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OVERVIEW

What is insomnia?

Insomnia is a sleep disorder that happens when you have trouble falling asleep, staying asleep, or both. Acute insomnia is short-term trouble sleeping. It may last a few weeks then go away. Chronic insomnia is when your sleeping problem happens several nights a week and lasts for more than a few months. Many people have insomnia. However, it’s more common in older adults, and more women than men have it.

Getting enough sleep is an important part of a healthy lifestyle. Insomnia can affect you mentally and physically. It can make you feel tired, depressed and irritable. It can also make it hard for you to concentrate or perform tasks during the day. If you have insomnia, you may also worry about being able to sleep. Sometimes this can make sleeping harder.

If you don’t get enough sleep on a regular basis, you’re at increased risk of diseases. These include high blood pressure, heart disease and diabetes.

SYMPTOMS

Symptoms of insomnia include

• Lying awake for a long time before falling asleep on most nights
• Not being able to stay asleep
• Waking up very early
• Feeling like you haven’t slept at all
• Falling asleep during the day, including while driving

CAUSES & RISK FACTORS

What causes insomnia?

Primary insomnia is a distinct disorder. It usually lasts at least a month. It isn’t well understood. Things that can cause this kind of insomnia include:

• Life changes
• Major or long-lasting stress or emotional upset
• Travel or work schedules that disrupt your sleep routine
• Habits that you’ve formed to deal with your lack of sleep (naps, worrying about sleep, going to bed early)

Some cases of insomnia are a symptom or side effect of another problem. This is called secondary insomnia. Many different disorders can cause insomnia. They include:

• Emotional conditions: Depression, anxiety, and posttraumatic stress disorder
• Neurological disorders: Alzheimer’s or Parkinson’s disease
• Pain conditions: Arthritis and headache disorders
• Gastrointestinal disorders: Heartburn, GERD
• Sleep disorders: Restless legs syndrome or sleep apnea
• Breathing disorders: Asthma or heart failure
• Other conditions: Such as overactive thyroid, stroke, or menopause

Secondary insomnia also can be caused by some medicines. These include asthma medicines, allergy or cold medicines, and certain heart and blood pressure medicines. Additionally, the use of some substances can cause insomnia. These include caffeine, tobacco, and alcohol.

Insomnia can sometimes run in families.

DIAGNOSIS & TESTS

How is insomnia diagnosed?

Your healthcare provider may ask you:

• Questions about your sleep habits (such as when you go to bed and when you get up)
• What medicines you take
• Your intake of caffeine and alcohol.
• If you smoke.
• About events or problems in your life that may be upsetting you
• How long you’ve been having insomnia
• If you have any pain (such as from arthritis)

If you have a bed partner, your healthcare provider may ask them if you snore while you sleep.

If the cause of your insomnia is not clear, your healthcare provider may may order a blood test.

Your healthcare provider may suggest that you fill out a sleep diary. For a sleep diary, you record:

• What time you went to bed
• How long you are in bed before falling asleep
• How often you wake up during the night
• What time you got up in the morning
• How well you slept
• The time and length of any naps.
• How you felt during the day (sleepy or alert)
• What you drank (caffeine or alcohol and at what time)
• When you exercise

Take your sleep diary to your next appointment. A sleep diary may help you and your healthcare provider identify patterns and conditions that are affecting your sleep. Your healthcare provider may also do a physical exam. This will help them rule out other medical problems that could be causing your insomnia.

If your healthcare provider thinks another sleep disorder is causing your insomnia, they may suggest a sleep study.

PREVENTION

Can insomnia be prevented or avoided?

The best way to prevent insomnia is to develop a good sleep routine. In some cases, it can’t be prevented or avoided.

TREATMENT

There are several ways to treat insomnia. Treatment usually depends on your health and sleep history. It also may depend on what kind of insomnia you have.

Lifestyle changes

• Avoid substances that make sleeping harder. These include caffeine, some medicines, and alcohol.
• Adopt better sleep habits. Follow a bedtime routine, keep your room dark and cool, and avoid watching TV or using your phone in the bedroom. Go to bed around the same time and wake up around the same time every day.
• Don’t eat, drink, or exercise close to bedtime.

