What causes insomnia – and what helps

For some, it happens every night: they can’t fall asleep when they’re tired, or they may wake up repeatedly during the night. The next day is then often a torment and can only be mastered with difficulty. Find out what sleep disorders there are – and what can help.

Sleep is essential to life. But almost everyone has occasional phases when sleep just doesn’t go well. This is usually nothing to worry about. However, if the sleep problems persist for a longer period of time, they should be clarified by a doctor.

Sleep disorders are not uncommon. About every third adult suffers from it, with an increasing trend in old age. From a medical point of view, a sleep disorder is when the affected person sleeps poorly for at least three nights a week, the condition lasts longer than a month and is noticeably reflected in everyday life.

Those who have trouble sleeping often feel exhausted and tired the next day. The desired relaxation that sleep usually brings is missing. This can make everyday life more difficult and, for example, mean that those affected have difficulty concentrating, make mistakes easily or are irritable.

Sleep disorders: symptoms

Depending on the type and cause of the sleep disorders, they can manifest themselves through different symptoms. First of all, these are symptoms related to sleep itself. Affected

sleeping too short or too long,
wake up frequently and sometimes have trouble falling asleep again quickly,
take a long time to fall asleep or
overall not restful sleep.
Under certain circumstances, the impaired sleep is accompanied by other nocturnal complaints, such as sweating, nightmares, restless sleep or an urge to move the legs.

During the day, sleep disorders can become noticeable through other signs. Those affected often feel tired and exhausted during the day or have a strong urge to sleep. A lack of sleep often leads to complaints such as concentration problems, a drop in performance, depressed mood or mood swings.

Last but not least, not sleeping well and not feeling rested triggers a great deal of suffering and can severely reduce the quality of life. Long-term sleep problems can also lead to other health problems. For example, prolonged insomnia increases the risk of developing depression. On the other hand, sleep disorders can also be a side effect of depression.

Lack of sleep also makes you forgetful because it impairs memory and thus the ability to remember in the long run. Persistent insomnia has also been shown to alter various metabolic processes in the body, increasing the risk of obesity and diabetes.

If sleep disorders lead to increased daytime sleepiness and thus to reduced alertness and responsiveness, the risk of accidents increases. This is especially true if those affected doze off briefly while working on machines or driving a car. A large number of accidents at work can be attributed to sleep disorders.

forms of sleep disorders

Not all sleep disorders are the same: experts today distinguish between over 80 different forms. These can be classified in different ways depending on the classification system. The following groups can be roughly distinguished:

Difficulties falling asleep and staying asleep (insomnia): Difficulties falling asleep and staying asleep are among the most common sleep disorders. Those affected have problems falling asleep quickly, cannot sleep through the night, regularly wake up unintentionally early in the morning or do not feel refreshed despite sleeping.

Sleep apnea: Sleep-related breathing disorders are characterized by pauses in breathing that last 10 seconds or longer.

Hypersomnia: These sleep disorders involve an excessive need for sleep. This group includes, for example, narcolepsy, in which those affected repeatedly nod off unintentionally during the day, sometimes in the middle of activities such as talking or eating.
Disorders of the sleep-wake cycle: Here sleep is often possible, but occurs at the wrong time. Possible causes for this can be shift work or jet lag, but also medication. As a result, those affected are often very sleepy during the day.

Parasomnias: This group includes abnormal behaviors that occur during or in connection with sleep. This includes, for example, sleepwalking, talking in your sleep, bedwetting, nightmares or what is known as sleep paralysis.

Sleep-related movement disorders: This refers to simple, repetitive movements that occur during sleep and can disturb it. These include, for example, restless legs syndrome, periodic leg movements at night, nocturnal calf cramps, muscle twitching when falling asleep or grinding your teeth.

