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Insomnia
What Is Insomnia?
Insomnia is a common sleep disorder.
With insomnia, you may have trouble falling asleep, staying asleep, or
getting good quality sleep. This happens even if you have the time and
the right environment to sleep well. Insomnia can get in the way of your
daily activities and may make you feel sleepy during the day.
Short-term insomnia may be caused
by stress or changes in your schedule or environment. It can last
for a few days or weeks. Chronic (long-term) insomnia occurs 3 or more
nights a week, lasts more than 3 months, and cannot be fully explained
by another health problem.
To diagnose insomnia, your
healthcare provider may ask about your sleep habits and ask you to keep
a sleep diary. Your provider may also recommend healthy lifestyle habits
such as a regular
sleep schedule, cognitive behavioral therapy for insomnia, and
medicines to help you manage
your insomnia.
Insomnia can affect your memory and
concentration. Chronic insomnia raises your risk of high
blood pressure, coronary
artery disease, diabetes, and cancer.
Prevalence of insomnia
Insomnia is a common condition. The American Academy of Sleep
Medicine (AASM) reports that among adults:
- 30 to 35 percent have brief symptoms of insomnia
- 15 to 20 percent have short-term insomnia lasting less
than 3 months
- 10 percent have a chronic insomnia disorder, which
occurs at least 3 times per week for at least 3 months
-
As many as 3 out of 4 adults 65 and older have insomnia
symptoms. This is either due to factors like aging-related
changes in the body's internal biological clock (circadian
rhythm) or having another medical condition.
-
At least 1 in 4 women report having insomnia symptoms,
compared to 1 in 5 men. Hormonal changes during the
menstrual cycle, pregnancy, and menopause may be common
culprits.
-
Roughly 1 in 5 children have insomnia symptoms, with preteen
girls reporting the highest prevalence. Shifting hormonal
patterns during the preadolescence and puberty stages
probably play a role.
-
The Cost of Insomnia: Because insomnia affects
daytime functioning, it takes a toll on workplace
productivity and performance. Researchers estimate that the
overall burden of insomnia on the U.S. workforce is about
$127 billion.
Symptoms
If you have insomnia, you may experience several different symptoms.
-
You may
lie awake for a long time before you fall asleep. This is
more common in younger adults.
-
Sleep may
be possible for only short amounts of time. You may wake up
often during the night or be awake for most of the night. This is
the most common symptom and affects mostly older adults.
-
Waking up
too early in the morning and not getting back to sleep is
also common.
-
Poor-quality sleep may lead you to wake up feeling unrested,
and you may feel sleepy during the day. You may also have trouble
focusing on daily tasks. Insomnia can cause you to feel anxious,
depressed, or easily annoyed.
Keep a sleep
diary, or a record of any symptoms of insomnia you might be
experiencing. Share these notes with a healthcare professional.
Some cases of insomnia are a
symptom or side effect of another problem. This is called
secondary insomnia. Many different disorders can cause insomnia.
They include:
- Emotional conditions:
Depression, anxiety, and posttraumatic stress disorder
- Neurological
disorders: Alzheimer’s or Parkinson’s disease
- Pain conditions:
Arthritis and headache disorders
- Gastrointestinal
disorders: Heartburn, GERD
- Sleep disorders:
Restless legs syndrome or sleep apnea
- Breathing disorders:
Asthma or heart failure
- Other conditions:
Such as overactive thyroid, stroke, or menopause
Secondary insomnia also can be
caused by some medicines. These include asthma medicines,
allergy or cold medicines, and certain heart and blood pressure
medicines. Additionally, the use of some substances can cause
insomnia. These include caffeine, tobacco, and alcohol.
Diagnosis
If not getting enough sleep is affecting your daily activities, talk to
your doctor. You may be diagnosed with insomnia if you have difficulty
falling or staying asleep for at least 3 nights a week. Insomnia is
considered chronic (long-term) when it occurs 3 or more nights a week
and lasts for 3 months or longer. Your doctor may do more tests to see
whether your insomnia is causing any other
health problems.
It may be helpful to keep a sleep diary for 1 to 2 weeks before seeing
your doctor. A sleep diary can
help your doctor understand the problems you’re having and whether
certain activities are affecting your sleep. Write down when you go to
sleep, wake up, and take naps each day. Also write down how sleepy you
feel throughout the day, when you drink caffeine or alcohol, and when
you exercise.
