CONDITIONS

What Is Insomnia

Insomnia is a common sleep disorder that affects millions of people worldwide—characterized by the inability to fall or stay asleep. You might go to bed but not be able to fall asleep, or you might wake up in the middle of the night and have a hard time getting back to sleep, even though you don’t feel rested. The next day, you may be tired and moody, and you may find it hard to concentrate or to do the things you need to do in the course of your day.

Insomnia commonly leads to daytime sleepiness, lethargy and a general feeling of being unwell both mentally and physically—and can exacerbate depression, anxiety, and can impact diet and weight.

Most people have trouble getting to sleep from time to time, especially when there’s a stressful situation at work or at home. But if you have trouble sleeping three nights a week or more, for at least three months, then it may be chronic insomnia.

Insomnia can disrupt your work and private life. And you’re not alone. According to one survey by the National Sleep Foundation, more than half of all people surveyed had suffered from insomnia in the past year. What’s more, the National Institutes of Health estimates that insomnia is a problem for about 1 in 3 Americans, and that this condition disrupts day-to-day life for one person out of every ten.

What Causes Insomnia

A number of issues in your life can make it hard for you to sleep. Sometimes insomnia is caused by a medical condition, while at other times it may be a result of stress, caffeine, or other issues in your day-to-day routine.

Common everyday causes of insomnia include:

  • Stress at work or at home, including both ordinary stresses such as a tight deadline and major events such as a divorce or the death of a loved one. Stressful events may also include some happy occasions, such as planning a wedding.
  • Poor sleep habits, such as taking work to bed or having a large meal just before going to bed.
  • A changing schedule at work or at home, such as switching to an evening shift or having a new baby in the house.
  • Travel to a different time zone or an unfamiliar location.
  • Stimulants, such as coffee, caffeinated sodas, tea, or cigarettes.
  • Alcohol, which may help you fall asleep but can make your sleep less restful.

For many people, insomnia has a medical cause. This can be a sleep disorder such as restless legs syndrome, {HYPERLINK TO RESTLESS LEGS SYNDROME CONDITION CENTER] or it can be an illness with symptoms that disrupt your sleep, such as gastroesophageal reflux disease, or GERD, {HYPERLINK TO GERD CONDITION CENTER] which can wake you with heartburn in the middle of the night. In addition, the medicines you take for another condition may also make it harder for you to sleep.

Common sleep disorders include:

  • Sleep apnea, {HYPERLINK TO SLEEP APNEA CONDITION CENTER] in which your body stops breathing and you need to wake up. You may wake up gasping for breath, or you may just change positions and go back to sleep.
  • Restless legs syndrome, {HYPERLINK TO RESTLESS LEGS SYNDROME CONDITION CENTER] also known as Willis-Ekbom disease, which can make your body want to move when you are at rest.
  • Periodic limb movement disorder, which may cause your arms or legs to twitch when you are fast asleep.

Other medical conditions that may disrupt your sleep include:

  • Asthma {HYPERLINK TO ASTHMA CONDITION CENTER]
  • Gastroesophageal reflux {HYPERLINK TO GERD CONDITION CENTER]
  • Problems that may wake you up to go to the bathroom, such as diabetes, incontinence, {HYPERLINK TO OAB INCONTINENCE CONDITION CENTER] or prostate problems
  • Thyroid disease or other hormone problems {HYPERLINK TO THYROID CONDITION CENTER]
  • Nervous system disorders such as Parkinson’s disease {HYPERLINK TO PARKINSONS CONDITION CENTER]
  • Lower back pain, {HYPERLINK TO BACK PAIN CONDITION CENTER] arthritis, {HYPERLINK TO ARTHRITIS CONDITION CENTER] or other chronic pain disorders {HYPERLINK TO PAIN AND PAIN MANAGEMENT CONDITION CENTERS]
  • Heart or lung disease {HYPERLINK TO HEART HEALTH OVERVIEW CONDITION CENTER]
  • Depression {HYPERLINK TO DEPRESSION CONDITION CENTER]
  • Anxiety disorders such as obsessive-compulsive disorder or post-traumatic stress disorder {HYPERLINK TO ANXIETY CONDITION CENTER]

In addition, the treatments for another disorder may also affect your sleep cycle. Medicines that can disrupt your sleep include:

  • Antidepressants
  • Blood pressure medicines
  • Heart medications
  • Allergy medicines and decongestants
  • Stimulants such as methylphenidate (Ritalin)
  • Steroids, including the corticosteroids used in anti-itch medicines
  • Some weight-loss treatments

This is not a complete list of the problems that might lead to insomnia. Ask your doctor about other issues that may be disrupting your sleep.

Risk Factors For Insomnia

Almost everyone has had trouble sleeping at some point, but there are factors that can make you more likely to have insomnia more often. Some of these are risk factors that you can change, or at least influence, while others are beyond your control.

