What is it?
Insomnia is any sleeping problem that makes you feel that your time spent sleeping is inadequate or unrefreshing. It includes the following: difficulty falling asleep, waking up too early, waking up intermittently in the middle of the night or having a normal sleep pattern that doesn’t leave you feeling rested. Insomnia is classified as transient if it lasts from one night to three to four weeks, but it becomes chronic when it persists almost nightly for at least one month. Transient insomnia that returns periodically over months or years, is classified as intermittent. Insomnia may be related to a medical or psychiatric illness, or it may be a result of lifestyle factors.
Lifestyle factors are particularly important as causes of transient or intermittent insomnia and may include:
- stress or anxiety;
- a change in sleeping environment (being a guest at a hotel or a relative’s home);
- an uncomfortable sleeping environment (too hot, too cold, too bright, too noisy);
- pajamas that are too tight;
- having a bed partner who snores or has disruptive sleep patterns;
- eating a heavy meal before bedtime;
- taking a prescription medication that has insomnia as a side effect (e.g., theophylline);
- drinking alcoholic beverages before bedtime;
- drinking a lot of beverages containing caffeine (coffee, tea, cola) during the day
- cigarette smoking;
- reducing or stopping your regular dose of sleeping pills or tranquilizers;
- being physically inactive during the daytime;
- exercising immediately before bedtime;
- taking a hot bath or shower before bed;
- traveling to a location in a different time zone; or
- traveling to a location at a much higher altitude (altitude insomnia).
Also, women who are pregnant may suffer from insomnia because of hormone changes, worries about the upcoming birth or a more frequent need to urinate. In addition, the unborn baby’s increasing size often makes it harder for the mother to find a comfortable sleeping position. Occasional episodes of insomnia are also fairly common in people older than age 60, although the precise reason for this remains unknown.
Chronic insomnia is more likely to have a medical or psychiatric cause than transient or intermittent insomnia. Some common causes of chronic insomnia include:
- psychiatric illness, especially depression;
- chronic medical illnesses, especially kidney disease, heart failure or asthma;
- painful illnesses, especially arthritis or cancer;
- hormone imbalance, especially hyperthyroidism;
- sleep apnea. In this condition, the patient has episodes in which breathing stops (apnea) for 10 to 30 seconds during sleep. Although this apnea triggers only brief periods of arousal during the night, it produces significant daytime sleepiness;
- narcolepsy, a condition in which the patient suffers from disturbed sleep at night, but falls asleep suddenly and involuntarily during the daytime;
- restless legs syndrome, a movement disorder that causes uncomfortable sensations in the legs. These sensations are typically worse during periods of rest, especially just before sleeping at night, but they may also happen during daytime periods;
- long-term heavy use of alcohol or caffeine.
In addition, workers may suffer from chronic insomnia if they work in shifts.
An estimated 25 percent to 33 percent of Americans currently suffer from some form of insomnia, and sleeping pills are among the most prescribed medicines in the United States. Women are more often affected than men, especially women older than age 60.
Symptoms of insomnia may include any of the following: difficulty falling asleep, waking up too early, waking up intermittently in the middle of the night or having a normal sleep pattern that doesn’t leave you feeling rested. In addition, persons with insomnia may complain that during the day they feel tired and irritable, lack energy and have trouble concentrating.
What your doctor looks for
Your doctor will ask you about all the lifestyle factors that may be triggering your insomnia. He or she will also review your medical history and ask you about symptoms of medical or psychiatric illness. If you have a bed partner, your doctor may ask your partner to describe what they have noticed about your sleep patterns, including any possible episodes of abnormal leg movements (restless legs), sleep apnea or snoring.
Your doctor can often determine the cause of your insomnia by assessing your lifestyle factors, by reviewing your physical or psychiatric symptoms (if present), and by performing a physical examination. If you have no obvious lifestyle risks for insomnia, your doctor may suggest that you keep a sleep diary (a log of your sleep patterns) to provide an exact record of how many hours you sleep and at what times you awaken. In some patients, an overnight sleep study at a sleep clinic may be necessary.
