Insomnia is considered a common problem that affects the quality of life and it should be taken seriously. The adult human needs between 7 to 8 hours of sleep daily. Sleep has an essential role in brain function, it gives the chance for neural cells to dispose of the waste produced during the day. Therefore, not getting enough sleep could have very bad side effects. Worldwide, about a third of people suffer from insufficient sleep. If troubled sleeping had specific standards, it is diagnosed as sleep and insomnia disorder. [1] 

What is Insomnia? 

According to the American Academy of Sleep Medicine, insomnia is defined as trouble in either sleeping or staying asleep, accompanied by agitations during the day which is connected to sleeping problems. [1]

Insomnia Symptoms and Diagnosis

Symptoms 

• Having difficulty falling asleep.
• Waking up several times during the night.
• Lying awake during the night.
• Waking up early and not being able to sleep again.
• Staying tired after waking up.
• Difficulty getting naps during the day, even though you are tired.
• Feeling tired and restless during the day.
• Difficulty concentrating during the day because you are tired. 

If you are suffering from insomnia for only a short while (less than 3 months), this is called short-term insomnia. Insomnia that lasts for 3 months or more is called long-term insomnia. [2]

Diagnosis

 Sleep difficulties are classified as insomnia only when they cause distress to a person. It begins to negatively affect aspects of his life, such as work or relationships. To be classified as chronic insomnia, symptoms must persist for at least three months. [1] 

There is no specific test to diagnose insomnia. Your healthcare provider will perform a physical exam and ask questions to learn more about sleep problems and symptoms. The key to diagnosing insomnia is to review your sleep history with your doctor. Your healthcare provider will also review your medical history and the medications you take to see if they affect your ability to sleep. 

It is also possible: 

-To perform a blood test: Your doctor may ask you to take a blood test to rule out certain medical conditions. Such as thyroid problems or low iron levels that can negatively affect sleep.

-Keep a sleep diary: You may be asked to write down your sleep patterns for one to two weeks. Such as bedtime, wake-up time, nap time, caffeine use, etc. 

-Complete a sleep study: Sleep studies (sleepgram) are not necessary to diagnose insomnia. If your doctor has concerns that your insomnia may be caused by sleep apnea or another sleep disorder, you may be referred for such studies. [3]

The reasons

– Biological factors: Some health conditions can disrupt sleep, including: 

• Conditions that cause chronic pain, such as arthritis and headache disorders. 
• Conditions associated with breathing difficulties, such as asthma, congestive heart failure, chronic obstructive pulmonary disease, and sleep apnea. 
• Depression, anxiety, and other mental disorders.
• Abnormal thyroid function. 
• Acid reflux disorder. 
• Restless leg syndrome. 
• Conditions that increase the frequency of urination, such as an enlarged prostate. 
• mental illness.
  

– Some medications and commonly used substances can disrupt sleep. These include the following:

• Caffeine, nicotine, and other stimulants. 
• Alcohol or other sedatives. 
• Certain asthma medicines (such as Theophylline). 
• Certain decongestants, allergy medications, and cold medications. 
• Some steroids, such as Prednisone.
• Beta-blockers (medicines used to treat heart conditions). [4] 

– Environmental factors: In some cases, even though stress and medical conditions subside, insomnia can persist. 

– Patients will find that they have difficulty falling asleep or staying asleep – and sometimes both. Here are some common reasons why people suffer from persistent insomnia:

• Conditioned wakefulness: The bed and bedroom become associated with wakefulness or negative emotions. For example, many people with insomnia report falling asleep while watching TV or reading in the living room. But they are fully awake when they go to bed. 
• Trying hard: Some people react to a lack of sleep by trying harder. They extend the time they spend in bed and avoid the evening activities they used to enjoy. Instead of solving the problem, these strategies often make it worse. The act of “trying” itself produces frustration, increases excitement, and can cause stress.
• Anxiety: Worrying about sleep is another common reaction to difficulty sleeping. After a period of not sleeping well, you may find that you start to worry about whether you will struggle to sleep the next night. Then you can start worrying about how not enough sleep will affect you the next day. These concerns, while understandable, are counterproductive and eventually lead to more difficulty sleeping. [5] 

Insomnia treatment

• Changing your sleep habits and addressing any issues that may be associated with insomnia, such as stress, medical conditions, or medications, can restore restful sleep for many people. If these measures don’t work, your doctor may recommend cognitive behavioral therapy, medications, or both to help improve relaxation and sleep. 
• Cognitive behavioral therapy: Cognitive behavioral therapy for insomnia (CBT-I) can help you control or eliminate negative thoughts and actions that keep you awake. It is generally recommended as the first line of treatment for people with insomnia. Cognitive behavioral therapy (CBT-I) is usually equal to or more effective than sleep medications. 
• Medications: Sleeping pills can help you fall asleep, stay asleep, or both. Doctors generally do not recommend relying on prescription sleeping pills for more than a few weeks. Prescription sleeping pills can have side effects such as causing daytime staggering and increasing the risk of falls. It can also be addictive, so talk to your doctor about these medications and other possible side effects. [6] 
• Avoid insomnia:
  Avoid large meals, caffeine, and alcohol before bed.
  Be physically active during the day, outside if possible.
  Limit caffeine, including coffee, soft drinks, and chocolate throughout the day and especially at night.
  Go to bed and wake up at the same time every day, including on weekends.
  Put smartphones, televisions, laptops, or other monitors away, at least 30 minutes before bedtime.
  Quit Smoking.
  Transform your bedroom into a dark, quiet, and cool haven.
  Relax with soft music, a good book, or meditate. [3] 

Insomnia in Women

 One in four women suffers from some symptoms of insomnia. such as difficulty falling asleep, difficulty staying asleep, or both. Women may be more likely to develop insomnia than men because women experience unique hormonal changes. Which can cause insomnia symptoms. These hormonal changes include: 

• Menstruation, especially in the days leading up to your period.
  Many women report problems falling asleep and staying asleep. This is especially common in women with Premenstrual Dysphoric Disorder (PMDD), a type of Premenstrual Syndrome (PMS) that is considered more severe. 

• Pregnancy: especially in the third trimester of pregnancy. It occurs when a woman wakes up frequently due to discomfort, leg cramps, or the need to use the bathroom.
• Perimenopause and menopause: Hot flashes and night sweats can cause sleep disturbances. 

Also, some health problems that can cause secondary insomnia are more common in women than in men. These include: 

• Depression and anxiety: People who suffer from insomnia are 10 times more likely to develop depression, and are more likely to suffer from anxiety by 17 times. 
• Fibromyalgia: It is a condition that causes aches and pain throughout the body and affects more women than men. [7] The pain caused by fibromyalgia can make it difficult to fall asleep and stay asleep. [8] 

Also read:
Phobia- Causes and Types.
Menopause Depression.

♀ The (Uplifting Syrian Women) initiative is an initiative that seeks to build sustainable peace in Syria by focusing on and assisting women by providing free online courses, workshops, discussions and trainings; With the aim of achieving the goals of gender equality, quality education and improving the economic situation, which are in the interest of society in general and serve the purpose of rebuilding it.

References:

[1] Sleep Foundation

[2] NHS

[3] Cleveland Clinic

[4] Stanford Health Care

[5] Stanford Health Care

[6] Mayo Clinic

[7] OASH

[8] OASH