Highlights
- Comorbid insomnia, by definition, is distressingly poor sleep patterns that co-exist with other health problems.
- Several medical or psychiatric conditions can co-exist with insomnia; these comorbidities may be the cause or effect of the poor sleep, or be completely unrelated.
- Comorbid insomnia may present with feeling unrefreshed after sleeping, daytime tiredness, poor concentration, and difficulty regulating emotions.
- Psychotherapy, self-help techniques, and medication are possible treatment options for comorbid insomnia. Importantly, if the co-occurring health condition is triggering insomnia, it also needs to be treated.
Ongoing poor sleep impacts both mental and physical health. However, sometimes, insomnia co-exists with other health conditions without affecting one another. Be it with or without mutual influence, when sleep issues co-exist with other conditions, the concept of comorbid insomnia comes in. Read on to explore its causes, symptoms, and treatment options.
What Is Comorbid Insomnia?
The easiest way to understand what comorbid insomnia is, is to look at the words separately.
Insomnia means you’re unhappy with your sleep patterns, and it’s affecting your daily functioning negatively. You might feel that you’re:
- Not getting enough sleep (poor quantity)
- Not sleeping deeply (poor quality)
Insomnia can present as:
- Having difficulty falling asleep
- Waking often during the night
- Sleeping continuously for some hours, but waking too early in the morning
Comorbid means to co-exist, co-occur, or be present at the same time.
So, comorbid insomnia is insomnia that occurs alongside any other diagnoses.
The Link Between Comorbid Insomnia and Co-existing Conditions
Insomnia and other conditions co-occur in three scenarios:
- They are completely separate diagnoses: unrelated, but co-existing
- Insomnia may trigger the co-existing condition
- The condition could lead to comorbid insomnia
Let’s take a closer look at some diagnoses that are related to their comorbid insomnia.
Common Comorbidities Associated With Insomnia
Here is a list of comorbid conditions that are commonly linked to persistent insomnia.
Mental Health Conditions
Psychiatric or mental health conditions are the most frequent comorbidities in people with chronic insomnia. According to a study, about
- Depression
- Anxiety
- Panic disorder
- Bipolar disorder
- Substance use disorder
- Post-traumatic stress disorder
Neurological Disorders
Comorbid insomnia is common in many
- Alzheimer’s disease and other dementias
- Parkinson’s disease
- Epilepsy
- Traumatic brain injury
- Stroke
- Multiple sclerosis
Often, having a neurological illness triggers anxiety and depression, which aggravate the sleep issues.
Chronic Pain
Many people with chronic pain, regardless of the cause,
Physical discomfort[3] interrupts sleep- Poor sleep quality intensifies pain; possibly due to
brain-based[3] changes
A few chronic pain conditions associated with insomnia are:
- Rheumatoid arthritis
Osteoarthritis[4] - Fibromyalgia
- Chronic headaches, including migraine and tension-types
Other Medical Conditions
Various medical conditions can lead to interrupted sleep due to symptoms such as frequent urination, difficulty breathing, or physical discomfort. Some illnesses associated with comorbid insomnia include:
- Prostatic enlargement
- Asthma and chronic obstructive pulmonary disease (COPD)
- Diabetes
- Heart failure
- Gastroesophageal reflux disease (GERD)
Comorbid Sleep Disorders
Insomnia itself might be a symptom of other
- Obstructive Sleep Apnea: Gasping or choking due to a blocked airway wakes the person repeatedly.
- Nightmare Disorder: Bad dreams cause poor sleep quality because of fear.
- Restless Legs Syndrome: An uncontrollable urge to move the legs makes falling asleep difficult.
- Rapid Eye Movement (REM) Sleep Behavior Disorder: A vivid dream event causes sudden waking with movement or talking.
- External Circadian Rhythm Sleep-Wake Disorders: Jet lag or shift work are examples of this.
When Insomnia Is Unrelated to Co-existing Conditions
When there is no link between insomnia and co-existing conditions, trouble sleeping is usually due to insomnia disorder. Simply put, if insomnia is not the cause or the consequence of another condition, then it’s pure, long-standing insomnia; even if you have another standalone health condition as well.
