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Chronic Insomnia: Symptoms, Causes, and Treatment

writtenByWritten by: Tessa Chatham Registered Nurse
Tessa Chatham Registered Nurse

Tessa Chatham Registered Nurse

Tessa is a MSN prepared Registered Nurse with 10 years of critical care experience in healthcare. When not practicing clinical nursing, she enjoys academic writing and is passionate about helping those affected by medical aliments live healthy lives.

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reviewBy Reviewed by: Dr. Katalin Karolyi
Reviewer

Dr. Katalin Karolyi

Katalin Karolyi, M.D. earned her medical degree at the University of Debrecen. After completing her residency program in pathology at the Kenezy Hospital, she obtained a postdoctoral position at Sanford Burnham Prebys Medical Discovery Institute, Orlando, Florida.

March 3, 2021 Read Time - 6 minutes

What is Chronic Insomnia?

Insomnia is a sleep disorder characterized by difficulty falling asleep or remaining asleep. According to the World Health Organization, insomnia can be recurrent or episodic and is defined as difficulty falling asleep or trouble staying asleep.

If you have insomnia, you may not feel rested or refreshed when you wake up. This is because of poor quality sleep caused by insomnia. Daytime fatigue is also another sign of insomnia in which impairment is seen in social, occupational, and other important areas of functioning.

Chronic insomnia is the long-term recurrence of sleep difficulty. Continue reading to learn more about the causes and symptoms of chronic insomnia, as well as potential treatments.

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What are the Symptoms of Insomnia?

 Insomnia is a common sleep disorder. Symptoms of insomnia include:

  • Lying awake for a long time before you fall asleep
  • Sleeping for only short periods of time
  • Being awake for much of the night
  • Feeling as if you did not sleep at all
  • Waking up too early

What Causes Chronic Insomnia?

Insomnia can be irregular or chronic and is caused by stressors or other medical disorders. Episodic insomnia can be caused by temporary stressors. Common stressors that may cause episodic insomnia include:

  • Loss of a loved one
  • Family or relationship challenges
  • School or career challenges
  • Events of big life changes such as moving, lifestyle change, or new parent
  • Drug abuse
  • Use of certain medications
  • Shift or night work

Chronic insomnia, or recurrent insomnia, can be caused by a mental disorder or another sleep-wake disorder. Sleep-wake disorders that mimic insomnia symptoms include:

  • Narcolepsy
  • Breathing-related sleep disorder
  • Circadian rhythm sleep-wake disorder
  • Parasomnia

Although co-existing mental disorders are correlated with insomnia, it does not adequately explain the predominant complaint of insomnia.

Can Insomnia Be Permanent?

Insomnia can be a chronic condition and long-lasting. Chronic insomnia occurs three or more nights a week, lasts longer than 3 months, and cannot be explained by another health problem or medication. 

Common health problems that can cause insomnia-like symptoms include:

Some medications and illicit drugs can cause sleep disturbances that mimic insomnia, but are not truly insomnia.

Chronic insomnia can affect your blood pressure and put you at risk to develop high blood pressure, coronary artery disease, diabetes, and cancer. Good sleep hygiene is the foundation for all other healthy habits.

How Do You Live With Chronic Insomnia?

Lifestyle habits, stress reduction, and environmental management can help reduce the episodes of chronic insomnia. Risk factors that you cannot control related to insomnia include:

  • Your genetics (insomnia runs in families) – your genes may  affect if you are a deep or light sleeper
  • Your age – insomnia can occur at any age, but increases as you get older
  • Your sex – insomnia is more common in women than in men

It is possible to reduce insomnia by altering some common lifestyle habits. Lifestyle habits that you can alter in order to reduce insomnia include:

  • Following a regular and consistent bedtime routine
  • Not taking long naps during the day
  • Getting enough physical activity during the day
  • Limiting caffeine, nicotine, alcohol, or illegal drugs
  • Limiting screen time (TV, smartphone, tablet) 2 hours before bedtime

Performing stress-reducing activities can help limit chronic insomnia episodes. Stress or worrying about school, work, relationships, money, or the death of a loved one can raise the risk of insomnia. Some activities you can do to reduce stress are:

  • Meditation
  • Deep breathing
  • Biofeedback
  • Progressive relaxation technique
  • Warm bath or shower

What are the Different Types of Insomnia?

