Insomnia

What is it?

Insomnia is a sleep disorder that is characterized by difficulty falling and/or staying asleep. People with insomnia have one or more of the following symptoms:

  • Difficulty falling asleep
  • Waking up often during the night and having trouble going back to sleep
  • Waking up too early in the morning
  • Feeling tired upon waking

There are two types of insomnia: primary insomnia and secondary insomnia.

  • Primary insomnia: Primary insomnia means that a person is having sleep problems that are not directly associated with any other health condition or problem.
  • Secondary insomnia: Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition (like asthma, depression, arthritis, cancer, or heartburn); pain; medication they are taking; or a substance they are using (like alcohol).

What are the causes?

Insomnia can vary in how long it lasts and to what extent it affects a person’s lifestyle:

Short-term insomnia (called “acute insomnia”) lasts a short amount of time, usually from one night to a few weeks. It usually is caused by emotional or physical discomfort — brought on by things such as environmental disturbances (noise, changes in the weather), stress, medication side effects or jet lag.

Chronic insomnia lasts a long time — three nights a week for one month or longer. It can be caused by many things, but is often caused by underlying medical conditions such as depression, chronic stress, or pain and discomfort at night.

What are the signs and symptoms?

A main sign of insomnia is not being able to sleep at times when the body is obviously tired. A person with insomnia will be tired the next day and may have a lack of energy.

Other symptoms include waking up earlier than expected and not being able to fall back asleep when waking up through the night.

How is it diagnosed?

If you think you have insomnia, talk to your health care provider. An evaluation may include a physical exam, a medical history, and a sleep history. You may be asked to keep a sleep diary for a week or two, keeping track of your sleep patterns and how you feel during the day. Your health care provider may want to interview your bed partner about the quantity and quality of your sleep. In some cases, a polysomnogram may be performed to diagnose whether the insomnia is caused by an underlying sleep disorder.

How is it treated?

Acute insomnia may not require treatment. Mild insomnia often can be prevented or cured by practicing good sleep habits (see below). If your insomnia makes it hard for you to function during the day because you are sleepy and tired, your health care provider may prescribe sleeping pills for a limited time. Rapid onset, short-acting medications can help you avoid effects such as drowsiness the following day. Avoid using over-the-counter sleeping pills for insomnia since they may have undesired side effects and tend to lose their effectiveness over time.

Treatment for chronic insomnia includes first treating any underlying conditions or health problems that are causing the insomnia. If insomnia continues, your health care provider may suggest behavioral therapy. Behavioral approaches help you to change behaviors that may worsen insomnia and to learn new behaviors to promote sleep. Techniques such as relaxation exercises, sleep restriction therapy, and reconditioning may be useful.

Sleep Hygiene Rules:

Good sleep habits, also called sleep hygiene, can help you get a good night’s sleep. Here are some tips:

  • Go to sleep when you are sleepy but get up at the same time each morning. Try not to take naps during the day because naps may make you less sleepy at night.
  • Avoid caffeine, nicotine, and alcohol late in the day. Caffeine and nicotine are stimulants and can keep you from falling asleep. Alcohol can cause waking in the night and interferes with sleep quality.
  • Get regular exercise. Try not to exercise close to bedtime because it may stimulate you and make it hard to fall asleep. Experts suggest not exercising for at least three to four hours before the time you go to sleep.
  • Don’t eat a heavy meal late in the day. A light snack before bedtime, however, may help you sleep.
  • Make your bedroom comfortable. Be sure that it is dark, quiet, and not too warm or too cold. If light is a problem, try a sleeping mask. If noise is a problem, try earplugs, a fan, or a “white noise” machine to cover up the sounds.
  • Follow a routine to help you relax before sleep. Read a book, listen to music, or take a bath.
  • Avoid using your bed for anything other than sleep or sex.
  • If you can’t fall asleep and don’t feel drowsy, get up and read or do something that is not overly stimulating until you feel sleepy.
  • If you find yourself lying awake worrying about things, try making a to-do list before you go to bed. This may help you to not focus on those worries overnight.