Insomnia

Sleep affects our well-being in many different ways. Sleep maintains brain metabolism, has an effect on nerve cells in the brain and thus on memory and learning, and regulates immunological balance. The need for sleep varies between individuals, but on average adults need 6 to 9 hours of sleep per night.

Insomnia may occur as difficulty falling asleep or remaining asleep, as waking up too early or as poor-quality sleep. Temporary insomnia is normal. It is often associated with stress in life or disturbances in the sleep-wake rhythm. About a third of adults occasionally experience insomnia. Short-term insomnia (1 to 3 months) occurs in 15% to 20% of adults yearly. Long-term insomnia occurs in nearly 12% of adults.

Long-term insomnia can be due to continuous stress, consumption of alcohol, certain mental conditions such as depression or anxiety, or certain physical conditions such as hyperthyroidism, heart failure, respiratory conditions, sleep apnoea, restless legs syndrome or prolonged pain conditions. Furthermore, worry and anxiety about the insomnia can cause a state of overstimulation that can contribute to sleep difficulties becoming a chronic problem.

If prolonged, insomnia has significant effects on mental and physical health: memory and the ability to concentrate and learn are impaired, symptoms of depression and anxiety increase, the risk of diseases and injuries increases, and the quality of life and ability to function worsen. 

Self-care

• Follow a healthy lifestyle. Eat healthy food, exercise regularly and keep your daily rhythm regular. 
• Evening mental and physical activities increase insomnia. Avoid strenuous exercise just before bedtime and abstain from hard work, future planning or worrying about the past in the evenings.
• If insomnia is associated with the thoughts running around in your head, use a moment during daytime to worry and go through things that cause anxiety. This may reduce time spent worrying in the evenings.
• Avoid alcohol consumption, as even a few drinks in the evening adversely affect the quality of sleep.
• Avoid caffeine drinks after 2:00 p.m., as it takes about 6 to 8 hours for caffeine to be eliminated from the body. 
• Create optimal sleeping conditions: control lighting and bedroom temperature (at about 19 to 20 degrees) and keep noise levels down.
• Go to bed only when you’re tired. If you can’t fall asleep in half an hour, get up and try again later. 
• Adopt a relaxing routine for the evenings.
• Try mindfulness and relaxation exercises before going to bed.
• It’s important not to be afraid of insomnia, as this often worsens the situation.
• If you’ve slept badly, try to be kind to yourself and think what you could skip that day. 

When should you seek treatment?

Insomnia refers to sleeping difficulties that occur during at least three nights per week. If insomnia continues for over a month and clearly interferes with your quality of life and ability to function, seek help. When seeking help, it’s important to mention any mental health disorders or physical conditions you may have. Be prepared to keep a sleep diary, so that the nature of your insomnia can be clearly defined.

Treatment of insomnia

In the treatment of insomnia, the key is to exclude any physical and mental conditions that could be behind it. If no conditions are found, the factors behind insomnia will be assessed. The most effective way to influence these factors is cognitive behavioural therapy. 

The aims of insomnia treatment include normalising sleep rhythm, creating optimal sleeping conditions and, if necessary, making lifestyle changes. Therapeutic treatment of insomnia can be carried out as personal or group therapy and nowadays also as online therapy. 

Medications have shown to be most effective in the treatment of temporary and short-term insomnia. Sleep aids prolong but also lighten sleep. They also shorten the stages of deep sleep and REM sleep that are vital for the body. Many sleep aids increase the risk of dependency, and their use should therefore be limited to short periods. 

If required, medication better suited for prolonged use can be prescribed as one solution for treating chronic insomnia. Suitable medications can be, for example, antidepressants or anti-anxiety medication with a soporific effect prescribed in small dosages.

Information sources: Duodecim Terveyskirjasto, Käypä hoito (Current Care guidelines), Mielenterveystalo.fi (Mentalhub.fi)

FSHS General practitioner / 15 June 2023

Service options