Editing Insomnia (section)

== Signs and symptoms ==
[[File:Complications of insomnia.svg|thumb|upright=1.4|Potential complications of insomnia<ref>{{cite web | url = http://www.mayoclinic.com/health/insomnia/ds00187/dsection=complications | title = Insomnia > Complications | archive-url = https://web.archive.org/web/20090208085332/http://mayoclinic.com/health/insomnia/DS00187/DSECTION%3Dcomplications |archive-date=8 February 2009 | work = Mayo Clinic | access-date = 5 May 2009 }}</ref>]]

Symptoms of insomnia:<ref name="BBDinsomnia">{{Cite journal |author1=Consumer Reports |author1-link=Consumer Reports |author2=Drug Effectiveness Review Project |author2-link=Drug Effectiveness Review Project |date=January 2012 |title=Evaluating New Sleeping Pills Used to Treat: Insomnia Comparing Effectiveness, Safety, and Price |journal=Best Buy Drugs Consumer Reports |page=4 |url=http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/InsomniaUpdate-FINAL-July2008.pdf |access-date=4 June 2013 |url-status=live |archive-url=https://web.archive.org/web/20131209122641/http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/InsomniaUpdate-FINAL-July2008.pdf |archive-date=9 December 2013}}</ref>
*Difficulty falling asleep, including difficulty finding a comfortable [[sleeping position]]
*Waking during the night, being unable to return to sleep<ref>{{Cite journal|title=Caffeine consumption, insomnia, and sleep duration: Results from a nationally representative sample|first1=Ninad S.|last1=Chaudhary|first2=Michael A.|last2=Grandner|first3=Nicholas J.|last3=Jackson|first4=Subhajit|last4=Chakravorty|date=October 9, 2016|journal=Nutrition (Burbank, Los Angeles County, Calif.)|volume=32|issue=11–12|pages=1193–1199|doi=10.1016/j.nut.2016.04.005|pmid=27377580|pmc=6230475}}</ref> and waking up early
*Not able to focus on daily tasks, difficulty in remembering
*[[Excessive daytime sleepiness|Daytime sleepiness]], [[irritability]], [[Depression (mood)|depression]] or [[anxiety]]
*Feeling tired or having low energy during the day<ref>{{Cite news|url=https://www.sleepfoundation.org/insomnia/symptoms|title=Symptoms|access-date=15 April 2019|language=en|archive-date=15 April 2019|archive-url=https://web.archive.org/web/20190415172923/https://www.sleepfoundation.org/insomnia/symptoms|url-status=live}}</ref>
*Trouble concentrating
*Being irritable, acting aggressive, or impulsive
[[Sleep onset]] insomnia is difficulty falling asleep at the beginning of the night, often a symptom of [[anxiety disorder]]s. [[Delayed sleep phase disorder]] can be misdiagnosed as insomnia, as sleep onset is delayed to much later than normal while awakening spills over into daylight hours.<ref>{{cite journal | vauthors = Kertesz RS, Cote KA | s2cid = 30439961 | title = Event-related potentials during the transition to sleep for individuals with sleep-onset insomnia | journal = Behavioral Sleep Medicine|volume=9|issue = 2|pages=68–85|year=2011| pmid = 21491230 |doi=10.1080/15402002.2011.557989}}</ref>

It is common for patients who have difficulty falling asleep to also have nocturnal awakenings with difficulty returning to sleep.<ref>{{Citation |last=Cormier |first=René E. |title=Sleep Disturbances |date=1990 |work=Clinical Methods: The History, Physical, and Laboratory Examinations |editor-last=Walker |editor-first=H. Kenneth |url=https://www.ncbi.nlm.nih.gov/books/NBK401/ |access-date=2024-11-15 |edition=3rd |place=Boston |publisher=Butterworths |isbn=978-0-409-90077-4 |pmid=21250242 |editor2-last=Hall |editor2-first=W. Dallas |editor3-last=Hurst |editor3-first=J. Willis}}</ref> Two-thirds of these patients wake up in the middle of the night, with more than half having trouble falling back to sleep after a [[middle-of-the-night insomnia|middle-of-the-night awakening]].<ref>{{cite book | vauthors = Doghramji K |title=Clinical Management of Insomnia |year=2007 |publisher=Professional Communications, Inc. |location=Caddo, OK |isbn=978-1-932610-14-7 |page=[https://archive.org/details/clinicalmanageme0000dogh/page/28 28] |url-access=registration |url=https://archive.org/details/clinicalmanageme0000dogh }}</ref>

