Chronic insomnia: Causes, effects, and treatment options

If you have trouble falling asleep for more than three nights a week for a significant time period, you may have chronic insomnia. H

ere are some causes and cures for this condition.

What is chronic insomnia?

Insomnia is a condition where we have persistent, problematic problems with sleeping. Some people with insomnia find it hard to sleep; others find that they wake often and for long periods through the night; some have both.

Having occasional problems with sleep is very common, and when it’s short-term or for an easily identifiable and manageable reason, it shouldn’t become a problem.

When we’re not easily able to improve our sleep and our sleeplessness begins to affect our daily lives, we need to take some action.

Having consistent sleeping problems – more than around three nights a week of disturbed sleep for at least one month is referred to as insomnia, rather than a more simple temporary sleeping problem.

Insomnia lasting less than three months can be referred to as short-term insomnia. Sleeping problems that last longer than six months may be called long-term insomnia.

Over 15per cent of adults in Singapore experience insomnia at some point in their lives.

What causes insomnia?

Humans have a natural ‘circadian rhythm’ – this means that we follow patterns of sleep and wakefulness that follow the rhythm of day and night.

When we do things that disturb that rhythm – sleeping through the day and staying up at night, or confusing our bodies with bright artificial lights at bedtime, for example – we can seriously disturb our sleeping patterns.

Stress, depression, anxiety and mental health problems

If you’re finding yourself lying awake thinking about the things in life that make you feel stressed, depressed, or anxious, it might be a good idea to consult a doctor.

We can’t always manage emotional trauma or mental illness without support, and there’s no need to suffer alone.

Discomfort or pain

It could be something as simple as an old, lumpy mattress or pillow, or a room that is too hot or cold. It could be a more complex problem like a chronic illness or condition that causes pain, in which case you might need input from your GP.

Jet lag and variable shift patterns

It can be much harder to get into a good sleep pattern if we’re continually having to change the times we sleep or the length of time we’re awake through the day.

Poor sleeping habits

Going to bed too late then lying in when we’ve slept badly just leads to a never-ending cycle of increasingly poor sleep. Looking at bright screens at the end of the day is a particular culprit for making it difficult to get to sleep.

Stimulants

It should come as no surprise that stimulants like caffeine or nicotine can make it harder for us to get to sleep. They can even still affect our bodies several hours after taking them, so it’s a bad idea to take any form of caffeine or nicotine within around 6 hours of bedtime.

Alcohol

Alcohol can make some people feel a little sleepy, so it can be tempting to use it to help you fall asleep. However, having too much alcohol can actually have a negative impact on your sleep patterns and sleep quality.

Night-time pressures

If you have a new baby in the house, or have other caring responsibilities within the home that may cause you to wake in the night, it might not be easy to get any good rest, and this can be hard to manage without help from other people.

Some illnesses can also cause insomnia. Chronic pain conditions or breathing problems associated with lung or heart disease, and sleep apnea, in particular, can impact sleep quantity and quality.

What are the effects of chronic insomnia?

Insomnia can have a serious negative impact on our day-to-day lives. Tiredness makes it hard to cope with challenges and illness, and just the experience of lying awake at night can have an impact on our emotions and resilience.

Insomnia also has some long-term effects on our health, and can make us more likely to develop certain serious diseases. Long-term sleep pattern disturbances can be extremely bad for our health.

Some people also find that they turn to a more unhealthy lifestyle as a way of managing either immediate tiredness or longer-term sleeplessness.

Becoming reliant on alcohol to sleep can cause serious problems, and is an independent risk factor for some serious conditions, including liver failure and cardiovascular disease.

Being tired throughout the day can increase the tendency to snack, having an impact on weight and fitness levels that might already be affected by sleep disturbances.

Increased risk for medical conditions

Insomnia is closely linked with certain diseases – insomnia significantly increases a person’s risk of hypertension and cardiovascular disease.

It’s not completely clear how it does so, but it is likely to be a complex combination of factors including inflammatory and nervous system responses, and the lifestyle factors associated with both causing and being caused by insomnia.

People with insomnia may be more likely to turn to food, caffeine, alcohol and nicotine to give them the boost they need to get through a day of tiredness.

In addition, getting enough exercise can feel impossible after some sleepless nights. Obesity is linked to insomnia, both as a contributing factor and an effect.

People with insomnia are also more likely to report breathing problems, urinary problems, chronic pain, and various other conditions.

It isn’t always clear whether a medical condition causes insomnia or insomnia causes or exacerbates another condition; the correlation of insomnia with other health conditions can become a self-perpetuating circle of illness.

Treating insomnia which is associated with underlying medical conditions requires a truly holistic approach that addresses several problems at once.

Increased risk for mental health disorders

Mental health problems can contribute to insomnia, but they can also be caused by or exacerbated by insomnia.

