Insomnia | Sleep

What is Insomnia?

Insomnia is a sleep disorder characterised by difficulty falling asleep, staying asleep or waking up too early. This often results in poor quality sleep which can affect mood and energy levels throughout the day.

The number of hours of sleep a person needs to feel rested varies. Some people require up to 10 hours, such as teenagers, while others may only require 7 hours such as adults.

Insomnia relates most to the quality of sleep, rather than the number of hours. A person who experiences insomnia may get an adequate amount of sleep, yet may spend hours trying to get to sleep or get back to sleep after waking. This disturbs the sleep cycle resulting in poor sleep quality thus becoming a problem.

Insomnia is the most common type of sleep disorder with most Australians experiencing it at least at some point in their lifetime. According to a Sleep Health Foundation report, at any given time almost 15% of Australians will have some form of insomnia. It found younger people often had more difficulty getting to sleep, while the elderly struggled with waking throughout the night and waking early.

Insomnia may only be short term in some people. These are sleep problems that occur infrequently for less than 3 months. Problems that occur long term (for more than 3 months) causing negative daytime effects, can be classified as chronic insomnia.

The sleep cycle

To fully understand how insomnia affects the quality of your sleep, you need to understand the basics of the sleep cycle. The cycle has four sleep stages broken down into 2 major categories, rapid eye moment (REM sleep) and non-rapid eye moment (non-REM). Each stage is important for a good nights sleep as they each carry out specific functions.

The first stage of sleep is non-REM stage 1. Here you begin to drift off to sleep but can be easily woken. It lasts about 5-10 minutes.

The second is non-REM stage 2. This is known as light sleep. Here your body prepares for a deeper sleep by lowing temperature and slowing your heart rate. This generally takes 10-25 minutes.

The last stage of non-REM sleep is deep sleep. As the name suggests, it is harder to wake during this type of sleep. If you do wake or get woken during this part of sleep you are often left disorientated and confused. This part of sleep is particularly important as here the body does most of its growth and repair as well as strengthening the immune system.

After deep sleep REM sleep begins. It will usually take about 90 minutes of sleeping to enter your first REM sleep of the night. Each REM sleep period you experience at night gets longer and longer until you wake. During this stage body temperature, brain activity, breathing and your pulse all raise bringing you close to waking. 

As brain activity raises it often results in lucid and vivid dreams which is why most occur in the morning just before waking. The muscles are paralysed during this phase to prevent movement during lucid dreams.

This stage is important for memory consolidation and learning.

Insomnia can disturb these sleep stages, preventing the body from carrying out the necessary functions of sleep.

Insomnia symptoms

Insomnia symptoms can be classified into two categories. What you will experience when you try to sleep and what you will experience as a result the next day.

The symptoms you may experience when you try to sleep are:

• Difficulty getting asleep
• Waking during the night
• Waking too early and being unable to fall back asleep

The symptoms you may experience the next day as a result of insomnia are:

• Waking disorientated or not refreshed
• Daytime sleepiness (fatigue)
• Mood changes
• Difficulty with memory
• Irritability
• Loss of motivation

What causes Insomnia?

Insomnia can be caused by a multitude of factors or nothing. Insomnia with no discernible cause is known as primary insomnia, while insomnia caused by an underlying factor or condition is known as secondary insomnia.

Secondary insomnia may be caused by:

• Poor sleep hygiene or bad sleeping habits
• Stimulants such as caffeine, drugs and some medicines- Particularly when taken close to intended sleep time
• Alcohol
• Mental health problems such as anxiety and depression
• Emotional factors such as stress and traumatic events
• Other sleep disorders such as sleep apnea (diagnosed through a sleep study) and restless leg syndrome
• Jet lag, shift work or irregular sleeping patterns
• Pain and Chronic pain

Understanding what is causing your insomnia is extremely important. If you are able to identify a cause you may be able to make lifestyle adjustments or treat the underlying cause of the condition possibly curing insomnia.

To do this it is best to talk to your doctor about your medical conditions, medicines and current sleep situation.

Insomnia treatment

Insomnia treatment should be comprised of primarily behavioural changes known as sleep hygiene or cognitive behavioural therapy. Once these techniques have been implemented, you and a doctor may decide to use pharmaceutical sleep aids to assist with sleep while you work through the underlying causes.

Please note: Australian law prevents us from naming specific sleeping medication names.

Sleeping Tablets

There are a number of sleeping pills available both on prescription and over the counter in Australia. Each will affect people slightly differently and you should discuss which one is right for you with a doctor.

Natural Hormone

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These sleeping pills work by increasing the amount of the natural hormone in the body, melatonin. The hormone melatonin is responsible for the natural feeling of drowsiness. It is the hormone produced by the body when it becomes dark that acts on the part of the brain that encourages you to sleep.

