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The Nightmare of Insomnia

Updated: Jun 13, 2022

It’s happened to all of us at one time or another. We go to bed ready for a good night’s sleep, but suddenly find ourselves tossing and turning, our thoughts restlessly flitting from one thought to another as the clock steadily ticks forward.

With our increasingly hectic lifestyles, we often find ourselves short on sleep. Even though we intuitively know sleep is essential to the rejuvenation of our bodies and minds, we frequently cheat ourselves. Feeling grouchy, tired and unfocused after a night of insufficient sleep is something we have all experienced.

What does sleep do for us?

During sleep the cells of our bodies repair themselves. The regulation of basic bodily functions such as heart rate, breathing, etc. and hormonal functions also occur during sleep. Thus, sleep is crucial to proper physical and emotional health.

What is insomnia?

Insomnia means difficulty initiating or maintaining sleep or both. It is important to understand insomnia is a symptom not a medical diagnosis or illness. Insomnia can be ‘primary’ (when there is no obvious medical condition causing it) or ‘secondary’ (caused by a known physical or emotional condition).

Short term vs. chronic insomnia

Insomnia symptoms lasting one to three weeks are considered short term while those lasting more than three weeks are considered chronic insomnia.

How common is it?

In the USA, about 30%-50% of people suffer from some form of insomnia and about 10% have chronic insomnia. About 30% of children receiving psychiatric care suffer from insomnia.

Who is likely to suffer from insomnia?

Any age group can have insomnia but older people are more likely to have it. People with low income, alcoholics, and those with psychiatric illnesses are at a higher risk.

Insomnia and psychiatric illnesses

Virtually any psychiatric illness can cause insomnia in all age groups. Most importantly, insomnia may be the first indication of an acute episode of many psychiatric illnesses such as major depressive or manic episode.

Chronic insomnia and physical health

Chronic insomnia has been shown to be related to weight problems, hypertension, heart ailments, etc. On the other hand, obesity may lead to sleep apnea which causes insomnia. Chronic pain is another common cause.

What to do if you have chronic insomnia?

  • First and foremost seek professional evaluation.

  • Make sure to work with your doctor to receive treatment for any physical or emotional condition that may be causing insomnia.

  • Pay attention to ‘sleep hygiene’: have ‘winding down’ time: sleep in a quiet, dark room: have a regular bedtime schedule, etc.

  • Relaxation exercises may be helpful: breathing exercises, guided meditation, progressive muscle relaxation are all helpful.

  • Regular exercise has been shown to regularize sleep habits.

  • Cognitive Behavioral Therapy (CBT) helps you understand what emotional reason may be causing sleep problems and effectively deal with them.

  • Medications may be very helpful: a number of prescription hypnotics (sleep aids) are now available. These include Ambien (Zolpidem), Sonata (Zaleplon), Prosom (Estazolam), Rozerem (Ramelteon), etc. A group of medications called benzodiazepines which include Dalmane (flurazem), Restoril (Tomazepam), Antivan (Lorazepam), etc. may also be helpful.

Sleep architecture and quality of life

Normal sleep has two main parts: REM (Rapid Eye Movement) and Non-REM. The later part has for distinct phases. Different parts and phases of sleep play different roles in our overall health. Sleep medication which disrupt this sleep architecture may not only fail to provide restful sleep but may also not be health-promoting in general. Please be sure to discuss this issue with your doctor before choosing a prescription sleep aid.

Over-the-counter sleep aids: Chronic effects

Popular over-the-counter sleep aids containing Benadryl (Diphenhydramine) may be very harmful to your short term memory especially if, taken over the long haul. So beware!!

The purpose of this article is for educational purposes only. It is not intended to diagnose or treat any medical or psychiatric issue. Dr. Rakesh Ranjan is a practicing psychiatrist and a researcher. He is a recipient of several research awards and has authored several peer-reviewed journal articles and book chapter on psychiatric illnesses and their treatments. He is a national speaker for several organizations and serves on the medical advisory board for NAMI for Greater Cleveland. If you or a loved one is experiencing any symptoms that would lead you to believe that there could be a mental imbalance, please email your questions to Dr. Ranjan at ask Each Wednesday, Dr. Ranjan will address some of these questions in this column. All contact info will be kept confidential.


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