Insomnia is a disorder that can make it hard to fall asleep, hard to stay asleep, or both. With insomnia, you usually awaken feeling unrefreshed, which takes a toll on your ability to function during the day. Insomnia can sap not only your energy level and mood but also your health, work performance and quality of life.
How much sleep is enough varies from person to person. Most adults need seven to eight hours a night. Many adults experience insomnia at some point, but some people have long-term (chronic) insomnia.
Skip to one of the following sections:
- What are Symptoms of Insomnia?
- What Causes Insomnia?
- What Insomnia Treatments are Available?
- Preparing for Your Appointment
What are the Symptoms of Insomnia?
Insomnia symptoms may include:
- Difficulty falling asleep at night
- Awakening during the night
- Awakening too early
- Not feeling well rested after a night's sleep
- Daytime fatigue or sleepiness
- Irritability, depression or anxiety
- Difficulty paying attention or focusing on tasks
- Increased errors or accidents
- Tension headaches
- Gastrointestinal symptoms
- Ongoing worries about sleep
Someone with insomnia will often take 30 minutes or more to fall asleep and may get only six or fewer hours of sleep for three or more nights a week.
When to See a Doctor
If insomnia makes it hard for you to function during the day, see your doctor to determine what might be the cause of your sleep problem and how it can be treated. If your doctor thinks you could have a sleep disorder, you might be referred to a sleep center for special testing.
What Causes Insomnia?
Common causes of insomnia include:
- Stress. Concerns about work, school, health or family can keep your mind active at night, making it difficult to sleep. Stressful life events, such as the death or illness of a loved one, divorce or a job loss, may lead to insomnia.
- Anxiety. Everyday anxieties as well as more-serious anxiety disorders may disrupt your asleep.
- Depression. You might 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. Insomnia often accompanies other mental health disorders as well.
- Medications. Many prescription drugs can interfere with sleep, including some antidepressants, heart and blood pressure medications, allergy medications, stimulants (such as Ritalin) and corticosteroids. 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 to urinate more during the night.
- Caffeine, nicotine and alcohol. Coffee, tea, cola and other caffeine-containing drinks are well-known stimulants. Drinking coffee in the late afternoon and later can keep you from falling asleep at night. Nicotine in tobacco products is another stimulant that can cause insomnia. Alcohol is a sedative that may help you fall asleep, but it prevents deeper stages of sleep and often causes you to awaken in the middle of the night.
- Medical conditions. If you have chronic pain, breathing difficulties or a need to urinate frequently, you might develop insomnia. Conditions linked with insomnia include arthritis, cancer, heart failure, lung disease, gastroesophageal reflux disease (GERD), overactive thyroid, stroke, Parkinson disease and Alzheimer's disease. Making sure that your medical conditions are well treated may help with your insomnia. If you have arthritis, for example, taking a pain reliever before bed may help you sleep better.
- Change in your environment or work schedule. Travel or working a late or early shift can disrupt your body's circadian rhythms, making it difficult to sleep. Your circadian rhythms act as internal clocks, guiding such things as your sleep-wake cycle, metabolism and body temperature.
- Poor sleep habits. Habits that help promote good sleep are called sleep hygiene. Poor sleep hygiene includes an irregular sleep schedule, stimulating activities before bed, an uncomfortable sleep environment and use of your bed for activities other than sleep or sex.
- Learned' 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 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 acid and food from the stomach into the esophagus after eating. This uncomfortable feeling may keep you awake.
Insomnia and Aging
Insomnia becomes more common with age. As you get older, changes can occur that may affect your sleep. You may experience:
- A change in sleep patterns. Sleep often becomes less restful as you age, and you may find that noise or other changes in your environment are more likely to wake you as you get older. With age, your internal clock often advances, which means you get tired earlier in the evening and wake up earlier in the morning. But older people generally still need the same amount of sleep as younger people do.
- A change in activity. You may be less physically or socially active. Activity helps promote a good night's sleep. You may also be more likely to take a daily nap, which also can 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.
- Increased use of medications. Older people use more prescription drugs than younger people do, which increases the chance of insomnia caused by a medication.
