If you've found yourself struggling to fall asleep for an extended period of time, you could be suffering from insomnia. Nearly half of the adult population experiences a persistent difficulty in sleeping at some point in their lives. Studies have shown that about 10-30% of adults suffer from chronic insomnia. Insomnia can stem from a variety of causes and can manifest differently in people. To clearly understand this problem, we look at the types, causes, symptoms, tests and also help out with a few tips to help you overcome insomnia.

What Is Insomnia? 

Before we discuss how to fall asleep, it is important to understand what insomnia is. Insomnia is a condition that either makes it difficult to fall or stay asleep. Insomnia also makes it difficult to fall asleep again after you wake up in the middle of your sleep cycle. A prolonged lack of sleep or low quality of sleep can make you irritable, incoherent and will give you a sense of perpetual exhaustion and tiredness. Though insomnia is a common issue, it has a far-reaching impact on the quality of your life.

Medical professionals categorize insomnia under several characteristics, some of which are - 

• Acute Insomnia: This form is the most prevalent. It is caused by a variety of factors like a change in environment, new medication, recent traumatic experiences, anxiety, and illness. Acute insomnia can last between a few days up to a few weeks. Most of the time, acute insomnia is resolved by managing the underlying cause or after the patient gets used to the new environment or predicament.
• Chronic Insomnia: When you have trouble sleeping for a minimum of three days a week in a given month, it's chronic insomnia. Chronic insomnia can be either without cause or idiopathic, and such a form of it is also called primary chronic insomnia. It can also be a manifestation of an underlying condition or serious disorder. This form of it is called secondary chronic insomnia and is referred to as comorbid insomnia by doctors. It could be caused by serious medical conditions like cancer, Parkinson's disease, dementia, severe mental health disorders, and drug abuse or withdrawal. The latter form of insomnia is more common than the former. 

Irrespective of the nature of insomnia, doctors will categorize your condition based on the period of sleep you have difficulty initiating or maintaining. Based on this, insomnia is classified as -

• Onset Insomnia: This form of the condition exists in people who find it difficult to fall asleep. It is seen in both acute and chronic forms of insomnia and can be aggravated by stimulants like caffeine.
• Maintenance Insomnia: A lot of people can have trouble staying asleep once they do fall asleep. They either wake up before getting the required sleep or have trouble falling back asleep after they unexpectedly wake up. This condition is called maintenance insomnia. It can cause a great deal of anxiety in individuals, creating a more complex sleep issue.
• Childhood or Behavioral Insomnia: This form of insomnia primarily affects children and is caused due to improper sleeping habits inculcated by the parent, the unwillingness or restlessness of a child, or a combination of both. 

If you find yourself sleepless on several nights, you must visit your doctor to help you through the process of sleeping right. Insomnia could also be one of the many symptoms caused by certain conditions or diseases. We look at the potential diseases and bodily changes that can result in you having insomnia and concerns about how to fall asleep. 

Medical Conditions & Insomnia

A variety of medical conditions and diseases can cause insomnia. This is an important reason to not ignore insomnia, as it could be an important indicator of an underlying medical problem. In such cases, a medical consultation is necessary. Some conditions that can cause insomnia are:

• Diabetes: This condition is known to cause people to visit the bathroom frequently, especially at night. Frequent urges to urinate can hamper your quality of sleep and result in you waking up several times a night. Uncontrolled diabetes can also result in a variety of other serious complications like kidney disease and nerve damage that can cause insomnia. 
• Kidney Disease: Though a broad term for several diseases, kidney imbalances can cause irregular or frequent urination. Obstructive conditions like kidney stones can cause persistent backaches and an inability to urinate. Important symptoms of kidney disease also include persistent itching and restless legs, two main causes of insomnia in people suffering from kidney disease. 
• Asthma & Chronic Obstructive Pulmonary Disease: People with frequent asthmatic attacks and breathing difficulty caused by diseases like COPD can suffer from perpetually low levels of oxygen in the blood. This coupled with labored breathing can precipitate insomnia.
• Gastric & Digestive Trouble: Diseases like irritable bowel syndrome, Celiac disease, Enteritis, and Gastroesophageal Reflux Syndrome can hamper the quality of life severely. Frequent abdominal cramps, bouts of diarrhea, painful reflux, and uneasiness impair your ability to sleep right.
• Cardiac Issues: People suffering from conditions like congestive heart failure and Angina can experience discomfort in the chest. A sensation of heaviness and shortness of breath can prevent the relaxation of your body and mind, a prerequisite for sleep.
• Neurological Conditions: A variety of neurological diseases like Alzheimer's, Parkinson's, dementia, multiple sclerosis, and epilepsy can cause severe bouts of insomnia. Insomnia tends to have a two-way relationship with neurological conditions, as prolonged and untreated insomnia can result in nerve damage and neurological trouble. 
• Hypertension: High blood pressure can cause throbbing pulse and palpitation that gives rise to a sensation of anxiety and restlessness. A restless body finds it difficult to fall asleep, and the inability to fall asleep in turn feeds into the anxiety loop and insomnia. Uncontrolled hypertension can even lead to serious conditions like stroke, where the damage to your brain can affect the sleep centers and cause insomnia. 
• Autoimmune Diseases & Conditions With Chronic Pain: Autoimmune diseases cause the body's immune system to attack its own cells and tissues, causing a great deal of inflammation and pain. Autoimmune diseases like lupus, rheumatoid arthritis, and multiple sclerosis can result in chronic pain and discomfort. Other conditions causing chronic pain like cancer, arthritis, fibromyalgia, migraine, and neuralgias can seriously affect your ability to fall asleep and the quality of your sleep. Pain and insomnia are directly related, as pain is often the greatest disruptor of sleep. 
• Hormonal Disturbances & Diseases: Diseases of glands like the thyroid, adrenal gland, and pituitary gland can lead to insomnia and sleeplessness. Hormones are important mediators of body chemistry and metabolism. Any change in their frequency or composition results in a variety of effects. Even normal physiological events like menstruation, menopause, and pregnancy can lead to hormonal changes and cause insomnia. 
• Allergies: Allergies can cause an itchy nose and throat, cough, difficulty in breathing, persistent sneezing, wheezing, a runny nose, and sinusitis. These symptoms can be quite damaging to sleep. Persistent and prolonged allergies can lead to conditions like sleep apnea and further hamper the quality of sleep. 
• Mental Health Issues: Conditions like depression, bipolar disorder, schizophrenia, and post-traumatic stress disorder can adversely impact the sleep cycle and prevent you from sleeping. One of the major symptoms of poor mental health is the lack of sleep and inability to stay asleep, leading to insomnia.

There are factors other than medical conditions that prevent you from sleeping well too. Drug abuse, frequent travel, improper eating and sleeping habits, excessive stress, and taking certain medications can affect your sleep. Be sure to list out every detail to your doctor when discussing the quality of your sleep. 

Symptoms of Insomnia

People suffering from insomnia commonly mention these symptoms:

• Inability to fall asleep 
• Lack of quality sleep/Disturbed sleep 
• Exhaustion following waking up in the morning
• Irritability
• Fatigue 
• Sudden and inexplicable mood changes 
• Waking up too early
• Reduced attention span
• Impaired ability to focus

If you have noticed these symptoms, consider visiting your physician. Your doctor may order a few tests in case they suspect an underlying condition causing your insomnia. We discuss a few common tests ordered by doctors during routine insomnia workups in the below section.

Testing For Insomnia

Before proceeding with your diagnosis, your doctor may require you to go through a panel of tests along with giving you a detailed physical exam. This will help your doctor determine any underlying conditions causing your insomnia. Some common tests are:

