Insomnia

Overview

What is insomnia?

Insomnia (say: "in-sohm-nee-uh") is a sleep disorder. People who have insomnia may not be able to fall asleep. They may wake up during the night and not be able to fall back asleep, or they may wake up too early in the morning. Many people have insomnia. Chronic insomnia is when your sleeping problem lasts for 4 weeks or longer.

Is insomnia a serious problem?

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

How much sleep do I need?

Most adults need about 7 to 8 hours of sleep each night. You know you’re getting enough sleep if you don’t feel sleepy during the day. The amount of sleep you need stays about the same throughout adulthood. However, sleep patterns may change as you age. For example, older people may sleep less at night and take naps during the day.

Causes & Risk Factors

What causes insomnia?

Insomnia is the body’s way of saying that something isn’t right. Things that may cause insomnia include:

Some medical conditions (such as depression) and certain medicines (such as heart and blood pressure medicines, allergy medicines and corticosteroids) can also cause insomnia.

  • Stress

  • Anxiety

  • Depression

  • Too much caffeine, alcohol or nicotine

  • Pain from medical conditions, such as arthritis

  • Changes in work shifts

  • Poor sleep habits, such as an irregular sleep schedule

  • Worrying too much about not being able to sleep

Diagnosis & Tests

What can my doctor do to find out why I’m not sleeping?

Your family doctor may ask you some questions about your sleep habits (such as when you go to bed and when you get up), what medicines you take, and your intake of caffeine and alcohol. Your doctor may also ask if you smoke. Your doctor may ask how long you’ve been having insomnia and if you have any pain (such as from arthritis). If you have a bed partner, your doctor may ask him or her if you snore while you sleep. Your doctor may also ask about events or problems in your life that may be upsetting you and making it hard for you to sleep.

What is a sleep diary?

If the cause of your insomnia is not clear, your doctor may suggest that you fill out a sleep diary. The diary will help you keep track of when you go to bed, how long you are in bed before falling asleep, how often you wake up during the night, when you get up in the morning and how well you sleep. A sleep diary may help you and your doctor identify patterns and conditions that are affecting your sleep.

Treatment

How is insomnia treated?

Learning good sleep habits may help treat insomnia. Behavior therapy can teach you about good sleep habits, and is often just as effective as prescription sleeping medicines. Behavior 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.If a medicine is causing your insomnia, your doctor may be able to prescribe a different medicine for your condition to help you sleep better.

Will an over-the-counter sleep aid or a supplement help?

Although you don’t need a doctor’s prescription to get an over-the-counter (OTC) sleep aid, it’s a good idea to check with your doctor before you try one, especially if you take any other medicines. 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 (for example, melatonin and valerian) are advertised as treatments for insomnia. However, there is little scientific evidence about how well these products work or what the long-term effects of using them are. Talk to your doctor before you try one of these products.

Will prescription sleeping pills help?

In some cases, your doctor 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. However, these medicines can also have side effects, and some may be serious. Side effects of prescription sleeping pills can include excessive drowsiness, trouble thinking clearly and problems with balance. Rare but serious side effects include facial swelling, severe allergic reactions and unusual behavior while asleep (such as driving or eating food). Doctors generally don’t recommend using prescription sleep medicines for long periods of time.

Prescription sleeping pills 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 his or her insomnia comes back even worse than before.Sleeping pills can be unsafe to use if you have certain health problems. Ask your doctor if sleeping pills would be helpful for you.

What can I do to help myself get better sleep?

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 8 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:

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.

  • 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.

Questions to Ask Your Doctor

  • Could my insomnia be a sign of another condition?

  • How can exercise help with insomnia?

  • Are there herbal supplements that help with insomnia? Are there any side effects to be aware of?

  • What types of over-the-counter medicine can help me sleep.

  • Are there prescription medicines that treat insomnia?

  • Does insomnia run in families?

Citations

  • Nonpharmacologic Management of Chronic Insomnia by Parul Harsora, MD and Jennifer Kessmann, MD( 01/15/09, http://www.aafp.org/afp/20090115/125.html)