Insomnia
Topic OverviewWhat is insomnia?Insomnia (also called insomnia disorder) is a common sleep problem that can
affect your quality of life. People with insomnia have trouble falling asleep
or staying asleep. They may wake up during the night or wake up too early the
next morning. Your sleep problems may come and go, or they may be
ongoing. - A short-term sleep problem is often linked to short-term stress. This short-term insomnia
can last for days to weeks. It often gets better in less than a
month.
- A chronic sleep problem is ongoing.
This is called chronic insomnia. It is often a symptom of another health
problem, such as
depression or
chronic pain. Chronic insomnia is less common than
short-term sleep problems.
What causes insomnia?There are many things that can cause sleep problems. Insomnia may be
caused by: - Stress. Stress can be
caused by fear about a single event, such as giving a speech. Or you may have
ongoing stress, such as worry about work or school.
- Depression, anxiety, and other mental or emotional
conditions.
- Poor sleep habits, such as
watching TV in bed or not having a regular bedtime schedule. If you have
trouble sleeping, you may worry about being able to fall asleep. This can make
the problem worse.
- Changes in your sleep habits or surroundings. This includes changes that happen where you sleep, such as
noise, light, or sleeping in a different bed. It also includes changes in your
sleep pattern, such as having jet lag or working a late
shift.
- Other health problems, such as pain,
breathing problems, and
restless legs syndrome.
- Stimulants, such as tobacco and caffeine, as well as certain
medicines, alcohol, and drugs.
- Lack of regular exercise.
What are the symptoms?The symptoms of insomnia are different for each person. People with
insomnia may: - Have trouble falling asleep. This can mean
lying in bed for up to an hour or more, tossing and turning, waiting to fall
asleep.
- Wake up during the night and have trouble going back to
sleep.
- Wake up too early in the morning.
- Feel tired
when they wake up, like they didn't get enough sleep.
- Feel grouchy,
sleepy, or anxious, and be unable to get things done during the daytime.
- Find it difficult to pay attention, focus on tasks, or remember to do things.
How is insomnia diagnosed?Insomnia is not a disease, and no test can diagnose it. But when you
can't sleep well, it often has to do with some other cause. Your doctor will
probably assess your current health and ask about any health problems you have
had and any medicines you are taking. Sometimes a doctor will do a
physical exam, blood tests, and, in some cases, sleep studies to help find out
if you have a health problem that may be causing the insomnia. Your doctor may also ask about your sleep history-how well you sleep, how
long you sleep, your bedtime habits, and any unusual behaviors you may have.
Your doctor may ask you to keep a sleep journal, which is a record of your sleep
patterns, for a week or two. He or she may recommend a counselor if your
symptoms point to a mental health problem, such as depression or
anxiety. How is it treated?Treatment for insomnia focuses on the reason why you don't sleep well. If
you have a medical problem, such as chronic pain, or an emotional problem, such
as stress, treating that problem may help you sleep better. You may be able to
sleep better by making some small changes. It may help to: - Go to bed at the same time each
night.
- Get up at the same time each day.
- Avoid caffeine
and alcohol for several hours before bedtime.
- Get regular exercise. Figure out what time of day works best for your sleep
patterns.
- Avoid daytime naps.
Some people may need medicine for a while to help them fall
asleep. Doctors often prescribe medicine for a short time if other treatment
isn't working. But medicine doesn't work as well over time as lifestyle and
behavior changes do. Sleep medicine can also become
habit-forming. Medicine works best as a short-term treatment combined with
lifestyle and behavior changes. Your doctor may also recommend
counseling, which can help you learn new habits that may help you sleep
better. Talk to your doctor about your sleep problems and any
other health issues you may have. This is important, because lack of sleep can
lead to depression, accidents, problems at work, marital and social problems,
drinking more alcohol than usual, and poor health. Treatment may help you avoid
these problems and feel better. Frequently Asked QuestionsLearning about insomnia: | | Being diagnosed: | | Getting treatment: | | Living with insomnia: | |
SymptomsEach person experiences
insomnia differently. People with insomnia may: - Have trouble falling asleep. This can mean
lying in bed for up to an hour or more, tossing and turning, waiting to fall
asleep.
- Become so worried about or focused on being able to fall asleep that the worry and attention interferes with being able to fall asleep.
- Wake up and have trouble falling back to
sleep.
- Wake up too early in the morning.
- Feel tired
when they wake up, as if they didn't get enough sleep.
- Feel grouchy,
sleepy, or anxious, and be unable to get things done during the daytime.
- Find it difficult to pay attention, focus on tasks, or remember to do things.
