who don't)
• Pain
• Medical conditions such as cancer, AIDS, lung disease, musculoskeletal disorders, and degenerative brain disease.
• Medications (including bronchodilators, caffeine, theophylline, and stimulants such as Ritalin, amphetamine, steroids, antihypertensive drugs, and antidepressants)
• Snoring or restless bed partner
• Stress and anxiety
• Excessive alcohol or drug use
• Sleep apnea, often seen in overweight individuals, where the airways become obstructed causing the individual to wake up frequently. Sleep apnea can be accurately diagnosed and treated by a doctor using something called Continuous Positive Airway Pressure (CPAP). This is a machine that delivers air into your airways through a mask that you wear at night.
• Shift work

Insomnia can lead to a host of other problems. For instance, about 40% of people with insomnia also suffer from anxiety or depression. It is difficult to say whether the insomnia or the mental disorder comes first. Trouble falling and staying asleep can also affect memory and cognition, as well as decreased productivity and decreased quality of life. Recent studies have shown that insomnia has an important effect on promoting a variety of poor physical health outcomes including a link between being overweight and lack of sleep.