INSOMNIA

Insomnia is a common sleep disorder marked by persistent difficulty in falling asleep, staying asleep, or achieving restorative sleep, despite sufficient opportunity and a conducive environment for sleep. The condition leads to significant daytime impairment, such as fatigue, concentration difficulties, mood disturbances, and reduced academic, occupational, or social functioning.

Clinically, chronic insomnia is diagnosed when symptoms occur at least three nights per week for three months or longer. Acute insomnia, typically related to stress or life events, is shorter in duration but may progress if unaddressed.

Subtypes of Insomnia:

  • Sleep-onset insomnia: Difficulty initiating sleep.

  • Sleep-maintenance insomnia: Frequent awakenings or problems returning to sleep.

  • Late insomnia: Waking too early without the ability to fall back asleep.

Etiology and Risk Factors:

Insomnia can occur as a primary disorder, but more often it is comorbid with other conditions such as:

  • Mental health disorders (e.g., depression, anxiety)

  • Chronic medical conditions (e.g., pain syndromes, cardiovascular disease)

  • Medication or substance use

  • Poor sleep hygiene or irregular schedules

  • Psychosocial stressors

Predisposing, precipitating, and perpetuating factors (the "3 Ps" model) are often used to conceptualize the development and maintenance of insomnia.

Health Implications:

If untreated, insomnia is associated with increased risk of:

  • Mood and anxiety disorders

  • Impaired cognitive performance

  • Substance use and self-medication

  • Cardiovascular and metabolic diseases

  • Lowered immune function and quality of life

Treatment:

The first-line treatment is Cognitive Behavioral Therapy for Insomnia (CBT-I), a structured, evidence-based approach that targets dysfunctional beliefs, behaviors, and patterns around sleep.

Other interventions may include:

  • Sleep hygiene education (e.g., consistent bedtime, limiting screens before bed)

  • Relaxation training and mindfulness

  • Pharmacologic options (used with caution), including sedative-hypnotics, melatonin receptor agonists, or off-label medications

Effective treatment often requires a combination of behavioral strategies and, when appropriate, management of underlying psychiatric or medical conditions.