What is insomnia?

Insomnia is defined as difficulty initiating or maintaining sleep, or both, despite adequate opportunity and time to sleep, leading to impaired daytime functioning. Insomnia may be due to poor quality or quantity of sleep.

Insomnia is very common and occurs in 30% to 50% of the general population. Approximately 10% of the population may suffer from chronic (long-standing) insomnia.

Insomnia affects people of all ages including children, although it is more common in adults and its frequency increases with age. In general, women are affected more frequently than men.

Insomnia may be divided into three classes based on the duration of symptoms.

• Insomnia lasting one week or less may be termed transient insomnia;
  
  
• short-term insomnia lasts more than one week but resolves in less than three weeks; and
  
  
• long-term or chronic insomnia lasts more than three weeks.

Insomnia can also be classified based on the underlying reasons for insomnia such as sleep hygiene, medical conditions, sleep disorders, stress factors, and so on.

It is important to make a distinction between insomnia and other similar terminology; short duration sleep and sleep deprivation.

• Short duration sleep may be normal in some individuals who may require less time for sleep without feeling daytime impairment, the central symptom in the definition of insomnia.
  
  
• In insomnia, adequate time and opportunity for sleep is available, whereas in sleep deprivation, lack of sleep is due to lack of opportunity or time to sleep because of voluntary or intentional avoidance of sleep.

What causes insomnia?

Insomnia may have many causes and, as described earlier, it can be classified based upon the underlying cause.

Situational and stress factors leading to insomnia may include:

• jet lag,
  
  
• physical discomfort (hot, cold, lighting, noise, unfamiliar surroundings),
  
  
• working different shifts,
  
  
• stressful life situations (divorce or separation, death of a loved one, losing a job, preparing for an examination),
  
  
• illicit drug use,
  
  
• cigarette smoking,
  
  
• caffeine intake prior to going to bed,
  
  
• alcohol intoxication or withdrawal, or
  
  
• certain medications.

Most of these factors may be short-term and transient, and therefore insomnia may resolve when the underlying factor is removed or corrected.

Sleep hygiene

Sleep hygiene can play an important role in insomnia. Poor sleep hygiene includes physical factors such as:

• using the bedroom for things other than sleeping,
  
  
• eating or exercising prior to sleep,
  
  
• going to bed hungry,
  
  
• sleeping in a room with too much noise or lighting, or
  
  
• doing work in bed.

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