Medical history and physical exam
Your healthcare provider will want to learn about your symptoms, risk
factors, health history, and family health history. To better
understand your sleep problems, you may be asked for some details
about your sleep habits, such as:
- How often you have trouble sleeping and how long you’ve had the
problem
- When you go to bed and get up on days you go to work as well as
days off
- How long it takes you to fall asleep, how often you wake up at
night, and how long it takes you to fall back asleep
- How refreshed you feel when you wake up and how unrested you
feel during the day
- Whether you use electronic devices or watch TV before bed, as
the light that comes from these sources can affect your sleep
- Whether you snore loudly and often or wake up gasping or feeling
out of breath
To find the cause of your sleep problems, your provider may also ask
whether you:
- Have any new or long-standing health problems
- Take any medicines
- Are pregnant or going through menopause
- Use caffeine, nicotine, alcohol, or illegal drugs
Your healthcare provider will do a physical exam to rule out other
medical problems that might affect your sleep. They will listen to
your heart and lungs and look for risk factors for sleep apnea, such
as large tonsils or a large neck circumference.
Diagnostic tests
-
A sleep
study looks for other sleep problems, such as circadian
rhythm disorders, sleep
apnea, and narcolepsy.
-
Actigraphy looks at your periods of rest and activity
and measures how well you sleep. This requires you to wear a
small motion sensor on your wrist for 3 to 14 days.
-
Blood
tests check
for thyroid problems or other medical conditions that can affect
sleep.
Causes and Risk Factors
Changes in your schedule or environment can cause or raise your risk of
insomnia. Some risk factors, such as your job or lifestyle, can be
changed. But your age and family history cannot be changed.
Age
You can develop insomnia at any age but your chances of having it
increase as you get older. Family history and genetics
Your genes may
raise your risk of insomnia, as insomnia sometimes runs in families.
Your genes may also affect whether you are a deep or light sleeper. Environment or occupation
The following can disturb your sleep-wake cycle, a pattern that your
body uses to figure out when to sleep and when to be awake:
- Shift or night work
- Noise or light during the night
- Uncomfortably high or low temperatures
Traveling often to different time zones. Lifestyle
Lifestyle habits can raise your risk of sleep problems.
- Changing your normal routine often, including your sleep
schedule
- Experiencing interruptions in your sleep, such as waking up
often to care for a baby
- Taking long naps during the day
- Getting too little physical activity during the day
- Using caffeine, nicotine, alcohol, or recreational drugs
- Watching TV or using electronic devices close to your bedtime
Stress
Stress or worrying about school or work, relationships, money, or
the death of a loved one raises your risk of insomnia.
Worrying about whether you will get enough sleep and watching the
clock can also raise your risk of insomnia or make it worse. Sex
Insomnia is more common in women than in men. hormones changes
that take place during pregnancy and menopause can cause problems
with sleep. Can I prevent insomnia?
Your doctor may talk to you about steps you can take to help you
sleep better and prevent chronic insomnia.
-
Adopt
healthy sleep habits and a regular daytime schedule to
help you maintain a regular sleep-wake cycle.
-
Avoid
caffeine, nicotine, and alcohol close to your bedtime,
as these can make it more difficult for you to fall asleep.
Learn more about healthy
sleep habits that may help prevent or manage insomnia.
Treatments
Healthy sleep habits
In addition to following a heart-healthy
lifestyle, try to adopt the following
bedtime habits. These habits can make it easier
for you to fall asleep and stay asleep.
-
Make your bedroom sleep friendly. Sleep
in a cool, quiet, dark place. Avoid watching
TV or looking at electronic devices, as the
light from these sources can disrupt your
sleep-wake cycle.
-
Go to sleep and wake up around the same time each
day, even on the weekends. If you can, avoid
a schedule that changes or other things that
may disrupt your sleep schedule.
-
Avoid caffeine, nicotine, and
alcohol close to your bedtime.
Although alcohol can make it easier to fall
asleep, it can cause you to have a sleep
that tends to be lighter than normal. This
makes it more likely that you will wake up
during the night.
-
Get regular physical activity during
the daytime, at least 5 to 6 hours
before going to bed. Exercising close to
bedtime can make it harder to fall asleep.
-
Avoid naps, especially in the
afternoon. This may help you sleep longer at
night.
-
Eat meals on a regular schedule and
avoid late-night dinners.
-
Limit how much you drink close to
bedtime. This may help you sleep longer
without having to use the bathroom.
