Insomnia can sneak up on you. It might start off as one or two sleepless nights. Maybe you’ve been overly stressed at work lately. You assume your sleep will return to normal soon. Eventually, you start to notice that it has been weeks or months since you’ve had a good night’s sleep. Before you know it, you have severe insomnia.
Even if your insomnia is making you feel rough, your treatment plan should be gentle. Severe insomnia medications can lead to serious side effects. The best way to treat insomnia is first to find out what is causing it. Then, use a series of sleep hygiene tips and natural remedies to reverse it. Here’s how.
What is Severe Insomnia?
Insomnia occurs when a person has trouble falling asleep, staying asleep, or both. They may also wake up during the night, unable to fall back asleep. Or they wake up too early in the morning and feel tired during the day.
The main types of insomnia are primary and secondary. Primary insomnia occurs when a person experiences sleep loss that is not due to any other condition. Secondary insomnia is usually a symptom of an underlying disorder, such as depression, chronic pain, or cancer.
Insomnia can either be short-term (acute) or long-term (chronic). Insomnia can also come and go. Some people may go months without a bout of insomnia. Acute insomnia usually only lasts for a few days or weeks. Chronic insomnia occurs when a person experiences sleep loss for at least three nights each week for one month (1).
Most people with severe insomnia have chronic insomnia, but they might not even be aware of it. According to a 2007 study, approximately 60 percent of people with insomnia don’t talk to their doctors about their sleep disturbances (2). Chronic insomnia is linked to an increased risk of many health disorders. It also affects your quality of life and impairs your work performance.
Insomnia occurs more frequently in women. One theory is that women experience more physical changes throughout their lifetime that account for keeping them awake at night. Aging also increases the risk of insomnia. Approximately 50 percent of people over the age of 65 have insomnia (2). It is also more prevalent in individuals who are widowed, separated or divorced, or are unemployed (2).
Severe Insomnia Causes
A person’s emotions may determine whether or not they develop severe insomnia. Stressful life events may also be causes of insomnia because they are closely tied to a person’s happiness and thus their likelihood of developing insomnia. Research shows that both children and adults with insomnia tend to be unhappy with themselves. They are less satisfied with their interpersonal relationships and have poor self-concepts, which leads to the inability to cope with stress (2).
According to the Minnesota Multiphasic Personality Inventory or MMPI, people with insomnia have common personality characteristics. They have high levels of depression, hysteria, and excessive anxiety (4). Research shows that insomniacs meet the following general criteria:
- Chronic anxiety
- Inhibition of emotions
- Inability to show anger
- Focusing on one’s problems
People who have underlying mental health conditions are also more likely to develop insomnia. One of the most commonly treated forms of insomnia in sleep disorder centers is insomnia due to a psychiatric disorder (2). Among people with mental health disorders, the most common types are:
- Major depression disorder
- Bipolar disorder
- Anxiety disorders
- Substance abuse disorders
- Cyclothymic disorder (a condition where a person fluctuates between depression highs and lows)
- Dysthymic disorder (mild but chronic depression)
Chronic insomnia is linked to other sleep disorders. According to a 2012 study of 106 patients with chronic insomnia, approximately 65.4 percent had primary insomnia based on their examination and history alone. After they were evaluated, roughly 42.5 percent of the test subjects also had obstructive sleep apnea, and 4.7 percent had periodic limb movement disorder. Approximately 35.9 percent of the 39 patients who reportedly had a mental health condition also had obstructive sleep apnea. Researchers concluded that chronic insomnia patients might also suffer from various other conditions that affect their sleep (3).
Other medical conditions cause secondary insomnia. Research shows that chronic insomnia is linked to the following health disorders (2):
- Cardiovascular disease (heart attack or heart failure)
- Chronic pain conditions (back pain, arthritis, and fibromyalgia)
- Gastrointestinal disturbances (duodenal ulcers and irritable bowel disease)
- Respiratory conditions (asthma or chronic obstructive pulmonary disease)
- Endocrine conditions (thyroid disease)
- Chronic renal insufficiency
- Neurological disorders (Parkinson’s disease, headaches, or Alzheimer’s disease)
Drinking alcohol and using nicotine or caffeinated products may also cause insomnia. The following prescription medications may cause insomnia (5):
- Statins such as atorvastatin (Lipitor), rosuvastatin (Crestor), lovastatin (Mevacor), and simvastatin (Zocor).
- ACE inhibitors such as lisinopril (Prinivil, Zestril), benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), ramipril (Altace), perindopril (Aceon), quinapril (Accupril), trandolapril (Mavik), and moexipril (Univasc).
- Alpha-blockers such as tamsulosin (Flomax), doxazosin (Cardura), silodosin (Rapaflo), prazosin (Minipress), alfuzosin (Uroxatral), and terazosin (Hytrin)
- Antidepressants such as fluoxetine (Prozac, Sarafem), escitalopram (Lexapro), fluvoxamine (Luvox), citalopram (Celexa), sertraline (Zoloft), and paroxetine (Paxil, Pexeva).
- Cholinesterase inhibitors such as galantamine (Razadyne), donepezil (Aricept) and rivastigmine (Exelon)
- Beta-blockers such as carvedilol (Coreg), propranolol (Inderal), atenolol (Tenormin), sotalol (Betapace), metoprolol (Lopressor or Toprol), and timolol (Timoptic)
- Corticosteroids such as prednisone (Deltasone and Sterapred), triamcinolone, cortisone, and methylprednisolone (Medrol).
