Insomnia

Definition

Insomnia is a sleep disorder. It may make it hard to fall asleep, stay asleep, or get restful sleep. It may be:

• Short-term (acute)—lasts a few days to a few weeks
• Long-term (chronic)—lasts more than 4 weeks

Causes

Insomnia happens for many reasons. Short-term insomnia is often caused by:

• A life crisis or stress
• Noise
• A room that is too hot or too cold
• Changes in surroundings
• Jet lag or other sleep-wake problems

The cause of long-term insomnia is not always clear. It can be caused by:

• Mental health problems, such as depression, anxiety, or post-traumatic stress disorder
• Arthritis, fibromyalgia, or other long-term pain
• Heart disease
• Problems that affect breathing, such as asthma, chronic obstructive pulmonary disease (COPD), or sleep apnea
• Hyperthyroidism
• Gastroesophageal reflux disease (GERD) or an ulcer

Both types of insomnia can be due to:

• Behaviors such as:
  • Using caffeine, alcohol, or other substances
  • Smoking
  • Sleeping on an irregular schedule—such as with shift work
  • Problems coping with stress
  • Napping too much in the afternoon or evening
• Certain medicines, such as:
  • Antidepressants, stimulants, and pain relievers
  • Steroid hormones, decongestants, and certain asthma medicines

Risk Factors

Insomnia is more common in women at and after menopause. It is also common in adults 50 years of age or older.

The risk of insomnia is higher for those who have:

• Any of the problems listed above
• Family members with insomnia
• Certain genetic factors

Symptoms

Insomnia may cause:

• Problems falling asleep or staying asleep
• Waking up too early
• Not feeling refreshed after sleep
• Daytime sleepiness
• Uneasiness and problems thinking

Diagnosis

The doctor will ask about symptoms and past health. A physical exam may be done. The doctor will ask about sleep, habits, schedule, and medicines.

If the cause is not clear, a sleep study may be done. This is done in a special lab. A technician will look at brain activity, breathing, and movement as a person sleeps.

Treatment

The goal is to improve sleep. This may be done by treating underlying problems or behaviors. Other options are:

• Sleep medicines—usually for a short time
• Relaxation techniques and physical activity—to ease stress
• Herbs or
• Sleep restriction—a program that limits time in bed to sleeping time only
• Reconditioning—using the bed only for sleep and sex
• Cognitive behavioral therapy—talk therapy with a mental health counselor
• Certain antidepressants

Some people use herbs or nonprescription melatonin for better sleep. However, it is unclear if these supplements work.

Prevention

To reduce the risk of insomnia:

• Do regular physical activity.
• Get treatment for health problems.
• Do not use substances that disrupt sleep.
• Learn and use good sleep practices.