Lying awake at night mulling over the things that you’re worried about to the point where your sleeplessness affects your daily life and mood can be a sign of a mental health problem that you need support with.

Having a mental illness and a sleep disorder can be a self-perpetuating spiral that may seem insurmountable. Your GP is always there to provide support, advice, and treatment for mental health problems.

Increased risk for accidents

Being tired causes accidents; it affects our concentration, our attentiveness, response times and our ability to make sensible choices.

As much as 30per cent of road traffic accidents are thought to be linked to tiredness while driving. We have a responsibility to recognise when we’re too tired to safely drive, operate machinery, work, or care for our families.

Unfortunately, the pressures to continue to live our essential daily tasks can make it hard to take a break or get help when we need to, which can lead to dangerous situations.

It’s important to be aware that tiredness is a major contributing factor in the incidence of accidents on the road, at work, and even in the home.

Shortened life expectancy

Maintaining a healthy balance with our circadian rhythm is important for our health, and can actually have an impact on our life expectancy.

People who only work day shifts live longer than night shift workers, and those who switch frequently between day and night shifts have a shorter average lifespan again.

Insomnia increases our risk of accidents, our physical and mental health, and seems to independently impact our lifespan even when these other factors are accounted for.

What can you do to manage insomnia?

Most short-term insomnia can be improved by practising good sleep hygiene. This means making simple changes in your lifestyle to improve your sleep quality. This includes:

• Going to bed and getting up at around the same time every day
• Managing external factors that may be causing disturbances in your circadian rhythm – if shift patterns are making you unwell, you can discuss this with your employer or human resources department as they may be able to make some changes. If you have caring responsibilities that keep you up through the night, try and find some way to reduce night-time disturbances. This may not always be possible; the demands of being the main carer for a new baby might not be easy to share, but some duties can be supported by a formal care package , for example if you have an elderly relative who needs care through the night.
• Staying active through the day, particularly if you can get some fresh air and exercise.
• Improving your sleeping environment – a cool, dark, quiet room with a comfortable bed.
• Restricting your screen use near bedtime – looking at bright artificial lights before bed can affect that all-important circadian rhythm.
• Sticking to regular mealtimes; eating late at night, in particular, can cause an unsettled night.

Home Remedies

Simple sleep hygiene practices can be tried at home without risk. There are a number of other home remedies, many of which combine traditional medicine with sleep hygiene. Home remedies for sleeplessness include:

Warm baths

Soaking in a warm, relaxing bath at bedtime might help you nod off. Using scented oils or bubble baths that are designed to help with rest and relaxation may also help.

Aromatherapy

There are lots of different aromatherapy products that can be used at home, including scented pillow sprays or lavender-filled cushions to keep on your bed, ‘sleepytime’ teas containing lavender, valerian, oats and other sleep remedies.

Milky drinks

But without caffeine. Malted milky drinks have a strong traditional association with improved sleep.

Oats, bananas, milk products

Some foods are positively associated with sleep. Eating oats may help, as they contain a chemical called tryptophan which is essential to sleep.

There isn’t a lot of evidence to guide the use of specific foods as sleep remedies, but a small bowl of porridge might be worth a try. Some people find it harder to sleep when they’ve eaten late at night, so finding the right balance is key.

Exercise

Getting enough exercise through the day can improve restfulness at night, and some relaxation exercises at night like gentle stretches and yoga can have good results.

Other Treatment options for insomnia

If you can identify the underlying cause of your insomnia, it may be enough just to make some changes to that cause.

If you can’t easily take away the cause – we may not be able to change our shift patterns or make sure our sleeping environment is comfortable and quiet – then we need to look for some pragmatic solutions to our insomnia.

There are some herbal remedies available to help manage sleeplessness, and a variety of teas and aromatherapy-based products containing calming plant extracts.

Even if a treatment is herbal, it’s best to check with a pharmacist to see if it’s right for you, especially if you’re pregnant, breastfeeding, or take other medications.

If simple home remedies or easily available products haven’t helped, consulting a GP is the next step. They can offer advice and sleep counselling, and may even prescribe some form of therapy designed to help you manage sleeplessness and its causes.

Cognitive behavioural therapy has a track record of excellent results when used to treat insomnia and related sleep disorders. If it’s appropriate, a doctor may consider a short course of medication to help you get back into a good sleeping pattern.

If insomnia is affecting your life and you can’t manage it by yourself, it’s important to get help.

Sleep disturbances are one of the most common reasons people consult their GP; you are not alone if you need support through times of sleeplessness.

Elaine Francis is a registered nurse with 17 years’ experience in healthcare. She turned to writing to follow her passion for realistic medical communication. She loves translating medical jargon into accessible language for the people who need to understand it most. When she’s not writing or working on a busy cardiology unit, she spends her time telling her children to hurry up.