• Complete Blood Count: This test enables your doctor to tell if anything is going wrong with the components of your blood. Anemia can present as symptoms of underlying liver, kidney, or bone marrow disease. These diseases can also result in the inability to sleep right. 
• Basic Metabolic Panel: This test gives your doctor a comprehensive picture of your body's chemistry. Any electrolyte or protein imbalances can indicate problems related to the body's metabolism, liver, spleen, and kidneys. These conditions can cause insomnia as a symptom. 
• Blood Sugar Tests: Elevated blood sugar can indicate diabetes. Uncontrolled diabetes can cause a variety of complex issues including sleeplessness or insomnia.
• Hormone Tests: Hormones are important chemical messengers that maintain equilibrium and are responsible for several bodily functions. Hormonal imbalances like those of the thyroid can cause insomnia. 
• Allergy Tests: Allergy tests can help determine the cause and extent of your allergies. In case the underlying cause for your insomnia is persistent, undiagnosed allergies, your doctor may advise you to get allergy testing done. 
• Imaging Tests: Imaging tests like MRIs, CT scans, ultrasounds, and X-rays can help your doctor detect any abnormal growths or developments within your body. These are especially important in individuals that have undiagnosed diseases like cancer, Alzheimer's, or chronic kidney and liver disease.

In case these tests rule out any underlying medical condition, your doctor might recommend a few specific tests concerned with insomnia. Some of these tests are -

• Epworth's Sleepiness Scale Questionnaire: This is a detailed set of questions given to you to determine your level of sleepiness during the daytime. 
• Sleep Journaling: Your doctor might require you to tabulate your sleep patterns and habits over a week to analyze the quality of your sleep. 
• Sleep Examination: You might be required to sleep one night at a sleep clinic to help your doctor look for any disturbances, movements, or events during your sleep. 
• Polysomnogram: This is a test that tabulates brain activity while you're asleep. Any abnormal levels of activity alert your doctor and help them arrive at a diagnosis. 

Beating Insomnia Using Simple Sleep Techniques

In case you've been wondering about how to fall asleep, there exist a few techniques you can try to implement to help you sleep right. Before you try these techniques, however, be sure to have visited your doctor and make sure you do not suffer from any underlying medical or mental conditions hampering your quality of sleep.

It is important to employ a few basic changes to your habits before you try any of these sleep techniques, some of these are:

• Avoid heavy meals at night. 
• Turn off any electronic gadgets at least an hour before sleep. 
• Avoid using your phone before bed.
• Skip the evening cup of coffee.
• Maintain a clean and tidy bedroom to ensure effective relaxation.
• Use room freshener or relaxing aromatic candles to help you relax.

For those of you that might ask how long it takes to fall asleep, the answer would be anywhere between ten and twenty minutes on an average night for a normal person. However, there exist techniques that help you fall asleep quicker than that. A few of these techniques include -

• Paradoxical Intention Technique: Although simple, this technique involves telling yourself to stay awake. Considering the mind often intends on doing the opposite of what you will, this technique involves the clever use of reverse psychology to help you sleep. Research has found people practicing this technique tend to fall asleep quicker than those who don't.
• Soothing Visualization Technique: Thinking of a serene environment alongside imagining the sounds from the setting helps people disconnect from their thoughts. This reduces conscious brain activity and helps you relax, causing you to fall asleep eventually. Several guided meditation sessions emphasize the soothing visualization technique for uninterrupted sleeping.
• 4-7-8 Technique: This technique involves breathing for specific intervals and relaxing your body. The method involves inhaling for four seconds through your mouth, holding your breath for seven seconds, and exhaling through your mouth again for eight seconds. Try to reduce your mental awareness and relax with each cycle. It is recommended to perform around four to six cycles to fall asleep. 
• Square Breathing & The Military Technique: This technique involves relaxing all of your body muscles. You should lay your hands down by the side, extend your neck, so it's relaxed and straight, try to relax your muscles on the brow and around the mouth. Try inhaling deeply to a count of four, holding the breath for four counts and exhaling for another four counts. Simultaneously, tell yourself not to think for a minimum of ten seconds. This technique promises quick relaxation and deep sleep. 
• Gradual Muscle Relaxation Technique: The exercise involves tensing muscles for a few seconds and then relaxing them for a few seconds. This is done progressively for each muscle, beginning at the muscles of the head and ending at the toe. The technique ensures effective and deep relaxation, and many people attest to falling asleep before completing the routine. 

If the above techniques do not help, consider visiting your healthcare provider or a sleep therapist to get to the bottom of your insomnia and to sleep right.