According to the Diagnostic and Statistical Manual of Psychiatric Disorders, there are three types of insomnia. The three types of insomnia include episodic, persistent, and recurrent. 

  • Episodic insomnia is defined as symptoms that last at least 1 month but less than 3 months. 
  • Persistent insomnia is defined as symptoms that last 3 months or longer.
  • Recurrent insomnia is defined as symptoms that include two or more episodes within the space of 1 year. 

Acute and short-term insomnia (symptoms lasting less than 3 months) should be considered another specified insomnia disorder. Criteria for diagnosing insomnia include:

  • Frequency of nocturnal awakening
  • Intensity of awakenings 
  • Distress during daytime and nighttime
  • Impairment of daily functions

Chronic Insomnia Treatment

Therapy, sleep habit changes, and medications are used to treat chronic insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first treatment option for long-term insomnia. CBT-I helps you feel less nervous about sleep, have more positive thinking related to sleep, teaches you how to relax and fall asleep, and teaches techniques to sleep and how to utilize your sleep space more effectively.

Healthy sleep habits is the next area to focus on if you have chronic insomnia. 

  • Making your bedroom sleep friendly is important to treat insomnia. 
  • Your room should be a cool and quiet place. 
  • Artificial lights such as TV or electronic devices should be turned off,  as this can disrupt your sleep cycle. 
  • You should also avoid caffeine, alcohol, and nicotine before bedtime. A common habit is drinking alcohol before bedtime to help you feel sleepy; however, this actually makes you sleep lighter than normal, further disrupting your sleep cycle. 
  • Light therapy is also used to help maintain your sleep-wake cycle and is done by sitting in front of a lightbox for a certain time which produces bright light similar to sunlight, but is not dangerous.

Other treatment for chronic insomnia includes medication therapy.

What is the Best Medication for Chronic Insomnia?

If CBT-I and sleep hygiene techniques do not help treat your insomnia, you may need medications to help you sleep. Many prescription medications are available to treat insomnia. These medications require a virtual visit with your PlushCare provider and together, you can determine the best treatment plan. 

Prescription medications used to treat insomnia include:

  • Benzodiazepines
  • Benzodiazepine receptors agonists
  • Melatonin receptor agonists
  • Orexin receptor antagonists

Benzodiazepines are habit-forming and should only be taken for a few weeks. Some other prescription medications are used off-label to treat insomnia such as antidepressants, antipsychotics, and anticonvulsants.

  • Book on our free mobile app or website.

    Our doctors operate in all 50 states and same day appointments are available every 15 minutes.

  • See a doctor, get treatment and a prescription at your local pharmacy.

  • Use your health insurance just like you normally would to see your doctor.

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How Can I Fight Insomnia Naturally?

Several supplements, over-the-counter medications, and herbal remedies are used to fight insomnia naturally. 

  • Over-the-counter medications used to fight insomnia include antihistamines that are sold as sleep aids. 
  • Melatonin is a sleep hormone and melatonin supplements are used to improve sleep. 
  • Some people take CBD oil or herbal teas to assist with sleep.

You should always speak with your doctor before you take over the counter or supplements to treat insomnia. If you have symptoms of insomnia, you may need to take medication to help.  You can speak with a certified online doctor at PlushCare about your insomnia symptoms and see if medication is right for you. 


Read More About Chronic Insomnia

Sources:

PlushCare is dedicated to providing you with accurate and trustworthy health information.

Krystal, A. D., Prather, A. A., & Ashbrook, L. H. (2019). The assessment and management of insomnia: an update. World Psychiatry : Official Journal of the World Psychiatric Association (WPA), 18(3), 337–352.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732697/

National Heart, Lung, and Blood Institute. Insomnia. Accessed on February 16, 2021. https://www.nhlbi.nih.gov/health-topics/insomnia 

Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.36, DSM-IV to DSM-5 Insomnia Disorder Comparison. Accessed on February 4, 2021. https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t36/

American Psychiatric Association. What are Sleep Disorders? Accessed on February 27, 2021.
https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders 

Most PlushCare articles are reviewed by M.D.s, Ph.Ds, N.P.s, nutritionists and other healthcare professionals. Click here to learn more and meet some of the professionals behind our blog. The PlushCare blog, or any linked materials are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment. For more information click here.

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