Insomnia (also called insomnia disorder) is a common sleep problem that can affect your quality of life. People with insomnia have trouble falling asleep or staying asleep. They may wake up during the night or wake up too early the next morning.
Your sleep problems may come and go, or they may be ongoing.
There are many things that can cause sleep problems. Insomnia may be caused by:
The symptoms of insomnia are different for each person. People with insomnia may:
Insomnia is not a disease, and no test can diagnose it. But when you can't sleep well, it often has to do with some other cause. Your doctor will probably assess your current health and ask about any health problems you have had and any medicines you are taking.
Sometimes a doctor will do a physical exam, blood tests, and, in some cases, sleep studies to help find out if you have a health problem that may be causing the insomnia.
Your doctor may also ask about your sleep history—how well you sleep, how long you sleep, your bedtime habits, and any unusual behaviors you may have. Your doctor may ask you to keep a sleep journal, which is a record of your sleep patterns, for a week or two. He or she may recommend a counselor if your symptoms point to a mental health problem, such as depression or anxiety.
Treatment for insomnia focuses on the reason why you don't sleep well. If you have a medical problem, such as chronic pain, or an emotional problem, such as stress, treating that problem may help you sleep better. You may be able to sleep better by making some small changes. It may help to:
Some people may need medicine for a while to help them fall asleep. Doctors often prescribe medicine for a short time if other treatment isn't working. But medicine doesn't work as well over time as lifestyle and behavior changes do. Sleep medicine can also become habit-forming. Medicine works best as a short-term treatment combined with lifestyle and behavior changes.
Your doctor may also recommend counseling, which can help you learn new habits that may help you sleep better.
Talk to your doctor about your sleep problems and any other health issues you may have. This is important, because lack of sleep can lead to depression, accidents, problems at work, marital and social problems, drinking more alcohol than usual, and poor health. Treatment may help you avoid these problems and feel better.
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Each person experiences insomnia differently. People with insomnia may:
One Man's Story:
"When I wake up at 2 or 3 in the morning, my mind starts processing stuff—things that I need to get done, that I forgot to do. Trying to relieve that anxiety seems to me a very worthwhile sleep prescription."— Cort, 64
Read more about Cort and how he learned to cope with insomnia.
The quality of their day is what makes people who have insomnia different from people who typically sleep fewer hours or who have a different sleep disorder. With insomnia, you sleep so badly that you feel grouchy and perform poorly during the day. But it is possible to be a restless sleeper or to sleep less than 8 hours a night and yet get the amount of sleep you need. If you wake up refreshed with energy and are able to get things done during the day, then you are probably getting enough sleep.
Not getting enough sleep can affect your quality of life. It can lead to serious problems including injury, accidents, anxiety, and depression. Talk with your doctor if you think that you have insomnia.
Insomnia is not a disease, and no specific test can diagnose it. But it can make you feel bad, and it can affect your health. It can also be a sign of other problems. Your doctor may want to do blood tests to rule out certain medical conditions such as thyroid problems. "Normal sleep" differs for each person. Checking your health and sleep history is an important first step to finding a cause for poor-quality sleep. Talk with your doctor about your medical history and any medical problems you have or any medicines you are taking.
Your doctor can learn a lot about your insomnia and its causes by reviewing your sleep history. He or she can look at how long you sleep each night, how well you sleep, and what unusual behaviors you may have while sleeping, like snoring or gasping. Since you may be unaware of all your sleep problems while you sleep, your doctor may ask your bed partner questions about your sleeping behavior to better understand your sleep problems. He or she may also ask you to keep a sleep journal for 1 or 2 weeks to monitor your sleep patterns and habits. Your sleep journal can help your doctor spot certain habits that may affect your sleep, or even see signs of a hidden health problem that may need to be checked out.
If your doctor thinks that you have a sleep disorder, he or she may refer you for a sleep study. When you have a sleep study, you stay overnight in a special sleep lab.
Your doctor may recommend a sleep study if your insomnia seems to be caused by breathing problems (such as sleep apnea) or periodic limb movement disorder, or if you have tried other treatments that haven't worked.
Sleep studies are not helpful for insomnia caused by mental health problems, fibromyalgia, or myalgic encephalomyelitis/chronic fatigue syndrome.
Tossing and turning during the night or having trouble falling asleep can make you sleepy and grouchy during the day. You may have tried some things to help your insomnia that haven't worked. The good news is that there are many treatments to help you sleep better. But first it helps to know the reason why you don't sleep well. If you have a medical problem, such as chronic pain, or an emotional problem, such as stress or depression, treating that problem may help you sleep better.
Treatment options include behavior and lifestyle changes, medicines, and complementary medicines.
Behavior and lifestyle changes
Getting ready for bed means more than turning down the sheets. Sleep experts know that there are many things that affect how well you sleep. Behavior and lifestyle changes improve overall sleep quality and the time it takes to fall asleep—without the side effects of sleep medicines. Perhaps most important, these improvements last over time.
To improve your sleep, here are some things you can try:
In some cases, taking sleeping pills for a short time helps you get some rest, while behavior and lifestyle changes can help you over the long term. Doctors recommend taking sleep medicines only now and then or only for a short time. They are not the first choice for treating chronic insomnia.
Many sleep medicines cause side effects, such as low blood pressure, anxiety, and nausea. These medicines also may become less effective when your body gets used to them and may cause withdrawal symptoms when you stop using them.
Sleep medicines include:
To help you decide if you should use sleeping pills to treat insomnia, see:
One Man's Story:
While Cort does have a prescription for sleeping pills, he uses the medicine only when he needs to be well rested the next day, such as when he has to give a presentation at work. Cort heeds his doctor's warning about becoming dependent on sleeping pills.
"I have a prescription for 5 mg tablets, and I never take a full one. I break them in half, and I never take them more than once in 2 weeks." — Cort, 64
Read more about Cort and how he learned to cope with insomnia.
Other treatments for insomnia may include complementary medicine. Two of the most popular dietary supplements used for insomnia are:
Don't rely on alcohol
Some people use alcohol to help them sleep, but that's not a good idea. At first, drinking alcohol may make you sleepy and help you fall asleep. But when you drink alcohol, you are more likely to wake up later in the night and have a hard time falling back asleep. This can leave you feeling tired the next day.
After you and your doctor have treated any health problems related to your insomnia, there are many steps you can take to improve your sleep. Here are a few examples:
For more tips on how to improve your sleep, see:
Older adults, especially those living in nursing homes or who are cared for by others, often have ongoing sleep problems. It's natural for your sleep patterns to change as you get older, but it doesn't mean that you need less sleep or that the sleep you do get is enough.
There are things you can do to cope with changing sleep patterns as you get older, such as having familiar evening and nighttime routines.
Be sure to talk to your doctor if your sleep problems get worse, you feel very tired, or have a hard time functioning during the day. Also, let your doctor know if your symptoms become more severe or happen more often.
- Valerian (2010). In A DerMarderosian et al., eds., Review of Natural Products. St. Louis: Wolters Kluwer Health.
Other Works Consulted
- Morin CM, et al. (2009). Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: A randomized controlled trial. JAMA, 301(19): 2005–2015.
- Ropper AH, et al. (2014). Sleep and its abnormalities. In Adams and Victor's Principles of Neurology, 10th ed., pp. 395–418. York: McGraw-Hill Education.
- Schutte-Rodin S, et al. (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of Clinical Sleep Medicine, 4(5): 487–503.
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