-
Learn new ways to manage stress. Follow
a routine that helps you wind down and relax
before bed. For example, read a book, listen
to soothing music, or take a hot bath. Your
doctor may also recommend massage therapy, meditation,
or yoga to help you relax. Acupuncture may
also help improve insomnia, especially in
older adults.
-
Avoid certain over-the-counter and
prescription medicines that can
disrupt sleep (for example, some cold and
allergy medicines). Talk with your
healthcare provider about which medicines
will not disrupt your sleep.
Cognitive behavioral therapy for insomnia (CBT-I)
CBT-I is a 6- to 8-week treatment plan to help
you learn how to fall asleep faster and stay
asleep longer. This is usually recommended as
the first treatment option for long-term
insomnia and can be very effective. CBT-I can be
done by a doctor, nurse, or therapist; you can
do it in person, by telephone, or online. It
involves the following parts:
-
Cognitive therapy helps you feel
less nervous about not being able to sleep.
-
Relaxation or meditation therapy teaches
you how to relax and fall asleep faster.
-
Sleep education helps you learn
good sleep habits.
-
Sleep restriction therapy gives you
a specific amount of time to spend in bed,
even if you are not able to sleep during
this time. With time, this helps you sleep
better when you go to bed. Your sleep time
can be increased when you start to sleep
better.
-
Stimulus control therapy helps you
have a regular sleep-wake cycle so you can
link being
in bed with being asleep. This involves
going to bed only when you are sleepy,
getting out of bed if you cannot sleep, and
using your bed only for sleep and sexual
activity.
Medicines
Prescription medicines
Some prescription medicines used to treat
insomnia are meant for short-term use while
others are meant for longer-term use. Talk to
your doctor about the benefits and side effects
of insomnia medicines. Some prescription
medicines used to treat other health conditions
can also increase your risk of insomnia.
-
Benzodiazepine receptors agonists are
medicines such as zolpidem, zaleplon, and
eszopiclone. Side effects may include
anxiety. Rare side effects may include a
severe allergic reaction or doing activities
while asleep such as walking, eating, or
driving.
-
Melatonin receptor agonists are
medicines such as ramelteon. Side effects
include dizziness and fatigue. Some people
experience the rare side effects of doing
activities while they are asleep, such as
walking, eating, or driving; or they may
have a severe allergic reaction.
-
Orexin receptor antagonists such as
suvorexant are not recommended for people
who have narcolepsy.
Rare side effects may include doing
activities while asleep such as walking,
eating, or driving; or not being able to
move or speak for several minutes while
going to sleep or waking up.
-
Benzodiazepines may be prescribed
if other treatments and medicines have not
worked. Talk to your healthcare provider
about the side effects of these medicines,
which can include dizziness, confusion, and
muscle weakness. Benzodiazepines can also
interact dangerously with other medicines.
It can be habit-forming and should be taken
for only a few weeks.
Off-label medicines
In some cases healthcare providers may prescribe
medicines that are commonly used for other
health conditions but are not approved by the
U.S. Food and Drug Administration (FDA) to treat
insomnia. Some of these medicines may include
antidepressants, antipsychotics, and
anticonvulsants.
Over-the-counter medicines and supplements
Tell your healthcare provider about any OTC
products that you are taking.
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OTC products that
contain antihistamines are sold as
sleep aids. Although these products might
make you sleepy, talk to your doctor before
taking them to treat your insomnia.
Antihistamines can be unsafe for some
people.
-
Melatonin supplements are
versions of the sleep hormone melatonin made
in a lab. Many people take melatonin
supplements to improve their sleep. However,
research has not proven that melatonin is an
effective treatment for insomnia. Side
effects of melatonin may include daytime
sleepiness, headaches, upset stomach, and
worsening depression. It can also affect
your body's control of blood pressure,
causing high or low blood
pressure.
-
Dietary supplements can be
beneficial to your health, but they can also
have health risks. Talk to your provider
before using dietary supplements.
The U.S. Food and Drug Administration (FDA)
regulates dietary supplements under a different
set of regulations than those covering
"conventional" foods and medicines. The FDA does
not currently review dietary supplement products
for safety and effectiveness before they are
marketed. Other treatments
Your healthcare provider may recommend that you
use light therapy to set and maintain your
sleep-wake cycle. With this treatment, you plan
time each day to sit in front of a light box,
which produces bright light similar to sunlight.
