Many people have experienced the misery of insomnia, lying awake in bed, tossing and turning. A study by the Department of Psychiatry at the University of Hong Kong last year found that nearly a quarter of young people suffer from insomnia. Occasional insomnia that leads to feeling unwell and tired the next day can be remedied by catching up on sleep at night. However, if insomnia persists, it not only affects concentration and work efficiency, but over time, it can also increase the risk of developing conditions such as high blood pressure, coronary heart disease, and diabetes. It can also trigger mental health issues like depression and anxiety. Some people even resort to alcohol or medication to aid sleep, which may lead to alcohol dependence or drug abuse in the long run. So, what exactly is insomnia? Let's explore the 7 major causes of insomnia and the Do's and Don'ts of sleep hygiene to alleviate the suffering of sleeplessness!
What is Insomnia: At Least Three Nights of Difficulty Falling Asleep per Week for 3 Months – 7 Major Causes of Insomnia
Dr. Alan Wong, a specialist in family medicine at Hong Kong Sanatorium & Hospital, stated that according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by the American Psychiatric Association, individuals with insomnia must be dissatisfied with the "quality" and "quantity" of their sleep. This includes experiencing difficulty falling asleep, difficulty staying asleep, waking up too early, or difficulty falling back asleep after waking, at least three nights a week, and these problems must persist for at least three months. Those who suffer from insomnia have trouble falling asleep even when they have the opportunity to do so.
Dr. Wong pointed out that there are many causes of insomnia, often due to stress, and it can also be affected by poor habits and some physiological problems that impact sleep quality. Here are the 7 major causes of insomnia:
- Stress: The body's autonomic nervous system can become overactive due to stress from studies, work, and family, leading to palpitations and muscle tension. This is especially true for people who work night shifts or rotating shifts, or airline crew who frequently cross multiple time zones, as their biological clocks are easily disrupted, increasing the risk of insomnia.
- Poor Habits: Some poor habits, such as eating too much in the evening, can cause acid reflux; drinking too much water can lead to nocturia; smoking, consuming coffee, strong tea, and alcohol in the evening or at night can stimulate the brain. Other poor habits like watching TV, using mobile phones and tablets in bed, or an uncomfortable room temperature and lighting in the bedroom can also affect our physiological and psychological state, making it difficult to fall asleep.
- Physical Illnesses: Besides external factors, some physiological problems can also lead to insomnia. Dr. Wong explained that conditions like benign prostatic hyperplasia, overactive bladder, and diabetes can cause frequent urination, leading patients to visit the bathroom frequently at night; hyperthyroidism can make patients psychologically and physiologically restless; patients with chronic obstructive pulmonary disease and heart failure may also suffer from insomnia due to difficulty breathing.
- Mental Illnesses: Insomnia can be a symptom of mental illnesses such as depression, anxiety, and post-traumatic stress disorder.
- Medications: Certain medications can cause insomnia, such as the antidepressant SSRIs, bronchodilators for asthma, and some high blood pressure medications. Other over-the-counter medications that contain pseudoephedrine (e.g., nasal decongestants) can also induce insomnia.
- Sleep-Related Disorders: Sleep apnea, periodic limb movement disorder, and restless legs syndrome can all affect sleep quality.
- Primary Insomnia: If all other causes of insomnia are completely ruled out through clinical assessment, the patient is diagnosed with primary insomnia.
Sleep Test to Assess the Cause of Insomnia
Dr. Wong points out that if a patient seeks medical attention for insomnia, the doctor will first understand their sleep patterns through a consultation, arrange appropriate physical examinations and tests, and may even conduct a sleep test. During the test, data such as brain waves, breathing, heart rate, eye movements, and body movements are monitored to identify any hidden underlying diseases causing insomnia.
Sleep Hygiene: Do’s and Don’ts
| ✓ | ✗ |
| Go to bed and wake up at regular times; limit naps (preferably less than 30 minutes) | Frequent napping |
| Create a comfortable sleep environment: keep it quiet, with appropriate indoor light and temperature | Go to bed too hungry or too full |
| Relax your mind, listen to soothing music before bed, or take a warm bath | Drink caffeinated beverages before bed, such as coffee, cola, or tea |
| If you can't fall asleep, don't force it. Get up and do something light until you feel sleepy again. | Use bright screens before bed, such as tablets, mobile phones, or television |
If the root cause of insomnia can be identified, it is essential to "treat the symptoms." Doctors will also educate patients on good sleep habits and help them adjust their lifestyle and sleep as a first-line treatment. Other treatment methods include psychotherapy and medication.
- Psychotherapy: Cognitive Behavioral Therapy (CBT) is one type of psychotherapy for insomnia, and its effectiveness is comparable to sleeping pills, yet it is much safer. The therapy teaches patients to identify the causes of insomnia and correct incorrect sleep beliefs, such as the idea that they cannot sleep without medication or alcohol.
- Over-the-counter medications: These medications can be purchased directly from pharmacies or supermarkets without a doctor's prescription. For example, first-generation antihistamines used for colds and flu can cause drowsiness, but individuals with glaucoma and benign prostatic hyperplasia should avoid them. Melatonin may be helpful for those who work rotating shifts or frequently cross different time zones, but its effectiveness in treating insomnia may not be significant.
- Prescription Medications: If the above methods are not effective, or before cognitive behavioral therapy takes full effect, doctors may prescribe sleeping pills for short-term treatment to help with faster sleep onset and increased sleep duration. Commonly used sleeping pills include benzodiazepines, such as lorazepam and diazepam, which can shorten the time to fall asleep, extend sleep duration, and reduce grogginess upon waking. These medications are more suitable for short-term treatment; continuous use for several weeks can lead to dependence, as well as affecting memory, causing hallucinations, respiratory depression, and increasing the risk of falls in elderly individuals. Another class of non-benzodiazepines, also known as "Z-drugs," commonly includes zopiclone and zolpidem. Their chemical structure is completely different from benzodiazepines, but their efficacy, adverse effects, and risks are similar.
Correctly treating insomnia is crucial for promoting physical and mental health and improving quality of life. Dr. Wong reminds that if you continue to suffer from insomnia, it is essential to consult a doctor and not to self-medicate with unknown health supplements or over-the-counter drugs, nor to increase the dosage of prescribed medications on your own.
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