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.
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 (like 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 these conditions that can lead to sleep problems include:
Both chronic and short-term insomnia may be due to
Behavioral factors, including:
Misuse of caffeine,
, or other substances
- Disrupted sleep/wake cycles from shift work or other nighttime activities
- Chronic stress
- Excessive napping in the afternoon or evening
Certain medicines such as:
- Allergy medicines
- Blood pressure medicines
- Psychiatric medicines
The doctor will ask 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.
The doctor will also ask 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 medicines you take, including over-the-counter medicines and herbal supplements. These questions will help your doctor understand what is causing your insomnia.
Your doctor may recommend observation in a
. 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 are monitored. This will allow your doctor to identify a treatable condition that is affecting your sleep.
Monitored Breathing During Polysomnography
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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 all together 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 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.
Sleeping pills are available by prescription or over-the-counter (OTC). 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 medicine may increase sleep. Most of these medicines are only approved for short-term use. They can cause drowsiness, dizziness and headache. Serious side effects can include abnormal thinking or behavior changes including having suicidal thoughts.
Many OTC sleep medicines contain diphenhydramine (Benadryl). This medicine 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.
Elderly persons in particular may have a variety of adverse effects to this drug. They should discuss its use with their doctor.
Exercise can help you get a better sleep. It can reduce stress and allow your body to reach a deeper 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
. It is not clear that these supplement help. Talk to your doctor before taking an herbs or supplements.
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.
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 five 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 medicine. CBT is usually applied over six weeks, with maintenance therapy given as needed.
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.