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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.

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.

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.

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

Adopting lifelong healthy lifestyle changes, including building healthy sleep habits, can help prevent insomnia from coming back after treatment.

These include the following steps:

Keep a regular sleep schedule.

Get regular physical activity.

Avoid caffeine, nicotine, alcohol, and recreational drugs.

Talk with your doctor about how often to schedule follow-up visits. Between visits, tell your doctor if you have any new or worsening symptoms or if you have side effects from your medicines.

Your doctor may ask you to keep a sleep diary to help you keep track of how well you are sleeping during and after your treatment.

Even when your sleep improves, you may need to keep a regular daily schedule, take your medicines regularly, and continue cognitive behavioral therapy for insomnia.

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.

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.

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