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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
heart disease, diabetes, and cancer.
Symptoms
If you have insomnia, you may experience several different symptoms.
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You may
lie awake for a long time before you fall asleep. This is
more common in younger adults.
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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.
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Waking up
too early in the morning and not getting back to sleep is
also common.
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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
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A sleep
study looks for other sleep problems, such as circadian
rhythm disorders, sleep
apnea, and narcolepsy.
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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.
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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.
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Adopt
healthy sleep habits and a regular daytime schedule to
help you maintain a regular sleep-wake cycle.
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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.
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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.
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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.
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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.
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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.
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Avoid naps, especially in the
afternoon. This may help you sleep longer at
night.
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Eat meals on a regular schedule and
avoid late-night dinners.
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Limit how much you drink close to
bedtime. This may help you sleep longer
without having to use the bathroom.
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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.
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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:
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Cognitive therapy helps you feel
less nervous about not being able to sleep.
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Relaxation or meditation therapy teaches
you how to relax and fall asleep faster.
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Sleep education helps you learn
good sleep habits.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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Breathing problems like asthma may
occur or worsen as a result of chronic
insomnia.
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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.
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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.
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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.
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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.
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