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Insomnia

Definition

Insomnia is difficulty getting to sleep or staying asleep, or having nonrefreshing sleep for at least 1 month.

Alternative Names

Psychophysiological insomnia; Learned insomnia; Chronic insomnia; Primary insomnia

Causes, incidence, and risk factors

Primary insomnia refers to insomnia that is not caused by any known physical or mental condition.

Insomnia is caused by many different things. The most common causes of insomnia are:

• Alcohol
• Anxiety
• Coffee
• Stress

Secondary insomnia is caused by a medical condition. Depression is a very common cause of secondary insomnia. Often, insomnia is the symptom that causes people with depression to seek medical help.

Symptoms

• Difficulty falling asleep on most nights
• Feeling tired during the day or falling asleep during the day
• Not feeling refreshed when you wake up
• Waking up several times during sleep

People who have primary insomnia tend to keep thinking about getting enough sleep. The more they try to sleep, the greater their sense of frustration and distress, and the more difficult sleep becomes.

Signs and tests

Your health care provider will do a physical exam and ask you questions about your current medications, drug use, and medical history. Usually, these are the only methods needed to diagnose insomnia.

Polysomnography, an overnight sleep study, can help rule out other types of sleep disorders (such as sleep apnea).

Treatment

The following tips can help improve sleep. This is called sleep hygiene.

• Avoid caffeine, alcohol, or nicotine before bed.
• Don't take daytime naps.
• Eat at regular times each day (avoid large meals near bedtime).
• Exercise at least 2 hours before going to bed.
• Go to bed at the same time every night.
• Keep comfortable sleeping conditions.
• Remove the anxiety that comes with trying to sleep by reassuring yourself that you will sleep or by distracting yourself.
• Use the bed only for sleep and sex.

Do something relaxing just before bedtime (such as reading or taking a bath) so that you don't dwell on worrisome issues. Watching TV or using a computer may be stimulating to some people and interfere with their ability to fall asleep.

If you can't fall asleep within 30 minutes, get up and move to another room. Engage in a quiet activity until you feel sleepy.

One method of preventing worries from keeping you awake is to keep a journal before going to bed. List all issues that worry you. By this method, you transfer your worries from your thoughts to paper. This leaves your mind quieter and more ready to sleep.

If you follow these recommendations and still have insomnia, your doctor may prescribe medications such as benzodiazepines.

Support Groups

Expectations (prognosis)

You should be able to sleep if you practice good sleep hygiene. See a doctor if you have chronic insomnia that does not improve.

It is important to remember that your health is not at risk if you do not get 6 - 8 hours of sleep every day. Different people have different sleep requirements. Some do fine on 4 hours of sleep a night, while others only thrive if they get 10 - 11 hours.

Sleep requirements also change with age. Listen to your body's sleep signals and don't try to sleep more or less than is refreshing for you.

Complications

Daytime sleepiness is the most common complication, though there is some evidence that lack of sleep can also lower your immune system's ability to fight infections. Sleep deprivation is also a common cause of auto accidents -- if you are driving and feel sleepy, take a break.

Calling your health care provider

Call your doctor if chronic insomnia has become a problem.

Prevention

References

Wilson JF. In the clinic. Insomnia. Ann Intern Med. 2008;148(1):ITC13-1-ITC13-16.

Morgenthaler T, Kramer M, Alessi C, Friedman L, Boehlecke B, Brown T, et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. Sleep. 2006;29:1415-1419.