All About Idiopathic Insomnia

Insomnia, coming from the Latin in somus meaning ‘without sleep’, is a sleep disorder characterised by people who have trouble sleeping or falling asleep. There are several distinctions within the insomnia umbrella and there are wide estimates of its prevalence ranging between 5% and 50%, depending on which definition you’re using. Idiopathic insomnia, which we’re specifically discussing in this article, is rare and is believed to occur in less than 1% of people.

Females tend to suffer from insomnia more than males—around one and a half to two times higher. It is also more common when people have other conditions as well, including psychiatric disorders. 

Idiopathic insomnia, also called childhood-onset insomnia, describes a serious and chronic problem with falling asleep and staying asleep. It has been observed even in infancy. The term ‘idiopathic’ relates to the fact that the cause is unknown. 

What is idiopathic insomnia?

Idiopathic insomnia is chronic and life-long with no identifiable cause. It usually begins in childhood. It used to appear in the International Classification of Sleep Disorders (ICSD), which is a manual that doctors use to diagnose sleep conditions. However, it is no longer in this diagnostic manual. Instead, you might be diagnosed with chronic insomnia.

The term idiopathic insomnia has been used since the 19th century but it was attributed to sleep that was non-restorative and affected waking hours. Essentially, if there is a long-term sleep difficulty that began in childhood and can’t be put down to any particular cause (like anxiety, caffeine or jet lag), we can call it idiopathic insomnia.

Other types of insomnia

There are several types of insomnia besides idiopathic insomnia. These include:

• Acute insomnia (when the problem has lasted for a short period of time, like with jet lag).
• Chronic insomnia (a long-term sleep disorder).

The sleep issue usually warrants a diagnosis when it causes impairment in functioning during waking hours, whether social, academic, occupational, behavioural, or otherwise.

What causes idiopathic insomnia?

The clue is in the name idiopathic. No one knows exactly what causes it. However, it does often run in families, which suggests a genetic link. 

Before diagnosing idiopathic insomnia, medical professionals will try to establish whether the condition does have an obvious (or at least an identifiable) cause.

Here are some of the potential causes for insomnia:

• Stress.
• Poor sleep hygiene (sleep times and routines, for example).
• Changes in hormones (e.g., during pregnancy).
• Having a partner who snores or is a restless sleeper.

Explanations for chronic insomnia or insomnia that developed from childhood include:

• Problems with the circadian rhythm (the body’s natural sleep-wake pattern). For instance, when these are skewed, it causes a person to feel sleepy later, which causes them to wake later. This is a fairly frequent occurrence with adolescents.
• Sleep-related breathing conditions. This includes sleep apnoea, a condition when breathing stops briefly during sleep. It reduces the overall quality of sleep and causes frequent waking.
• Behavioural childhood insomnia. This is when children refuse to sleep or can’t sleep unless they have special requests made like being rocked.

Chronic insomnia

Alongside idiopathic insomnia is chronic insomnia. This describes a person who has had trouble sleeping for three or more days per week for one month or more. There are sub-types to this condition: it can be primary or secondary. Primary chronic insomnia is essentially idiopathic insomnia. It is insomnia that doesn’t have any obvious cause or an associated medical condition. 

Secondary insomnia is also referred to as comorbid insomnia as it occurs with another condition. This is more common. 

For secondary chronic insomnia, the causes can be among the following:

• Chronic medical conditions. This includes Parkinson’s, diabetes, hyperthyroidism, obstructive sleep apnoea and central sleep apnoea.
• Mental health problems. This includes anxiety, depression, PTSD, and Attention Deficit Hyperactivity Disorder (ADHD).
• Certain medicines like antidepressants, beta blockers and chemotherapy drugs.
• Stimulants like caffeine, nicotine, alcohol or other drugs.
• Lifestyle influences. This includes having an alternating shift pattern, taking frequent naps, frequent travelling and jet lag.

Chronic insomnia is also more prevalent in those with chronic obstructive pulmonary disease, heart failure, chronic pain conditions and psychiatric problems. Half of those who suffer from chronic insomnia also have a comorbid psychiatric disorder.

Signs of idiopathic insomnia

Chronic and idiopathic insomnia have the same signs and symptoms. These are:

• Problems getting to sleep.
• Problems staying asleep. A person may wake frequently at night or have trouble getting back to sleep if they wake up.
• Waking up too early or after a short amount of sleep.

For a diagnosis, these symptoms must happen persistently and regularly. There will also be a lack of explanation so no other factors present like substance use, a new medication with side effects, a different sleep diagnosable sleep disorder like sleep apnoea, narcolepsy or a circadian rhythm disorder.

In the past, many believed that you couldn’t develop idiopathic insomnia with a mental health condition like anxiety as it was considered to be a symptom of the mental health condition. However, if a comorbid condition is not thought to cause the insomnia, you can be diagnosed.

The impact of idiopathic insomnia

Many people think that you can get used to not having much sleep. However, there is evidence that not enough sleep takes its toll on your body and brain. When you’ve had insufficient sleep, even for a short period of time, you’re going to feel its effects. You might feel sleepier during the daytime and your performance is likely to be affected. Over time, your decision-making, creativity, memory and focus will all suffer. You might also see effects on your health. This includes poor metabolism, weight gain, a poor immune system, effects on hormones and your cardiovascular system, and problems with your mental health. 