Quality versus quantity of sleepThe quality of
their day is what makes people who have insomnia different from people who
typically sleep fewer hours or who have a different sleep disorder. With
insomnia, you sleep so badly that you feel grouchy and perform poorly during
the day. But it is possible to be a restless sleeper or to sleep less than 8
hours a night and yet get the amount of sleep you need. If you wake up
refreshed with energy and are able to get things done during the day, then you
are probably getting enough sleep. Not getting enough sleep can
affect your quality of life. It can lead to serious problems including injury,
accidents, anxiety, and
depression. Talk with your doctor if you think that
you have insomnia. Exams and TestsInsomnia is not
a disease, and no specific test can diagnose it. But it can make you feel bad,
and it can affect your health. It can also be a sign of other problems. Your
doctor may want to do blood tests to rule out certain medical conditions such
as thyroid problems. "Normal sleep" differs for each person. Checking your
health and sleep history is an important first step to finding a cause for
poor-quality sleep. Talk with your doctor about your medical history and any
medical problems you have or any medicines you are taking. Sleep history Your doctor can learn a lot about your
insomnia and its causes by reviewing your
sleep history. He or she can look at how long you sleep each night, how well you sleep, and what unusual behaviors you may have while sleeping, like snoring or gasping. Since you may be unaware of all your sleep problems while you sleep, your doctor may ask your bed partner questions about your sleeping behavior to better understand your sleep problems. He or she may also ask you to keep a
sleep journal(What is a PDF document?) for 1 or 2 weeks to monitor your sleep
patterns and habits. Your sleep journal can help your doctor spot certain habits
that may affect your sleep, or even see signs of a hidden health problem that
may need to be checked out. If your symptoms point to mental health concerns, such as
depression or
anxiety, you may be referred to a mental health
professional. Sleep studiesIf your
doctor thinks that you have a sleep disorder, he or she may refer you for a
sleep study. When you have a sleep study, you stay
overnight in a special sleep lab. Your doctor may recommend a sleep
study if your insomnia seems to be caused by breathing problems (such as
sleep apnea) or
periodic limb movement disorder, or if you have tried
other treatments that haven't worked. Sleep studies are not helpful for insomnia caused by mental health
problems,
fibromyalgia, or
myalgic encephalomyelitis/chronic fatigue syndrome. Treatment OverviewTossing and turning during the night
or having trouble falling asleep can make you sleepy and grouchy during the
day. You may have tried some things to help your
insomnia that haven't worked. The good news is that
there are many treatments to help you sleep better. But first it helps to know
the reason why you don't sleep well. If you have a medical problem, such as
chronic pain, or an emotional problem, such as stress or
depression, treating that problem may help you sleep
better. Treatment options for insomniaTreatment options include behavior and lifestyle
changes, medicines, and complementary medicines. Behavior and lifestyle changesGetting ready for
bed means more than turning down the sheets. Sleep experts know that there are
many things that affect how well you sleep. Behavior and lifestyle changes improve overall sleep quality and the time it takes to fall asleep-without the side effects of sleep medicines.
Perhaps most important, these improvements last over time. To
improve your sleep, here are some things you can try: Medicines In some
cases, taking sleeping pills for a short time helps you get some rest, while
behavior and lifestyle changes can help you over the long term. Doctors
recommend taking sleep medicines only now and then or only for a short time.
They are not the first choice for treating chronic insomnia. Many sleep medicines cause side
effects, such as low blood pressure, anxiety, and nausea. These medicines also
may become less effective when your body gets used to them and may cause
withdrawal symptoms when you stop using them. Sleep medicines
include: - Prescription sleep medicines, such as
eszopiclone (Lunesta), ramelteon (Rozerem), zaleplon (Sonata), and zolpidem
(Ambien). They are the first-choice medicines for short-term insomnia.
- Orexin receptor antagonists, such as suvorexant (Belsomra). These medicines block chemicals in the brain that keep you awake, helping to promote sleep.
- Benzodiazepines, such as diazepam (such as Valium), lorazepam (Ativan), and quazepam
(Doral). These medicines
help you fall asleep or stay asleep. You need a prescription for these
medicines.
- Antidepressants that have a calming or sedative
effect. These can be used to help you sleep.
- Antihistamines.
Typically used for allergies, these can provide short-term relief of
sleeplessness.
- Nonprescription medicines for sleep.
These can help, but they also can cause side effects, such as drowsiness the
next day. Over time, sleeping pills may not work as well as they did when you
first started using them.
To help you decide if you should use sleeping pills to treat
insomnia, see: - Insomnia: Should I Take Sleeping Pills?
