Insomnia - overview
Sleep disorder - insomnia; Sleep issues; Difficulty falling asleep; Sleep hygiene - insomnia
Insomnia is trouble falling asleep, staying asleep through the night, or waking up too early in the morning.
Episodes of insomnia may come and go or be long-lasting.
The quality of your sleep is as important as how much sleep you get.
Sleep habits we learned as children may affect our sleep behaviors as adults. Poor sleep or lifestyle habits that may cause insomnia or make it worse include:
- Going to bed at a different time each night
- Daytime napping
- Poor sleeping environment, such as too much noise or light
- Spending too much time in bed while awake
- Working evenings or night shifts
- Not getting enough exercise
- Using the television, computer, or a mobile device in bed
The use of some medicines and drugs may also affect sleep, including:
- Alcohol or other drugs
- Heavy smoking
- Too much caffeine throughout the day or drinking caffeine late in the day
- Getting used to certain types of sleep medicines
- Some cold medicines and diet pills
- Other medicines, herbs, or supplements
Physical, social, and mental health issues can affect sleep patterns, including:
- Bipolar disorder.
- Feeling sad or depressed. (Often, insomnia is the symptom that causes people with depression to seek medical help.)
- Stress and anxiety, whether it is short-term or long-term. For some people, the stress caused by insomnia makes it even harder to fall asleep.
Health problems may also lead to problems sleeping and insomnia:
- Physical pain or discomfort.
- Waking up at night to use the bathroom, common in men with enlarged prostate
- Sleep apnea
With age, sleep patterns tend to change. Many people find that aging causes them to have a harder time falling asleep, and that they wake up more often.
Do you have trouble falling asleep at night? Or, do you go to sleep, only to wake up a few hours later and stay awake for hours at night? Well, let's today talk about insomnia. Your sleep-wake cycle is a delicate pattern run by something called circadian rhythms. These rhythms are physical, mental, and behavioral changes in your brain that roughly follow a 24-hour cycle. Your daily and nightly habits, many you learned as a child, may affect your circadian rhythms and how well you sleep at night. Poor sleep or lifestyle habits that may cause insomnia include going to bed at different times each night, daytime napping, and a poor sleeping environment such as too much noise or light. Spending too much in time in bed while you're awake can change your sleep patterns too. Likewise, working evenings or night shifts and not getting enough exercise can affect your sleep. People who use alcohol or recreational drugs may have trouble sleeping. Heavy smoking and drinking too much caffeine can also cause insomnia. And, even using some types of sleep medications a lot can cause you to lose sleep. Medical problems can cause insomnia too. People with anxiety disorders, bipolar disorder, thyroid disease, depression, and chronic pain problems may have trouble going to sleep or staying asleep. So, what do you do about insomnia? Well, it's important to remember that not everyone needs 8 hours of sleep every night. Some people do just fine on 6 hours of sleep, while others need much more. If you need more sleep, your doctor will probably ask about any medications you're taking, your drug or alcohol use, and your medical history. Spend some time thinking about your lifestyle and sleep habits. It's best to avoid caffeine and alcohol at night. If you don't exercise, starting regular exercise might help you sleep better. If you're depressed or anxious, talk to your doctor to see if relaxation techniques can help, if medication might be helpful, or if seeing a mental health provider is best. If you're suffering from bouts of insomnia, take heart. Most people can return to more normal sleep patterns when they make simple changes in their lifestyle or habits.
The most common complaints or symptoms in people with insomnia are:
- Trouble falling asleep on most nights
- Feeling tired during the day or falling asleep during the day
- Not feeling refreshed when you wake up
- Waking up several times during sleep
People who have insomnia are sometimes consumed by the thought of getting enough sleep. But the more they try to sleep, the more frustrated and upset they get, and the harder sleep becomes.
Lack of restful sleep can:
- Make you tired and unfocused, so it is hard to do daily activities.
- Put you at risk for auto accidents. If you are driving and feel sleepy, pull over and take a break.
Exams and Tests
Your health care provider will do a physical exam and ask about your current medications, drug use, and medical history. Usually, these are the only methods needed to diagnose insomnia.
Not getting 8 hours of sleep every night does not mean your health is at risk. Different people have different sleep needs. Some people do fine on 6 hours of sleep a night. Others only do well if they get 10 to 11 hours of sleep a night.
Treatment often begins by reviewing any drugs or health problems that may be causing or worsen insomnia, such as:
- Enlarged prostate gland, causing men to wake up at night
- Pain or discomfort from muscle, joint, or nerve disorders
You should also think about lifestyle and sleep habits that may affect your sleep. This is called sleep hygiene. Making some changes in your sleep habits may improve or solve your insomnia.
Some people may need medicines to help with sleep for a short period of time. But in the long run, making changes in your lifestyle and sleep habits is the best treatment for problems with falling and staying asleep.
- Most over-the-counter (OTC) sleeping pills contain antihistamines. These medicines are commonly used to treat allergies. Your body quickly becomes used to them.
- Sleep medicines called hypnotics can be prescribed by your provider to help reduce the time it takes you to fall asleep. Most of these can become habit-forming.
- Medicines used to treat anxiety or depression can also help with sleep
Different methods of talk therapy may help you gain control over anxiety or depression.
Most people are able to sleep by practicing good sleep hygiene.
When to Contact a Medical Professional
Call your provider if insomnia has become a problem.
Chokdroverty S, Avidan AY. Sleep and its disorders. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 102.
Morin CM, Benca R. Chronic insomnia. Lancet. 2012;379(9821):1129-1141. PMID: 22265700
Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4(5):487-504. PMID: 18853708
Vaughn BV. Disorders of sleep. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 405.
Wakefield TL, Lam DJ, Ishman SL. Sleep apnea and sleep disorders. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 18.
Last reviewed on: 3/26/2018
Reviewed by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.