Sleep disorders: causes

Acute or long-standing sleep disorders can have different causes. In many cases, the sleep disorder is not based on a disease in the actual sense, but rather the causes are to be found in habits that hinder sleep. Examples of such behaviors and circumstances may include:

Excessive stress or distressing experiences, especially before bedtime

doing mentally taxing things before bed
Sleep longer during the day at least twice a week
too long nap (more than 15 minutes)

constantly changing wake-up and bed times

prolonged stays in bed unrelated to sleep or sexual activity (such as eating or watching TV)
regularly smoke a lot before going to bed, drink caffeinated beverages (such as coffee, black or green tea, cola sodas, energy drinks) or alcohol

exercise or be very physically active before going to bed
uncomfortable bed

unfavorable sleeping conditions (e.g. too warm, too cold, too humid, too loud, too bright, vibrations)

frequent periods of rumination in bed

Other possible causes and factors that may accompany insomnia or sleep problems include:

new circumstances

Working in shift system
Jet lag
depressions
anxiety disorders
dementia diseases
lung diseases
Pains
thyroid disorders
menopause in women
Nocturnal breathing pauses (sleep apnea)
teeth grinding
snoring
nocturnal urge to urinate
nocturnal urge to move the legs (restless legs syndrome)
sleepwalking
side effects of medication
drug use

Sleep duration: How much sleep is normal?

How much sleep a person needs varies from person to person – some need a little more sleep, others a little less. The average length of sleep also changes over the course of a lifetime. For example, while children from the age of 6 sleep an average of 9 hours, most adults only sleep about 7 hours a night. Sleep duration also decreases with age. Over 80-year-olds often only sleep about 6 hours.

How long it takes for someone to fall asleep can also vary widely. Some fall asleep as soon as they turn off the light, others need a few minutes. Up to about half an hour, however, everything is still within the normal range.

sleep disorders in pregnancy

Sleep disorders are more common in pregnant women. So this is usually not uncommon. For example, the growing stomach can make it difficult to find a comfortable sleeping position, or those affected wake up every time they have to change their lying position at night.

For many women, nocturnal symptoms such as heartburn, calf cramps or restless legs cause sleep disorders during pregnancy. Or they wake up because they often have to go to the toilet.

A cause of insomnia during pregnancy can also be the sleep-wake phases of the unborn child. Because these are not based on those of the expectant mother, but are shorter. So it can happen that the baby wakes up in the middle of the night and moves a lot – and wakes you up.

Studies show that every second pregnant woman suffers from sleep disorders. In early pregnancy, i.e. in the first trimester, pregnant women sleep more hours overall, but the quality of sleep decreases. After the first trimester, total sleep time decreases, with sleep problems occurring especially in the last trimester.

Sleep disorders during menopause

When women go through menopause, the hormonal changes can trigger various symptoms, including sleep disorders. As a result, some women have a harder time falling asleep after the menopause than they used to or wake up more frequently at night.

In addition to problems falling asleep and staying asleep, sleep during the menopause can also suffer from other typical symptoms: Many women experience hot flashes and sweating as a result of the falling level of sex hormones. These often occur at night and cause those affected to wake up drenched in sweat.

Sleep disorders: diagnosis

If insomnia persists, it should be investigated. The first point of contact is usually the family doctor’s practice. In order to make the diagnosis, the doctor usually first asks those affected about the exact symptoms, the type of sleep problems and possible accompanying circumstances (such as stress, illnesses, medication or lifestyle). This is usually followed by a physical examination and, if necessary, a blood test.

In order to get more information about the type and frequency of sleep problems, the doctor often recommends keeping a sleep diary for a while (e.g. on paper or as an app). In it, those affected note details such as bedtimes, sleep duration and interruptions, how the sleep was perceived as well as symptoms occurring during the day and other circumstances (such as stressful events, medication, teeth grinding, etc.). In this way, you can find out more about sleep patterns, the severity and possible triggers of sleep disorders.

Depending on the situation, the doctor will also arrange for an examination in the sleep laboratory. Sleep can be monitored there and the sleep stages affected can be determined. This provides information, for example, about how deep sleep and light sleep phases are distributed, whether there are nocturnal breathing pauses or whether there are an unusual number of leg movements during sleep.

Treating Insomnia: What Can You Do?

