What is insomnia?
Insomnia is a common sleep disorder that is characterized by difficulty:
- Falling asleep initially.
- Waking up during the night.
- Waking earlier than desired.
What are the symptoms of insomnia?
Chronic insomnia may cause:
- Difficulty falling asleep and/or waking up in the middle of the night.
- Difficulty returning to sleep.
- Feeling tired/fatigued during the daytime.
- Irritability or depressed mood.
- Problems with concentration or memory.
What are the types of insomnia?
Insomnia can come and go, or it may be an ongoing, longstanding issue. There is short term insomnia and chronic insomnia:
- Short term insomnia tends to last for a few days or weeks and is often triggered by stress.
- Chronic insomnia is when the sleep difficulties occur at least three times a week for three months or longer.
How common is insomnia?
Sleep disorders are very common. They affect up to 70 million Americans every year.
Insomnia symptoms occur in approximately 33% to 50% of the adult population while Chronic Insomnia disorder that is associated with distress or impairment is estimated at 10% to 15%.
How much sleep do most people need?
Most adults need around seven to nine hours of sleep per night but the amount of sleep needed to function at your best varies between individuals. The quality of your rest matters just as much as the quantity. Tossing and turning and repeatedly awakening is as bad for your health as being unable to fall asleep.
Symptoms and Causes
What causes insomnia?
Many things can contribute to the development of insomnia including environmental, physiological and psychological factors, including:
- Life stressors including your job, relationships, financial difficulties and more.
- Unhealthy lifestyle and sleep habits.
- Anxiety disorders, depression and/or other mental health problems.
- Chronic diseases like cancer.
- Chronic pain due to arthritis, fibromyalgia or other conditions.
- Gastrointestinal disorders, such as heartburn.
- Hormone fluctuations due to menstruation, menopause, thyroid disease or other issues.
- Medications and other substances.
- Neurological disorders, such as Alzheimer’s disease or Parkinson’s disease.
- Other sleep disorders, such as sleep apnea and restless legs syndrome.
What are the risk factors for insomnia?
Insomnia occurs more often in women than in men. Pregnancy and hormonal shifts can disturb sleep. Other hormonal changes, such as premenstrual syndrome (PMS) or menopause, can also can affect sleep. Insomnia becomes more common over the age of 60. Older people may be less likely to sleep soundly because of bodily changes related to aging and because they may have medical conditions or take medications that disturb sleep.
What are the consequences of insomnia?
When you can’t fall asleep or your rest is fitful, you may:
Diagnosis and Tests
How is insomnia diagnosed?
There is no specific test to diagnose insomnia. Your healthcare provider will perform a physical exam and ask questions to learn more about your sleep problems and symptoms. The key information for the diagnosis of insomnia is reviewing your sleep history with your doctor. Your provider will also review your medical history and medications you are taking to see if they may be affecting your ability to sleep. You may also:
- Get a blood test: Your doctor may want you do a blood test to rule out certain medical conditions such as thyroid problems or low iron levels that can negatively impact sleep.
- Keep a sleep diary: You may be asked to write down your sleep patterns for one to two weeks (bedtime, wake time, naps, caffeine use, etc.) This information can help your provider identify patterns or behaviors that interfere with rest.
- Complete a sleep study: Sleep studies (polysomnograms) are not necessary for diagnosing insomnia. If your doctor has concerns that your insomnia may be caused by sleep apnea or another sleep disorder, you may be referred. You may go to a sleep disorders center or do the study at home.
Management and Treatment
What are the complications of insomnia?
Over time, lack of sleep or poor quality sleep can negatively affect your physical and mental health. Insomnia can contribute to:
- Driving accidents, injuries and falls.
- High blood pressure (hypertension), heart disease and stroke.
- Mood disorders.
- Weight gain and obesity.
How is insomnia managed or treated?
Short-term insomnia often gets better on its own. For chronic insomnia, your healthcare provider may recommend:
- Cognitive Behavioral Therapy for Insomnia: Therapy (CBT-I): CBT-I is a brief, structured intervention for insomnia that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Unlike sleeping pills, CBT-I helps you overcome the underlying causes of your sleep problems.
- Medications: Behavior and lifestyle changes can best help you improve your sleep over the long term. In some cases, though, taking sleeping pills for a short time can help you sleep. Doctors recommend taking sleep medicines only now and then or only for a short time. They are not the first choice for treating chronic insomnia.
Can melatonin help me sleep?
Your body produces a hormone called melatonin that promotes sleep. Some people take melatonin supplements as a sleep aid. But there’s no proof that these supplements work. Because the U.S. Food and Drug Administration (FDA) doesn’t regulate supplements the same as medications, you should talk to your healthcare provider before taking one.
How can I prevent insomnia?
Lifestyle changes and improvements to your bedtime routine and bedroom setup can often help you sleep better:
- Avoid large meals, caffeine and alcohol before bed.
- Be physically active during the day, outside if possible.
- Cut back on caffeine, including coffee, sodas and chocolate, throughout the day and especially at night.
- Go to bed and get up at the same time each day, including weekends.
- Put away smartphones, TVs, laptops or other screens at least 30 minutes before bedtime.
- Quit smoking.
- Turn your bedroom into a dark, quiet, cool sanctuary.
- Unwind with soothing music, a good book or meditation.
Outlook / Prognosis
What is the prognosis (outlook) for people who have insomnia?
Some people with insomnia sleep better after changing daytime and nighttime behaviors. When these changes don’t help, therapy or medications can improve slumber.
When should I call my healthcare provider?
You should call your healthcare provider if you experience:
- Difficulty concentrating or memory problems.
- Extreme fatigue.
- Mood problems, such as anxiety, depression or irritability.
- More than three months of sleep problems.
What should I ask my healthcare provider about insomnia?
If you have insomnia, you may want to ask your healthcare provider:
- Am I taking any medications keeping me awake?
- What changes can I make to sleep better?
- How does cognitive behavioral therapy improve sleep?
- How do I find a therapist?
- Could I have other sleep disorders like sleep apnea?
If you're suffering from insomnia, don't hesitate to reach out to your healthcare provider for help. They may offer tips for managing issues that interfere with your sleep. Many people with insomnia rest better after changing their diet, lifestyle and nighttime routines. Or they may also recommend medications or cognitive behavioral therapy.