Insomnia is one of the most common conditions seen by GPs. In this article, Dr Fiona McAndrew discusses the different types of insomnia and what can be done about the problem.
Difficulty in sleeping is a common problem
If you’ve ever had trouble sleeping, you know the frustration it can cause – tiredness, irritability, difficulty concentrating – and you’re hardly alone.
Insomnia is one of the most common conditions seen by GPs, affecting about one-third of the population at some point in their lifetime. Most people sleep between seven to nine hours a night, but many people experience difficulty falling asleep, trouble staying asleep, frequent waking, early morning waking and difficulty getting back to sleep.
Primary and secondary causes
There are two main types of insomnia: primary and secondary. Primary insomnia has no obvious cause. Secondary insomnia is caused by an underlying problem, such as a medical condition or psychological problem, such as grief or depression. In fact, approximately half of all cases of insomnia are caused by psychological problems. Some other common secondary causes include obstructive sleep apnoea, excess alcohol, illicit drug use, delayed sleep phase disorders, and parasomnias (conditions such as restless leg syndrome, sleep talking/walking, teeth grinding, etc).
Obstructive sleep apnoea is often associated with obesity and is caused by upper airway obstruction. This obstruction reduces oxygen intake, causing you to wake. Symptoms include snoring, waking up gasping for breath, episodes of breathing pauses and excessive daytime sleepiness. You will often find your partner is the one who sends you to the doctor for this. Luckily, obstructive sleep apnoea responds well to a machine called a CPAP (continuous positive airway pressure). Your GP will need to refer you to a sleep specialist to confirm a diagnosis of obstructive sleep apnoea.
Another common secondary cause is delayed sleep-phase disorder, which accounts for about 12 per cent of cases. This is when your ‘body clock’ makes it difficult to go to sleep at the time when most other people do. In other words, you go to bed very late and wake up late, making it difficult to wake up in time for a typical school or work day.
Tips for getting a good night’s sleep
If you don’t have an underlying medical or psychological condition, the following can be helpful to getting you back on track for getting a good night’s rest.
- Go to bed only when you’re sleepy. If you’re unable to sleep after 15-20 minutes get up and go back to bed only when you’re feeling sleepy again.
- Use your bed/bedroom only for sleep and sex – don’t use it to read, watch TV or work.
- Get up at the same time each day.
- Don’t take naps during the day.
- Limit coffee intake to one cup a day in the morning.
- Avoid alcohol and cigarettes in the evening.
- Get regular exercise.
- Make sure your bedroom is conducive to sleep, e.g. quiet, the right temperature, no flashing clock lights, etc.
- Don’t use computers in the hour before bed as light waves are thought to reduce the production of melatonin, the hormone responsible for sleep.
- Use medication as a last resort. Use only as a short-term measure as these medications can be addictive.
Diagnosing the causes
Making a good diagnosis is mainly based upon the history of your problem, such as when you go to bed, when you get to sleep, awakenings, etc. Keeping a sleep diary can give your GP more information about what is really going on. It is very important your GP also does a physical examination. They may also need to refer you for a polysomnograph (an overnight sleep study) to make a diagnosis.