If your doctor suspects that a medical illness is causing your insomnia, you may require an initial workup with routine blood tests, an electrocardiogram (ECG or EKG) or other tests. If sleep apnea is suspected, a sleep study will usually be recommended. This involves having brainwaves and breathing while sleeping through a night. If your doctor suspects a psychiatric illness, he or she may refer you to a psychiatrist for further evaluation and treatment.
As described above, insomnia may last only one or two nights, or it may persist for weeks, months or years. The duration of insomnia depends on its underlying cause, and on the success of lifestyle changes and medical/psychiatric treatment (if necessary).
In many cases, simple transient or intermittent insomnia can be prevented by adopting a sleep-healthy lifestyle. Follow these guidelines for a good night’s sleep.
- Follow a regular sleep schedule: have a routine bedtime and awaken at roughly the same hour each morning.
- Sleep in loose, comfortable clothes, in a comfortable bed.
- Eliminate any sources of noise or bright lights that prevent or disrupt sleep.
- Maintain a comfortable temperature in your bedroom.
- Cut down on beverages containing caffeine during the day, and avoid any caffeine at all after noon, since the stimulating effects of caffeine can last for many hours.
- Avoid heavy meals and alcohol before bedtime.
- Adopt a program of regular daily exercise.
If you are taking sleeping pills or tranquilizers and you need to withdraw from these medications, talk with your doctor about how to do this gradually and safely.
If you suffer from chronic insomnia because of chronic pain, medical illness or psychiatric problems, you can often prevent insomnia by seeking more effective treatment for your underlying health problem. Don’t assume that insomnia is an unavoidable part of your illness.
If lifestyle factors seem to be the cause of your transient or intermittent insomnia, your doctor will offer suggestions about ways to modify these factors. Your doctor may also prescribe a brief course of a short-acting sleep medication, especially if insomnia is seriously interfering with your ability to function during the daytime. In general, nonprescription medications available at drug stores are not recommended.
If you suffer from chronic insomnia, your doctor will search for the cause of your problem and tailor treatment to your individual needs. For example, patients with heart failure may require changes in their heart medications and may benefit from sleeping with the head of the bed elevated. Medications are also available to treat narcolepsy, restless legs syndrome and psychiatric illnesses. Special masks can be used to assist the breathing of patients with sleep apnea.
Behavioral therapies may also be used to treat some patients with insomnia.
- Relaxation therapy. Special techniques to quiet the mind and relax the muscles.
- Sleep restriction. A program that initially permits only a few hours of sleep per night, then gradually increases the nightly sleeping time.
- Reconditioning. A program that teaches the patient to associate the bed only with sleeping and sexual activity. The patient goes to bed only when sleepy and avoids daytime naps.
When to call your doctor
Call your doctor whenever you are worried about sleeping problems, especially if insufficient sleep or disturbed sleep is interfering with your ability to function normally during the day. Call your doctor immediately if sleep problems are making it unsafe for you to drive a car or to perform potentially dangerous tasks at work.
In many patients with transient insomnia, normal sleep patterns return within a few days, especially if a short-term lifestyle factor (brief stress, a heavy meal before bed, a change in time zones) disappears or is modified.
In patients with chronic insomnia, the prognosis depends on the underlying chronic problem. For example, patients with restless legs syndrome may find that their symptoms wax and wane, possibly worsening over time. Although patients with narcolepsy often respond to medication, their illness is chronic and typically has no remissions. In patients with sleep apnea related to a throat obstruction, 80 percent experience relief after treatment with a nighttime nose mask.
For more information about insomnia, you can contact:
National Center on Sleep Disorders Research
National Heart, Lung and Blood Institute
Two Rockledge Centre
6701 Rockledge Drive, MSC 7920
Bethesda, MD 20892-7920
Phone: (301) 435-0199
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