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Insomnia

Definition

Insomnia is trouble falling asleep or staying asleep through the night.

Episodes may come and go (episodic), last up to 3 weeks (short-term), or be long-lasting (chronic).

Alternative Names

Sleep disorder - insomnia; Learned insomnia; Chronic insomnia; Primary insomnia

Causes, incidence, and risk factors

Sleep habits we learned as children may affect our sleep behaviors as adults. When we repeat these behaviors over many years, they become habits.

Poor sleep or lifestyle habits that may cause insomnia or make it worse:

  • Going to bed at different times each night
  • Daytime napping
  • Poor sleeping environment, such as too much noise or light
  • Spending too much time in bed while awake
  • Working evening or night shifts
  • Not getting enough exercise
  • Using the television, computer, or smartphone in bed

The use of some medications and drugs may also affect sleep:

  • Alcohol or other drugs
  • Heavy smoking
  • Too much caffeine, especially late in the day
  • Getting used to certain types of sleep medications
  • Some cold medications and diet pills
  • Other medicines, herbs, or supplements prescribed by a health care provider or bought on your own

Physical, social, and mental health issues can affect sleep patterns, including:

  • Anxiety disorders
  • Bipolar disorder
  • Certain medical conditions, such as thyroid disease
  • Feeling sad or depressed. Often, insomnia is the symptom that causes people with depression to seek medical help.
  • Physical pain or discomfort
  • Stress, whether it is short-term or long-term. For some people, the stress caused by the insomnia makes it even harder to fall asleep.

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.

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Symptoms

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 sometimes keep thinking about getting enough sleep. The more they try to sleep, the more frustrated and upset they get, and the harder sleep becomes.

A lack of restful sleep can affect your ability to do your daily activities because you are tired or have trouble concentrating.

Signs and tests

Your health care provider will do a physical exam and ask you questions about your current medications, drug use, and medical history. Usually, these are the only methods needed to diagnose insomnia.

Polysomnography, an overnight sleep study, can help rule out other types of sleep disorders (such as sleep apnea).

Treatment

It is important to remember that not getting 8 hours of sleep every night does not mean you are putting your health 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.

Treatment often begins by reviewing any drugs or medical conditions that may be causing your insomnia or making it worse.

Thinking about any lifestyle and sleep habits that may be affecting your sleep is an important next step. This is called sleep hygiene. Making some changes in your sleep habits may improve or solve your insomnia.

Using medicine to treat insomnia can sometimes be useful, but there can be risks.

  • Antihistamines (the main ingredient in over-the-counter sleeping pills) may cause memory problems over time, especially in the elderly.
  • Only use sedatives under the close care of a doctor, because they can cause tolerance and sometimes dependence. Stopping these medications suddenly can cause rebound insomnia and withdrawal.
  • Lower doses of certain antidepressant medicines may help. These medicines do not carry the same problems with tolerance and dependence as sedatives.

It may help to see a psychiatrist or other mental health provider to test for a mood or anxiety disorder that can cause insomnia.

  • They may use talk therapy, such as cognitive-behavioral therapy, to help you gain control over anxiety or depression.
  • A psychiatrist may also prescribe antidepressants or another medicine to help your sleeping problem and any mood or anxiety disorder you might have.

Expectations (prognosis)

Most people are able to sleep by practicing good sleep hygiene. See a doctor if you have insomnia that does not improve.

Complications

Daytime sleepiness is the most common complication of insomnia. There is also evidence that a lack of sleep can lower your immune system's ability to fight infections.

A lack of sleep is also a common cause of auto accidents. If you are driving and feel sleepy, take a break.

Calling your health care provider

Call your doctor if insomnia has become a problem.

References

Wickwire EM, Collop NA. Insomnia and sleep-related breathing disorders. Chest. 2010;137:1449-1463.

Morgenthaler T, Kramer M, Alessi C, Friedman L, Boehlecke B, Brown T, et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. Sleep. 2006;29:1415-1419.

Vitiello MV, Rybarczyk B, Von Korff M, Stepanski EJ. Cognitive behavioral therapy for insomnia improves sleep and decreases pain in older adults with co-morbid insomnia and osteoarthritis. J Clin Sleep Med. 2009;5:355-362.

Review Date:8/16/2011

Reviewed by:David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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