Insomnia

Insomnia is a common sleep disorder in which a person has persistent difficulty falling asleep, staying asleep, waking up too early, or experiencing sleep that is not refreshing — despite having adequate time and opportunity to sleep. These sleep difficulties cause significant distress and impair daytime functioning. Insomnia is classified as short-term (acute, lasting less than 3 months, often linked to a specific stressor) or chronic (lasting 3 months or more, occurring at least 3 nights per week). It is the most common sleep disorder worldwide, affecting an estimated 10–30% of adults. In Nigeria, insomnia is underrecognised and underreported but significantly impacts work performance, mental health, and quality of life.

• Difficulty falling asleep at night: taking more than 20–30 minutes to fall asleep • Waking up repeatedly during the night and having trouble returning to sleep • Waking up too early in the morning and being unable to go back to sleep • Feeling unrefreshed and tired despite sleeping Daytime consequences of poor sleep: • Fatigue, low energy, and drowsiness • Difficulty concentrating, memory problems, and poor decision-making • Irritability, mood swings, and low frustration tolerance • Reduced performance at work or school • Increased errors and accidents • Tension headaches • Gastrointestinal disturbances • Worry about sleep itself (which then makes sleep harder: a vicious cycle)

Insomnia is rarely caused by a single factor. Common causes and contributors include: Psychological causes (most common): • Stress: work pressure, financial concerns, relationship difficulties, bereavement • Anxiety disorders: worry and mental hyperarousal prevent sleep onset • Depression: both early morning awakening and difficulty falling asleep are classic features • Post-traumatic stress disorder (PTSD) • Chronic worrying about sleep itself (conditioned arousal) Medical causes: • Chronic pain conditions (arthritis, back pain, headaches) • Respiratory conditions (asthma, COPD, sleep apnoea) • Urinary conditions requiring frequent nighttime urination • Heartburn and reflux • Thyroid disease (hyperthyroidism) • Menopause (hot flushes) Lifestyle and environmental factors: • Irregular sleep schedule (shift work, travel across time zones) • Use of stimulants: caffeine, energy drinks, tobacco • Heavy or late evening meals • Alcohol: disrupts sleep architecture even if it initially induces drowsiness • Excessive use of electronic screens (phones, tablets) before bed: blue light suppresses melatonin • Noise, heat, or light in the sleeping environment Medications: • Certain antidepressants, antihypertensives, steroids, and stimulants can impair sleep

• Female sex: women are more likely than men to experience insomnia, particularly around menstrual cycle changes, pregnancy, and menopause • Age: older adults are more frequently affected due to changes in sleep architecture, medical conditions, and medications • Mental health conditions: anxiety and depression are strongly linked to insomnia • Shift work or irregular working hours • Stressful life events: bereavement, job loss, relationship breakdown • Chronic illness • Stimulant and alcohol use • Poor sleep hygiene: irregular schedule, stimulating bedroom environment

Chronic insomnia has significant health consequences: • Increased risk of anxiety and depression: insomnia and mental health disorders have a bidirectional relationship • Impaired immune function: sleep deprivation reduces the immune response • Higher risk of hypertension, heart disease, and type 2 diabetes • Obesity: disrupted sleep affects hormones that regulate appetite • Cognitive decline and increased dementia risk in older adults • Reduced work performance and increased risk of accidents (including road traffic accidents) • Relationship difficulties and social withdrawal • Increased risk of substance misuse (alcohol, sedatives) as coping mechanisms

Sleep hygiene — the foundation of insomnia prevention and management: • Maintain a consistent sleep schedule: go to bed and wake at the same time every day, including weekends • Create a calm, dark, quiet, and cool sleeping environment • Avoid caffeine (coffee, strong tea, energy drinks, cola) after midday • Avoid alcohol, especially within 4 hours of bedtime • Avoid heavy meals in the 2–3 hours before bed • Switch off electronic screens (phones, TVs, tablets) at least 1 hour before bed • Exercise regularly: but avoid vigorous exercise within 2 hours of bedtime • Use the bedroom only for sleep and sex: not for work, television, or eating • Develop a relaxing pre-sleep routine: reading, gentle stretching, warm bath • Do not lie in bed trying to force sleep: get up and do a calm activity until sleepy Cognitive Behavioural Therapy for Insomnia (CBT-I) is the most effective long-term treatment for chronic insomnia and is preferred over sleeping medications.