Definition

Insomnia is a poor quality sleep. This may mean a lack of sleep or difficulty staying asleep. Some have trouble falling asleep, or problems waking in the middle of the night or very early in the morning. It may be characterized as:

  • Transient—lasts from a single night to a few weeks
  • Intermittent or short term—episodes of transient insomnia occur from time to time
  • Chronic—if it occurs on most nights and lasts a month or more; this form usually needs treatment

Causes

There are many causes.

Transient and intermittent insomnia generally occur in people who are temporarily experiencing one or more of the following:

  • A life crisis or stress, including the loss of a life partner, divorce, or loss of a job
  • Environmental noise
  • Extreme temperatures (like a room that is too hot or too cold)
  • Change in the surrounding environment (one of the most common causes)
  • Sleep/wake schedule problems such as those due to jet lag
  • Hormonal shifts during the menstrual cycle, pregnancy, perimenopause, or menopause
  • Side effects of medicine
    • Nonprescription: diet aids, decongestants, cold and cough remedies
    • Prescription: steroids, theophylline, phenytoin (Dilantin), levodopa

Chronic insomnia sometimes results from the following conditions:

Chronic insomnia may also be due to behavioral factors, including:

  • Misuse of caffeine, alcohol, or other substances
  • Disrupted sleep/wake cycles from shift work or other nighttime activities
  • Chronic stress

In addition, the following behaviors have been shown to perpetuate insomnia in some people:

  • Expecting to have difficulty sleeping and worrying about it—usually starts in young adults
  • Smoking cigarettes before bedtime
  • Excessive napping in the afternoon or evening

Insufficient Sleep Syndrome

This results from a person not getting enough sleep due to life circumstances. The person may be working more than one job or working and going to school at the same time. As a result they do not get enough sleep every day, over a longer period of time. This may lead to daytime sleepiness. It can also lead to problems with focus and muscle aches and pains.

Risk Factors

Factors that increase your chance of getting a disease or condition:

  • Age: 50 or older
  • Sex: female (especially during and after menopause)
  • Stress
  • A history of mental disorders such as anxiety and depression
  • Chronic pain
  • Alcohol, drugs, or certain medicines
  • Shift work
  • Obesity
  • Use of multiple medications

Symptoms

Symptoms include:

  • Difficulty falling asleep
  • Waking up frequently during the night with difficulty returning to sleep
  • Waking up too early
  • Feeling unrefreshed after sleep
  • Irritability, anxiety, inability to concentrate, unexplained symptoms like muscle aches or pains

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. You will also be asked about your job, eating habits, and drug and alcohol use. The doctor will also ask about your schedule and travel patterns. You may be asked to keep a sleep diary. This will include information about your naps, bedtime, and how often you awaken during the night.

Laboratory Testing

Polysomnography

Certain types of insomnia or severe daytime sleepiness may be observed in a sleep lab. You will spend the night in a special center. Your movements, breathing, and brain activity are monitored. This will allow your doctor to identify a treatable condition that is affecting your sleep.

Monitored Breathing During Polysomnography

Sleep monitor apnea
© 2009 Nucleus Medical Art, Inc.

Treatment

Treat Underlying Medical Conditions

A number of physical and mental disorders can disrupt sleep. Diagnosis and treatment of underlying illness, such as restless legs syndrome, may prevent insomnia.

Identify and Modify Behaviors That Worsen Insomnia

  • Reduce or avoid caffeine, alcohol, and drug use.
  • Go to bed and wake up at the same time each day.
  • If you must take naps, keep them short.
  • Do not smoke close to bedtime.

Medications

Sleeping pills are available by prescription or over the counter. Some doctors advise against the long-term use of sleeping pills. They may cause dependence.

Proper prescription sleep medicine can be effective. They should not interfere with memory, work functioning, or daytime drowsiness.

Most over-the-counter sleep medications contain diphenhydramine (Benadryl). This antihistamine will help many people fall asleep more rapidly. It will probably improve sleep quality. Elderly persons may have a variety of adverse effects to this drug. They should discuss its use with their doctor.

Herbal Therapies and Supplements

Some people use the herb valerian to reduce insomnia. Others take melatonin. In the US, these products do not undergo the same testing as drugs. Their long-term impact, side effects, and possible interactions with other drugs or medical conditions are often unknown.

Relaxation Therapy

This may reduce or eliminate anxiety and body tension. therapy. This stops the mind from racing and allows the muscles to relax so that restful sleep can occur. It may include deep breathing, stopping thought, and using progressive relaxation.

Sleep Restriction

A sleep restriction program at first allows only a few hours of sleep during the night. This is usually about five hours. Gradually, the time is increased until a more normal night's sleep is achieved.

Reconditioning

Reconditioning helps people associate the bed and bedtime with sleep. This means not using the bed for activities other than sleep and sex. As part of the reconditioning process, the person is usually advised to go to bed only when sleepy.

Prevention

To reduce your chance of having insomnia:

  • Minimize intake of caffeinated food and drinks after lunch (like coffee, tea, chocolate, cola drinks).
  • Avoid eating too fast or too much. Do not eat too close to bedtime.
  • Avoid drinking fluids before bedtime.
  • Do not smoke.
  • Exercise regularly, but not within less than three hours of bedtime.
  • Use the bedroom only for sleep and sex.
  • Schedule relaxing bedtime routines. Listen to quiet music or soak in warm water.
  • Make sure that the bedroom is not too cold or too hot.
  • Use a humidifier or dehumidifier as needed.
  • Get more sunlight or ultraviolet light during the day.
  • Use shades or lined drapes. Or wear an eye mask to reduce sleep disruption.
  • Use earplugs, or listen to relaxing music or white noise. This helps reduce the disturbing effects of noise.
  • Make sure your mattress is supportive and the bedding is comfortable.
  • Avoid "clock watching" after going to bed.
  • Keep bedtimes and wake-times consistent throughout the week.
  • If you cannot avoid naps, keep them short.