This eBook has been developed by Idorsia Pharmaceuticals Ltd as a resource to improve understanding of insomnia. It provides a useful summary of current information about insomnia, how it is diagnosed, and how it can be treated. It highlights the impact insomnia can have on the life of a person diagnosed with the condition, and those around them. It also outlines the strategies people with insomnia can use to help improve the quality of their sleep.

The book is intended for the use of a general audience.

“It’s like a barrier. I can’t feel much other than tired. If something happy happens, rather than being excited about it, I’m just too tired”

Patient

Introduction

Sleep is one of the three key pillars of health, alongside diet and exercise, and is foundational to our physical, mental and social well-being. We spend approximately a third of our lives asleep, and a lack of good quality, restorative sleep can have significant short- and long-term consequences.

If you’ve struggled to sleep for months, or even years  – you could have chronic insomnia.

“It really annoys me when people say ‘if you were really tired, you would sleep’. If only it were that simple! Unless you have suffered from true insomnia, you have absolutely no idea what it’s like”

Patient

Understanding insomnia

Many of us go through times when we have trouble sleeping. This is known as insomnia. The meaning of the word is, literally, ‘without sleep’. But, for some people, insomnia goes way beyond the odd sleepless night. It can go on for several nights a week for over 3 months and leave people tired during the day. This is chronic insomnia, and it’s a recognized medical disorder.

When you have difficulties falling asleep (sleep initiation) or staying asleep (sleep maintenance), you’re unable to get restorative sleep. This means you may feel tired and not really at your best during the day.

With a better understanding of chronic insomnia, you can also think about new ways of managing it. It’s time to rethink insomnia for better days ahead.

Sleep: why it matters

We need sleep as much as we need food, water, and air. We can’t live without it. While we don’t fully know why we’ve evolved to sleep, what we do know is that it’s essential for pretty much every aspect of our well-being—including brain function, metabolism, immunity, mental health, growth, repair, and recovery—as well as our long-term health.

What are the stages of sleep?

Sleep is composed of two different types: non-rapid eye movement (NREM) and rapid eye movement (REM). NREM is divided into three further stages (1-3).

Non-rapid eye movement (NREM) sleep is divided into three stages: stages 1 and 2 are light sleep and stage 3 is deep sleep. Deep sleep is a very refreshing type of sleep and is needed to restore the mind and body.

On average, NREM accounts for 75–80% of the total sleep in an adult.

Rapid eye moment (REM) is the stage people tend to remember – it’s when we dream. It’s also the stage that helps with learning. In REM sleep, nearly all our muscles, except for the ones that move our eyes and keep us breathing, are completely relaxed and don’t move. When you’re dreaming, your breathing rate is irregular. You don’t typically go into REM in the first sleep cycle, and when you do in the second cycle, REM only lasts for 10 minutes. This length of time increases with each cycle over the night, and an adult usually spends about 25% of their night in REM sleep. 

Types of insomnia

When you have insomnia, it usually starts because something has triggered it. This could be something like stress at work, a new baby, or grief from losing a loved one. Once these triggers resolve, or as time passes, most people are able to sleep again. This is known as acute insomnia.

However, in some cases, acute insomnia can develop into chronic insomnia. Chronic insomnia happens when insomnia symptoms last for 3 months or longer.

Chronic insomnia is a recognized medical condition where you have trouble sleeping at least 3 times a week for 3 months or longer. This negatively affects the quality and quantity of your sleep, as well as how well you function during the day.

What happens in your brain when you have chronic insomnia?

  • Medical research suggests that people with chronic insomnia may have an overactive brain at night.

  • Parts of the brain that keep you awake are still active, making it hard to drift off and/or stay asleep until morning.

  • When you find it difficult falling asleep or staying asleep for a long time, you’re unable to get restorative sleep. This can leave you feeling tired and not at your best during the day.

Who gets chronic insomnia?

About 1 in 10 people suffer from chronic insomnia. So, if you’re living with any of its symptoms, know that you’re not alone.

Associated causes

Some of the things that may increase your risk of chronic insomnia are:

  • Your age – your risk increases as you get older

  • Going through the menopause
  • Stressful triggers
  • Poor sleep habits, like trying to nap during the day or drinking more caffeine. These can become counter-productive and may play a role in continuing your chronic insomnia
  • Feeling stressed, anxious or depressed
  • Too much screen time
  • Overstimulating your brain with alcohol, caffeine or nicotine

"I am always amazed how I cope at work with minimal sleep. You just get used to it, but I do wonder about the damage to my long-term health”

Patient

Burden of Insomnia

The impact of insomnia is often underestimated. In reality, it can be a distressing condition that can reduce quality of life. It may affect many aspects of daily life, from studying and employment to social activities and relationships, with both short- and long-term consequences.

  • Chronic insomnia can affect cognitive functioning and increase daytime fatigue.
  • People with chronic insomnia are 3.5 times more likely to have a fatal motor injury, and miss twice as many work days compared to someone without chronic insomnia.
  • Billions of dollars are estimated to be lost per year due to reduced productivity.
  • ​​​​​Different studies have found that people with insomnia are 4 to 39.8 times more likely to develop major depression, compared to people with normal sleep patterns.
  • Worrying about sleep can cause stress, leading to negative thought patterns, which may make it more difficult to sleep, setting up a vicious circle.
  • People who suffer from insomnia may lack the energy or motivation to take part in social activities.
  • Family, friends and colleagues may not realize the true impact that insomnia can have, and people affected by insomnia may perceive them as not very supportive or empathetic.
  • Sleepless nights can leave you feeling irritable and out of sorts – this may impact relationships.
People with chronic insomnia are at increased risk of serious health conditions, including high blood pressure, diabetes, dementia, and depression.

