Insomnia

(Sleeplessness)

Definition

Insomnia is a sleep disorder. It may cause many sleep problems. These include trouble falling asleep, waking in the middle of the night, or waking very early in the morning. It may also be a sleep that's not restful. Insomnia can be a short-term problem, or it can be chronic. Chronic insomnia lasts for more than 4 weeks.

Causes    TOP

Insomnia happens for many reasons. Short-term insomnia is often caused by temporary situations or problems with the environment such as:

  • A life crisis or stress such as the loss of a life partner or job
  • Noise around you
  • A room that is too hot or too cold
  • Changes in your surroundings
  • Jet lag or other sleep-wake problems

There may be no clear reason for chronic insomnia. It may also be linked to other health or mental problems such as:

Both chronic and short-term insomnia may be due to

  • Behavioral factors such as:
    • Misuse of caffeine, alcohol, or other substances
    • Smoking cigarettes
    • Disrupted sleep/wake cycles from shift work or other nighttime activities
    • Chronic stress
    • Napping too much in the afternoon or evening
  • Certain medicines such as antidepressants, stimulants, or pain relievers

Risk Factors    TOP

Insomnia is more common in women during and after menopause. It is also common in adults 50 years of age or older.

Your chances of insomnia are higher for having any of the problems listed above.

Symptoms    TOP

Insomnia may cause:

  • Problems falling asleep
  • Waking up many times during the night and having a hard time falling back to sleep
  • Waking up too early
  • Not feeling refreshed after sleep
  • Daytime sleepiness
  • Feeling restless, anxious, or having a hard time thinking

When Should I Call My Doctor?

Call your doctor if you are having frequent insomnia. Let your doctor know if you're having a hard time getting through the day.

Diagnosis    TOP

You will be asked about your symptoms and health history. A physical exam will be done. You will also be asked about your job, eating habits, and drug and alcohol use.

You will also be asked about your schedule and sleep patterns. You may be asked to keep a sleep diary. This will include information about your naps, bedtime, and how often you wake during the night. Your doctor will review the medicines you take, including over-the-counter medicines and herbal supplements. Your answers may point to a cause.

Testing

You may be watched in a sleep lab. This may be done if the cause isn't clear. It may be also done to find out if you have a sleep disorder. You will need to spend the night in a special center. Your movements, breathing, and brain activity will be monitored. This will allow your doctor to identify a treatable condition that is affecting your sleep.

Monitored Breathing During Polysomnography

Sleep monitor apnea
Copyright © Nucleus Medical Media, Inc.

Treatment    TOP

Treat Underlying Medical Conditions

Many physical and mental disorders can disrupt sleep. Getting them treated may help restore normal sleep patterns.

Identify and Modify Behaviors That Worsen Insomnia

There are steps you can take to help get a good night's rest. You may be advised to lower your intake of certain items or avoid them to see if your sleep improves. You may be asked to:

  • Lessen or avoid caffeine, especially late in the day.
  • Lessen or avoid alcohol and avoid drug use.
  • Quit smoking. If you smoke, avoid doing so near bedtime.
  • Stop eating or drinking close to bedtime.

Your sleep habits can also affect how well you sleep. Steps that may help you sleep better:

  • Go to bed and wake up at the same time each day.
  • If you must take naps, keep them short.
  • Only use the bedroom for sleep or sex. Don't watch TV or worry in bed.
  • Keep your bedroom dark. Make sure the temperature is comfortable. Lessen disruptions such as pets.
  • If you work at night and sleep during the day, block daylight from the room. Lower the amount of noise. Use a fan to block out noise.

Medicines    TOP

Sleeping pills are available by prescription or over-the-counter. Most doctors don't want you to use them for a long time. They can cause dependency. This is a physical change in your body. It makes your body depend on the drug for sleep.

