By Fariha Abbasi-Feinberg, MD, as told to Susan Bernstein
Insomnia is a common sleep disorder that can make it hard to fall asleep or stay asleep, or cause you to wake up too early. We all have occasional difficulties with sleep. But insomnia is considered chronic if it's been going on for more than 3 months.
There are lots of causes of insomnia, both emotional and physical.
It can result from stresses in your life, or any situation that changes your sleep schedule and habits. Often, it's caused by concerns about work, family, or health. A move, divorce, or the illness or death of a loved one can lead to insomnia.
Also, people with mental health conditions such as anxiety, depression, or posttraumatic stress disorder (PTSD) often have insomnia.
Other Conditions That Can Cause Insomnia
I frequently see patients with chronic insomnia who also have other sleep disorders, such as obstructive sleep apnea or restless legs syndrome. Treating these other disorders can help their insomnia symptoms.
Other common medical causes of insomnia include:
- Chronic pain
- Heart disease
- Gastroesophageal reflux disease (GERD)
- Overactive thyroid
- Some neurological disorders.
How Do Other Conditions Cause Insomnia?
There are several reasons these conditions can cause insomnia. It's hard to fall asleep when you're physically uncomfortable. Chronic pain interferes with sleep quality.
Also, many chronic health conditions are linked to feelings of depression or stress about your disease itself, so this can keep you awake at night.
Some studies have shown a link between sleep disorders and GERD. But it’s hard to say whether these two conditions just exist together, or if GERD is a cause of insomnia.
You have acid in your stomach to help with digestion. But with conditions like GERD, it can travel into your esophagus. When you’re upright, that acid may get pushed back down into your stomach when you swallow. But when you’re lying down, gravity no longer helps that happen. It also turns out that we don’t swallow much when we sleep, so acid can stay in your esophagus longer. That causes discomfort and disturbs your sleep.
If you have GERD, sleeping with your head elevated and making sure you don’t eat for a few hours before bed can help.
Many people with type 2 diabetes have sleep problems due to unstable blood sugar levels. Both high and low blood sugar during the night can make it hard to stay asleep.
Sleep and asthma are related in a couple of different ways. Sleep loss can increase inflammation in your body and make your asthma worse. Many people with asthma also have other health conditions, including sleep apnea.
Some people struggle with nighttime, or nocturnal, asthma, which clearly affects sleep.
Medications That Can Cause Insomnia
In addition, many prescription drugs can interfere with sleep. They include certain antidepressants and medications for asthma and blood pressure.
I always ask my patients about over-the-counter (OTC) medications they take. Some of them contain caffeine and other stimulants that can disrupt sleep. The most common culprits are headache or allergy medications, and weight loss supplements.
Nicotine in tobacco products is another stimulant that may keep you from getting enough sleep. Alcohol might help you fall asleep. But it keeps you from reaching the deeper stages of sleep, and often causes you to wake up in the middle of the night.
How to Get the Right Treatment
If you have insomnia, it's important that you and your doctor do a thorough medical history. It should include your sleep schedule, sleep habits, OTC medications, and any substance use. Sometimes, patients don't know to tell you about these things unless you specifically ask.
As a sleep specialist, I evaluate my patients for other sleep disorders first. If someone has other health issues, I'll refer them to other specialists to get their input. Patients really benefit from having a team of doctors to help them.
I always start with reviewing good sleep habits and simple behavioral changes. But the most effective treatment for chronic insomnia is cognitive behavioral therapy for insomnia (CBT-I).
You should get this therapy from a trained provider. I have a few in my area that I work with. Telemedicine has really made this therapy more accessible for many people.
If medical causes of insomnia are found, I'll work with other specialists to find the best option for each person. If I can get my patients to sleep better, it often helps their chronic underlying medical conditions and vice versa.
Sleep is essential to our health. You need sleep for your body to function well. It's also important for your mood, how well you interact with your family and co-workers, your immune system, your memory, your cardiovascular system, and more.
If you get treatment for any underlying conditions you have, whether it's sleep apnea, restless legs, GERD, or chronic pain, you certainly will sleep better.
Also, good sleep habits can be very helpful.
Start by waking up at the same time each day. Get some sunlight every morning to help set your biological clock. This morning routine can help you fall asleep easier at night.
Avoid electronic devices for at least 60 minutes before bed. Not only does the light from them harm your sleep, but most people scroll through social media or watch news or stimulating shows. These things interfere with your brain’s ability to relax.
Another good tip: Practice gratitude before sleep. I always try to think of three things I’m grateful for before I go to sleep. Sometimes, it’s a beautiful sunset, or a fun interaction I had with someone I know, or even just my wonderful, comfortable bed with soft sheets.