Insomnia
All about Insomnia
Around 20-25% of adults state that they have problems falling asleep or sleeping through the night. Around 6-10% meet the criteria for clinically relevant insomnia, i.e. with a noticeable impact on daily life.
What is Insomnia?
Insomnia is a long-lasting or intermittently recurring sleep disorder. It is characterized by difficulty falling asleep and staying asleep, which is accompanied by physical or psychological complaints during the day. In contrast to occasional sleep problems that can be caused by stressful phases or external influences, insomnia is a chronic or recurring disorder that can have a significant impact on daily life.
When do we speak of insomnia?
Insomnia is present when sleep disturbances and early morning awakenings occur for ≥ 3 nights/week for ≥ 3 months. The diagnosis is primarily clinical.
Possible symptoms of insomnia
People who suffer from insomnia often have difficulty falling asleep, staying asleep or wake up early in the morning and are unable to fall asleep again. These sleep disorders lead to poor sleep quality and affect the entire day of those affected. The most common symptoms include difficulty falling asleep, where it is difficult to get back to sleep after going to bed. Difficulty sleeping through the night is also common, with sufferers waking up repeatedly during the night and finding it difficult to fall asleep again. Another typical symptom is early awakening, where those affected wake up too early and cannot find their way back to sleep. These sleep problems are often accompanied by physical and psychological complaints during the day, such as tiredness, listlessness, concentration problems, irritability and mood swings. These symptoms usually occur at least three times a week and can last for weeks or months.
Diagnostics
The following options are available for diagnosing insomnia:
Source: WMF register number 063-003, German Society for Sleep Research and Sleep Medicine (DGSM), last update: 2022
- Medical history (sleep, lifestyle, medication history)Schlafprotokolle
- Questionnaires (Insomnia Severity Index)
- Aktimetri
You can find more information in the guide: AWMF guideline register
Causes of insomnia
The causes of insomnia can be varied and often complex. Several factors are often responsible for the sleep disorder at the same time. The most common causes include:
- Psychological factors: Stress, anxiety or mental illnesses such as depression and anxiety disorders can lead to reduced sleep quality.
- Physical illnesses: Conditions such as chronic pain, respiratory illnesses or hormonal changes can cause insomnia.
- Medication: Certain medications, such as antidepressants, blood pressure medication or corticosteroids, can cause sleep disorders.
- Life circumstances: Stressful life events such as separation, loss of a loved one or work-related pressure can also cause sleep problems.
- Poor sleeping habits: Irregular sleeping times, too much caffeine or restless sleeping environments can encourage the development of insomnia.
Forms of Insomnia
Insomnia can occur in various forms, which have different causes and effects.
Non-organic insomnia
The most common form is non-organic insomnia. This form of insomnia occurs without an underlying physical illness. It is often triggered by psychological factors such as stress, anxiety or worry. Stressful life events such as professional pressure or personal conflicts can also contribute to this sleep disorder. Non-organic insomnia is often acute, but can recur or become chronic if the underlying stress is not adequately managed. Poor sleeping habits, such as irregular sleeping times or the use of caffeine, can also play a role.
Lethal familial insomnia
Lethal familial insomnia, on the other hand, is a rare and severe form of insomnia that is genetically determined. This disease leads to a progressive loss of the ability to sleep, which is accompanied by severe neurological symptoms. Lethal familial insomnia is usually fatal, as the persistent lack of sleep leads to irreversible damage to the brain. This form only affects a very small number of people and poses a significant medical challenge.
Treatment options for insomnia
The treatment of insomnia depends on the cause and severity of the sleep disorder and can include both non-pharmacological and pharmacological approaches.
Non-medicinal treatment options
Non-medication treatment primarily involves improving sleep hygiene: regular sleeping times, avoiding caffeine and alcohol before sleep and a quiet sleeping environment. Relaxation techniques such as autogenic training, progressive muscle relaxation or yoga can also help to promote sleep. For psychological causes such as stress or anxiety, psychotherapy is also helpful in overcoming thoughts that disturb sleep.
Medication treatment options
Drug treatment is used for more severe forms of insomnia. Herbal preparations such as valerian have a calming effect and can improve sleep. For more severe sleep problems, sleeping pills are often used, but these should only be used in the short term. It is important to tailor the treatment to the individual and to carry it out under medical supervision in order to find the right solution.
Therapy recommendations from the German Society for Sleep Research and Sleep Medicine (DGSM)
Source: AWMF register number 063-003, German Society for Sleep Research and Sleep Medicine (DGSM), last update: 2022
Click here: AWMF Leitlinienregister
Cognitive Behavioral Therapy for Insomnia (CBT-I)
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Sleep restriction
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Stimulus control
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Cognitive techniques
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Relaxation techniques
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PsychoeducationCognitive Behavioral Therapy for Insomnia (CBT-I)
Drug therapy (short-term)
- Indication: severe stress or failure of non-pharmacological measures
- Substances:
- Z-substances (e.g. zolpidem) – only for a short time
- Sedative antidepressants (e.g. doxepin)
- Melatonin (for older people)
- Caution with dependency risks, side effects
