| What is insomnia? |
Insomnia is the most common of all sleep complaints. Almost everyone has occasional sleepless nights, perhaps due to stress, heartburn or drinking too much caffeine or alcohol. Insomnia is a lack of sleep that occurs on a regular or frequent basis, often for no apparent reason.
How much sleep is enough varies. Although 7 1/2 hours of sleep is about average, some people do fine on 4 or 5 hours of sleep. Other people need 9 or 10 hours a night.
Inability to get a good night's sleep can affect not only your energy level and mood but your health as well because sleep helps bolster your immune system. Fatigue, at any age, leads to diminished mental alertness and concentration. Lack of sleep is linked to accidents both on the road and on the job.
About one out of three people have insomnia sometime in their life. Sleeplessness may be temporary or chronic. You don't necessarily have to live with sleepless nights. Some simple changes in your daily routine and habits may result in better sleep.
| Signs and symptoms |
Signs and symptoms of insomnia may include:
- Inability to sleep enough at night
- Difficulty falling asleep at night
- Waking up during the night
- Waking up too early
- Awakening not restored, even after a full night's sleep
- Daytime fatigue or sleepiness
- Daytime irritability
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| Causes |
Common causes of insomnia include:
- Stress. Concerns about work, school, health or family keep your mind too active and unable to
relax for sleep. Excessive boredom, such as after retirement or during a long illness, also can create
stress and keep you awake.
- Anxiety. Everyday anxieties as well as severe anxiety disorders may keep your mind too alert
to fall asleep.
- Depression. You may either sleep too much or have trouble sleeping if you're depressed. This
may be due to chemical imbalances in your brain or because worries that accompany depression may keep
you from relaxing enough to fall asleep when you want to.
- Stimulants. Prescription drugs, including some antidepressant, high blood pressure and
steroid medications, can interfere with sleep. Many over-the-counter (OTC) medications, including some
pain medication combinations, decongestants and weight-loss products, contain caffeine and other
stimulants. Antihistamines may initially make you groggy, but they can worsen urinary problems, causing
you to get up more during the night.
- Change in your environment or work schedule. Travel or working a late or early shift can
disrupt your body's circadian rhythms, making you unable to get to sleep when you want to. The word
circadian comes from two Latin words: circa for "about" and dia for "day." Your circadian rhythms act as
internal clocks, guiding such things as your wake-sleep cycle, metabolism and body temperature.
- Long-term use of sleep medications. Doctors generally recommend using sleeping pills for only
up to 4 weeks, or until you notice benefits from self-help measures. If you need sleep medications for
longer, take them no more than two to four times a week, so they don't become habit-forming. Sleeping
pills often become less effective over time. If you're taking sleeping pills every evening and they
help, keep taking them. If they lose their effectiveness, you might sleep better by slowly withdrawing
from them.
- Medical conditions that cause pain. These include arthritis, fibromyalgia and neuropathies,
among other conditions. Making sure that your medical conditions are well treated may help with your
insomnia.
- Behavioral insomnia. This may occur when you worry excessively about not being able to sleep
well and try too hard to fall asleep. Most people with this condition sleep better when they're away
from their usual sleep environment or when they don't try to sleep, such as when they're watching TV or
reading.
- Eating too much too late in the evening. Having a light snack before bedtime is OK, but
eating too much may cause you to feel physically uncomfortable while lying down, making it difficult to
get to sleep. Many people also experience heartburn, a backflow of food from the stomach to the
esophagus after eating. This uncomfortable feeling may keep you awake.
- Inherited condition. Some people have inherited poor sleep tendency. If that's your case, be extremely careful not to overexcite yourself, especially in the evening.
- A change in sleep patterns. After age 50, sleep often becomes less restful. You spend more
time in stages 1 and 2 of non-rapid eye movement (NREM) sleep and less time in stages 3 and 4. Stage 1
is transitional sleep, stage 2 is light sleep, and stages 3 and 4 are deep (delta) sleep, the most
restful kind. Because you’re sleeping lighter, you're also more likely to wake up. With age, your
internal clock often speeds up. You get tired earlier in the evening and consequently wake up earlier in
the morning.
- A change in activity. You may be less physically or socially active. Activity helps promote a
good night's sleep. You may also have more free time and, because of that, drink more caffeine or
alcohol or take a daily nap. These things can also interfere with sleep at night.
- A change in health. The chronic pain of conditions such as arthritis or back problems as well as depression, anxiety and stress can interfere with sleep. Older men often develop noncancerous enlargement of the prostate gland (benign prostatic hyperplasia), which can cause the need to urinate frequently, interrupting sleep. In women, hot flashes that accompany menopause can be equally disruptive. Other sleep-related disorders, such as sleep apnea and restless legs syndrome, also become more common with age. Sleep apnea causes you to stop breathing periodically throughout the night and then awaken. Restless legs syndrome causes unpleasant aches in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.
| When to seek medical advice |
If insomnia has been severely interfering with your daytime functioning for a month or longer, see your doctor to determine what might be the cause of your sleep problem and how it might be treated.
| Screening and diagnosis |
Insomnia may be difficult to diagnose because of its partly subjective nature and because so many factors can affect your sleep. Also, the kind of sleep patterns and degree of daytime fatigue that some people might consider to be indications of insomnia other people would not.
