What Is It?

Insomnia is any sleeping problem that makes you feel that your time spent sleeping is inadequate or not refreshing. It includes difficulty falling asleep, waking up too early, waking up periodically during 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 every night for at least one month. Transient insomnia that returns periodically over months or years is classified as intermittent. Insomnia can be related to a medical or psychiatric illness or it can be a result of lifestyle.

Lifestyle factors are usually the cause of transient or intermittent insomnia. They can 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
• Drinking alcoholic beverages before bedtime
• Having a high intake of beverages containing caffeine (coffee, tea, cola) during the day
• Cigarette smoking
• Reducing or stopping your regular dose of sleeping pills or tranquilizers
• Exercising immediately before bedtime
• Taking a hot bath or shower before bed
• Traveling to a location in a different time zone
• Traveling to 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 for 10 seconds to 30 seconds during sleep. Although this apnea triggers only brief periods of arousal during the night, it causes significant daytime sleepiness.
• Narcolepsy — In this condition, the patient’s sleep is disturbed at night, but he or she falls asleep suddenly and involuntarily during the daytime
• Restless legs syndrome — This is 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 also can happen during the day.
• Long-term heavy use of alcohol or caffeine
• Shift work among laborers

An estimated 25 percent to 33 percent of people in the United States currently have some form of insomnia, and sleeping pills are among the most prescribed medicines in the United States. Women are affected more often than men, especially women older than age 60.

Symptoms of insomnia can include:

• Difficulty falling asleep
• Waking up periodically during the night
• Having a normal sleep pattern that doesn’t leave you feeling rested
• Feeling tired and irritable during the day
• Having trouble concentrating

Your doctor often can determine the cause of your insomnia by asking about your lifestyle, by reviewing your symptoms, and by examining you. 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 wake up. 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 need additional tests, such as blood tests and an electrocardiogram (EKG). If your doctor suspects a psychiatric illness, he or she may refer you to a psychiatrist for further evaluation and treatment.

Insomnia may last only one or two nights, or it may persist for weeks, months or years. How long insomnia lasts depends on its cause, and on the success of lifestyle changes and treatment.

In many cases, simple transient or intermittent insomnia can be prevented by adopting a sleep-healthy lifestyle, which includes:

• Following a regular sleep schedule — having a routine bedtime and waking up at roughly the same hour each morning
• Sleeping in loose, comfortable clothes, in a comfortable bed
• Eliminating any sources of noise or bright lights that prevent or disrupt sleep
• Maintaining a comfortable temperature in your bedroom
• Cutting down on beverages containing caffeine during the day, since the stimulating effects of caffeine can last for many hours
• Avoiding heavy meals and alcohol before bedtime
• Exercising daily

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 may be able to prevent insomnia by seeking more effective treatment for your 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 suggest ways to modify these factors. Your doctor also may prescribe a short-acting sleep medication for a few days, especially if insomnia is seriously interfering with your ability to function during the day. In general, nonprescription medications available at drug stores are not recommended.

If you have chronic insomnia, your doctor will search for the cause of your problem and tailor treatment to your 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 help patients with sleep apnea breathe better. Behavioral therapies also may be used to treat some patients with insomnia. These therapies include:

• Relaxation therapy — Special techniques to quiet the mind and relax the muscles
• Sleep restriction — A program that at first 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) by having the patient go to bed only when sleepy and avoid daytime naps

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 problem. For example, patients with restless legs syndrome may find that their symptoms come and go, and may get worse over time. Although patients with narcolepsy often are helped by medication, their illness is long-lasting. In patients with sleep apnea related to a throat obstruction, 80 percent experience relief when they use a nighttime nose mask.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.