Behavioral therapy

Behavioral therapy can teach you about good sleep habits Behavioral therapy for sleep usually includes learning ways to relax and not worry as much about sleep. You can also learn muscle relaxation and deep breathing exercises to help you relax.

Medicines

You don’t need a healthcare provider’s prescription to get an over-the-counter (OTC) sleep aid. But it’s a good idea to check with your healthcare provider before you try one OTC sleep aids are not meant to be used for a long period of time. Be sure to follow the directions on the label carefully. Don’t drink alcohol while you are taking an OTC sleep aid.

Certain supplements are advertised as treatments for insomnia. Some examples are melatonin and valerian) There is not much evidence about how well these products work. Researchers don’t know what the long-term effects of using them are. Contact your healthcare provider before you try one of these products.

In some cases, your healthcare provider may prescribe medicine to help you fall asleep and stay asleep. Prescription sleeping pills, such as eszopiclone, zolpidem and zaleplon, may help you sleep better.

Side effects

These medicines can have side effects. Some may be serious. Side effects of prescription sleeping pills can include:

• Excessive drowsiness,
• Trouble thinking clearly
• Problems with balance.

Rare but serious side effects include

• Facial swelling,
• Severe allergic reactions
• Unusual behavior while asleep (such as driving or eating food).

Healthcare providers generally don’t recommend using prescription sleep medicines for long periods of time. They are not a cure for insomnia. Although they can help in some cases, they’re only a temporary form of relief. Regular use may lead to rebound insomnia. This happens when a person quits taking sleeping pills and their insomnia comes back even worse than before.

Sleeping pills can be unsafe to use if you have certain health problems. Ask your healthcare provider if sleeping pills would be helpful for you.

Living with insomnia

Keep in mind that you may need less sleep as you age. Some people need only 5 to 6 hours of sleep a night, but most people do better with 7 to 9 hours. Sleep usually occurs in 3-hour cycles, so it is important to get at least 3 uninterrupted hours of sleep.

These tips can help you develop better sleep habits:

• Go to sleep only when you feel tired.
• Avoid reading, watching TV or worrying in bed. These can cause your body and brain to associate your bed with these activities, rather than with sleep.
• Develop a bedtime routine. Do the same thing every night before going to sleep. For example, take a warm bath and then read for 10 minutes every night before going to bed. Soon you’ll connect these activities with sleeping and doing them will help make you sleepy.
• Use the bedroom only for sleep and sexual activity.
• If you can’t fall asleep after 15 minutes, go to another room and return to your bed only when you feel tired. You may repeat this as often as needed during the night.
• Go to sleep and wake up at the same times each day, even on weekends. This helps your body develop a sleep schedule.
• Avoid or limit napping, because it can disturb your normal sleep rhythm. If you must take a nap, only rest for 30 minutes and don’t nap after 3:00 p.m.
• Avoid caffeine from coffee and soft drinks, and nicotine from cigarettes, especially late in the day.
• Avoid eating large meals or drinking a lot of water in the evening.
• Keep your bedroom at a comfortable temperature and as dark as possible.
• Make sure your bedroom is quiet and dark. If noise is a problem, use a fan to mask the noise or use ear plugs. If you must sleep during the day, hang dark blinds over the windows or wear an eye mask.
• Try eating a light snack before going to bed, but don’t eat too much right before bedtime. A glass of warm milk or some cheese and crackers may be all you need.
• Exercise regularly, but don’t exercise within a few hours before going to bed.
• Set aside some time to relax before going to bed. For example, spend 30 minutes after dinner writing down what’s worrying you and what you can do about it.

Another good way to relax is to focus on your breathing by taking slow, deep breaths while counting to 5. Then listen to the sound of your breath as you breathe out. You can also try to tighten and relax the muscle groups in your body, beginning at your feet and ending with your face muscles. A trained therapist can teach you other ways to relax. Relaxation CDs or tapes may also help you relax.