Insomnia (also called insomnia disorder) is a common sleep problem that can affect your quality of life. People with insomnia have trouble falling asleep or staying asleep. They may wake up during the night or wake up too early the next morning.
Your sleep problems may come and go, or they may be ongoing.
A short-term sleep problem is often linked to short-term stress. This short-term insomnia can last for days to weeks. It often gets better in less than a month.
A chronic sleep problem is ongoing. This is called chronic insomnia. It is often a symptom of another health problem, such as depression or chronic pain. Chronic insomnia is less common than short-term sleep problems.
What causes insomnia?
There are many things that can cause sleep problems. Insomnia may be caused by:
Stress. Stress can be caused by fear about a single event, such as giving a speech. Or you may have ongoing stress, such as worry about work or school.
Depression, anxiety, and other mental or emotional conditions.
Poor sleep habits, such as watching TV in bed or not having a regular bedtime schedule. If you have trouble sleeping, you may worry about being able to fall asleep. This can make the problem worse.
Changes in your sleep habits or surroundings. This includes changes that happen where you sleep, such as noise, light, or sleeping in a different bed. It also includes changes in your sleep pattern, such as having jet lag or working a late shift.
Stimulants, such as tobacco and caffeine, as well as certain medicines, alcohol, and drugs.
Lack of regular exercise.
What are the symptoms?
The symptoms of insomnia are different for each person. People with insomnia may:
Have trouble falling asleep. This can mean lying in bed for up to an hour or more, tossing and turning, waiting to fall asleep.
Wake up during the night and have trouble going back to sleep.
Wake up too early in the morning.
Feel tired when they wake up, like they didn't get enough sleep.
Feel grouchy, sleepy, or anxious, and be unable to get things done during the daytime.
Find it difficult to pay attention, focus on tasks, or remember to do things.
How is insomnia diagnosed?
Insomnia is not a disease, and no test can diagnose it. But when you can't sleep well, it often has to do with some other cause. Your doctor will probably assess your current health and ask about any health problems you have had and any medicines you are taking.
Sometimes a doctor will do a physical examination, blood tests, and, in some cases, sleep studies to help find out if you have a health problem that may be causing the insomnia.
Your doctor may also ask about your sleep history—how well you sleep, how long you sleep, your bedtime habits, and any unusual behaviours you may have. Your doctor may ask you to keep a sleep journal, which is a record of your sleep patterns, for a week or two. He or she may recommend a counsellor if your symptoms point to a mental health problem, such as depression or anxiety.
How is it treated?
Treatment for insomnia focuses on the reason why you don't sleep well. If you have a medical problem, such as chronic pain, or an emotional problem, such as stress, treating that problem may help you sleep better. You may be able to sleep better by making some small changes. It may help to:
Go to bed at the same time each night.
Get up at the same time each day.
Avoid caffeine and alcohol for several hours before bedtime.
Get regular exercise. Figure out what time of day works best for your sleep patterns.
Avoid daytime naps.
Some people may need medicine for a while to help them fall asleep. Doctors often prescribe medicine for a short time if other treatment isn't working. But medicine doesn't work as well over time as lifestyle and behaviour changes do. Sleep medicine can also become habit-forming. Medicine works best as a short-term treatment combined with lifestyle and behaviour changes.
Your doctor may also recommend counselling, which can help you learn new habits that may help you sleep better.
Talk to your doctor about your sleep problems and any other health issues you may have. This is important, because lack of sleep can lead to depression, household injuries or car crashes, problems at work, marital and social problems, drinking more alcohol than usual, and poor health. Treatment may help you avoid these problems and feel better.
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Each person experiences insomnia differently. People with insomnia may:
Have trouble falling asleep. This can mean lying in bed for up to an hour or more, tossing and turning, waiting to fall asleep.
Become so worried about or focused on being able to fall asleep that the worry and attention interferes with being able to fall asleep.
Wake up and have trouble falling back to sleep.
