Insomnia

Insomnia is a persistent disorder that can make it hard to fall asleep, hard to stay asleep or both, despite the opportunity for adequate sleep. With insomnia, you usually awaken feeling unrefreshed, which takes a toll on your ability to function during the day. Insomnia can sap not only your energy level and mood but also your health, work performance and quality of life.

Symptoms

Insomnia symptoms may include:

• Difficulty falling asleep at night
• Awakening during the night
• Awakening too early
• Not feeling well rested after a night’s sleep
• Daytime tiredness or sleepiness
• Irritability, depression or anxiety
• Difficulty paying attention, focusing on tasks or remembering
• Increased errors or accidents
• Tension headaches
• Distress in the stomach and intestines (gastrointestinal tract)
• Ongoing worries about sleep

Someone with insomnia will often take 30 minutes or more to fall asleep and may get only six or fewer hours of sleep for three or more nights a week over a month or more.

When to see a doctor

If insomnia makes it hard for you to function during the day, see your doctor to determine what might be the cause of your sleep problem and how it can be treated. If your doctor thinks you could have a sleep disorder, you might be referred to a sleep center for special testing.

Causes

Common causes of insomnia include:

• Stress
• Anxiety
• Depression
• Medical conditions
• Change in your environment or work schedule
• Poor sleep habits
• Medications
• Caffeine, nicotine and alcohol
• Eating too much late in the evening

Insomnia and aging

Insomnia becomes more common with age. As you get older, you may experience:

• A change in sleep patterns. Sleep often becomes less restful as you age, and you may find that noise or other changes in your environment are more likely to wake you.
• A change in activity. You may be less physically or socially active.
• A change in health. The chronic pain of conditions such as arthritis or back problems as well as depression, anxiety and stress can interfere with sleep.
• More medications. Older people typically use more prescription drugs than younger people do, which increases the chance of insomnia caused by a medication.

Risk factors

Nearly everyone has an occasional sleepless night. But your risk of insomnia is greater if:

• You’re a woman. Women are much more likely to experience insomnia. Hormonal shifts during the menstrual cycle and in menopause may play a role. During menopause, night sweats and hot flashes often disturb sleep. Insomnia is also common with pregnancy.
• You’re older than age 60
• You have a mental health disorder
• You’re under a lot of stress
• You work night or changing shifts
• You travel long distances

Complications

Complications of insomnia may include:

• Lower performance on the job or at school
• Slowed reaction time while driving and higher risk of accidents
• Psychiatric problems, such as depression or an anxiety disorder
• Overweight or obesity
• Irritability
• Increased risk and severity of long-term diseases or conditions, such as high blood pressure, heart disease and diabetes
• Substance abuse

Tests and diagnosis

Your doctor will likely do a physical exam to look for signs of other problems that may be causing insomnia. Occasionally, a blood test may be done to check for thyroid problems or other conditions that can cause insomnia.

Treatments and drugs

Behavior therapies include:

• Education about good sleeping habits. Good sleep habits include having a regular sleep schedule, avoiding stimulating activities before bed, and having a comfortable sleep environment.
• Cognitive behavioral therapy. This type of therapy helps you control or eliminate negative thoughts and worries that keep you awake. It may also involve eliminating false or worrisome beliefs about sleep, such as the idea that a single restless night will make you sick.
• Relaxation techniques. Progressive muscle relaxation, biofeedback and breathing exercises are ways to reduce anxiety at bedtime. These strategies help you control your breathing, heart rate, muscle tension and mood.
• Stimulus control. This means limiting the time you spend awake in bed and associating your bed and bedroom only with sleep and sex.
• Sleep restriction. This treatment decreases the time you spend in bed, causing partial sleep deprivation, which makes you more tired the next night. Once your sleep has improved, your time in bed is gradually increased.
• Remaining passively awake. Also called paradoxical intention, this treatment for learned insomnia is aimed at reducing the worry and anxiety about being able to get to sleep by getting in bed and trying to stay awake rather than expecting to fall asleep.
• Light therapy. If you fall asleep too early and then awaken too early, you can use light to push back your internal clock. You can go outside during times of the year when it’s light outside in the evenings, or you can get light via a medical-grade light box.

Prescription medications

Taking prescription sleeping pills — such as zolpidem , eszopiclone , zaleplon or ramelteon — may help you get to sleep. Doctors generally don’t recommend relying on prescription sleeping pills for more than a few weeks, but several medications are approved for long-term use.

Over-the-counter sleep aids

Nonprescription sleep medications contain antihistamines that can make you drowsy. Antihistamines may initially make you groggy, but they may also reduce the quality of your sleep, and they can cause side effects, such as daytime sleepiness, dizziness, urinary retention, dry mouth and confusion. These effects may be worse in older adults. Antihistamines also can worsen urinary problems, causing you to get up to urinate more during the night.

Lifestyle and home remedies

No matter what your age, insomnia usually is treatable. The key often lies in changes to your routine during the day and when you go to bed. Good sleep habits promote sound sleep and daytime alertness. These tips may help.

Basic tips:

• Exercise and stay active. Activity helps promote a good night’s sleep. Get at least 20 to 30 minutes of vigorous exercise daily at least five to six hours before bedtime.
• Check your medications. If you take medications regularly, check with your doctor to see if they may be contributing to your insomnia. Also check the labels of OTC products to see if they contain caffeine or other stimulants, such as pseudoephedrine.
• Avoid or limit naps. Naps can make it harder to fall asleep at night. If you can’t get by without one, try to limit a nap to no more than 30 minutes and don’t nap after 3 p.m.
• Avoid or limit caffeine and alcohol and don’t use nicotine. All of these can make it harder to sleep. Avoid caffeine after lunchtime. Avoiding alcohol can help prevent restless sleep and frequent awakenings.
• Don’t put up with pain. If a painful condition bothers you, make sure the pain reliever you take is effective enough to control pain while you’re sleeping.
• Stick to a sleep schedule. Keep your bedtime and wake time consistent from day to day, including on weekends.

At bedtime:

Avoid large meals and beverages before bed. A light snack is fine. But avoid eating too much late in the evening to reduce the chance of gastroesophageal reflux disease (GERD) and improve sleep. Drink less before bedtime so that you won’t have to urinate as often.

• Use your bed and bedroom only for sleeping or sex. Don’t read, work or eat in bed. Avoid TV, computers, video games, smartphones or other screens just before bed, as the light can interfere with your sleep cycle.
• Make your bedroom comfortable for sleep. Close your bedroom door or create a subtle background noise, such as a running fan, to help drown out other noises. Keep your bedroom temperature comfortable, usually cooler than during the day, and dark. Don’t keep a computer or TV in your bedroom.
• Hide the bedroom clocks. Set your alarm so that you know when to get up, but then hide all clocks in your bedroom, including your wristwatch and cellphone, so you don’t worry about what time it is.
• Find ways to relax. Try to put your worries and planning aside when you get into bed. A warm bath or a massage before bedtime can help prepare you for sleep. Create a relaxing bedtime ritual, such as reading, soft music, breathing exercises, yoga or prayer.
• Avoid trying too hard to sleep. The harder you try, the more awake you’ll become. Read in another room until you become very drowsy, then go to bed to sleep.
• Get out of bed when you’re not sleeping. Sleep as much as you need to feel rested, and then get out of bed. If you can’t sleep, get out of bed after 20 minutes and do something relaxing, such as reading. Then try again to get to sleep.