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Emotional Health

Causes and symptoms

There are many causes of insomnia. Transient (short term) and intermittent (on and off) insomnia generally occur in people who are temporarily experiencing one or more of the following:

stress

environmental noise

extreme temperatures

change in the surrounding environment

sleep/wake schedule problems such as those due to jet lag

medication side effects

Chronic insomnia is more complex and often results from a combination of factors, including underlying physical or mental disorders. One of the most common causes of chronic insomnia is depression. Other underlying causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, narcolepsy, restless legs syndrome, Parkinson's disease, and hyperthyroidism. However, chronic insomnia may also be due to behavioral factors, including the misuse of caffeine, alcohol, or other substances; disrupted sleep/wake cycles as may occur with shift work or other nighttime activity schedules; and chronic stress.

Some behaviors may prolong existing insomnia, and they can also be responsible for causing the sleeping problem in the first place:

expecting to have difficulty sleeping and worrying about it

excessive amounts of caffeine

drinking alcohol before bedtime

smoking cigarettes before bedtime

excessive napping in the afternoon or evening

irregular or continually disrupted sleep/wake schedules

Stopping these behaviors may eliminate the insomnia altogether. Patients with insomnia are evaluated with the help of a medical history and a sleep history. The sleep history may be obtained from a sleep diary filled out by the patient or by an interview with the patient's bed partner concerning the quantity and quality of the patient's sleep. Specialized sleep studies may be recommended, but only if there is suspicion that the patient may have a primary sleep disorder such as sleep apnea or narcolepsy.