Testing & Sleep Studies
If youve been struggling at night to fall or stay asleep, you may want to get tested for insomnia. There is no one definitive test for insomnia that doctors use, but signs and clues that can lead to a diagnosis. If you find that you repeatedly cant sleep, first discuss potential insomnia causes with your doctor and/or therapist. Let your doctor know about all insomnia symptoms youre experiencing, including those that are emotional and physical. He or she will likely want to perform a medical exam, talk to you about any recent life changes and discuss your medical history.
Your doctor might also suggest that you take part in a sleep study test. Sleep studies/sleep tests are used to determine if insomnia is caused by conditions such as breathing problems, sleep apnea or limb movement disorders .
An insomnia test is conducted at a sleep laboratory that has rooms for you to sleep in for 12 nights. During your sleep, you will be connected to an EEG and monitored at different stages of sleep in order to indicate how long you spend in deep, restful sleep. This is a non-invasive test that is used to indicate the extent of your sleeping difficulty. Your body movements, breathing patterns, heart rate and oxygen levels overnight will also be tested.
What Are The Symptoms Of Insomnia
People experience insomnia differently. Some of the symptoms of insomnia are:
- having difficulty falling asleep
- waking a lot during the night
- waking up too early and being unable to go back to sleep
- not feeling refreshed when you wake up
Insomnia can lead to the following symptoms during the day:
- tension headaches
- feeling sleepy when sitting quietly
Home Remedies For Short
Reducing anxiety and sticking to a daynight routine can improve sleep quality. Suggestions include:
- Dont nap during the day.
- Cut down on smoking and drinking.
- Avoid tea, coffee and other caffeinated drinks before bed.
- Dont exercise strenuously before bedtime.
- Do something to relax, such as meditate or have a warm bath.
- Only go to bed if you feel sleepy.
- Go to bed later.
- Stop reading, worrying or watching television in bed and limit your activities in the bedroom to sleeping and sex.
- If you cant sleep, get up, go to another room and do something else until you feel sleepy again.
- Get up at the same time every morning regardless of how much sleep you have had.
- Avoid judging your sleep on a day-to-day basis.
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Medical History And Physical Exam
Your doctor will want to learn about your signs and symptoms, risk factors, health history, and family health history. To better understand your sleep problem, your doctor may have you fill out a questionnaire or ask you for details such as these about your sleep habits:
- How often you have trouble sleeping and how long youve had the problem
- When you go to bed and get up on workdays and days off
- How long it takes you to fall asleep, how often you wake up at night, and how long it takes you to fall back asleep
- How refreshed you feel when you wake up and how unrested you feel during the day
- Whether you use electronic devices with artificial light or watch TV before bed
- Whether you snore loudly and often or wake up gasping or feeling out of breath
To find the cause of your sleep problems, your doctor may ask whether you:
- Have any new or ongoing health problems
- Take any medicines
- A sleep study to look for other sleep problems, such as circadian rhythm disorders, sleep apnea, and narcolepsy.
- Actigraphy to measure how well you sleep. This requires you wear a small motion sensor three to 14 days.
- Blood teststo check for thyroid problems or other medical conditions that can affect sleep.
Mechanisms Of Action Of Insomnia Medication
Benzodiazepines and benzodiazepine receptor agonists
Benzodiazepine receptor agonists work through GABAA receptors to promote sleep by inhibiting brainstem monoaminergic arousal pathways, through facilitation of VLPO inhibitory GABAergic projections to arousal centers such as the anterior hypothalamus TMN, the posterolateral hypothalamic hypocretin neurons, and the brainstem arousal regions.
The GABAA receptor consists of 5 protein subunits arranged in a ring around a central pore. Most GABAA receptors consist of 2 alpha subunits, 2 beta subunits, and 1 gamma subunit. Upon GABAA receptor activation, chloride ions flow into the cell, resulting in neuronal hyperpolarization.
BZRAs enhance the effect of GABA by lowering the concentration of GABA required to open the GABA channel. BZRAs bind to a modulatory site on the GABAA receptor that is distinct from the GABA binding site and change the receptor complex allosterically to increase the affinity of the receptor to GABA, thus producing a larger postsynaptic current prolonging inhibition. Although BZRAs do not directly open the chloride channel, they modulate the ability of GABA to do so, thus enhancing its inhibitory effect.
Synaptic GABAA receptors typically contain a subunit in combination with an 1, 2, and 3 subunit. Most GABAA receptors expressed in the CNS are 1 2 2, 2 3 2, 3 3 2, 5 3 2.
Melatonin and melatonin receptor agonists
When Should I See My Doctor
It is a good idea to see your doctor if you are having trouble sleeping or you are having problems with your mood, feeling restless in bed, snoring badly or waking up not feeling refreshed. Keeping a sleep diary is a good way to track symptoms, which you can share with your health professional.
If they think you have insomnia, your doctor may refer you to see a sleep specialist or psychologist.
