Insomnia is a sleep disorder. It may cause a number of sleep problems including trouble falling asleep, waking in the middle of the night, or waking very early in the morning. It may also be a sleep that is not restful. Insomnia can be a short-term problem, or it can be chronic. Chronic insomnia lasts for more than 4 weeks.
Insomnia can occur for many reasons. Short-term insomnia is often caused by temporary situations or problems with the environment. They may include:
There may be no clear reason for chronic insomnia. It may also be due to other medical or psychiatric conditions. Examples of conditions that can lead to sleep problems include:
Both chronic and short-term insomnia may be due to
Insomnia is more common in women during and after menopause. It is also common in adults 50 years of age or older.
Other factors that increase the risk of insomnia include:
You will be asked about your symptoms and medical 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 medications you take, including over-the-counter medications and herbal supplements. These questions will help your doctor understand what is causing your insomnia.
Observation in a sleep lab may be advised. This may be done if the diagnosis is uncertain or if other sleep disorders are suspected. 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.
A number of physical and mental disorders can disrupt sleep. Diagnosis and treatment of the underlying illness, may fix the insomnia.
There are steps you can take to improve your chance of a good night's rest. You may be advised to reduce intake of certain items or avoid them to see if your sleep improves. You may be asked to:
Your sleep habits can also affect how well you sleep. Steps that may help you sleep better include:
Sleeping pills are available by prescription or over-the-counter. Some doctors advise against the long-term use of sleeping pills. They may cause dependence. This is a physical change in your body. It makes your body dependent on the drug for sleep.
Proper use of prescription sleep medication may increase sleep. Most of these medications are only approved for short-term use. They can cause drowsiness, lightheadedness, and headache. Serious side effects can include abnormal thinking or behavior changes, including having suicidal thoughts.
Many over-the-counter sleep medications contain diphenhydramine. This medication can make you feel groggy and might help you fall asleep. However, this drug can have serious side effects. Most people should avoid using this drug regularly.
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. Exercising early in the day may be best if you are having trouble sleeping. If you have to exercise later in the day, make sure you are done exercising at least a few hours before bedtime.
Some people use the herb valerian to reduce insomnia. Others take melatonin. It is not clear that these supplements help. Talk to your doctor before taking any herbs or supplements.
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.
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. Gradually, the time is increased until a more normal night's sleep is achieved.
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.
To reduce your chance of having insomnia:
National Center on Sleep Disorders Research
National Sleep Foundation
Better Sleep Council Canada
Canadian Sleep Society
Insomnia in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 21, 2016. Accessed June 20, 2016.
Jacobs GD, Pace-Schott EF, et al. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med . 2004 Sep 27;164(17):1888-96. Available at: http://archinte.jamanetwork.com/article.aspx?articleid=217394. Accessed June 20, 2016.
Insomnia. Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/insomnia.html. Updated April 2014. Accessed June 20, 2016.
Morin CM, Vallieres A, et al. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA. 2009;301(19):2005-2015.
Sleep insomnia, lack of sleep. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/inso/. Updated December 13, 2011. Accessed June 20, 2016.
Last reviewed June 2016 by Marcin Chwistek, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.