Risk factors you may be able to change include:

  • Stress at work or in the home
  • Working a night shift, or changing shifts
  • Long-distance travel, especially between time zones
  • Poor sleep hygiene

Risk factors you can’t change include:

  • Your sex. Insomnia is more common in women than in men.
  • A mental health disorder, such as depression, bipolar disorder, or post-traumatic stress disorder. These conditions can be treated, but they are not usually curable, and sometimes the treatment can make sleep problems worse.
  • Your age. Insomnia is common in your late teens and twenties. Some medical authorities say that insomnia is also common after age 60, while other sources report that it becomes less common later in life.

Diagnosing Insomnia

You can bring up insomnia at a regular doctor’s visit, or you can make an appointment just to talk with your doctor about your sleep problems. If you regularly share your bed with a spouse or significant other, then you may want to bring your significant other along to talk about things you might not notice, such as whether you snore or move in your sleep.

Your doctor will likely start by asking about your symptoms and your sleep patterns, such as:

  • When your insomnia started
  • How often you have trouble sleeping
  • Whether you sleep at the same time on weekends as on weekdays
  • Whether you wake up in the night or have trouble getting to sleep in the first place
  • Answers to specific questions, such as whether you snore or wake up gasping for breath, may help your doctor diagnose a specific cause for your sleep problems.

Your doctor may also ask about your bedtime routine, your eating and drinking habits, and other aspects of your life that may affect your sleep, such as traumatic or stressful events. To help keep track of the answers, your doctor may give you a questionnaire to fill out.

In all likelihood, your doctor will also perform a physical exam, and possibly a blood test. Your doctor may also ask you to use a sleep log to keep track of your day-to-day sleep habits, such as when you go to bed, when you get up in the morning, and any times you wake up during the night.

If the cause of your insomnia still isn’t clear, you may need an overnight sleep study to watch how you sleep. During a sleep study, you will stay overnight in a lab or hospital, and lab techs will keep track of:

  • How often you wake up
  • How much you move while sleeping
  • Your heart rate
  • Your brain waves on an electroencephalogram, or EEG

Firsthand observations about how you sleep can help your doctor diagnose your insomnia.

Symptoms of Insomnia

The definition of insomnia is difficulty falling asleep or staying asleep. If you have trouble sleeping at least 3 nights a week for 3 months or longer, then you may have chronic insomnia.

Specific symptoms of insomnia may include:

  • Having a hard time getting to sleep
  • Awakening in the middle of the night, or the early morning
  • Waking up but not feeling rested, this is sometimes called non-restorative sleep

Lack of sleep can also make it hard to function during the daytime. Problems caused by your insomnia may include:

  • Being tired or sleepy
  • Trouble concentrating or paying attention
  • Mood problems, such as irritability or depression
  • Frequent mistakes or accidents
  • Tension headaches
  • Having a hard time at work, at school, or in your personal relationships
  • Behavior problems, such as impulsiveness or aggression

Prognosis

Insomnia itself is almost never fatal, but it can impair your concentration, slow your reaction time, and increase your risk of accidental death or injury. According to some reports, drowsy driving causes 200,000 traffic accidents and 1,500 deaths every year in the United States.

Moreover, your body needs sleep to function properly. Failing to get enough sleep can lead to serious health problems. Over time, insomnia may lead to:

  • Weight gain
  • High blood pressure
  • Heart disease
  • Diabetes
  • Mental health problems such as depression or anxiety

One study found that people who sleep less than 6 hours per night or rely on sleeping pills die at an earlier age, on average, than those who get 7 hours of sleep per night.

The course of insomnia can be very different from one person to the next. For many people, insomnia gets better on its own or with minor lifestyle changes, often within a few weeks. But if you have chronic insomnia, effective treatment may depend on finding and treating the underlying cause. Treatment can help most people with insomnia live happier, healthier, more productive lives.

Living With Insomnia

Insomnia can disrupt your life, but you don’t have to let it control your life. Some things you can do to help you sleep better at night include:

  • Stay on a sleep schedule. If you go to bed at the same time every night and get up at the same time every morning–even on weekends–then you train your body’s internal clock to know when it’s time to sleep.
  • Keep a bedtime routine. Find something that relaxes you, such as yoga, a hot bath, or reading a good book, and do the same thing every night before you go to bed. This routine can help you get your mind and your body ready for sleep. Even run-of-the-mill routines like brushing your teeth can help tell your body that it’s time to sleep, if you make sure to do the same thing every night.
  • Don’t overeat at bedtime. A light snack is OK, but avoid heavy late-night meals, and stay away from alcohol, caffeine, or cigarettes in the evening.
  • Exercise every day. 20 minutes to half an hour of vigorous exercise in the afternoon can help you relax later in the evening. Aim to exercise at least 5 to 6 hours before bedtime, if possible.
  • Avoid naps, especially in the afternoon or evening.
  • Make sure your bed is comfortable, and your room is dark and quiet, to make it easier to fall asleep.
  • Don’t take your work to bed. Distractions such as televisions, computers, or work should be kept out of the bedroom.
  • Don’t force it. If you can’t sleep, do something else for a while, in another room, and come back later when you’re ready to sleep.
  • Get natural daylight. Go out in the sun in the early morning and other times during the day. Avoid too much bright light in the evening. Observing the natural rhythms of day and night can help you remember when it’s time to sleep.