It’s not just the length of sleep that matters either. The quality of your sleep is also crucial. With insomnia, the potential small amount of sleep you’ll get likely won’t be restorative. You need to move through the different stages of the sleep cycle to be fully rested. 

Being unable to sleep is draining and lonely. Many people self-medicate with alcohol, believing that this will improve their sleep. However, the drowsiness that alcohol causes won’t send you into a high-quality, restorative sleep. It will interfere with your sleep cycles and potentially worsen sleep apnoea and snoring. 

Diagnosing idiopathic insomnia

There are no tests to diagnose idiopathic insomnia or chronic insomnia. Instead, a doctor will make a diagnosis based on the presented symptoms. They may, however, run tests like a sleep study to rule out other conditions like sleep apnoea or narcolepsy. 

The diagnosis for idiopathic insomnia will likely be given in the following situations:

• The person finds it difficult to fall asleep or stay asleep, or wakes up too early.
• Any sleep is non-restorative and poor in quality.
• Sleep problems are occurring despite good sleep hygiene.
• The difficulties have existed for one month or more.
• There is evidence that daytime impairment is present.
• There is no identifiable cause.
• It began in infancy or childhood.
• There have been no instances of sustained remission.
• The problem isn’t better explained by any other sleep disorder nor by a neurological or medical condition, mental health problem, or substance or medication use.

Treatment for idiopathic insomnia

There are several available treatment options for individuals with insomnia.

Cognitive Behavioural Therapy for insomnia

Cognitive Behavioural Therapy (CBT) is a talking therapy that can be adapted to help those with sleep problems. When it comes to insomnia, CBT works to challenge and change the person’s thoughts around sleep and worries about getting enough. 

According to an article in the American Journal of Lifestyle Medicine, CBT for insomnia can have a similar effect to medication without any side effects. This CBT-i as it is called has shown to have long-term improvements well past the end of treatment as the patient learns to support and promote their natural sleep mechanisms. 

There are five key aspects of CBT-i. These are:

• Sleep consolidation (also known as sleep restriction).
• Stimulus control.
• Cognitive restructuring.
• Sleep hygiene.
• Relaxation techniques.

Sleep consolidation

Many people who suffer from insomnia will spend hours awake in bed attempting to sleep. This means they then worry about it—whether they’ll ever get to sleep, whether they’ll stay asleep if they do, and whether they’ll be able to get back to sleep if they happen to wake up. They try to maximise the time they have for sleep by going to bed earlier and staying in bed later but this can make things worse as they end up having more wake time in bed. 

Sleep consolidation—or sleep restriction—aims to reverse this by putting a limit on how much time is spent in bed. Since the body is active and awake longer, the drive for sleep builds and thus makes falling asleep and staying asleep easier.

Stimulus control

Struggling to fall asleep can mean a person associates their bed with anxiety and wakefulness. CBT-i aims to reduce how the person uses their bed and bedroom. They are instructed to only use their bed for sleep and sex. Other activities like watching TV, using your phone, reading, drinking, eating and working on a computer should happen elsewhere and in a different room. 

If the person turns out their light and isn’t able to sleep after 10 minutes, they are told to go into a different room and do something relaxing until they feel sleepy. When sleepiness comes, they’re to go back to bed.

Cognitive restructuring

A large part of CBT is changing the way you think about things. Insomniacs often have thoughts about dreading going to bed because they know they won’t be able to sleep or hating being in bed awake. With cognitive restructuring, people are encouraged to reframe their thoughts to be more positive ones like, ‘even if I can’t sleep straight away, I will be ok in the morning’.

Sleep hygiene

Sleep hygiene refers to guidelines about healthy sleep. It will include things like:

• Don’t drink alcohol in the few hours before bedtime.
• Go to bed at the same time every night.
• Wake up at the same time every morning.
• Don’t eat in the few hours before bedtime.
• Avoid bright lights in the two hours before going to bed.
• Don’t have caffeine after lunch or through the evening.
• Have a relaxing evening routine.
• Ensure you have access to sunlight or outdoor light in the morning and early afternoon.
• In the few hours before bed, ensure you’re not over-exposed to computer screens or phones.

Relaxation techniques

People who choose CBT-i will be shown how to use relaxation techniques to promote healthy sleep. This includes mindfulness and meditation to quieten the mind and calm emotions to help calm the nervous system.

Other relaxation techniques could include progressive muscle relaxation, breathing techniques, tai chi or yoga.

Medication for insomnia

When other interventions aren’t working, someone suffering from insomnia might be prescribed medication to help them sleep. 

Here are some medicines that might be offered:

• Melatonin: this is a hormone that occurs naturally in the body and helps promote sleep. In the evening, the body’s melatonin levels rise, which causes you to be in a state of quiet wakefulness. These levels rise around two hours before you go to bed. A melatonin supplement can help patients with insomnia, though it’s not considered a long-term solution.
• Benzodiazepine receptor agonists (BZRAs): These can be prescribed for those with insomnia. However, they’re not without side effects. Long-term use can also see their effects dwindle.

Final thoughts on idiopathic insomnia

This relatively common yet complex condition is difficult to treat due to the variety of potential contributing factors to the problem. However, with the right support and approach, many people who suffer from long-term insomnia can lead a healthier life and get help with their sleep.