Your doctor may ask you questions about your sleep patterns, such as how long you've experienced your symptoms and whether they occur every night. Your doctor may also ask about whether you snore, how well you function during the day, whether you take any medications and whether you have other health disorders. You may be asked to complete a questionnaire to determine your wake-sleep pattern and your level of daytime sleepiness.
If your complaint is insomnia, your doctor will only rarely suggest you spend a night at a sleep disorders center. These centers are accredited by the American Academy of Sleep Medicine. A team of people at the center can monitor and record a variety of body activities during the night, including brain waves, breathing, heartbeat, eye movements and body movements. But for most people whose main complaint is insomnia, their sleep is usually so distorted by the laboratory environment that doctors can learn little useful information.
| Complications |
Sleep could be considered as important to your health as a healthy diet and regular exercise. Whatever your reason for sleep loss, insomnia can impact you both mentally and physically.
That impact can be cumulative. People with chronic insomnia are more likely than others to develop some kinds of psychiatric problems such as depression and anxiety disorders. Long-term sleep deprivation may increase the severity of chronic diseases such as high blood pressure and diabetes.
Insufficient sleep can also lead to serious or even fatal accidents. According to the National Highway Traffic Safety Administration, more than 100,000 crashes each year are due to drivers falling asleep at the wheel.
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| Treatment |
If self-help measures don't work or you feel that another condition, such as depression, restless legs syndrome or anxiety, is causing your insomnia, talk to your doctor. He or she may recommend that you take medications to promote relaxation or sleep.
Often, taking prescription sleeping pills for a couple of weeks until there's less stress in your life may help you get to sleep until you notice benefits from behavioral self-help measures. Doctors generally don't recommend prescription sleeping pills for the long term because they can lead to dependence and other side effects.
In addition, sleeping pills can become less effective after a while. OTC sleep aids contain antihistamines to induce drowsiness. They're OK for occasional sleepless nights, but they, too, often lose their effectiveness the more you take them. Many sleeping pills contain diphenhydramine, which can cause difficulty urinating and a drowsy feeling in the daytime.
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| Coping skills |
No matter what your age, insomnia usually is treatable. The key often lies in changes to your routine during the day and when you go to bed. Try these steps:
- Stick to a schedule. Keep your bedtime and wake time on a constant schedule.
- Limit your time in bed. Too much time in bed can promote shallow, unrestful sleep. For 2
weeks, try to cut the time you spend in bed by 1 hour and see if it helps you sleep.
- Avoid trying to sleep. The harder you try, the more awake you'll become. Read or watch
television in bed until you become very drowsy and fall asleep naturally. In the morning, get up at the
same time as usual even if you read for a large part of your time in bed.
- Hide the bedroom clocks. Set your alarm so that you know when to get up, but then hide all
clocks in your bedroom. The less you know what time it is at night, the better you'll sleep.
- Exercise and stay active. Get at least 20 to 30 minutes of vigorous exercise daily,
preferably 5 to 6 hours before bedtime.
- Avoid or limit caffeine, alcohol and nicotine. Caffeine after lunch and nicotine can keep you
from falling asleep. Alcohol can cause unrestful sleep and frequent awakenings.
- Reset your body's clock. If you fall asleep too early and then wake up too early, use light
to push back your internal clock. In the evenings, go outside for 30 minutes or sit near a very bright
light.
- Check your medications. If you take medications regularly, check with your doctor to see if
they may be contributing to your insomnia. Also check the labels of OTC products to see if they contain
caffeine or other stimulants, such as pseudoephedrine.
- Don't put up with pain. If a painful condition bothers you, make sure the pain reliever you
take is effective enough to control your pain while you're sleeping.
- Find ways to relax. A warm bath or light snack before bedtime may help prepare you for sleep.
Having your partner give you a massage also may help relax you.
- Avoid or limit naps. Naps can make it harder to fall asleep at night. If you can't get by
without one, try to limit a nap to 45 minutes in bed and to 30 minutes asleep.
- Minimize sleep interruptions. Close your bedroom door or create a subtle background noise, such as running a fan, to help drown out other noises. Keep your bedroom temperature comfortable, usually cooler than you keep during the day. Drink less before bedtime so that you won't have to go to the toilet as often.
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| Complementary and alternative medicine |
Melatonin is a widely used OTC supplement that's marketed as a way to help you overcome insomnia, prevent jet lag, battle cancer, rejuvenate your sex life and slow aging. It helps some people, but no more than 10 percent of people with insomnia. To find out if you're one of those people who benefit from melatonin, try it for 2 weeks, comparing your sleep with the prior 2 weeks without melatonin.
The benefits of melatonin are often exaggerated. Your body already produces melatonin, releasing it into your bloodstream in increasing amounts starting at dusk and tapering off toward the morning. More research may help evaluate how melatonin works and its potential long-term risks.
Some people are helped by herbal preparations such as valerian. Try herbal preparations to see if you benefit from them.
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— April 11, 2003 —