- ARBs such as valsartan (Diovan), losartan (Cozaar), candesartan (Atacand), telmisartan (Micardis) and irbesartan (Avapro)
- Second-generation (nonsedating) H1 antagonists such as fexofenadine (Allegra), loratadine (Claritin), cetirizine (Zyrtec), desloratadine (Clarinex), azelastine (Astelin) nasal spray, and levocetirizine (Xyzal).
In many cases, poor sleep hygiene is to blame for causing insomnia. Sleep hygiene is another term used to describe your sleep habits. It describes what you do before you go to bed. Examples of poor sleep hygiene include going to bed stressed or light exposure in your bedroom. A 2010 study found that working women with sleep problems who took either a three or five-week education course on sleep hygiene improved their sleep. After taking the course, the women reported having improved sleep disturbances, sleep duration, daytime function, sleep latency, and sleep quality (6).
Severe Insomnia Treatments: Relaxation Therapy
Treating severe insomnia doesn’t require a harsh prescription medication. You can achieve great results using natural remedies, such as relaxation techniques or a natural sleep aid. Making simple changes to your daily routine can go a long way, such as avoiding caffeine late at night or making your bedroom a cozy place to rest.
Relaxation techniques can be used to help you mentally and physically relax. Research shows that people who use relaxation techniques tend to sleep longer and fall asleep faster (7). Most relaxation techniques are free and can be done whenever you need stress relief. They are most effective when done at night before bed. The most popular relaxation techniques include:
Imagery or Visualization Therapy
During imagery or visualization therapy, you picture a peaceful or relaxing scene in your head. You can imagine yourself in pleasant scenarios, such as walking on the beach or watching a waterfall. Counting or focusing on your breathing at the same time may help you relax and fall asleep faster.
Progressive Muscle Relaxation
Progressive muscle relaxation is sometimes called Jacobson’s or deep muscle relaxation. It works by relaxing your muscles to get rid of any tension before sleep. Start by laying on your back in bed with your arms and legs straight out. Inhale and tense each one of your major muscle groups and hold for 10 seconds. Relax the muscle group and exhale out any stress. Do this two to three times for each major muscle group. By the time you’re done, your entire body should feel relaxed and free of tension.
Autogenic Training (AT)
Autogenic training is a form of relaxation training that teaches the body how to respond to vocal commands. The goal is to help you relax and reduce stress by telling your body what to do (8). It consists of six steps that can be taught by a professional and then conducted in the comfort of your own home. You can start by sitting in a comfortable chair, closing your eyes, and commanding yourself to relax different parts of your body. Studies show that autogenic training may be able to help you control involuntary body functions when done at an advanced level, such as your heart rate and breathing (7).
Biofeedback combines visual therapy and progressive muscle relaxation to help you relax. It can be done with the assistance of a biofeedback therapist. During a session, you will be hooked up to electrodes and finger sensors that monitor your brain activity, muscle tension and pulse (9). While using other relaxation techniques, your stress levels are measured so that you can see your progress as you move through different exercises. Portable biofeedback devices are available so that you can use them at home to watch on a screen as your body relaxes.
Treating Severe Insomnia With Sleep Hygiene
Studies show that improving your sleep hygiene can also help treat insomnia (7). Here are some tips for improving your sleep:
Stimulants such as caffeine, nicotine, and alcohol can keep you awake at night. Some forms of caffeine can stay in your system for up to ten hours. To be on the safe side, limit your caffeine intake six hours before bed. Caffeine isn’t just found in coffee. It is also present in soda, tea, chocolate and some pain relievers. The same rules apply to nicotine products- don’t use them too close to bedtime.
Alcohol can make you sleepy at first, but after a few hours it can wake you up. Research from Harvard University stated that alcohol increases the number of times you wake up during the night, which decreases your sleep quality (9). Alcohol is also high in sugar, which may spike your blood glucose levels and disrupt your sleep. It can also increase the number of times you wake up to use the bathroom during the night. It’s best to limit alcohol three hours before going to bed.
Improve Your Sleep Environment
It’s almost impossible to sleep unless you have a comfortable place to rest. Make sure your bedroom is completely dark when you go to bed. Any exposure to light can throw off your melatonin levels, which are responsible for making you feel sleepy. Blackout curtains are a good way to keep it dark. Invest in a comfortable mattress and sheets. You’ll also want to keep all electronics out of your bedroom and keep the temperature around 60 to 75 degrees Fahrenheit (9).
Develop A Healthy Outlet For Stress
Had a stressful day at work? Get that frustration out before going to bed, or you’ll be up all night. Exercising early in the day is an excellent way to improve all areas of your health, including sleep. Some people are not bothered when they exercise at night. But if you have insomnia, try scheduling your exercise session for first thing in the morning. It will help you wake up and energize you throughout the day.
Meditation is another great way to reduce stress. Studies show that individuals who meditate produce more melatonin than those who don’t (10). The goal is to replace negative thoughts with relaxing ones. If you’re not one to meditate, try counting or doing breathing exercises to relax while laying in bed. When your thoughts stray to something negative, return them to what you were focusing on. If you have a stressful day ahead of you tomorrow, try writing out a to-do list. Tell yourself that you’ll review your list in the morning so you can stop thinking about it at night.
Your severe insomnia treatment plan doesn’t need to include harsh medications to be effective. In addition to improving your sleep hygiene, it may also help to incorporate a natural sleep aid into your bedtime routine. Many natural remedies, such as chamomile, GABA, tryptophan, and passion flower, can help relax you so that you can fall asleep. They are also much safer and less addictive than prescription drugs. Try taking a natural sleep aid an hour or so before bed after a warm shower and a light meal.