To officially be diagnosed with
- ✅ Dissatisfaction with your sleep patterns
- ✅ Poor sleep for at least 3 months
- ✅ Poor sleep at least 3 nights every week that is not better explained by another sleep-wake disorder or a co-existing physical or mental health condition
Symptoms of Comorbid Insomnia to Look Out For
Let’s look at some symptoms of insomnia. If you’re having poor sleep quality or quantity, this could lead to:
- Feeling unrefreshed in the morning
- Experiencing daytime mental and physical fatigue, lethargy, and drowsiness
It makes sense then that if you’re mentally exhausted during the day, there will be
- Difficulty concentrating
- Memory problems
- Making mistakes
- A higher risk of accidents
- Mood changes
It is also critical to look out for symptoms of conditions that might lead to or be triggered by comorbid insomnia.
Can Medications Cause Insomnia?
Unfortunately, while treating one condition, some medications may affect our sleep cycles and cause insomnia. There are many reasons why this happens. For instance, they might stimulate the brain or affect neurotransmitters that impact sleep. In some cases, insomnia is a medication’s side effect, with no clear explanation.
Examples of medications that can cause insomnia include:
- ADHD Stimulants: Ritalin (methylphenidate), Adderall (amphetamine and dextroamphetamine), and Vyvanse (lisdexamfetamine).
- Selective Serotonin Reuptake Inhibitors (SSRIs): Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline).
- Steroids: Prednisone
- Beta-Blockers: Propranolol (Inderal), used to treat high blood pressure and anxiety, can cause insomnia for some people.
However, everyone responds to medication differently, and insomnia is not an inevitable effect. If you suspect your trouble sleeping is associated with a new medication, talk with your healthcare provider about possible solutions.
Comorbid Insomnia Treatment and Prevention
Treating comorbid insomnia can be challenging because if a co-existing diagnosis triggers it, that condition needs to be treated first to improve sleep quality. But sometimes, it can be difficult to determine which comorbidity causes the other, which is why it is essential to see a healthcare provider for a workup.
Before that, you can try a few
- Avoid caffeine intake after lunchtime.
- Go to bed and wake up at the same time every day.
- Get physically active, but not close to bedtime.
- Don’t use mobile phones, watch television, or work in bed.
- Ensure your bedroom is quiet, dark, and cool.
- Listen to relaxing music, read a book, or have a warm bath to wind down before bedtime.
For all types of insomnia, even if a chronic illness causes it,
Cognitive-Behavioral Therapy (CBT)
CBT is very effective for treating sleep disturbances.
- Cognitive Restructuring: A therapist helps you identify and reduce worrying thoughts that are associated with and cause disrupted sleep patterns.
- Sleep Restriction: A therapist will ‘prescribe’ a sleep schedule after reviewing your sleep diary, reducing the time you spend in bed to the actual number of hours you spend sleeping.
- Stimulus Control: People with insomnia start to fear bedtime, and this actually triggers the fight-or-flight response. When this happens, it helps to move out of the bedroom until you are sleepy again, helping you to associate your bed with comfort and relaxation rather than stress.
Relaxation Techniques
Based
- Deep Breathing: Because focusing on your breathing helps reduce anxiety, it
could promote sleep[11] . There are many benefits of slow, deep breathing for the mind and body. - Progressive Muscle Relaxation: Releasing tension from all joints and major areas of your body one by one may help you fall asleep faster.
- Mindfulness Meditation: Facilitates sleep by improving emotional regulation and reducing anxiety.
Medication
If CBT, relaxation, and sleep hygiene are slow to work, a healthcare provider might recommend short-term medication for comorbid insomnia. The FDA has approved the following prescription medications:
- Sedative hypnotics (nonbenzodiazepines)
- Benzodiazepines
- Tricyclic antidepressants
- Melatonin agonists
- Barbiturates
Even though there are over-the-counter options like Benadryl (diphenhydramine) and Unisom (doxylamine), you should consult with a medical provider before taking them. Remember, it’s important to identify the comorbid insomnia trigger if there is one.
In Conclusion
Successfully treating comorbid insomnia requires targeting the sleep issues and the co-existing condition. This is why professional support is essential to optimize a personalized treatment plan for comorbid insomnia. If you want to discuss your symptoms in more detail and get a personalized treatment plan for insomnia online, contact licensed medical providers at MEDvidi by booking an online appointment.