Early morning awakening occurs earlier (more than 30 minutes) than desired with an inability to go back to sleep and before total sleep time reaches 6.5 hours. Early morning awakening is often a characteristic of [[major depressive disorder|depression]].<ref>{{cite book | vauthors = Morin C |title=Insomnia: A Clinician's Guide to Assessment and Treatment |year=2003 |publisher=Kluwer Academic/Plenum Publishers |location=New York |isbn=978-0-306-47750-8 |page=16}}</ref> Anxiety symptoms may well lead to insomnia. Some of these symptoms include [[psychological stress]], compulsive worrying about the future, feeling overstimulated, and overanalyzing past events.<ref>{{Cite news|url=https://www.sleepfoundation.org/insomnia/what-causes-insomnia|title=What Causes Insomnia?|access-date=24 April 2019|language=en|archive-date=15 April 2019|archive-url=https://web.archive.org/web/20190415173039/https://www.sleepfoundation.org/insomnia/what-causes-insomnia|url-status=live}}</ref>

=== Poor sleep quality ===
Poor sleep quality can occur as a result of, for example, [[restless legs]], [[sleep apnea]], or [[major depression]]. Poor sleep quality is defined as the individual not reaching [[Slow-wave sleep|stage 3]] or delta sleep, which has restorative properties.<ref>{{Cite web |url=https://sleepfoundation.org/how-sleep-works/what-happens-when-you-sleep |title=What Happens When You Sleep? |date=22 December 2009 |access-date=24 February 2017 |url-status=live |archive-url=https://web.archive.org/web/20170305005723/https://sleepfoundation.org/how-sleep-works/what-happens-when-you-sleep |archive-date=5 March 2017 }}</ref>

Major depression leads to alterations in the function of the [[hypothalamic–pituitary–adrenal axis]], causing excessive release of [[cortisol]], which can lead to poor sleep quality.

Nocturnal [[polyuria]], excessive night-time urination, can also result in a poor quality of sleep.<ref>{{cite journal | vauthors = Adler CH, Thorpy MJ | s2cid = 24024570 | title = Sleep issues in Parkinson's disease | journal = Neurology | volume = 64 | issue = 12 Suppl 3 | pages = S12–20 | date = June 2005 | pmid = 15994219 | doi = 10.1212/WNL.64.12_suppl_3.S12 }}</ref>

=== Subjectivity ===
{{Main|Sleep state misperception}}
Some cases of insomnia are not insomnia in the traditional sense because people experiencing [[sleep state misperception]] often sleep for a normal amount of time.<ref name="Harvey_2012" /> The problem is that, despite sleeping for multiple hours each night and typically not experiencing significant daytime sleepiness or other symptoms of sleep loss, they do not feel like they have slept very much, if at all.<ref name="Harvey_2012" /> Because their perception of their sleep is incomplete, they incorrectly believe it takes them an abnormally long [[Sleep onset latency|time to fall asleep]], and they underestimate how long they stay asleep.<ref name="Harvey_2012">{{cite journal | vauthors = Harvey AG, Tang NK | title = (Mis)perception of sleep in insomnia: a puzzle and a resolution | journal = Psychological Bulletin | volume = 138 | issue = 1 | pages = 77–101 | date = January 2012 | pmid = 21967449 | pmc = 3277880 | doi = 10.1037/a0025730 }}</ref>

=== Problematic digital media use ===
{{See also|Screen time|Binge-watching|Internet addiction disorder|Nomophobia|Problematic smartphone use|Problematic social media use|Television addiction|Video game addiction}}
{{Excerpt|Digital media use and mental health|Sleep}}