Living With Insomnia
Keep in mind that you may need less sleep as you age. Some people need
only 5 to 6 hours of sleep a night, but most people do better with
between 7 and 9 hours. Sleep usually occurs in 3-hour cycles, so it’s
important to get at least 3 uninterrupted hours of sleep.
These tips can help you develop better sleep habits:
- Go to sleep only when you feel tired.
- Avoid reading, watching TV, or
worrying in bed. These can cause your body and brain to associate
your bed with these activities, rather than with sleep.
- Develop a bedtime routine. Do the
same thing every night before going to sleep. For example, take a
warm bath and then read for 10 minutes every night before bed. Soon
you’ll connect these activities with sleeping and doing them will
help make you sleepy.
- Use the bedroom only for sleep and
sexual activity.
- If you can’t fall asleep after 15
minutes, go to another room. Return to your bed only when you feel
tired. You may repeat this as often as needed during the night.
- Go to sleep and wake up at the same
times each day, even on weekends. This helps your body develop a
sleep schedule.
- Avoid or limit napping. It can
disturb your normal sleep rhythm. If you must take a nap, only rest
for 30 minutes. Don’t nap after 3:00 p.m.
- Avoid caffeine and tobacco,
especially late in the day.
- Avoid eating large meals or drinking
a lot of water in the evening.
- Keep your bedroom at a comfortable
temperature.
- Make sure your bedroom is quiet and
dark. If noise is a problem, use a fan to mask the noise or use
earplugs. If you must sleep during the day, hang dark blinds over
the windows or wear an eye mask.
- Try eating a light snack before going
to bed, but don’t eat too much right before bedtime. A glass of warm
milk or some cheese and crackers may be all you need.
- Exercise regularly, but don’t
exercise within a few hours before going to bed.
- Set aside some time to relax before going
to bed. For example, spend 30 minutes after dinner writing down
what’s worrying you and what you can do about it
Another good way to relax is to focus on your breathing by taking slow,
deep breaths while counting to 5. Then listen to the sound of your
breath as you breathe out. You can also try to tighten and relax the
muscle groups in your body. Begin at your feet and work your way up to
your face and head. A trained therapist can teach you other ways to
relax. Listening to relaxation music may also help.
Health problems caused by insomnia
Sleep is important for your body and mind. To
understand how sleep is important for good
health, read How
Sleep Works and Sleep
Deprivation and Deficiency.
In the short term, insomnia can make it hard to
concentrate or think clearly. You may feel
irritable, sad, and unrested or have headaches.
Insomnia raises your risk of falling, having a
road accident, or missing work.
In addition, chronic insomnia can affect how
well your brain, heart, and other parts of your
body work. It can raise your risk of certain
health problems or make existing problems worse.
-
Breathing problems like asthma may
occur or worsen as a result of chronic
insomnia.
-
Heart problems are also a risk when
you have chronic insomnia, including
conditions such as arrhythmia, heart
failure, coronary
heart disease, and high
blood pressure.
-
Mental health conditions such as
anxiety, depression, and thoughts of suicide
may occur. The lack of sleep can also make
it difficult for you to stick to treatment
for a substance use disorder
- People who have chronic
pain and insomnia may become more
aware of and distressed by their pain.
-
Pregnancy complications such as
having more pain during labor, giving birth
preterm, needing a cesarean section
(C-section), and having a baby with low
birth weight can happen if you experience
chronic insomnia.
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Your immune system, your body’s
natural defense against germs and sickness,
can also be affected by too little sleep.
These problems can lead to inflammation in
your body or make it harder to fight
infections.
-
Problems with your metabolism can
arise when you don’t get enough sleep. Lack
of sleep can change the levels of hormones
that control hunger and how you break down
food. This can raise the risk of overweight
and obesity, metabolic
syndrome, and diabetes.
What can I do to improve my sleep?
-
Create a sleep
schedule. Try to go to sleep and wake up at the same times every
day. Keep a record of your sleep patterns, and any sleeping problems
you have. Bring the record to follow-up visits with healthcare
providers.
-
Do not take naps. Naps
could make it hard for you to fall asleep at bedtime.
-
Keep your bedroom
cool, quiet, and dark. Turn on white noise, such as a fan, to
help you relax. Do not use your bed for any activity that will keep
you awake. Do not read, exercise, eat, or watch TV in your bedroom.
-
Get up if you do
not fall asleep within 20 minutes. Move to another room and do
something relaxing until you become sleepy.
