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Having trouble sleeping? Find out what insomnia is and how it’s diagnosed and treated.


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You try to get 8 hours of sleep each night, but you struggle to fall asleep or wake up throughout the night. Sounds familiar? You might have insomnia.

About 30% of all people have difficulty sleeping and about 10% of those people will get an insomnia diagnosis, according to Dr. Deirdre Conroy, clinical director of the Behavioral Sleep Medicine Clinic at the Michigan Medicine Sleep Disorders Centers. 

Out of those 10% of people who have diagnosed insomnia, about 40% of them experience mental health disorders, according to the National Sleep Foundation. That’s not surprising given that most people can tell you that if they are stressed, they’re also having a hard time sleeping.

Even though mental health issues are one of the biggest causes of insomnia, they don’t explain all cases. Keep reading to find out more about the most common causes of insomnia and what you can do to get some relief and much needed sleep. 

What is insomnia and how is it diagnosed?

Insomnia, broadly speaking, is a sleep disorder that is characterized by difficulty with falling asleep, staying asleep or getting enough hours of sleep. Insomnia can happen for a short amount of time, or it can be persistent, which is called chronic insomnia. 

There is no test or lab work that can specifically diagnose insomnia, so according to Dr. Conroy, most doctors will look for a few key symptoms in order to make the diagnosis. “They have to tell me that they’re either having trouble falling asleep or staying asleep or waking up too early, and it’s interfering with their daytime functioning in some way,” Dr. Conroy says. 

Interfering with your daytime functioning can look different for everyone, according to Dr. Conroy. You might feel more irritable or sad or, in some extreme cases, you might fall asleep in the middle of the day while you’re trying to work.

Besides having difficulty falling asleep, staying asleep or waking up too early, the Mayo Clinic says other insomnia symptoms may include:

  • Not feeling well-rested after a night’s sleep
  • Daytime tiredness or sleepiness
  • Irritability, depression or anxiety
  • Difficulty paying attention, focusing on tasks or remembering
  • Increased errors or accidents
  • Ongoing worries about sleep

How do you know if you have insomnia?

Many people will experience occasional sleep issues, which are sometimes related to stressful events or other life factors that affect sleep (like having a baby). But insomnia has a specific set of symptoms. For example, if you’ve only had sleep issues for a week or two, you most likely won’t get an insomnia diagnosis from a doctor.

The first thing a doctor will ask is how long you’ve had trouble sleeping. If you have insomnia you have to report to a doctor that you’ve been having trouble sleeping for more than a month. Then you also have to report that the sleep issues you experience have a significant impact on your quality of life or affects your work or social life. Your doctor will also want to rule out that your sleep issue isn’t related directly to another medication or other substance you are taking.

“The thing is it’s really what you tell the provider — there’s no blood tests, in fact even sleep studies are not indicated for insomnia in the absence of other medical complications,” Dr. Conroy explains.

The most common causes of insomnia and how they’re treated

Mental health disorders like anxiety and depression

Mental health conditions like anxiety and depression are common and can affect your sleep, which explains why many people with insomnia also experience mental health issues.

When it comes to treating insomnia related to mental health, you have several options that can help address both sleep issues and mental health. “In general there are two major options that most of the research studies support. Either medication and/or cognitive behavioral therapy for insomnia specifically. CBT is a big one, it can be used for anxiety and depression but there’s a specific course of action that we take when it relates to insomnia,” Dr. Conroy says. 

Shift work or working the night shift 

When you work shift work, specifically the night shift, your body begins to readjust its circadian rhythm, also known as the “clock” your body operates on. When you change the time that you sleep from night to day, or vice versa, your body will shift that circadian clock over time. Once that changes, it’s not easy to go back, or at least not right away.

“You readjust. But it does take some time. For many people just having that experience of a few nights or a few weeks of difficulty sleeping could then trigger some stress about it. So then you have two problems. You have an internal biological clock problem and you have anxiety about it,” Dr. Conroy says.

“The good news is there are things you can do like behavioral interventions which we work with people on all the time, lifestyle factors that you can modify to get you back on track,” Dr. Conroy says.

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Writing down what’s worrying you in a journal may help you sleep better.


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Medical problems and other sleep disorders

One of the most common sleep disorders is sleep apnea, which can lead to other serious health issues and make you feel more tired during the day. According to the National Sleep Foundation, sleep apnea can be an underlying cause of insomnia. 

“If you have some snoring, if anyone has seen you stop breathing, or if you are having any choking or gasping at night, that’s a sign or symptom of sleep apnea. And that could manifest as I’m having trouble staying asleep. So you may want to talk to your doctor about those other types of symptoms because there are hundreds of types of sleep disorders and many of them we test for in the laboratory,” Dr. Conroy says. 

Tips for better sleep

If stress or worry surrounding COVID-19 is keeping you up at night and it’s interfering with your daily life, be sure to talk to a medical professional first. You want to rule out any possible medical or mental health problems first to determine why you’re struggling to sleep.  Beyond that, Dr. Conroy shares a few tips on how to cope with worry or stress-induced sleep issues.


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Disengage

“We are bombarded with information throughout the day and so many of my patients are just scrolling through their phones before bed,” says Dr. Conroy. While you might have good intentions for all that scrolling — say, wanting to keep up with current COVID-19 or political news — Dr. Conroy suggests putting your phone down an hour before bedtime. “Put your phone outside of the bedroom if you can,” she says.

Worry journal 

Rather than lie in bed stressing out about all the things you need to take care of tomorrow, try getting those worries out on paper. “Worry can be OK if you do it constructively. A technique I go over with my patients is to take 15 minutes to write down all of your worries and what you can do about it right now. Most people push off their worries until they go to bed and turn the lights off. So set aside a time to constructively worry,” Dr. Conroy says.

Exercise during the day and avoid naps 

Be more active in the day if you can. Take a walk and get light exposure, maybe if you’re not exercising now, establish an exercise routine. And watch the naps and avoid dozing off between Zoom meetings. Avoid naps in general in the first part of your day and not too close to bedtime, and try to limit them to 20 to 30 minutes,” Dr. Conroy says. 

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.

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