Insomnia

Also known as: Sleep disorder - insomnia, Learned insomnia, Chronic insomnia or Primary 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).

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.

What percent of adults are getting 6 hours or less of sleep each night?The correct answer is 30%. Nearly 30% of adults sleep an average of 6 hours or less each night. If you’re getting less than 7 - 9 hours of sleep each night, talk to your doctor about how you can get more sleep. Lack of sleep is linked to which if the following?The correct answer is all of the above. Lack of sleep can cause you to nod off while driving or lose focus at work. This can lead to serious accidents and work errors. Do not drive a car, operate heavy machinery, or try to do difficult or risky tasks when you are tired. Getting too little sleep put you at risk for:The correct answer is all of the above. Over time, not getting enough sleep can harm your health. People who don't get enough sleep are more likely to have the health problems listed above, and may die earlier than people who get enough sleep.Which of the following is NOT a good sleep habit?The correct answer is sleeping in on the weekends. You'll sleep better if you go to bed and wake up at the same times every day, even on weekends. Also be sure to get 7-9 hours of sleep a night. Talk with your doctor if you are having trouble sleeping.You need the same amount of sleep throughout your lifespan.The correct answer is false. Sleep patterns change with age. Plus, not everyone needs the same amount of sleep. Children 5-10 years old should get 10-11 hours of sleep daily, teens 10-17 years old need 8.5-9 hours, and adults need about 7-9 hours.Which of the following can make it hard to get to sleep and stay asleep?The correct answer is all of the above. Insomnia occurs when you have trouble getting to sleep and staying asleep. The factors listed above all make it harder to sleep. Try making some changes in your TV watching, exercise, and sleep habits, and see what works for you.Sleeping pills are the best treatment for insomnia.The correct answer is false. Sleeping pills don't treat the underlying cause of your sleeping problems, but they may help you get some rest. Changing the habits that make it hard to sleep works for most people. Talk to your doctor to find out which approach is best for you. Getting less than 8 hours of sleep at night is bad for your health.The correct answer is false. Different people have different sleep needs. Some people only need 6 hours of sleep each night. Others need 9 hours of sleep to work at their best. Find out if you need more sleep by paying attention to how sleepy or tired you are during the day.Some people stop breathing while they’re asleep.The correct answer is true. If you stop breathing while you’re sleeping, you may have a condition called sleep apnea. Sleep apnea causes your breathing to stop and start. Breathing pauses can last from a few seconds to minutes. If you’re getting enough sleep but still feel sleepy during the day, ask your doctor if you might have sleep apnea.Which of the following is a symptom of sleep apnea?The correct answer is all of the above. If you notice symptoms of sleep apnea, talk with your doctor. Losing weight can decrease the number of apnea spells you have during the night. Your doctor will talk with you about other treatments, including a using a machine to help you breathe while you sleep.Which group of people is at risk for sleep apnea?The correct answer is all of the above. Being overweight can make your airways narrower, so it's harder to breathe when you are asleep and your mouth and throat relax. So can enlarged tonsils. Men are also more likely to get sleep apnea.Drinking alcohol before bed will help you sleep better.The correct answer is false. Drinking alcohol might make you sleepy, but it keeps you from getting deep sleep. If you have sleep apnea, drinking alcohol can make symptoms worse. You should avoid alcohol close to bedtime.

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:
July 16, 2014
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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