Do I Have Insomnia A Checklist
How do you know if you have insomnia? Heres a list of possible signs and symptoms:
- Difficulty falling asleep. You may feel wide awake at bedtime. Some people complain of racing thoughts or a busy brain. You may find the tiniest noises distract you and prevent you from relaxing. Or maybe you feel nervous and anxious. If you cant get to sleep when you want to even if youve adjusted your sleep habits and tried to unwind properly before bed you may have insomnia.
- Trouble staying asleep. Even more common than difficulty falling asleep is difficulty staying asleep . A great many insomniacs find they wake up in the middle of the night and cant go back to bed. If you find yourself feeling fully alert after less than a full nights sleep and you cant get back to sleep you may be experiencing a form of insomnia.
- Waking up tired. If you wake up feeling tired rather than restored, this may be a sign of lack of sleep or poor quality sleep. Insomnia may be to blame, but other sleep disorders may also lead to this result. Only a sleep specialist can tell you for certain.
- Daytime tiredness and fatigue. Some people fall asleep and believe they stay asleep all night yet they wake up tired and experience whats called excessive daytime sleepiness. If youre an adult with good sleep hygiene and are getting 6.5 or more hours of sleep each night but you still feel worn out and sleepy during the day, you may have a form of insomnia.
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Can Melatonin Help Me Sleep
Your body produces a hormone called melatonin that promotes sleep. Some people take melatonin supplements as a sleep aid. But theres no proof that these supplements work. Because the U.S. Food and Drug Administration doesnt regulate supplements the same as medications, you should talk to your healthcare provider before taking one.
Media Technology In The Bedroom
suggests that using devices with screens before bed can cause a loss of sleep in young people.
These devices can also harm sleep patterns in adults. Recreational use after lights-out appears to
- over-the-counter sleep aids, some of which are available for purchase online
- melatonin, which is also available for purchase online
However, there is not enough strong evidence to prove that melatonin helps with sleep.
A number of remedies and tips can help manage insomnia. They involve changes to:
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The Definition Of Insomnia
Heres the basic definition of insomnia: a condition in which someone lives without enough hours of sleep, or quality sleep, despite ample opportunity. In terms of a diagnosis, this lack of sleep must also cause distress and impairment in your life.
People often think of insomnia as difficulty falling asleep , but difficulty sleeping can happen at any stage of sleep. The most common experience is having trouble staying asleep , which includes experiencing frequent or prolonged awakenings throughout the night.
You may also awaken in the early morning before your body is rested and have trouble falling back asleep.
One of the most important things to know about insomnia is that it occurs during sleep time, but the impact continues throughout the day. Plus, its strongly associated with other health conditionsand can lead to significant difficulties functioning in at least one key area of life, such as social life, work, or school.
Pathophysiology And Biological Findings
Insomnia has long been considered to be a disorder of hyperarousal . Additional work has investigated the role of the hypothalamic-pituitary-adrenal axis in insomnia, both through physiological studies measuring the status and responsiveness of this system29 as well as the preliminary use of a corticotropin-releasing hormone antagonist to treat insomnia.30 The studies suggest that activation of the hypothalamic-pituitary-adrenal axis may contribute to the development of insomnia.
Quantitative electroencephalography has long been used as a potential marker of hyperarousal and or diminished homeostatic sleep drive. New evidence continues to suggest increased high frequency activity in at least some patients with insomnia, although the relationship of this finding to specific clinical features is less clear.31
Finally, additional work has continued regarding psychological models of insomnia in humans. In particular, new work has been focused on cognitive components of insomnia, including the development of safety responses and the involvement of selective attention as potential mechanisms for perpetuating insomnia.40,41
Charles M. Morin, Ruth M. Benca, in, 2011
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Dietary Supplements For Insomnia
There are many dietary and herbal supplements marketed for their sleep-promoting effects. Although they may be described as natural, be aware that sleep remedies can still have side effects and interfere with other medications or vitamins youre taking. For more information, talk to your doctor or pharmacist.
How Do I Know If I Am Suffering From Psychophysiological Insomnia
Do you go to bed at night feeling tired and sleepy, only to feel like a deer in the headlights when your head hits the pillowalert, awake, alarmed? Tend to fall asleep anywhere but in your bed? Or, do you tend to doze off any time but your bedtime? Do your morning conversations revolve around how bad or good your night has been? And is your psychological state mainly determined by how well or poorly you slept? If you recognize yourself in these descriptions, there is a high probability you are experiencing psychophysiological insomnia.
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What Are The Risk Factors For Insomnia
Insomnia occurs more often in women than in men. Pregnancy and hormonal shifts can disturb sleep. Other hormonal changes, such as premenstrual syndrome or menopause, can also can affect sleep. Insomnia becomes more common over the age of 60. Older people may be less likely to sleep soundly because of bodily changes related to aging and because they may have medical conditions or take medications that disturb sleep.
