Physical, Psychological, and Situational Causes of Insomnia
Sometimes insomnia can be traced to a single cause. Usually, however, multiple factors cause insomnia. Fortunately, this means that taking care of any cause of insomnia will usually bring relief.
Psychological Causes of Insomnia
Psychological problems can cause loss of sleep. Loss of sleep can cause psychological problems. A combination of insomnia with anxiety, depression, and/or unresolved stress can create a vicious cycle of loss of sleep and mental distress. Among the most common psychological issues causing sleep loss and fatigue are:
- Anxiety and insomnia. Apprehension, tension, and feelings of helplessness, hopelessness, and worry almost always cause insomnia. There are many rational reasons to be anxious in the modern world, at least as many triggers for anxiety as there are people. Treating anxiety usually relieves insomnia.
- Depression and insomnia. Sadness, discouragement, and despair during the day usually cause sleeplessness during the night. Correcting the imbalances in brain chemicals that aggravate depression usually improves insomnia.
- Stress. Short-term and chronic worries keep people awake. Removing the stress in the insomniac's life is more useful than taking medications to feel it less.
Counseling from a sleep therapist or medical treatment help. But changes in routine (link back to five tips in Anxiety and Insomnia article) can bring relief even when it's not possible to see a specialist.
Physical Causes of Insomnia
One of the most common causes of insomnia in women is menopause. Hot flashes, skin dryness causing itch, and irritability link menopause and insomnia in up to 80 per cent of women at one time or another. Among women who have not reached menopause, premenstrual syndrome and premenstrual dysphoric disorder can cause monthly problems with insomnia that usually last 3 to 7 days before changes in hormone levels bring relief.
One of the most common causes of insomnia in men is enlargement of the prostate. Interfering with a man's ability to hold urine, prostate problems can cause nighttime dribbling, incontinence, and "needing to go." Every time a man turns on the light to get up to go to the bathroom, the production of melatonin in his brain is interrupted, and getting back to sleep is made more difficult.
Males and females of all ages, children, teen, or adults, need to have at least six hours of uninterrupted sleep every night so their brains can make melatonin. Exposure to light in the blue wavelengths in the visible spectrum resets the pineal gland so it stops making melatonin. Even if your eyelids are closed, and even if the light is very dim, blue light keeps you awake. Avoiding exposure to light during the night is critical for avoiding the "sun's up" signal that makes you wake up early.
Situational Causes of Insomnia
Sometimes, of course, you don't have to be sick to be unable to sleep. As mentioned above, too much light is a common cause of failure to get enough sleep. Noise, extreme temperatures, a lumpy mattress, or a snoring sleeping partner will keep you awake. You have to take care of these causes of insomnia yourself, but when you do, relief is almost always immediate.
Apnea, the Insomnia that isn't Really Insomnia
Even if you take care of these three causes of insomnia, there may be another problem with a purely physical cause: Sleep apnea. Apnea is a word derived from two Greek words that literally mean "not breathing." People who have sleep apnea literally stop breathing dozens or even hundreds of times during the night.
How common is sleep apnea?
Sleep scientists report that breathing problems are extremely common in people who endure insomnia or chronic fatigue. According to Dr. Barry Krakow:
1. If you have either chronic fatigue or chronic insomnia, there is a 90 per cent or greater chance that you also have a sleep breathing problem.
2. If you have a sleep breathing problem, you can also suffer other kinds of insomnia, but over 50 per cent of your lost sleep is probably due to apnea.
Sleep apnea makes sleep impossible. If you cannot breathe because some portion of the airway from your nose to your throat is closed, your oxygen levels fall.
Your heart has to pump harder and faster to attempt to circulate the oxygen remaining in your bloodstream to your brain and other vital organs. Finally enough pressure builds up with your exhalation that your mouth explodes open. There will be a snort or a snore, and for at least a few seconds or a few minutes, you breathe faster to try to make up your oxygen deficit.
You may not remember anything about your sleep apnea unless your spouse or bed partner tells you about them the next morning. If you sleep alone, you may just be puzzled that you never feel refreshed when you get up in the morning. There are telltale signs, however, that you have sleep apnea in addition to any other kinds of insomnia:
- Having to get up to urinate once or more during the night even though you do not have a bladder infection or (in men) enlarged prostate.