-
Limit caffeine,
alcohol, and food to earlier in the day. Only drink caffeine in
the morning. Do not drink alcohol within 6 hours of bedtime. Do not
eat a heavy meal right before you go to bed.
-
Exercise
regularly. Daily exercise may help you sleep better. Do not
exercise within 4 hours of bedtime.
When should I contact my healthcare provider?
- Your symptoms do not get better, or they get worse.
- You begin to use drugs or alcohol to fall asleep.
- You have questions or concerns about your condition or care.
Questions to ask your doctor
- How can I make myself go back to
sleep if I wake up during the night?
- How can exercise help with
insomnia?
- Are there herbal supplements
that help with insomnia? Are there any side effects to them?
- What types of
over-the-counter medicine can help me sleep?
- Are there prescription
medicines that treat insomnia?
- What are the side effects of
these medicines?
- Does insomnia run in families?
10 Lesser Known Facts About Insomnia
1. Insomnia can be hereditary
A research on genome-wide analysis of
insomnia disorder found that
insomnia was connected to certain
genetic variations on chromosomes 7 and 9.
The chromosome 7 is found close to a gene linked in brain development
and electrical signalling for sleep. Similarly, a research on Sleep
Journal said about 35 percent of people with insomnia had history of
insomnia in their family.
2. Pets can have insomnia too
Some pets were found to have sleep
disorders too. Canine
insomnia is often termed to be a symptom of anxiety, stress or
undetected chronic medical condition in dogs. It can also occur due to
lack of proper exercise and is often observed in older dogs.
3. Sleeping pills do not cure insomnia
Sleeping pills are often prescribed
for insomniacs. According to the National Sleep Foundation, 1 in 4
Americans take some type of medication every year to help them sleep.
However, sleep specialists do not have any evidence for medications that
can cure insomnia. They focus more on cognitive therapy lessons for
patients to help them sleep better.
4. Women are more likely to have insomnia
According to National Sleep
Foundation,
women are two times more likely to have
insomnia than men.
Sleeplessness during night time in women is seen due to frequent
hormonal changes because of their menstruation cycles, pregnancy,
menopause, or similar reasons.
5. Insomnia can be fatal
Fatal familial insomnia is a rare
genetic disease caused by a protein formed due to a genetic abnormality.
This disease prevents a person from falling asleep, and thus leading to
death due to sleep deprivation. It also affects brain function, causes
memory loss, lack of motor functions and hallucinations.
6. Insomnia increases alcohol abuse
According to a study published in the
American Journal of Psychiatry, participants with insomnia were about
twice as likely to report using alcohol to sleep, compared with those
without insomnia. Insomnia if not treated in the right way can increase
alcohol abuse, thus giving rise to other liver and lung diseases.
7. Insomnia increases risk of car accidents
According to the study conducted by
National Healthy Sleep Awareness Project, people who had difficulty
falling asleep were two times more likely to die from a motor vehicle
injury and 1.5 times more likely to die from any other fatal injury than
people who don’t suffer from sleep disorders.
8. Chronic smoking can lead to insomnia in adults
Several researches on insomnia has
found that chronic cigarette smokers tend to have more cases of insomnia
symptoms which include lack of sleep, longer sleep latency, higher rapid
eye movement, sleep density, and more
episodes of obstructive sleep apnea.
9. Insomnia can trigger migraines
A survey research by UNC done on poor
sleeping habits found that people with poor sleep hygiene reported
having chronic headaches and feeling tired after waking up. Migraine
patients who changed and improved their sleep hygiene routines had
significant improvements in frequency and intensity of their headaches.
10. Yoga can help with insomnia
Yoga doesn’t cure insomnia, but it
helps reduce the stress and anxiety which is sometimes the cause of the
sleeplessness. Yoga serves as a complementary method to address the
issue of sleeplessness in a holistic way.
One Final Note..
Insomnia—defined as trouble getting to sleep and/or staying
asleep—occasionally affects at least one-third of the
population. Roughly 1 in 10 adults will experience chronic
insomnia, meaning the sleep disturbances are long-term. Insomnia
is more common in older adults, women, and people experiencing
mental health issues. Other contributing factors for insomnia
include stress, shift work, medication or substance use, and
certain medical or mental health conditions.
Insomnia is a common condition that can affect anyone.
It has various underlying causes, some of which can be
treated with medications, behavioral therapy, or lifestyle
changes.
If left untreated, insomnia can negatively impact your
quality of life and lead to health complications.
Talking with your doctor can help create a treatment plan
that works for you.
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