Insomnia is the perception or complaint of inadequate or
poor-quality sleep because of one or more of the following:
difficulty falling asleep
waking up frequently during the night with difficulty returning
waking up too early in the morning
Insomnia is not defined by the number of hours of sleep a person
gets or how long it takes to fall asleep. Individuals vary normally
in their need for, and their satisfaction with, sleep. Insomnia may
cause problems during the day, such as tiredness, a lack of energy,
difficulty concentrating, and irritability. Insomnia can be
classified as transient (short term), intermittent (on and off),
and chronic (constant). Insomnia lasting from a single night to a
few weeks is referred to as
. If episodes of
transient insomnia occur from time to time, the insomnia is said to
. Insomnia is considered to be
if it occurs on most nights and lasts a month or more.
What causes it?
Certain conditions seem to make individuals more likely to
experience insomnia. Examples of these conditions include:
advanced age (insomnia occurs more frequently in those over age
a history of depression
If other conditions (such as
, or the use of
occur along with the above conditions, insomnia is more likely.
There are many causes of insomnia. Transient and intermittent
insomnia generally occur in people who are temporarily experiencing
one or more of the following:
change in the surrounding environment
sleep/wake schedule problems such as those due to jet lag
medication side effects
is more complex and often results from a
combination of factors, including
underlying physical or mental
. One of the most common causes of chronic insomnia is
. Other underlying causes include arthritis,
kidney disease, heart failure, asthma, sleep apnea, narcolepsy,
restless legs syndrome, Parkinson's disease, and hyperthyroidism.
However, chronic insomnia may also be due to
, including the misuse of caffeine, alcohol, or other
substances; disrupted sleep/wake cycles as may occur with shift
work or other nighttime activity schedules; and chronic stress. In
addition, the following behaviors have been shown to perpetuate
insomnia in some people:
expecting to have difficulty sleeping and worrying about
ingesting excessive amounts of caffeine
drinking alcohol before bedtime
smoking cigarettes before bedtime
excessive napping in the afternoon or evening
irregular or continually disrupted sleep/wake schedules
These behaviors may prolong existing insomnia, and they can also
be responsible for causing the sleeping problem in the first place.
Stopping these behaviors may eliminate the insomnia altogether.
Who gets insomnia?
Insomnia is found in males and females of all age groups,
although it seems to be more common in females (especially after
menopause) and in the elderly. The ability to sleep, rather than
the need for sleep, appears to decrease with advancing age.
How is it diagnosed?
Patients with insomnia are evaluated with the help of a medical
history and a sleep history. The sleep history may be obtained from
a sleep diary filled out by the patient or by an interview with the
patient's bed partner concerning the quantity and quality of the
patient's sleep. Specialized sleep studies may be recommended, but
only if there is suspicion that the patient may have a primary
sleep disorder such as sleep apnea or narcolepsy.
How is it treated?
Transient and intermittent insomnia may not require treatment
since episodes last only a few days at a time. For example, if
insomnia is due to a temporary change in the sleep/wake schedule,
as with jet lag, the person's biological clock will often get back
to normal on its own. However, for some people who experience
daytime sleepiness and impaired performance as a result of
transient insomnia, the use of short-acting sleeping pills may
improve sleep and next-day alertness. As with all drugs, there are
potential side effects. The use of over-the-counter sleep medicines
is not usually recommended for the treatment of insomnia.
Treatment for chronic insomnia consists of:
First, diagnosing and treating underlying medical or
Identifying behaviors that may worsen insomnia and stopping (or
Possibly using sleeping pills, although the long-term use of
sleeping pills for chronic insomnia is controversial. A patient
taking any sleeping pill should be under the supervision of a
physician to closely evaluate effectiveness and minimize side
effects. In general, these drugs are prescribed at the lowest dose
and for the shortest duration needed to relieve the sleep-related
symptoms. For some of these medicines, the dose must be gradually
lowered as the medicine is discontinued because, if stopped
abruptly, it can cause insomnia to occur again for a night or
Trying behavioral techniques to improve sleep such as
relaxation therapy, sleep restriction therapy, and
There are specific and effective techniques that can reduce or
eliminate anxiety and body tension. As a result, the person's mind
is able to stop "racing," the muscles can relax, and restful sleep
can occur. It usually takes much practice to learn these techniques
and to achieve effective relaxation.
Some people suffering from insomnia spend too much time in bed
unsuccessfully trying to sleep. They may benefit from a sleep
restriction program that at first allows only a few hours of sleep
during the night. Gradually the time is increased until a more
normal night's sleep is achieved.
Another treatment that may help some people with insomnia is to
recondition them to associate the bed and bedtime with sleep. For
most people, this means not using their beds for any activities
other than sleep and sex. As part of the reconditioning process,
the person is usually advised to go to bed only when sleepy. If
unable to fall asleep, the person is told to get up, stay up until
sleepy, and then return to bed. Throughout this process, the person
should avoid naps and wake up and go to bed at the same time each
day. Eventually the person's body will be conditioned to associate
the bed and bedtime with sleep.
Talk to your doctor if you are having trouble getting good,
refreshing sleep each night. Together you can identify possible
reasons for your sleeping difficulty and then try appropriate
measures to correct the problem.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a