- Waking up with a dry mouth.
- Signs of tossing and turning, such as sheets and blankets kicked off the bed even though the air temperature was comfortable.
These are symptoms of sleep apnea. Sleep apnea isn't something you can treat entirely on your own, but you don't necessarily have to have a CPAP machine. Many people find that taking care of sinus congestion, using breathing strips, or treating allergies helps a great deal.
Some Insomnia Symptoms Are Not What You Would Expect
If you have stared at the clock all night long, or if your racing thoughts kept from getting to sleep for hours, you don't have to have anyone tell you that you have insomnia. Sometimes the most serious insomnia symptoms, however, occur in people who don't even know they aren't getting enough sleep.
When some people who have serious issues with insomnia are first asked by their doctors about their sleeping habits, they usually answer with something on the lines of, "My sleep is fine. I just don't get enough of it." But their reality is that it is very common for people who have been diagnosed with certain kinds of insomnia, especially sleep apnea, to find the time for bed rest. The problem with these forms of insomnia is that resting in bed is usually not restful.
Subtle Symptoms of Insomnia
Some of the subtle symptoms of insomnia are things you would never expect, such as:
- Having to get up to urinate in the middle of the night even though you do not have a bladder or (in men) prostate problem.
- Waking up in the morning with a dry mouth.
- Signs that you tossed and turned, such as bed linens kicked off the bed even though the bedroom temperature was comfortable.
These are classic symptoms of insomnia in snorers. Snoring actually makes people need to go to the bathroom. When you snore, the muscles in your diaphragm have to work harder to pull air into your lungs. When your diaphragm presses down on your heart, your blood pressure goes up. When your blood pressure goes up, your kidneys increase the rate at which they remove water from circulation to try to your blood pressure back down to normal.
Waking up in the morning with a dry mouth is a sign that you have been breathing through your mouth. This can happen when you have a stuffy nose, or when you have some injury or defect in your nose, such as a deviated septum. The constant flow of air over your lips and tongues dries out your mouth and gives your whole mouth a cottony feel.
Kicking off the covers can be a sign of sleep apnea, a kind of breathing obstruction that is relieved by changing position, or restless legs syndrome. Snoring, snorting, sleep apnea, and restless legs syndrome may totally interrupt the sleep of your bed partner, but they may not ever make you fully conscious. Since you never completely wake up, you only have the sensation of still feeling tired even if you have spent eight, nine, ten, or more hours in bed. Sleeping pills, by the way, make all of these symptoms worse.
Can Insomnia Symptoms Result in Death?
And if you never get these problems remedied, the effects of insomnia can even include potentially fatal insomnia symptoms:
- High blood pressure that does not respond to medication,
- Type 2 diabetes after appetite-induced weight gain,
- Fluid retention in the ankles and wrists due to congestive heart failure,
- Heart attack, or
Serious Effects of Insomnia
How can something as simple as insomnia have such dreadful consequences? About 90 per cent of people who snore have insomnia. About 50 per cent of people who have insomnia snore. The breathing obstructions that cause snoring also cause alterations in oxygen supply and blood pressure that can devastate the cardiovascular system. And because the brain does not have a chance to process appetite signals from your fat cells, you can wake up wanting to eat, eat, and eat some more.
None of these symptoms exclude the more obvious symptoms of insomnia such as grouchiness, poor memory, diminished attention span, and accident proneness. But if you have both insomnia and snoring, you need to give attention to keeping your airways open to avoid potentially fatal insomnia symptoms.
Budhiraja R, Budhiraja P, Quan SF. Sleep-disordered breathing and cardiovascular disorders. Respir Care. 2010 Oct;55(10):1322-32; discussion 1330-2. Review.
Krakow B, Ulibarri VA, Romero EA. Patients with treatment-resistant insomnia taking nightly prescription medications for sleep: a retrospective assessment of diagnostic and treatment variables. Prim Care Companion J Clin Psychiatry. 2010;12(4). pii: PCC.09m00873.