By increasing the amount of melatonin in the body, the medicine brings on a natural feeling of drowsiness 1-2 hours after being taken.

The medicine is generally well tolerated by most people however like all medicines, it can have side effects. Up to 1% of people may experience side effects such as headaches, indigestion, dry mouth and dizziness.

Hypnotics, Benzodiazepines & Sedating Antihistamines

Your doctor may decide to use one of these medicines short term. These medicines have a sedating effect causing drowsiness to assist with getting to and staying asleep. Long term use of these medicines is not recommended as there is the potential for addiction and reliance on the medicine.

These medicines will generally take between 30-60 minutes to absorb and take effect. If prescribed these treatments they should be used about 30 minutes to one hour before your intended sleep time.

These sleeping tablets can drastically affect your ability to safely drive and operate machinery. Do not drive or operate machinery while under the effects of sleeping tablets.

Some of the side effects of these sleeping tablets are drowsiness into the next day, sleepwalking, difficulty thinking, dizziness, profound drowsiness and muscle weakness.

These sleeping pills have the potential to cause rebound insomnia if taken for a long duration. This causes the symptoms of insomnia to come back after the medicine is stopped. 

Please note: Hypnotics and benzodiazepines are not available from Simple Online Doctor or any legitimate online service. Please talk to your doctor in person if you require these medicines.

Natural sleep medicines

These are the over the counter herbal & natural treatments for sleep. Some people may experience improved sleep with these medicines however, there is little scientific evidence that these medicines work better than a placebo.

If you would prefer a natural remedy for insomnia, speak to your doctor about sleep hygiene as well as whether these herbal options would be safe with your medical conditions and other medicines.

Sleep hygiene & underlying condition management

While primary insomnia (no discernible cause) may require medicines to treat, the recommended starting treatment for secondary insomnia is behavioural changes and underlying condition management.

Sleep hygiene is a term used to describe a number of changes to a person behaviour to encourage healthy and unassisted sleep. These techniques include:

• Having regular sleep times - go to bed and wake at a consistent time allowing enough time to sleep a healthy amount. This also improved your circadian rhythm or body clock.
• Limiting napping - naps too late in the evening or too long can result in a disturbance to your sleep pattern
• Avoiding big meals close to sleep - digesting food while trying to sleep can be uncomfortable and disrupt sleep
• Create a comfortable environment for sleep - control the amount of light and noise that enter the room and avoid using the bed for non-sleep and intimate activities.
• Avoid substances that affect sleep - Stimulant drugs such as nicotine from smoking, illicit drugs, alcohol and caffeine can all have negative effects on sleep, particularly when taken close to intended sleeping time
• Avoid blue light at night - Screens can emit blue light which prevents natural melatonin production and drowsiness. Avoid using your phone or computer without a blue light filter close to bedtime
• Allow yourself to unwind - do not perform activities that induce stress or wakefulness close to sleep. Complete an activity that relaxes your mind such as reading or meditation.

Management of an underlying medical condition causing secondary insomnia may result in significant improvement in symptoms. It is important that if you are diagnosed with a condition that can affect your sleep, that you feel this condition is being adequately and effectively managed. Sleep disorders such as insomnia could indicate a worsening of an underlying condition which may need a review by your doctor.

If you have not been diagnosed with an underlying condition such as anxiety, depression or diabetes, yet you suspect there may be a chance you have these conditions, see your doctor for a diagnosis.

Insomnia & Sleep FAQ

How much sleep do we need?

Adults are recommended to get at least 7 hours of sleep per night. Children 6-12 are recommended at least 9-12 hours to assist with development. Teenagers 13-18 require slightly less than children, but more than adults with the recommendation being between 8-10 hours.

Why is sleep so important?

Sleep is linked to numerous positive health effects such as higher energy, better concentration, improved mood and reduced risk of health complications. Sleep deprivation has been linked to the opposite, fatigue, decreased immune function, difficulty learning and concentrating and serious health conditions such as depression.

How do I get to sleep quickly?

Falling asleep quickly is best achieved through implementing sleep hygiene strategies. These should maximise natural drowsiness and improve the sleep you get to sleep.

Can I cure insomnia?

Secondary insomnia can be drastically improved and even cured if the underlying cause of the insomnia is addressed. The cause should be investigated with your doctor who can advise how to address your potential underlying cause of insomnia.

Why can’t I sleep?

There are multiple reasons people may not be able to sleep such as bad sleeping habits, stimulants, sleep disorders or a combination of multiple factors. These should be investigated and address with your GP.

How do I get over jet lag?

Jet lag can be addressed using a number of techniques and medicines. For more information visit our jet lag clinic.

Written by Clinical Pharmacist Tyson Wilkman