What Insomnia Treatments are Available?
You don't have to put up with sleepless nights. Simple changes in your daily habits can help.
Changing your sleep habits and addressing any underlying causes of insomnia can restore restful sleep for many people. Good sleep hygiene — simple steps such as keeping the same bedtime and arising time — promotes sound sleep and daytime alertness. If these measures don't work, your doctor may recommend medications to help with relaxation and sleep.
Behavioral treatments teach you new sleep behaviors and ways to improve your sleeping environment. Behavior therapies are equally or more effective than are sleep medications. Behavior therapies are generally recommended as the first line of treatment for people with insomnia.
Behavior therapies include:
- Education about good sleeping habits. Sleep hygiene teaches habits that promote good sleep.
- Relaxation techniques. Progressive muscle relaxation, biofeedback and breathing exercises are ways to reduce anxiety at bedtime. These strategies help you control your breathing, heart rate, muscle tension and mood.
- Cognitive behavioral therapy. This involves replacing worries about not sleeping with positive thoughts. Cognitive behavioral therapy can be taught through one-on-one counseling or in group sessions.
- 'Stimulus control'. This means limiting the time you spend awake in bed and associating your bed and bedroom only with sleep and sex.
- Sleep restriction. This treatment decreases the time you spend in bed, causing partial sleep deprivation, which makes you more tired the next night. Once your sleep has improved, your time in bed is gradually increased.
- Light therapy. If you fall asleep too early and then awaken too early, you can use light to push back your internal clock. During times of the year when it's light outside in the evenings, you go outside or get light via a medical-grade light box.
Taking prescription sleeping pills, such as zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata) or ramelteon (Rozerem), also may help you get to sleep. However, in rare cases, these medications may cause severe allergic reactions, facial swelling and unusual behaviors, such as driving or preparing and eating food while asleep. Side effects of prescription sleeping medications are often more pronounced in older people and may include excessive drowsiness, impaired thinking, night wandering, agitation and balance problems.
Doctors generally don't recommend relying on prescription sleeping pills for more than a few weeks, but several newer medications are approved for indefinite use. However, some of these medications are habit-forming.
Over-the-Counter Sleep Aids
Sleep medications available over-the-counter contain antihistamines that can make you drowsy. But antihistamines may reduce the quality of your sleep, and they can cause side effects, such as daytime sleepiness, dry mouth and blurred vision. These effects may be worse in the elderly.
Preparing for Your Appointment
If you're having sleep problems, start by talking to your family doctor or a general practitioner. Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
Information to Gather in Advance
- Write down your symptoms, when they first started and when they tend to occur.
- Write down your key medical information, other conditions with which you've been diagnosed and any prescription or over-the-counter medications you're taking, including vitamins and supplements. Also note whether you or anyone in your family has a history of insomnia.
- Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. Below are some basic questions to ask your doctor about insomnia. If any additional questions occur to you during your visit, don't hesitate to ask.
- What is the most likely cause of my signs and symptoms?
- Are there any other possible causes?
- What tests are needed to make a diagnosis?
- What treatment options are available for this condition?
- If you're recommending medications, what are the possible side effects?
- I have these other health conditions. How can I best manage them together?
- What self-care steps are likely to improve my symptoms?
- Can you recommend any educational materials for me to take home or look up on the Web?
- Where can I find a support group for people with sleep disorders?
What to Expect from Your Doctor
A key part of the evaluation of insomnia is a detailed history, meaning your doctor will ask you many questions.
In addition to asking you a number of questions, your doctor may have you complete a questionnaire to determine your sleep-wake pattern and your level of daytime sleepiness. You may also be asked to keep a sleep diary for a couple of weeks, if you haven't already done so.
Your doctor will do a physical exam to look for signs of other problems that may be causing insomnia. Occasionally, a blood test may be done to check for thyroid problems or other conditions that can cause insomnia.
If the cause of your insomnia isn't clear, or you have signs of another sleep disorder, such as sleep apnea or restless legs syndrome, you may need to spend a night at a sleep center. Tests are done to monitor and record a variety of body activities while you sleep, including brain waves, breathing, heartbeat, eye movements and body movements.