Proper use of certain sleep medicines may improve sleep. Most of these medicines are only approved for use for a short time. They can cause drowsiness, lightheadedness, and headache. Serious problems such as abnormal thinking, behavior changes, or suicidal thoughts can happen.

Many over-the-counter sleep medicines contain diphenhydramine. This can make you feel groggy and might help you fall asleep. But, it has serious side effects. Most people should avoid using it regularly.

Exercise    TOP

Exercise can help you get a better sleep. It can reduce stress and allow your body to reach a deeper state of relaxation. The timing of exercise is important. It's best to do it early in the day if you have sleeping problems. If you have to exercise later in the day, make sure you are done at least a few hours before bedtime.

Herbal Therapies and Supplements    TOP

Some people use the herb valerian to help insomnia. Others take melatonin. It is not clear that these supplements help. Talk to your doctor before taking any herbs or supplements.

Relaxation Therapy    TOP

This therapy may reduce or eliminate anxiety and body tension. It stops the mind from racing and allows the muscles to relax. This can support a restful sleep. The therapy may include deep breathing and progressive relaxation.

Sleep Restriction    TOP

A sleep restriction program is a strict sleep program. It limits the amount of time in bed to only the time that you are actually sleeping. Previous sleep logs will determine the amount of time allowed in bed. The time you spent sleeping will be used to determine the amount of time you can spend in bed. At first, your time in bed may seem short, usually about 5 hours. More time is slowly added until you get to a normal night's sleep.

Cognitive Behavioral Therapy    TOP

Cognitive behavioral therapy (CBT) is a form of talk therapy. This means that you discuss your thoughts, feelings, and behaviors with a mental health professional. CBT focuses on how the way you think affects the way you feel and act. CBT may have more lasting effects than medication.

Reconditioning    TOP

Reconditioning helps people associate the bed and bedtime with sleep. This means not using the bed for activities other than sleep and sex. As part of the reconditioning process, the person is usually advised to go to bed only when sleepy.

Prevention    TOP

To help lower your chances of insomnia:

  • Limit intake of caffeinated food and drinks after lunch.
  • Limit drinking alcohol.
  • Limit eating too fast or too much. Don't eat too close to bedtime.
  • Limit drinking fluids before bedtime.
  • If you smoke, talk to your doctor about ways to quit.
  • Exercise regularly, but not within less than 3 hours of bedtime.
  • Use the bedroom only for sleep and sex. Don't use electronics or watch TV while in bed
  • Make bedtime routines to relax you. Listen to quiet music or soak in warm water.
  • Make sure the bedroom isn't too cold or too hot.
  • Use a humidifier or dehumidifier as needed.
  • Get sunlight during the day.
  • Use shades or lined drapes.
  • Wear an eye mask to keep it dark.
  • Use earplugs or listen to relaxing music or white noise. This helps reduce the disturbing effects of noise.
  • Make sure your mattress is supportive and the bedding is comfortable.
  • Avoid staring at the clock after going to bed.
  • Keep bedtimes and wake-times consistent throughout the week.
  • If you can't avoid naps, keep them short.

RESOURCES:

National Heart, Lung, and Blood Institute
https://www.nhlbi.nih.gov
National Sleep Foundation
http://www.sleepfoundation.org

CANADIAN RESOURCES:

Better Sleep Council Canada
http://www.bettersleep.ca
Canadian Sleep Society
https://css-scs.ca

References:

Insomnia. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/insomnia. Updated July 25, 2017. Accessed August 21, 2018.
Insomnia. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health-topics/insomnia. Accessed August 21, 2018.
Insomnia in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114839/Insomnia-in-adults. Updated August 19, 2018. Accessed August 21, 2018.
Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med . 2004;164(17):1888-1896.
Morin CM, Vallieres A, Guay B, et al. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA. 2009;301(19):2005-2015.
Last reviewed June 2018 by EBSCO Medical Review Board Marcin Chwistek, MD
Last Updated: 8/21/2018

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