Insomnia

Insomnia is the inability to sleep. Although many people associate insomnia with difficulty falling asleep, it can also mean frequent sleep disturbance during the night or awakening too early in the morning. While statistics on insomnia vary widely, it is considered a common problem that is frequently undiagnosed and untreated.

Short-lived, or transient insomnia, is the most common type of sleep disturbance and is usually associated with specific events, like jet lag or various types of everyday life stress. This type of insomnia responds well to simple self-care measures.

Chronic (or persistent) insomnia is that which lasts more than a month and may be associated with a number of physical or mental conditions, behavioral factors or drugs. Among the mental or emotional conditions that can cause chronic insomnia are depression, stress, anxiety disorders, and manic disorders. Physical conditions that can cause chronic sleeplessness include arthritis, bursitis and fibromyalgia, benign prostatic hyperplasia (or BPH), heart and circulatory disorders, kidney disease, menopause, and sleep apnea (an interruption in normal breathing caused by airway obstruction; heavy snoring often is associated with sleep apnea).

Behaviors that both cause and aggravate insomnia include being too sedentary on a regular basis (not getting enough exercise); staying in bed too long in the morning, or napping too much during the day. However, vigorous exercise or mental exertion just before bedtime also can cause insomnia.

Drugs are among the most frequent causes of sleeplessness. Culprits include caffeine, nicotine, antidepressants, cardiac medications, decongestants, amphetamines, thyroid medications and bronchodilators, which are prescribed for asthma and similar respiratory conditions. Over-reliance on sleeping pills also can cause chronic insomnia.

Inadequate sleep for extended has many negative results, including drowsiness during the day, headaches, chronic fatigue and a diminished capacity to concentrate. This can impair work performance and rob people of the ability to enjoy life. It also heightens the risk of accidents.

What You Can Do

You can take a number of steps proven to relieve or end insomnia. For example:

  • Exercise on a regular basis. (Avoid exercise within two hours of bedtime, however.)

  • Take a warm bath a couple of hours before retiring, or drink some warm milk before bedtime.

  • Maintain a regular bedtime routine that includes relaxing activities such as reading for pleasure.

  • Reserve the bedroom for sleeping and romance only; avoid paying bills, studying and other potentially distracting activities at bed-time.

  • Avoid drinking alcohol or smoking before bedtime.

  • Don't drink coffee or other caffeinated drinks after noon.

  • Don't take long naps.

Keeping a sleep diary to record patterns of sleep and behaviors may provide insight into how to improve sleep.

What Your Doctor May Do

Chronic insomnia may require consultation with a health care provider who will look for any significant underlying causes.

Diagnosis

To determine the cause of chronic insomnia, your health care provider will complete health history and perform a physical examination. Your health history will include details of any underlying medical conditions you may have, as well as information on the medications you take, stress factors in your life, your exercise habits and how much caffeine, nicotine or alcohol you consume.

Treatment

Treating chronic insomnia may involve a combination of behavioral approaches and medication, at least for a short period. However, there are potential problems associated with all medications used to treat insomnia, however, including daytime drowsiness, memory problems and restlessness (especially among older people). Many of these drugs are also dangerous in combination with alcohol or certain drugs. You should have a thorough discussion with your doctor before taking any sleeping medications.

It's also important to note that long-term use of some types of sleep medications can lead to seizures if you stop taking them abruptly. Sleep inducing medications often have an additive effect when used in combination with drugs that slow the central nervous system (CNS depressants), such as opioids used to relieve pain. Most sleep inducing medications are not recommended for individuals with any of the following:

  • Pregnancy

  • Breathing disorders

  • Alcoholism or patterns of excessive alcohol intake

  • Drug abuse

  • A situation that requires alertness upon awakening

  • Susceptibility to drug side effects

  • Serious or chronic diseases

Final Note

 

Before you see a doctor about your insomnia, see whether the self-care measures listed here help. If these methods don't work, you may be prescribed sleep-inducing medication for a short while to help break the cycle of chronic insomnia. Medication should be used as a last resort, however, and only after medical diagnosis and a thorough discussion with your doctor.

Last Update: 05/17/05
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