Insomnia Due To Drug/substance Abuse
Sleep disruption is common with the excessive use of stimulants, alcohol, or sedative-hypnotics. One of the following applies:
The patient has current, ongoing dependence on or abuse of a drug or substance known to have sleep-disruptive properties either during periods of use or intoxication or during periods of withdrawal
The patient has current ongoing use of or exposure to a medication, food, or toxin known to have sleep-disruptive properties in susceptible individuals
The insomnia is temporally associated with the substance exposure, use, or abuse, or acute withdrawal. The sleep disturbance cannot be better explained by another sleep disorder, medical or neurologic disorder, medication use, or substance abuse disorder.
Insomnia Not Due To Substance Or Known Physiologic Condition Unspecified
This diagnosis is used for forms of insomnia that cannot be classified elsewhere in ICSD-2 but are suspected to be the result of an underlying mental disorder, psychological factors, or sleep disruptive processes. This diagnosis can be used on a temporary basis until further information is obtained to determine the specific mental condition or psychological or behavioral factors responsible for the sleep difficulty.
How Many Hours Are Best
Some people do fine with six to seven hours per night, while others need nine, 10, or more hours a night to feel refreshed. Around seven to eight hours is optimal. There are also people who only need five or fewer hours of sleep to function at full speed. Some people need quiet and darkness to doze off, while others prefer white noise or the sound of a city humming in the background while they dream.
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Check If You Have Insomnia
You have insomnia if you regularly:
- find it hard to go to sleep
- wake up several times during the night
- lie awake at night
- wake up early and cannot go back to sleep
- still feel tired after waking up
- find it hard to nap during the day even though you’re tired
- feel tired and irritable during the day
- find it difficult to concentrate during the day because you’re tired
If you have insomnia for a short time its called short-term insomnia. Insomnia that lasts 3 months or longer is called long-term insomnia.
Improving Health With Current Research
Learn about the following ways the NHLBI continues to translate current research into improved health for people who have insomnia. Research on this topic is part of the NHLBIs broader commitment to advancing Sleep Science and Sleep Disorders scientific discovery.
Learn about some of the pioneering research contributions we have made over the years that have improved clinical care.
Another NHLBI-supported study, using fruit flies, showed that genes may explain sleep variations and may help to identify ways to treat insomnia. View To Sleep or Not: Researchers explore complex genetic network behind sleep duration for more information.
Challenging The Worries And Thoughts That Fuel Insomnia
Its also helpful to challenge the negative attitudes about sleep and your insomnia problem that youve developed over time. The key is to recognize self-defeating thoughts and replace them with more realistic ones.
|Challenging self-defeating thoughts that fuel insomnia|
|Self-defeating thought:||Sleep-promoting comeback:|
|Unrealistic expectations: I should be able to sleep well every night like a normal person. I shouldnt have a problem!||Lots of people struggle with sleep from time to time. I will be able to sleep with the right techniques.|
|Exaggeration: Its the same every single night, another night of sleepless misery.||Not every night is the same. Some nights I do sleep better than others.|
|Catastrophizing: If I dont get some sleep, Ill tank my presentation and jeopardize my job.||I can get through the presentation even if Im tired. I can still rest and relax tonight, even if I cant sleep.|
|Hopelessness: Im never going to be able to sleep well. Its out of my control.||Insomnia can be cured. If I stop worrying so much and focus on positive solutions, I can beat it.|
|Fortune telling: Its going to take me at least an hour to get to sleep tonight. I just know it.||I dont know what will happen tonight. Maybe Ill get to sleep quickly if I use the strategies Ive learned.|
What It Is How It Affects You And How To Help You Get Back Your Restful Nights
According to the American Academy of Sleep Medicines ICSD-3 manual, insomnia is defined as persistent difficulty with sleep initiation, duration, consolidation or quality. Insomnia has many potential contributing factors and symptoms, but its diagnosis hinges on two essential components: sleep difficulties that occur despite adequate opportunities for normal sleep, and daytime impairment that directly results from poor sleep quality or duration.
Chronic insomnia is characterized by symptoms that occur at least three times per week for at least three months. Insomnia that lasts or less than three months is known as short-term insomnia. In rare cases, patients may exhibit insomnia symptoms without meeting the criteria for short-term insomnia and may warrant some form of treatment. This is known as other insomnia.
While insomnia can manifest in different ways, most diagnoses fall into one of two categories:
Some people may have mixed insomnia that involves both sleep-onset and sleep maintenance difficulties, and people with chronic insomnia may find that these symptoms shift over time.
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What Other Problems Can Insomnia Cause
Insomnia can cause daytime sleepiness and a lack of energy. It also can make you feel anxious, depressed, or irritable. You may have trouble focusing on tasks, paying attention, learning, and remembering. Insomnia also can cause other serious problems. For example, it could make you may feel drowsy while driving. This could cause you get into a car accident.