Insomnia - overview
Insomnia is trouble falling asleep, staying asleep through the night, or waking up too early in the morning.
Episodes of insomnia may come and go or be long-lasting.
The quality of your sleep is as important as how much sleep you get.
Sleep disorder - insomnia; Sleep issues; Difficulty falling asleep
Sleep habits we learned as children may affect our sleep behaviors as adults. Poor sleep or lifestyle habits that may cause insomnia or make it worse include:
- 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 evenings or night shifts
- Not getting enough exercise
- Using the television, computer, or a mobile device in bed
The use of some medications and drugs may also affect sleep, including:
- Alcohol or other drugs
- Heavy smoking
- Too much caffeine throughout the day or drinking caffeine late in the day
- Getting used to certain types of sleep medicines
- Some cold medicines and diet pills
- Other over-the-counter or prescription medicines, herbs, or supplements
Physical, social, and mental health issues can affect sleep patterns, including:
- Bipolar disorder
- Overactive thyroid gland.
- Waking up at night to use the bathroom.
- Feeling sad or depressed. (Often, insomnia is the symptom that causes people with depression to seek medical help.)
- Physical pain or discomfort.
- Stress and anxiety, whether it is short-term or long-term. For some people, the stress caused by 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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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 are sometimes consumed by the thought of getting enough sleep. But the more they try to sleep, the more frustrated and upset they get, and the harder sleep becomes.
Lack of restful sleep can:
- Make you tired and unfocused, so it is hard to do daily activities.
- Put you at risk for auto accidents. If you are driving and feel sleepy, pull over and take a break.
Exams and tests
Your doctor 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.
Not getting 8 hours of sleep every night does not mean your health is 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 a night.
Treatment often begins by reviewing any drugs or medical conditions that may be causing or worsen insomnia, such as:
- Enlarged prostate gland, causing men to wake up at night
- Pain or discomfort from arthritis or nerve disorders
You should also think about lifestyle and sleep habits that may affect your sleep. 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. It may help to see a psychiatrist or another mental health provider to test for mood or anxiety disorders 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 you sleep and to address any mood or anxiety disorders you might have.
Most people are able to sleep by practicing good sleep hygiene.
When to contact a medical professional
Call your doctor if insomnia has become a problem.
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.
Morin CM, Benca R. Chronic Insomnia. The Lancet. 2012 March24; vol. 379 (9821):1129-1141.
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 Aug 15;5:355-362.
Wickwire EM, Collop NA. Insomnia and sleep-related breathing disorders. Chest. 2010;137:1449-1463.
Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.