WHAT CAUSES CHRONIC INSOMNIA?
In many cases, it is unclear if chronic insomnia is a symptom of some physical or psychological condition or if it is a primary disorder of its own. In most instances, a collaboration of psychological and physical conditions causes the failure to sleep.
Psychophysiologic Insomnia After Short-Term Insomnia
Psychophysiologic insomnia is the revolving door of sleeplessness:
- An episode of transient insomnia disrupts the person's circadian rhythm.
- The patient begins to associate the bed not with rest and relaxation but with a struggle to sleep. A pattern of sleep failure emerges.
- Overtime, this event repeats, and bedtime becomes a source of anxiety. Once in bed, the patient broods over the inability to sleep, the consequences of sleep loss, and the lack of mental control. All attempts to sleep fail.
- Eventually excessive worry about sleep loss becomes persistent and provides an automatic nightly trigger for anxiety and arousal. Unsuccessful attempts to control thoughts, images, and emotions only worsen the situation. After such a cycle is established, insomnia becomes a self-fulfilling prophecy that can persist indefinitely.
Sometimes anxiety and the inability to sleep dates back to childhood when parents used various threats to force their children into sleep for which they may not have been ready.
Medical Conditions and Treatments
In a 1999 survey, 22% of adults reported that health conditions, pain or discomfort impaired their sleep.
Nightly Leg Problems. Leg disorders that occur at night, such as restless legs syndrome or leg cramps, are of special note. They are very common and an important cause of insomnia, particularly in older people. [For more information, see, Leg Disorders (Sleep-Related): Restless Legs Syndrome and Others.]
Medical Problems. Among the many medical problems (and some of the drugs that treat them) that can cause chronic insomnia are allergies, arthritis, cancer, fibromyalgia, heart disease, gastroesophageal reflux disease (GERD), hypertension, asthma, emphysema, rheumatologic conditions, Alzheimer's disease, Parkinson's disease, hyperthyroidism, and attention deficit hyperactivity disorder.
Medications. Among the many medications that can cause insomnia are nicotine, certain antidepressants (e.g., fluoxetine, bupropion), theophylline, lamotrigine, felbamate, beta-blockers, and beta-agonists.