Insomnia and sleep disorders

Insomnia and sleep disorders
International Classification (ICD) F51.-
Symptoms Daytime sleepiness, Concentration disorders, Reduced performance/strength, Decreased sleep quality
Possible causes Stress, family problems, Pain, Urinary urgency, Caffeine, alcohol, drug, medication use., Bright or uncomfortable sleeping environment


Sleep disorders are among the most widespread health problems, with a prevalence of 6 to 10% of the population. While isolated sleepless nights occur in almost all people, the causes should be clarified in the case of longer-lasting sleep problems.

Woman suffering from insomnia Tero Vesalainen / iStock

The amount of sleep required varies from person to person and generally decreases with age. While a schoolchild needs about nine hours of sleep, adults only need an average of seven hours and older people only six hours. However, these are average values that can vary greatly from person to person.

In technical language, insomnia is called "insomnia" and sleep deprivation is called "hyposomnia". Other sleep disorders, such as nightmares, sleepwalking or nocturnal breathing disorders(sleep apnea) do not fall under this term. There are additional diseases that are associated with pathologically increased sleep (e.g. narcolepsy), which are also referred to as sleep disorders.


Primary sleep disorders

Primary sleep disorders do not have specific causes, but are triggered by psychological stress factors, such as stress or worries, for example, at work or due to family problems. Furthermore, sleep quality and duration can be hindered by unfavorable sleep conditions (e.g., a noisy, bright or uncomfortable sleeping environment). Often a simple trigger leads to a further intensification of the sleep disorder, in which further brooding, thinking about the negative consequences of insomnia and tension further prevents falling asleep.

Secondary sleep disorders

Secondary sleep disorders are triggered by physical or psychiatric causes. The ingestion of certain substances can also have an influence: In addition to caffeine, alcohol and drugs, medications can also disrupt sleep quality.

Possible physical causes of a secondary sleep disorder are:


The focus is on insufficient duration or quality of nighttime sleep. These difficulties can take different forms. While some people take a long time to fall asleep (sleep onset disorder), others may wake up too early and be unable to continue sleeping (sleep maintenance disorder). The consequences are daytime fatigue, concentration problems and reduced performance or resilience the following day. The performance restriction on the following day and the general level of suffering are the main parameters for assessing the severity of a sleep disorder.


Basic diagnostics

The basis for the diagnosis is a survey of the symptoms. From a duration of one month and a frequency of at least three nights per week, the symptoms are considered to be an expression of a sleep disorder. It can be helpful to keep a sleep diary before visiting the doctor. The following information should be noted in it:

  • Restfulness of sleep
  • Caffeine consumption
  • Alcohol consumption
  • Medication intake
  • stressful events on the same day
  • pain

In the doctor's office, the severity of the sleep disorder and possible causes can then be assessed with the help of a conversation (anamnesis). In addition, a physical examination can be performed. This is usually sufficient for the diagnosis of a sleep disorder.

Additional examinations

In individual cases or if an underlying cause of the sleep disorder is suspected, additional examinations may be helpful.

Laboratory examination

Blood sampling and laboratory diagnostics can detect physical causes of a sleep disorder, such as hyperthyroidism.


A simple method of determining physical activity during the day and sleep quality at night are actigraphs or actometers. These technical devices can use sensors to record body movements over a longer period of time. An example of this is modern smartwatches or sports watches that usually include integrated programs for measuring sleep quality.

Sleep lab

In some cases, monitoring (polysomnography) in a sleep laboratory can provide further important information about sleep behavior. The following examinations are used:

  • Electroencephalography (EEG): for this, electrodes are glued to the scalp or worn by means of a special "hood". The examination is not painful, but may cause some tingling or irritation of the skin. Brain activity is displayed in the form of waves, which can provide information about the depth of sleep.
  • Measurement ofheart rate: to diagnose cardiac arrhythmias or stress reactions (e.g. during nocturnal pauses in breathing)
  • Measurement ofbreathing rate: to detect nocturnal pauses in breathing (sleep apnea). These impair nocturnal restfulness and are caused by narrowing of the airways due to anatomical peculiarities or obesity.
  • Measurement of oxygen saturation (pulse oximetry): This involves using light to shine through the finger and measure absorption. This examination is also painless and serves to detect nocturnal respiratory disorders and drops in saturation.
  • Leg movements: the so-called restless legs syndrome manifests itself through an uncontrollable urge to move the legs and is a frequent cause of sleep disorders.
Monitor during examination in sleep laboratory

gorodenkoff / iStock


Efficient sleep hygiene is the first step in the treatment of a sleep disorder and in many cases can achieve an improvement in the symptoms. The sleeping environment should be quiet, dark and comfortable. In addition, time in bed should be limited to bedtime, and such activities as watching television, reading, or other activities in bed should be avoided. In the morning, the bed should be left soon after awakening and staying in bed for a long time should be avoided. In the evening, you should only go to bed when you are already tired. Physical activity and exercise during the day can improve sleep, but physically strenuous or mentally demanding activities should be avoided in the evening. Making the evening more relaxing, such as reading, taking a warm bath, or drinking a hot herbal tea, can promote sleep and provide relaxation. Consumption of alcohol, caffeine, and foods that are difficult to digest should be avoided in general, but especially in the evening. Counterproductive is napping during the day.

