Insomnia is the most common of all
sleep complaints. Almost everyone has occasional sleepless nights,
perhaps due to stress, heartburn or drinking too much caffeine or
alcohol. Insomnia is a lack of sleep that occurs on a regular or
frequent basis, often for no apparent reason.
How much sleep is enough varies.
Although 7 1/2 hours of sleep is about average, some people do fine on 4
or 5 hours of sleep. Other people need 9 or 10 hours a night.
Inability to get a good night's sleep
can affect not only your energy level and mood but your health as well
because sleep helps bolster your immune system. Fatigue, at any age,
leads to diminished mental alertness and concentration. Lack of sleep is
linked to accidents both on the road and on the job.
About one out of three people have
insomnia sometime in their life. Sleeplessness may be temporary or
chronic. You don't necessarily have to live with sleepless nights. Some
simple changes in your daily routine and habits may result in better
Signs and symptoms
Signs and symptoms of insomnia may include:
Inability to sleep
enough at night
asleep at night
Waking up during
Waking up too
restored, even after a full night's sleep
Daytime fatigue or
Common causes of insomnia include:
Concerns about work, school, health or family keep your mind too
active and unable to relax for sleep. Excessive boredom, such as
after retirement or during a long illness, also can create stress
and keep you awake.
Everyday anxieties as well as severe anxiety disorders may keep your
mind too alert to fall asleep.
You may either sleep too much or have trouble sleeping if you're
depressed. This may be due to chemical imbalances in your brain or
because worries that accompany depression may keep you from relaxing
enough to fall asleep when you want to.
Prescription drugs, including some antidepressant, high blood
pressure and steroid medications, can interfere with sleep. Many
over-the-counter (OTC) medications, including some pain medication
combinations, decongestants and weight-loss products, contain
caffeine and other stimulants. Antihistamines may initially make you
groggy, but they can worsen urinary problems, causing you to get up
more during the night.
Change in your
environment or work schedule.
Travel or working a late or early shift can disrupt your body's
circadian rhythms, making you unable to get to sleep when you want
to. The word circadian comes from two Latin words: circa
for "about" and dia for "day." Your circadian rhythms act as
internal clocks, guiding such things as your wake-sleep cycle,
metabolism and body temperature.
of sleep medications.
Doctors generally recommend using sleeping pills for only up to 4
weeks, or until you notice benefits from self-help measures. If you
need sleep medications for longer, take them no more than two to
four times a week, so they don't become habit-forming. Sleeping
pills often become less effective over time. If you're taking
sleeping pills every evening and they help, keep taking them. If
they lose their effectiveness, you might sleep better by slowly
withdrawing from them.
conditions that cause pain.
These include arthritis, fibromyalgia and neuropathies, among other
conditions. Making sure that your medical conditions are well
treated may help with your insomnia.
This may occur when you worry excessively about not being able to
sleep well and try too hard to fall asleep. Most people with this
condition sleep better when they're away from their usual sleep
environment or when they don't try to sleep, such as when they're
watching TV or reading.
Eating too much
too late in the evening.
Having a light snack before bedtime is OK, but eating too much may
cause you to feel physically uncomfortable while lying down, making
it difficult to get to sleep. Many people also experience
a backflow of food from the stomach to the esophagus after eating.
This uncomfortable feeling may keep you awake.
Some people have inherited poor sleep tendency. If that's your case,
be extremely careful not to overexcite yourself, especially in the
Insomnia becomes more prevalent with age. As you get older, three
changes often occur that may affect your sleep. You may experience:
A change in
After age 50, sleep often becomes less restful. You spend more time
in stages 1 and 2 of non-rapid eye movement (NREM) sleep and less
time in stages 3 and 4. Stage 1 is transitional sleep, stage 2 is
light sleep, and stages 3 and 4 are deep (delta) sleep, the most
restful kind. Because you're sleeping lighter, you're also more
likely to wake up. With age, your internal clock often speeds up.
You get tired earlier in the evening and consequently wake up
earlier in the morning.
A change in
You may be less physically or socially active. Activity helps
promote a good night's sleep. You may also have more free time and,
because of that, drink more caffeine or alcohol or take a daily nap.
These things can also interfere with sleep at night.
A change in
The chronic pain of conditions such as arthritis or back problems as
well as depression, anxiety and stress can interfere with sleep.
Older men often develop noncancerous enlargement of the prostate
gland (benign prostatic hyperplasia), which can cause the need to
urinate frequently, interrupting sleep. In women, hot flashes that
accompany menopause can be equally disruptive. Other sleep-related
disorders, such as sleep apnea and restless legs syndrome, also
become more common with age. Sleep apnea causes you to stop
breathing periodically throughout the night and then awaken.
Restless legs syndrome causes unpleasant aches in your legs and an
almost irresistible desire to move them, which may prevent you from
Sleep problems can be a problem for children and teenagers, as well. In
addition to many of the same causes of insomnia as those of adults,
younger people may have trouble sleeping because of conditions such
sleepwalking, night terrors or bruxism — teeth grinding. In addition,
some children and teenagers simply have trouble getting to sleep or
resist a regular bedtime, often because their inherent (circadian) clock
is slow. When the clock on the wall says it's 10 p.m., their bodies may
feel like it's only 8 p.m., because of their slow clock.
When to seek medical advice
If insomnia has been severely interfering with your daytime functioning
for a month or longer, see your doctor to determine what might be the
cause of your sleep problem and how it might be treated.
Screening and diagnosis
Insomnia may be difficult to diagnose because of its partly subjective
nature and because so many factors can affect your sleep. Also, the kind
of sleep patterns and degree of daytime fatigue that some people might
consider to be indications of insomnia other people would not.
Your doctor may ask you questions about your sleep patterns, such as how
long you've experienced your symptoms and whether they occur every
night. Your doctor may also ask about whether you snore, how well you
function during the day, whether you take any medications and whether
you have other health disorders. You may be asked to complete a
questionnaire to determine your wake-sleep pattern and your level of
If your complaint is insomnia, your doctor will only rarely suggest you
spend a night at a sleep disorders center. These centers are accredited
by the American Academy of Sleep Medicine. A team of people at the
center can monitor and record a variety of body activities during the
night, including brain waves, breathing, heartbeat, eye movements and
body movements. But for most people whose main complaint is insomnia,
their sleep is usually so distorted by the laboratory environment that
doctors can learn little useful information.
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This information is
provided for general medical education purposes only and
is not meant to substitute for the independent medical
judgment of a physician relative to diagnostic and
treatment options of a specific patient's medical
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decision made or action taken in reliance upon the
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