(Sleeplessness)
Definition
Definition
Insomnia is a sleep disorder. It may cause a number of sleep problems including trouble falling asleep, waking in the middle of the night, or waking very early in the morning. It may also be a sleep that is not restful. Insomnia can be a short-term problem, or it can be chronic. Chronic insomnia lasts for more than 4 weeks.
Causes
Causes
Insomnia can occur for many reasons. Short-term insomnia is often caused by temporary situations or problems with the environment. They may include:
- A life crisis or stress, including the loss of a life partner, divorce, or loss of a job
- Environmental noise
- Extreme temperatures, such as a room that is too hot or too cold
- Change in the surrounding environment
- Sleep/wake schedule problems, such as those due to jet lag
There may be no clear reason for chronic insomnia. It may also be due to other medical or psychiatric conditions. Examples of conditions that can lead to sleep problems include:
- Depression
- Anxiety
- Arthritis
- Fibromyalgia
- Heart disease
- Asthma or chronic obstructive pulmonary disease (COPD)
- Sleep apnea
- Hyperthyroidism
- Gastroesophageal reflux disease (GERD) or ulcer
Both chronic and short-term insomnia may be due to
-
Behavioral factors, including:
- Misuse of caffeine, alcohol, or other substances
- Smoking cigarettes
- Disrupted sleep/wake cycles from shift work or other nighttime activities
- Chronic stress
- Excessive napping in the afternoon or evening
-
Certain medications such as:
- Allergy medication
- Corticosteroids
- Blood pressure medication
- Psychiatric medication
Risk Factors
Risk Factors
Insomnia is more common in women during and after menopause. It is also common in adults 50 years of age or older.
Other factors that increase the risk of insomnia include:
- Stress
- A history of psychiatric disorders, such as anxietyanddepression
- Chronic pain
- Having chronic medical conditions
- Using alcohol, drugs, or certain medications
- Shift work
- Use of multiple medications
Symptoms
Symptoms
Symptoms include:
- Difficulty falling asleep
- Waking up frequently during the night with difficulty returning to sleep
- Waking up too early
- Not feeling refreshed after sleep
- Daytime sleepiness
- Irritability, anxiety, and inability to concentrate
When Should I Call My Doctor?
Call your doctor if you are having frequent insomnia. Let your doctor know if the insomnia is making it hard for you to do your daily activities.
Diagnosis
Diagnosis
You will be asked about your symptoms and medical history. A physical exam will be done. You will also be asked about your job, eating habits, and drug and alcohol use.
You will also be asked about your schedule and sleep patterns. You may be asked to keep a sleep diary. This will include information about your naps, bedtime, and how often you wake during the night. Your doctor will review the medications you take, including over-the-counter medications and herbal supplements. These questions will help your doctor understand what is causing your insomnia.
Laboratory Testing
Your doctor may recommend observation in a sleep lab. This may be done if the diagnosis is uncertain or if other sleep disorders are suspected. You will need to spend the night in a special center. Your movements, breathing, and brain activity will be monitored. This will allow your doctor to identify a treatable condition that is affecting your sleep.
Monitored Breathing During PolysomnographyCopyright © Nucleus Medical Media, Inc.
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Treatment
Treatment
Treat Underlying Medical Conditions
A number of physical and mental disorders can disrupt sleep. Diagnosis and treatment of the underlying illness, may fix the insomnia.
Identify and Modify Behaviors That Worsen Insomnia
There are steps you can take to improve your chance of a good night’s rest. Your doctor may ask you to reduce intake of certain items or avoid them to see if your sleep improves. You may be asked to:
- Reduce or avoid caffeine, especially late in the day.
- Reduce or avoid alcohol and avoid drug use.
- Quit smoking. If you smoke, avoid doing so near bedtime.
- Avoid eating or drinking close to bedtime.
Your sleep habits can also affect how well you sleep. Steps that may help you sleep better include:
- Go to bed and wake up at the same time each day.
- If you must take naps, keep them short.
- Only use the bedroom for sleep or sex. Avoid watching TV or worrying in bed.
- Keep your bedroom at a comfortable temperature and dark. Minimize disruptions, such as pets.
- If you work at night and sleep during the day, make sure to block daylight from the room. Decrease the amount of noise. Use a fan to block out noise.
