Insomnia
Insomnia is a sleep disorder in which an individual has trouble falling or staying asleep. It can be transient (i.e. lasting from one night to several weeks), intermittent (i.e. recurrent bouts of transient insomnia), or chronic (i.e. occurring most nights and lasting for more than three months).
Overview
Insomnia can be caused by any number of factors that interfere with sleep, including behavioral factors such as use of caffeine and alcohol, use of screens (television, computer, phone) close to bedtime, chronic stress and mood disorders, long or irregular work hours, circadian rhythm disorders, medical conditions that cause pain, reflux, anxiety, or frequent urination, or fragmenting sleep disorders like sleep apnea. Irregularities in any of these domains can lead to difficulty falling asleep or fragmented sleep.
Symptoms
Individuals with insomnia typically describe difficulty falling asleep, difficulty with waking too often during sleep, or having prolonged awakenings, waking up too early and not being able to return to sleep, or waking up unrefreshed.
Diagnosis
Insomnia is diagnosed based on clinical history. Sleep logs and wearable devices that track sleep times are helpful in characterizing sleep-wake patterns. Sleep studies aren’t required for diagnosis and are only recommended when an individual describes symptoms of a co-existing sleep disorder such as sleep apnea.
Treatment
To adequately treat insomnia, behavioral interventions are often recommended. Behavioral interventions include addressing daytime habits that can impact sleep quality, minimizing use of caffeine and alcohol, minimizing use of television, computer, and phone screens prior to bedtime, establishing regular bedtimes and rise times, and avoiding stimulating activities during the sleep period. Cognitive behavioral therapy for insomnia (CBTI) is a formal approach to treating insomnia using cognitive and behavioral methods. It has been proven to be an effective treatment for insomnia. CBTI is considered a first-line therapy for chronic insomnia by the American Academy of Sleep Medicine. It’s also important to address any underlying sleep disorders as well as any psychiatric, pain, or medical conditions that may contribute to insomnia. Some individuals also benefit from using sedative medications to fall asleep and stay asleep.
Sleep Disorders Center
The Sleep Disorders Center at BIDMC is one of the largest academic sleep centers in New England. This multi-disciplinary center includes neurologists, pulmonologists and psychologists who treat adult patients with the full range of sleep disorders, ranging from sleep apnea to insomnia, narcolepsy to restless leg syndrome.