If improved sleep hygiene is not sufficient, further therapy options may follow.

Cognitive behavioral therapy

Cognitive behavioral therapy can be another valuable tool. Therapy is offered in individual, group, or online sessions. It involves learning how to break negative thinking patterns with the help of a psychotherapist, in addition to relaxation techniques. The relaxation methods used include visualization, progressive muscle relaxation and breathing exercises.

Some treatments are not scientifically proven, but are used by many patients in addition to the above-mentioned therapeutic approaches. These include acupuncture, aromatherapy, homeopathy, light therapy, music therapy, and yoga.

Drug therapy options

Sleep-promoting agents can also be used in the short term. The prerequisite for this is a complete diagnosis, including exclusion of treatable underlying diseases and an unsuccessful attempt at therapy with non-drug treatment options such as sleep hygiene and psychotherapy. A number of substance groups are available for therapy.

Attention should be paid to the following problems when using over-the-counter and prescription sleep aids, and a specialist should be consulted if in doubt:

  • Habituation effect: falling asleep without the medication is no longer possible
  • Withdrawal symptoms: restlessness and anxiety when the drug is suddenly discontinued
  • Loss of effect: persistence of sleep disturbance despite taking the substance
  • Life-threatening overdose or hypersensitivity: manifested by confusion, respiratory failure, and blue coloration of fingertips and lips
  • Daytime drowsiness: concentration and reaction time may be impaired the day after ingestion. Caution is advised when operating vehicles and other machines!
  • Interaction: Especially alcohol, strong painkillers (opioids), antihistamines and antidepressants may have dangerous interactions with benzodiazepines.

Herbal extracts of passionflower, lemon balm, hops or valerian are used by some patients to promote sleep and in many cases are already sufficient for a sufficient therapy. The evidence base for efficacy is weak, so no general recommendation can be made.

Melatonin-based sleeping pills are available over the counter and act on the brain like the body's own sleep hormone melatonin, producing a mild sleep-inducing effect. This is especially helpful for short-term sleep disturbances caused by jet lag or shift work. Melatonin is jointly responsible for the natural sleep-wake cycle and is released in the brain at night. The external supply of the hormone is harmless, but its long-term effectiveness has not been proven. Since it is often sold as a dietary supplement rather than as a drug, it is not subject to the strict legally established quality standards for drugs. Nevertheless, it is a substance with possible adverse effects, so medical consultation is recommended before and during use.

Sedative antihistamines are also available over the counter, but should not be used permanently or by the elderly. Their use is limited to isolated restless nights.

The group of so-called benzodiazepines includes a number of substances that are suitable for short-term treatment of a sleep disorder. They differ in dosage and duration of action. Even though they have a strong sleep-inducing effect, they often lead to fatigue the next day (hangover) due to a long duration of action. An important negative characteristic of benzodiazepines is the rapid development of dependence and tolerance. This means that falling asleep without taking the drug is no longer possible and a steadily higher dose must be taken to fall asleep. Experts therefore advise against long-term treatment with benzodiazepines.

Other prescription sleeping pills are the "Z-substances" (e.g. zolpidem, zopiclone), which are similar to benzodiazepines. These are also suitable for short-term therapy and also have a risk of dependence.


Psychologically induced sleep disorders are often chronic. The best results can be achieved with cognitive behavioral therapy. If a physical cause such as pain or a chronic illness is the trigger, treatment of the underlying condition can at least bring about improvement in most cases.

Untreated insomnia exposes the body to great stress and can lead to complaints such as depressive moodsand high blood pressure. The latter also increases the risk of heart attacks and strokes.


There are no special ways to specifically prevent falling asleep and staying asleep. Adherence to sleep hygiene can often help. However, early detection of the symptoms can intervene quickly and thus minimize the discomfort and risks of insomnia.

Editorial principles

All information used for the content comes from verified sources (recognised institutions, experts, studies by renowned universities). We attach great importance to the qualification of the authors and the scientific background of the information. Thus, we ensure that our research is based on scientific findings.
Olivia Malvani, BSc

Olivia Malvani, BSc

As a student of nutritional sciences, she writes magazine articles on current medical and pharmaceutical topics, combining them with her personal interest in preventive nutrition and health promotion.

Dr. med. univ. Bernhard Peuker, MSc

Dr. med. univ. Bernhard Peuker, MSc

Bernhard Peuker is a lecturer and medical advisor at Medikamio and works as a physician in Vienna. In his work, he incorporates his clinical knowledge, practical experience and scientific passion.

The content of this page is an automated and high-quality translation from DeepL. You can find the original content in German here.



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