Doctors often speak of prognosis in relation to medical problems, and people with difficulty falling or staying asleep may question: Does insomnia ever go away? Though this may largely depend on the underlying causes, by better understanding the potential triggers you may be able to answer this question for yourself. Discover how to stop insomnia and reverse poor sleep with simple changes.
Considering the Causes of Insomnia
Insomnia is defined as difficulty falling or staying asleep or sleep that is not refreshing in the absence of another sleep disorder like sleep apnea. Our understanding of the cause of the condition relies on three factors: predisposition, provocation, and perpetuation. Considering each of these factors, in turn, can be helpful to determine if insomnia will resolve.
Everyone has the potential to develop the difficulty sleeping that characterizes insomnia. This is referred to as a predisposition or threshold. For some people, the threshold is high and they rarely experience insomnia. For others, unfortunately, a lowered threshold may easily tip a person into trouble sleeping with even minor provocation.
Provoking factors are diverse and variable. Consider what has previously caused you to have trouble sleeping: an uncomfortable bed, a warm room, a noisy street, a crying baby, stress, and the list goes on. Although the triggers are familiar, something that leads to insomnia for you may have little effect on your spouse, and vice versa. Typically when the cause is removed, insomnia abates. However, it can also become perpetuated by changes you make and become chronic insomnia.
People with insomnia often make changes that they hope will improve their situation. For example, an earlier bedtime may be arranged to try to get enough sleep. This may backfire when it is suddenly much more difficult to fall asleep at the earlier hour. These changes, many of which are behavioral or may relate to thoughts and emotions, are called perpetuating factors.
Can Insomnia Be Stopped or Reversed with Treatments?
Now that you have a better understanding of the underlying causes of insomnia, it is possible to consider whether insomnia goes away. The underlying threshold that you have to develop insomnia does not change. Therefore, given the right scenario, insomnia may persist or recur. Imagine it as a large rock that is present just under the surface of a lake: when the water level drops enough, the rock shows itself again. In the same way, insomnia may come back to the surface. The factors that create this predisposition cannot be changed and are likely genetically determined and relate to neurotransmitters within the brain.
The good news is that the precipitating factors or triggers may be a place to intervene. Many of these triggers will resolve on their own. For example, a bad night of sleep before a test will go away as soon as the test passes. Many others can be alleviated once they are properly identified. In fact, cognitive-behavioral therapy for insomnia (CBTI) is a highly effective treatment for insomnia that manages to do just that.
A specially trained psychologist typically conducts CBTI by identifying triggers for your insomnia and then helping to defuse these causes. If you cannot fall asleep because you moved your bedtime early, sleep restrictionmay be the recommendation. If you lie awake at night and cannot get to sleep, stimulus control is helpful. If your mind races when you lie down, you may benefit from observing a buffer zone before bedtime or scheduling worry time during the day.
Medications are frequently used to treat insomnia, but many people wish to avoid sleeping pills because of the risk of side effects. In particular, sleeping pills may cause something called tachyphylaxis: the medications become less effective, higher doses are needed for the same effect, ultimately they stop working, and when discontinued rebound insomnia occurs. (Fortunately, rebound insomnia typically resolves in short order.) Therefore, though sleeping pills may temporarily provide relief, they are not recommended for long-term use to treat insomnia.
It can also be very important to address any chronic issues that might be contributing to insomnia. Insomnia frequently coexists with anxiety or depression, and these conditions will often continue if the other is left untreated. If the insomnia is related to problems in the sleep environment, these likewise should be addressed to provide relief.
Although the underlying tendency towards insomnia persists, just below the surface, the good news is that insomnia itself does not have to. The long-term prognosis to cure insomnia can be excellent.
Written By Brandon Peters, MD