Insomnia

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Introduction

What is insomnia?

If you have insomnia, you have trouble falling asleep or remaining asleep. You may not feel refreshed when you wake up. Insomnia may be temporary or acute, or it may be chronic (symptoms occur three or more times a week for more than a month). Insomnia may be due to emotional, neurological, medical or sleep disorders or due to certain medications, stimulants, or drug or alcohol use.

Insomnia can lead to daytime drowsiness, fatigue, slowed reaction times, anxiety, irritability, and depression. It can affect your performance at work or in school. Insomnia can also increase your risk of accidents and falls. According to estimates, drowsy drivers account for more than 100,000 auto accidents each year (Source: NHLBI).

Treatment of insomnia begins with evaluation of possible causes. A sleep diary may be helpful in identifying sleep patterns and the severity of your insomnia. If a sleep disorder is suspected, a sleep study called a polysomnogram may be performed.

If an underlying cause is identified, treating it may be enough to relieve the insomnia. Lifestyle changes, such as exercising in the morning, avoiding stimulants, such as caffeine past midday, avoiding alcohol before bed, developing good sleep habits, and limiting bedtime distractions, can often be quite helpful. Cognitive-behavioral therapy may be recommended for some people. Medications may also be helpful, but some are habit-forming and some have other potentially serious side effects.

Insomnia may be a temporary problem that resolves on its own or it may be chronic. Seek prompt medical care if you develop chronic insomnia, especially if it is interfering with your daily life or causing other problems. Also seek prompt medical care if you are being treated for insomnia but the symptoms persist, recur or worsen.

Symptoms

What are the symptoms of insomnia?

If you have insomnia you may not feel refreshed when you wake up or you may feel drowsy while you are awake. Drowsiness may contribute to accidents, lack of focus, inattention, and poor performance. Anxiety or depression may occur, or worsen if already present.

Common symptoms of insomnia

You may experience insomnia symptoms daily or just once in a while. Common insomnia symptoms include:

  • Anxiety or irritability
  • Concentration difficulties
  • Daytime drowsiness
  • Decreased attention span
  • Depressed mood
  • Difficulty falling asleep
  • Difficulty remaining asleep
  • Falling asleep during the day
  • Fatigue
  • Feeling like you have not had enough sleep
  • Increased incidents of accidents and falls
  • Poor work or school performance

Symptoms that might indicate a serious condition

In some cases, insomnia may occur with other symptoms that might indicate a serious condition. Seek prompt medical care if you, or someone you are with, have insomnia along with any of these symptoms:

  • Depressed mood
  • Drowsiness that interferes with daily activities
  • Increased anxiety or irritability

Causes

What causes insomnia?

Insomnia can be caused by a variety of medical conditions, neurological conditions, mental health conditions, lifestyle habits, sleep disorders, stress, and some medications. Sometimes, a cause cannot be identified.

Common causes of insomnia

Common causes of insomnia include:

  • Alcohol use

  • Anxiety or worry

  • Certain medications

  • Disruption of normal sleep schedule, such as rotating shift work or travel across time zones

  • Drinking coffee or other caffeinated beverages or using other stimulants

  • Environmental distractions, such as noise, lights, sleep partner issues, or temperature extremes

  • Menopause symptoms such as hot flashes

  • Stress

Other causes of insomnia

Less commonly, insomnia may be due to chronic conditions or sleep disorders. Examples include:

  • Dementia

  • Depression

  • Medical conditions that can cause chronic pain, such as arthritis, neuropathy and injury

  • Medical conditions that can interfere with breathing, such as asthma, chronic obstructive pulmonary disease (COPD, includes emphysema and chronic bronchitis), and congestive heart failure (deterioration of the heart’s ability to pump blood)

  • Medical conditions that frequently awaken you or your sleep partner (need to use bathroom, etc.)

  • Sleep disorders such as restless leg syndrome

  • Tobacco use

      What are the risk factors for insomnia?

      A number of factors increase the risk of developing insomnia. Not all people with risk factors will get insomnia. Risk factors for insomnia include:

      Reducing your risk of insomnia

      You may be able to lower your risk of insomnia by:

      • Avoiding alcohol before bed

      • Avoiding caffeine, tobacco, and other stimulants for at least eight hours before bedtime

      • Avoiding daytime napping

      • Avoiding large meals before bed

      • Establish consistent bedtime routines

      • Exercising early in the day

      • Limiting potential distractions than might keep you awake

      • Observing a regular sleep schedule

      • Preparing your bedroom to enhance sleep

      • Relaxing before going to bed

      • Using your bed only for sleep or sex

      Treatments

      How is insomnia treated?

      Treatment of insomnia begins with seeking regular medical care throughout your life. Regular medical care allows a health care professional to provide early screening tests. Regular medical care also provides an opportunity for your health care professional to promptly evaluate symptoms and your risks for developing insomnia.

      If a specific cause can be identified, insomnia may resolve with treatment of the underlying condition. Exercise may improve sleep, provided it is done several hours before bedtime. Adjusting sleep habits may also be helpful. If these methods are not enough to improve sleep, cognitive-behavioral therapy may be helpful. Medications may be used, but generally are not recommended for long-term use due to the risk of dependence and rebound insomnia.

      Common treatments for insomnia

      Aside from treating its underlying causes, treatment for insomnia may include:

      • Cognitive-behavioral therapy to address sleep-disruptive thoughts and actions
      • Education about healthy sleep habits
      • Temporary use of medications to promote sleep

      What you can do to improve your insomnia

      You also may be able to prevent or limit insomnia by:

      • Avoiding daytime napping
      • Avoiding large meals before bed
      • Establish consistent bedtime routines
      • Getting regular exercise early in the day
      • Going to bed at the same time each night
      • Limiting alcohol, tobacco and caffeine use, especially before bedtime
      • Making your bedroom favorable for sleeping
      • Relaxing before you go to bed
      • Using your bed only for sleep or sex

      Complementary treatments

      Some complementary treatments may help some people to better deal with insomnia. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

      Complementary treatments may include:

      • Acupuncture
      • Massage therapy
      • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products
      • Yoga

      What are the potential complications of insomnia?

      Complications of untreated or poorly controlled insomnia can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of insomnia include:

      • Anxiety and irritability
      • Car accidents and other types of accidents due to drowsiness
      • Decreased performance at school or work
      • Depression
      • Inattention or difficulty focusing on tasks
      • Poor quality of life
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      Medical Reviewer: William C. Lloyd III, MD, FACS
      Last Review Date: 2019 Jan 5
      1. What is insomnia? National Heart Lung and Blood institute. http://www.nhlbi.nih.gov/health/dci/Diseases/inso/inso_signsandsymptoms.html
      2. What is Insomnia? National Sleep Foundation. https://www.sleepfoundation.org/insomnia/content/what-is-insomnia

      3. Insomnia. American Academy of Sleep Medicine. https://aasm.org/resources/factsheets/insomnia.pdf


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