What is insomnia?
Insomnia is a sleep disorder in which people have one or more of the following symptoms:
- Difficulty falling asleep
- Waking up often during the night and having trouble going back to sleep
- Waking up too early in the morning
- Having sleep that is not refreshing
Who gets insomnia?
Approximately 50% of adults experience occasional bouts of insomnia, and 1 in 10 complain of chronic insomnia. Insomnia is approximately twice as common in women as in men, and is more common in older than younger people.
Kinds of insomnia
There are two kinds of insomnia:
- Primary insomnia means that a person is having sleep problems that are not directly associated with any other health condition or problem.
- Secondary (co-morbid) insomnia means that a person is having sleep problems because of something else, such as a health condition (for example, asthma, depression, arthritis, cancer, or heartburn); pain, medicine they are taking; or a substance they are using (such as alcohol).
Insomnia also varies in how long it lasts and how often it occurs. Insomnia can be short-term (acute insomnia) or can last a long time (chronic insomnia). It can also come and go, with periods of time when a person has no sleep problems. Acute insomnia can last from one night to a few weeks. Insomnia is called chronic when a person has insomnia at least three nights a week for a month or longer.
There are still other ways to classify insomnia. One of the most common forms of insomnia is called psychophysiological ("mind-body") insomnia. This is a disorder of learned, sleep-preventing associations, such as not being able to sleep because either your body or your mind is not relaxed. People with this insomnia usually have excessive, daily worries about not being able to fall or stay asleep when desired and worry that their efforts to fall asleep will be unsuccessful. Many people with this condition are concerned that they will never have a good night of sleep again.
Stress is the most common cause of psychophysiological insomnia. While sleep problems are common when going through a stressful event, some people continue to have sleep problems long after the stressful event is over. Sometimes the stress and sleep problems create an ongoing, worsening cycle of each problem.
In addition to stress, what are other causes of insomnia?
Causes of acute insomnia can include:
- Other significant types of life stressors (job loss or change, death of a loved one, moving)
- Emotional or physical discomfort
- Environmental factors such as noise, light, or extreme temperatures (hot or cold) that interfere with sleep
- Things that interfere with a normal sleep schedule (jet lag or switching from a day to night shift, for example)
Causes of chronic insomnia include:
- Chronic stress
- Pain or discomfort at night
What are the symptoms of insomnia?
Symptoms of insomnia include sleepiness during the day, general tiredness, irritability, and problems with concentration or memory.
How is insomnia diagnosed?
If you think you have insomnia, talk to your health care provider. An evaluation may include a physical exam, a medical history, and a sleep history. You may be asked to keep a sleep diary for a week or two, keeping track of your sleep patterns and how you feel during the day. Your health care provider may want to interview your bed partner about the quantity and quality of your sleep. In some cases, you may be referred to a sleep center for special tests.
How is insomnia treated?
Acute insomnia may not require treatment. Mild insomnia often can be prevented or cured by practicing good sleep habits (see below). If your insomnia makes it hard for you to function during the day because you are sleepy and tired, your health care provider may prescribe sleeping pills for a limited time. Rapid onset, short-acting medicines can help you avoid effects such as drowsiness the following day. Some medicines may be less effective after several weeks of nightly use, however, and long-term safety and effectiveness have not yet been established. Avoid using over-the-counter sleeping pills for insomnia.
Treatment for chronic insomnia includes first treating any underlying conditions or health problems that are causing the insomnia. If insomnia continues, your health care provider may suggest behavioral therapy. Behavioral approaches help you to change behaviors that may worsen insomnia and to learn new behaviors to promote sleep. Behavior therapy is commonly used to treat psychophysiological insomnia. Other techniques such as relaxation exercises, biofeedback, sleep restriction therapy, and reconditioning can be tried. Although these techniques require some effort and take time to work, they do provide a means of coping with insomnia that help people return to more normal sleep patterns.
What habits promote a good night's sleep?
Good sleep habits, also called sleep hygiene, can help you get a good night's sleep. For example:
- Think positive. Avoid going to bed with a negative mindset, such as "If I don't sleep for 8 hours, I will feel terrible tomorrow."
- Try to go to sleep at the same time each night and get up at the same time each morning. Try not to take naps during the day because naps may make you less sleepy at night.
- Avoid caffeine, nicotine, and alcohol late in the day. Caffeine and nicotine are stimulants and can keep you from falling asleep. Alcohol can cause waking in the night and interferes with sleep quality.
- Get regular exercise. Try not to exercise close to bedtime because it may stimulate you and make it hard to fall asleep. Experts suggest not exercising for 4 hours before the time you go to sleep.
- Don't eat a heavy meal late in the day. A light snack before bedtime, however, may help you sleep.
- Make your sleeping place comfortable. Be sure that it is dark, quiet, and not too warm or too cold. If light is a problem, try a sleeping mask. If noise is a problem, try earplugs or a fan.
- Relax before going to bed by reading a book, listening to music, taking a bath, or enjoying another activity you find relaxing.
- Avoid using your bed for anything other than sleep or sex.
- If you can't fall asleep and don't feel drowsy, get up and read or do something that is not overly stimulating until you feel sleepy.
- If you have trouble lying awake worrying about things, try making a to-do list before you go to bed. This may help you to not focus on those worries overnight.
- Stop clockwatching. Turn the clock around and only use the alarm.
- Avidan, Alon Y; Zee, Phyllis C. Handbook of Sleep Medicine. 1st edition. Philadephia: Lippincott Williams and Wilkins, 2006.
- Foldvary-Schaefer N. The Cleveland Clinic Guide to Sleep Disorders. New York: Kaplan Publishing, 2009.
- American Sleep Association. Insomnia. Accessed 6/8/2010.
- American Academy of Sleep Medicine. Insomnia. Accessed 6/8/2010.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 10/1/2010...#12119