Medications
Sleeping pills are available by prescription or over-the-counter. Some doctors advise against the long-term use of sleeping pills. They may cause dependence. This is a physical change in your body. It makes your body dependent on the drug for sleep.
Proper use of prescription sleep medication may increase sleep. Most of these medications are only approved for short-term use. They can cause drowsiness, lightheadedness, and headache. Serious side effects can include abnormal thinking or behavior changes, including having suicidal thoughts.
Many over-the-counter sleep medications contain diphenhydramine. This medication can make you feel groggy and might help you fall asleep. However, this drug can have serious side effects. Most people should avoid using this drug regularly.
Exercise
Exercise can help you get a better sleep. It can reduce stress and allow your body to reach a deeper state of relaxation. The timing of exercise is important. Exercising early in the day may be best if you are having trouble sleeping. If you have to exercise later in the day, make sure you are done exercising at least a few hours before bedtime.
Herbal Therapies and Supplements
Some people use the herb valerian to reduce insomnia. Others take melatonin. It is not clear that these supplements help. Talk to your doctor before taking any herbs or supplements.
Relaxation Therapy
This therapy may reduce or eliminate anxiety and body tension. It stops the mind from racing and allows the muscles to relax. This can support a restful sleep. The therapy may include deep breathing and progressive relaxation.
Sleep Restriction
A sleep restriction program is a strict sleep program. It limits the amount of time in bed to only the time that you are actually sleeping. Previous sleep logs will determine the amount of time allowed in bed. The time you spent sleeping will be used to determine the amount of time you can spend in bed. At first, your time in bed may seem short, usually about 5 hours. Gradually, the time is increased until a more normal night’s sleep is achieved.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a form of talk therapy. This means that you discuss your thoughts, feelings, and behaviors with a mental health professional. CBT focuses on how the way you think affects the way you feel and act. CBT may have more lasting effects than medication.
Reconditioning
Reconditioning helps people associate the bed and bedtime with sleep. This means not using the bed for activities other than sleep and sex. As part of the reconditioning process, the person is usually advised to go to bed only when sleepy.
Prevention
Prevention
To reduce your chance of having insomnia:
- Minimize intake of caffeinated food and drinks after lunch.
- Avoid drinking alcohol.
- Avoid eating too fast or too much. Do not eat too close to bedtime.
- Avoid drinking fluids before bedtime.
- If you smoke, talk to your doctor about ways to quit.
- Exercise regularly, but not within less than 3 hours of bedtime.
- Use the bedroom only for sleep and sex. Do not use electronics or watch TV while in bed
- Schedule relaxing bedtime routines. Listen to quiet music or soak in warm water.
- Make sure that the bedroom is not too cold or too hot.
- Use a humidifier or dehumidifier as needed.
- Get sunlight during the day.
- Use shades or lined drapes; or wear an eye mask to reduce sleep disruption.
- Use earplugs or listen to relaxing music or white noise. This helps reduce the disturbing effects of noise.
- Make sure your mattress is supportive and the bedding is comfortable.
- Avoid “clock watching” after going to bed.
- Keep bedtimes and wake-times consistent throughout the week.
- If you cannot avoid naps, keep them short.
RESOURCES:
National Sleep Foundation http://www.sleepfoundation.org
CANADIAN RESOURCES:
Canadian Sleep Society http://www.canadiansleepsociety.ca
References:
http://www.ebscohost.com/dynamed
Updated April 10, 2015. Accessed June 2, 2015.
Jacobs GD, Pace-Schott EF, et al. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med . 2004 Sep 27;164(17):1888-96. Available at:
http://archinte.jamanetwork.com/article.aspx?articleid=217394
Accessed June 2, 2015.
Insomnia. Family Doctor—American Academy of Family Physicians website. Available at:
http://familydoctor.org/familydoctor/en/diseases-conditions/insomnia.html
Updated Apirl 2014. Accessed June 2, 2015.
Morin CM, Vallieres A, et al. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA. 2009;301(19):2005-2015.
Sleep insomnia, lack of sleep. National Heart, Lung, and Blood Institute website. Available at:
http://www.nhlbi.nih.gov/health/health-topics/topics/inso/
Updated December 13, 2011. Accessed June 2, 2015.
Last Updated: 5/11/2013