If you have insomnia, you want one thing above all: sleep properly again. Which treatment is the right one depends on the particular cause of the sleep problems. If physical illnesses or complaints (such as sleep apnea, nocturnal leg cramps) or mental illnesses (such as depression) trigger insomnia, it should be treated.

At the same time, it is important to educate those affected about healthy sleep – and also about which deviations are still within a normal range. This can help reduce any anxiety you may have about sleep.

If the insomniac causes are not purely physical, in many cases tips on sleep hygiene will help to improve the insomniac. Sleep hygiene refers to various measures and habits that can promote healthy sleep. You can often do something yourself with small everyday changes.

Finding good sleep with sleep hygiene

The aim of so-called sleep hygiene is to design the sleeping environment in such a way that it is as pleasant and trouble-free as possible. It also helps to develop sleep-related habits and maintain them regularly. Then they can signal to the body that it is now time for sleep.

The following tips can contribute to good sleep hygiene and thus to a healthy sleep:

no caffeinated beverages (such as coffee, colas, black or green tea, energy drinks) after lunch
Avoid alcoholic beverages as much as possible and do not use them as a sleeping aid
do not smoke before going to bed or at night
eat light meals in the evening; Avoid heavy, spicy meals
don’t eat anything right before bed
exercise or exercise regularly, but not just before bedtime
not watch TV or be on the computer or smartphone until just before bedtime
relax physically and mentally in the evening before going to bed
develop your own pleasant bedtime rituals or routines before going to bed (e.g. dim the lights, read a nice book, drink tea, do relaxation exercises, etc.)
Make the sleeping situation pleasant (comfortable bed, pleasant room temperature, sufficient darkening, quiet enough, etc.)
try earplugs if there is disturbing ambient noise
don’t look at the clock at night
Always go to bed and get up at the same time, preferably on weekends too

Find peace with relaxation techniques

If done regularly, relaxation techniques such as progressive muscle relaxation or autogenic training can help to reduce the overall stress level and help you to calm down more easily. This can also have a positive effect on sleep. Many health insurance companies offer courses or instructions that can be used to learn such techniques.

Behavioral therapy for sleep disorders

In some cases, the doctor may recommend cognitive behavioral therapy. If unfavorable thought patterns and behavior contribute to the sleep problems, those affected learn to recognize and change them.

Drugs for sleep disorders

Depending on the type of sleep disorder, medication may be used in the treatment.

If the sleep problems occur, for example, as a side effect of mental illnesses such as depression or an anxiety disorder, these often improve when the doctor prescribes antidepressants or anti-anxiety medication. Even with purely psychotherapeutic treatment, in many cases sleep disorders subside after a while.

In the case of a neurological disease such as narcolepsy, special medications that promote wakefulness (so-called stimulants) can help to reduce daytime sleepiness. As a result, those affected are less likely to fall asleep suddenly during the day.

Real sleeping pills (so-called hypnotics) such as the active ingredients zopiclone, zaleplon or zolpidem or active ingredients from the benzodiazepine group should only be used and prescribed with caution in the case of sleep disorders. Because these can quickly become addictive and should therefore only be used for a short time over a few weeks (usually a maximum of four). After that, the funds should not be discontinued abruptly, but gradually tapered off.

There are also over-the-counter sleeping pills based on antihistamines, which are primarily considered to promote sleep. However, how effective these are for insomnia has not been well studied.

Melatonin can also be an option for sleep disorders; either as a prescription drug or in dietary supplement form. Melatonin is a messenger substance that also occurs naturally in the body. There it acts as a tiring “sleep hormone” and influences the sleep-wake cycle. Drugs with melatonin are considered to promote sleep and may in some cases help with insomnia. However, further studies are needed to make a definitive statement.

Important NOTE

Both “real” sleeping pills and drugs with antihistamines or melatonin often make you tired during the day as a side effect and reduce your ability to react. This can promote falls and accidents, for example when driving a car or operating machines.

Herbal sleeping pills and sedatives (e.g. with valerian, hops, passion flower or lemon balm) can sometimes help with sleep disorders, but are often less effective or only effective in mild cases. It has not been scientifically proven that such drugs are actually effective in alleviating sleep disorders.