One Man's Story: While Cort
does have a prescription for sleeping pills, he uses the medicine only when he
needs to be well rested the next day, such as when he has to give a
presentation at work. Cort heeds his doctor's warning about becoming dependent
on sleeping pills. "I have a prescription for 5 mg tablets, and I
never take a full one. I break them in half, and I never take them more than
once in 2 weeks." -Cort, 64 Read more about Cort and how he learned to cope with insomnia. |
Complementary medicineOther treatments for insomnia may include complementary medicine. Two of the most popular dietary supplements used for insomnia are: - Melatonin, a hormone produced by the brain. You can
also buy it as a supplement. Melatonin has also been used to treat
jet lag and poor sleep from working the
night shift. The long-term effects of taking melatonin are unknown. If you are using melatonin regularly, talk to your doctor.
- Valerian, an herbal sleep remedy.
Valerian appears to be safe, and it may improve sleep when taken for a week or
two.footnote 1
Don't rely on alcohol
Some people use alcohol to help them sleep, but that's not a good idea. At
first, drinking alcohol may make you sleepy and help you fall asleep. But when
you drink alcohol, you are more likely to wake up later in the night and have a
hard time falling back asleep. This can leave you feeling tired the next
day. Home TreatmentAfter you and your doctor have treated
any health problems related to your
insomnia, there are many steps you can take to improve
your sleep. Here are a few examples: - Avoid or limit caffeine, nicotine, and alcohol.
Don't use them at all late in the day or in the evening.
- Check all
of your medicines with your doctor to see if they could be affecting your
sleep. To help avoid sleep problems, you may be able to adjust your dose or
change the time of day you take your medicine.
- Use the evening
hours for settling down. Avoid watching TV and using the
computer or phone if they keep you from getting to sleep.
- Create a bedtime routine that you do each night to help teach your body and mind that it is time to wind down. For example, before bed, take a warm shower, listen to soothing music, or have a cup of herbal tea.
- Make exercise a regular part of your life. Figure out what time of day works best for your sleep
patterns.
- Keep your bedroom quiet, dark, and cool. Try using a sleep mask
and earplugs to help you sleep.
- If you can't fall asleep (or fall back to sleep) after 20 minutes, get out of bed and do a quiet task. This will help you to not link being in bed with not being able to sleep.
- If you are overweight, set goals to manage your weight. Being overweight can be linked with sleep problems.
- Try to avoid napping during the day.
For more tips on how to improve your sleep, see: - Insomnia: Improving Your Sleep.
- Shift Work Sleep Disorder.
- Sleep: Helping Your Children-and Yourself-Sleep Well.
- Sleep Problems: Dealing With Jet Lag.
Sleep tips for older adultsOlder adults, especially those living in nursing homes or who are cared
for by others, often have ongoing sleep problems. It's natural for your sleep
patterns to change as you get older, but it doesn't mean that you need less
sleep or that the sleep you do get is enough. There are things you
can do to
cope with changing sleep patterns as you get older, such as having familiar
evening and nighttime routines. Treatment if sleep problems don't get betterBe sure to talk to your doctor if
your sleep problem gets worse, if it lasts for more than 2 weeks, or if your
symptoms become more severe or happen more often. Other Places To Get HelpOrganizationsAmerican Academy of Sleep Medicine: Yoursleep
http://yoursleep.aasmnet.org Centers for Disease Control and Prevention: Sleep and Sleep Disorders (U.S.) www.cdc.gov/sleep ReferencesCitations- Valerian (2010). In A DerMarderosian et al., eds., Review of Natural Products. St. Louis: Wolters Kluwer Health.
Other Works Consulted- Morin CM, et al. (2009). Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: A randomized controlled trial. JAMA, 301(19): 2005-2015.
- Ropper AH, et al. (2014). Sleep and its abnormalities. In Adams and Victor's Principles of Neurology, 10th ed., pp. 395-418. York: McGraw-Hill Education.
- Schutte-Rodin S, et al. (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of Clinical Sleep Medicine, 4(5): 487-503.
CreditsByHealthwise Staff Primary Medical ReviewerKathleen Romito, MD - Family Medicine Adam Husney, MD - Family Medicine E. Gregory Thompson, MD - Internal Medicine Specialist Medical ReviewerHasmeena Kathuria, MD - Pulmonology, Critical Care Medicine, Sleep Medicine Current as of:
May 3, 2017 Valerian (2010). In A DerMarderosian et al., eds., Review of Natural Products. St. Louis: Wolters Kluwer Health. Last modified on: 8 September 2017
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