“When I am going through a bad patch, insomnia gets in the way of everything. Work, going out, doing exercise. Everything just seems like too much of an effort. I try not to think about it too much – you can so easily get obsessed with getting a good night’s sleep – but it’s always there at the back of my mind”

Patient

What can be done to help you get to sleep?

If you’ve been struggling with insomnia for a long time, you may start getting nervous or even anxious before getting into bed and this can make it harder to drift off. This section outlines some of the strategies that can be helpful.

Sleep habits

Sleep habits are a blend of your sleeping environment and your habits before bedtime. But with busy schedules and long working hours, it can be easy for sleep habits to go out of the window. Integrating the following sleep habit techniques into your night-time routine may help you to relax and wind down so you get a good night’s rest.

  • Switch screens for music or reading – try not to watch TV in the place where you sleep or spend the time before you sleep endlessly scrolling on your phone.
  • Save your bed for sleep – only get into bed when you feel you’re ready to nod off.
  • Keep your bedroom cool – your core body temperature decreases as you fall asleep so a bedroom temperature between 19–21°C is optimum for sleep.
  • Avoid day-time napping.
  • Get some daily movement – regular exercise can help improve the quality of your sleep.
  • Reduce your caffeine intake.

Relaxation techniques and meditation for insomnia

"Lying awake in the small hours is an incredibly lonely experience. You start worrying about what you have to do next day and your mind fills with other fears and anxieties. Everything seems worse in the dead of the night."
— Patient

“Some mornings you get up and wonder how on earth you are going to get through the day. Somehow you do, but it can be a massive struggle”

Patient

Diagnosis and treatment of chronic Insomnia

Insomnia is often under-diagnosed and under-treated. It is estimated that around 70% of people with persistent insomnia never seek medical help.

What treatments are available for insomnia?

A variety of approaches can be tried, depending on the likely cause of insomnia and the degree of severity:

Cognitive behavioral therapy (CBT)

What is CBT for insomnia (CBT-I)?

  • CBT-I is a way of building back a better, healthier and happier relationship with sleep. It does this by helping you see the bedroom through a new lens as a calming and inviting space, rather than a disruptive one.
  • CBT-I uses a number of different techniques, including stimulus control and sleep restriction. It is a non-pharmacological form of treatment, and some people see lasting results after they complete a course.
  • That being said, CBT-I takes a lot of time and some dedication, and not everyone is able to access this form of treatment.

The most popular types include antihistamines, melatonin, and valerian.

However, evidence for some sleep aids is mixed, suggesting that some could even contribute to poor-quality sleep. To top it off, some may leave you feeling drowsy and unrefreshed during the day.

There are also prescription drugs available that don’t have a sedative effect which can help you to sleep.

Although many prescription drugs can help you sleep, some may not help you to get the restorative sleep you need to feel your best during the day. Plus, they may be long lasting with means you can experience daytime symptoms (difficulty remembering things, dizziness, fatigue, blurred vision) after using them.

It’s important to talk to your doctor about any symptoms you may be experiencing, as well as how long you’ve been having trouble sleeping. They can then find a way to help you, so you can not only fall asleep but also feel your best during the day.

The types of prescription drugs that can be prescribed to you depend on certain factors, such as your age, as well as other medications you may be taking.

There are lots of different types. Some are recommended for short-term sleep troubles, while others are more suitable for long-term sleep problems, like chronic insomnia. The most common prescription drugs for insomnia are sedative medications, which act on your brain to make you feel drowsy and relaxed so you can fall asleep more easily. They can also help your muscles relax and may help reduce anxiety.

What do guidelines recommend?

The recent European Insomnia Guideline, developed by groups from the European Sleep Research Society (ESRS) and the European Insomnia Network (EIN), recommends the use of CBT-I as a first-line option, with elements of exercise and light therapy integrated to provide additional benefits, followed by sleep aids and prescription drugs where and when appropriate.

This resource has been developed by Idorsia Pharmaceuticals in order to provide an environment to deliver a better understanding of insomnia and to pool information regarding the disease, the diagnosis procedure, available treatments, and the impact it could have on the life of someone diagnosed with insomnia. The resource is for use by a general audience.

The information in this resource is not intended as a substitute for advice/treatment by a physician, whose instructions should always be followed. Neither does the information provided constitute an alternative to advice from a doctor or a pharmacist and should not be used on its own to produce a diagnosis or to commence or cease a particular treatment.

The links provided are for informational purposes only; they do not constitute an endorsement or an approval from Idorsia Pharmaceuticals Ltd of the services or opinions of the corporation, organization or individual. Idorsia Pharmaceuticals Ltd bears no responsibility for the accuracy, legality or content of the external sites or subsequent links. You are requested to contact the respective external site for answers to questions regarding its content.

The information provided is valid on the publication date but may be subject to further modifications. Even though Idorsia aims to provide accurate and up to date information at all times, please acknowledge that the present resource is made available “as is”. Idorsia does not give any warranty or representation, whether expressly stated or implied, of any kind related to the comprehensiveness, usefulness, reliability or timelines of the content of this resource. Idorsia cannot be held liable for any direct or indirect damage of a material or non-material nature that might be caused by the use or non-use of the information presented.

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