Screening

Proper sleep is essential to your health. But many people don’t tell their doctor if they have trouble sleeping. For that reason, it’s a good idea for doctors to take the initiative. Many brief questionnaires are available to help your doctor watch for insomnia.

Yet you shouldn’t assume your doctor will screen you for insomnia. If you have trouble sleeping, tell your doctor, especially if it gets in the way of your day-to-day life.

Prevention

Like many illnesses, insomnia is less troublesome if you deal with it before it becomes a big problem. The things you can do to help get your sleep back on track can also help you keep your sleep habits on track from the start.

  • Go to bed at the same time every evening, even on weekends, and wake up at the same time every morning.
  • Make your bedroom a calm, relaxing space, and practice a relaxing daily routine before going to bed.
  • Exercise every day for 20 minutes to half an hour—ideally 5 hours or more before your bedtime.
  • Avoid things that can disrupt your sleep, such as cigarettes, alcohol, coffee, or large meals just before bedtime.
  • Avoid daytime naps, especially in the afternoon or the evening.
  • If a medicine makes it hard for you to sleep, ask your doctor if there’s something else you can take instead.
  • Get natural sunlight in the daytime.
  • Use stress management to get any anxiety under control.

Medication And Treatment

Medical treatments are available to help you sleep, but you should not rely on sleeping pills as a first resort.1 Sleep aids can be very helpful in the short term for some people, but long-term reliance on sleeping pills may lead to addiction or dependence, and make it harder for you to overcome your insomnia.

The first line of treatment for insomnia usually relies on lifestyle changes and non-medical treatments. These treatments include:

  • Sleep hygiene. Learning good sleep habits can go a long way toward helping you get more and better sleep.
  • Cognitive behavioral therapy. This is a type of psychotherapy designed to help you replace bad habits with healthier behavior.
  • Relaxation techniques such as breathing exercises or progressive relaxation.
  • Light therapy using natural sunlight or a light box to get your body’s rhythms in sync with the natural cycle of day and night.
  • Specific techniques that run counter to most people’s expectations, such as sleep restriction, which involves getting sleep for a while to make you more tired, or paradoxical intention, in which you go to bed and try to stay awake until you can’t.

If lifestyle changes and behavioral therapies aren’t enough, then short-term medication may help. Benadryl (diphenhydramine) is available over the counter for short-term sleep problems, but if the problem lasts 4 weeks or longer, you should talk to a doctor.

Prescription medicines to help you sleep include:

  • Benzodiazepines such as triazolam (Halcion) and temazepam (Restoril). Benzodiazepines can help you sleep, but your doctor may need to decrease your dose gradually to avoid withdrawal symptoms when it’s time to stop taking them.
  • Non-benzodiazepine hypnotics, such as zolpidem (Ambien) and eszopiclone (Lunesta). These medicines are safer and less addictive than benzodiazepines, but doctors still don’t recommend them for long-term use.
  • Ramelton (Rozerem), a melatonin agonist. This is a relatively new treatment that causes your body to produce more of the sleep hormone melatonin. Ramelteon may help bring your sleep cycle back to normal, but it can still leave you tired or dizzy during the daytime.

All sleeping pills have side effects and at least some risk of addiction, so most doctors recommend limiting sleep aids to just a few weeks, until you get your sleep schedule back on track.

Complementary and Alternative Treatment

In addition to behavioral therapies, lifestyle changes, and medical sleep aids, there are many complementary and alternative treatments that may also help you sleep.

Some studies have found acupuncture to be very helpful, possibly in as many as 9 patients out of 10,although more research is still needed.

Another popular approach is melatonin, a sleep hormone your body produces naturally. Scientific evidence is mixed, but melatonin supplements appear to be effective for some specific types of insomnia, such as jet lag.

Other complementary and alternative approaches that may help you sleep include:

  • Relaxation techniques such as meditation, yoga, biofeedback, or massage
  • Herbal treatments such as valerian, kava kava, or chamomile
  • Tart cherry juice
  • Vitamins A, B, C, and E
  • Other supplements, such as L-tryptophan, coenzyme Q10, or omega 3 fatty acids
  • Homeopathic medicine
  • Chiropractic adjustments

Always talk to your doctor about any treatments you use, including alternative and complementary treatments. Many herbal medicines and supplements may cause side effects or interact with other medicines you take.

When To Contact A Doctor

7 out of 10 people with sleep problems don’t tell their doctor, but try to deal with the problem on their own. Yet lack of sleep can be devastating to your overall health and the quality of your life. If poor sleep makes it hard for you to function during the day, or if you have trouble sleeping 3 or more nights a week for 3 months or longer, talk to your doctor about your insomnia and what you can do to get a good night’s sleep.

Questions For A Doctor

When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:

  • What do you think is keeping me awake?
  • What can I do in my day-to-day life to help me sleep?
  • Do you recommend any other treatments?
  • Is a sleep study likely to help?
  • Is there anything else I should know about my insomnia?