Wake up too early in the morning.
Feel tired when they wake up, as if they didn't get enough sleep.
Feel grouchy, sleepy, or anxious, and be unable to get things done during the daytime.
Find it difficult to pay attention, focus on tasks, or remember to do things.
One Man's Story:
"When I wake up at 2 or 3 in the morning, my mind starts processing stuff—things that I need to get done, that I forgot to do. Trying to relieve that anxiety seems to me a very worthwhile sleep prescription."— Cort, 64
Read more about Cort and how he learned to cope with insomnia.
Quality versus quantity of sleep
The quality of their day is what makes people who have insomnia different from people who typically sleep fewer hours or who have a different sleep disorder. With insomnia, you sleep so badly that you feel grouchy and perform poorly during the day. But it is possible to be a restless sleeper or to sleep less than 8 hours a night and yet get the amount of sleep you need. If you wake up refreshed with energy and are able to get things done during the day, then you are probably getting enough sleep.
Not getting enough sleep can affect your quality of life. It can lead to serious problems including household injuries, car crashes, anxiety, and depression. Talk with your doctor if you think that you have insomnia.
Examinations and Tests
Insomnia is not a disease, and no specific test can diagnose it. But it can make you feel bad, and it can affect your health. It can also be a sign of other problems. Your doctor may want to do blood tests to rule out certain medical conditions such as thyroid problems. "Normal sleep" differs for each person. Checking your health and sleep history is an important first step to finding a cause for poor-quality sleep. Talk with your doctor about your medical history and any medical problems you have or any medicines you are taking.
Sleep history
Your doctor can learn a lot about your insomnia and its causes by reviewing your sleep history. He or she can look at how long you sleep each night, how well you sleep, and what unusual behaviours you may have while sleeping, like snoring or gasping. Since you may be unaware of all your sleep problems while you sleep, your doctor may ask your bed partner questions about your sleeping behaviour to better understand your sleep problems. He or she may also ask you to keep a sleep journal for 1 or 2 weeks to monitor your sleep patterns and habits. Your sleep journal can help your doctor spot certain habits that may affect your sleep, or even see signs of a hidden health problem that may need to be checked out.
If your symptoms point to mental health concerns, such as depression or anxiety, you may be referred to a mental health professional.
Sleep studies
If your doctor thinks that you have a sleep disorder, he or she may refer you for a sleep study. When you have a sleep study, you stay overnight in a special sleep lab.
Your doctor may recommend a sleep study if your insomnia seems to be caused by breathing problems (such as sleep apnea) or periodic limb movement disorder, or if you have tried other treatments that haven't worked.
Tossing and turning during the night or having trouble falling asleep can make you sleepy and grouchy during the day. You may have tried some things to help your insomnia that haven't worked. The good news is that there are many treatments to help you sleep better. But first it helps to know the reason why you don't sleep well. If you have a medical problem, such as chronic pain, or an emotional problem, such as stress or depression, treating that problem may help you sleep better.
Treatment options for insomnia
Treatment options include behaviour and lifestyle changes, medicines, and complementary medicines.
Behaviour and lifestyle changes
Getting ready for bed means more than turning down the sheets. Sleep experts know that there are many things that affect how well you sleep. Behaviour and lifestyle changes improve overall sleep quality and the time it takes to fall asleep—without the side effects of sleep medicines. Perhaps most important, these improvements last over time.
To improve your sleep, here are some things you can try:
Relaxation exercises, such as progressive muscle relaxation, may help you if you lie in bed with your mind racing. Try these relaxation exercises:
Choose a healthier way of thinking . Healthy thinking is a way to help you stay well or cope with a health problem by changing how you think. Cognitive-behavioural therapy is a type of counselling that can help you understand why you have sleep problems and can show you how to deal with them. Cognitive-behavioural therapy helps reduce interrupted sleep over time.
Lifestyle changes are simple things you can do that may help you sleep better. These include changing your sleep area or schedule, watching what and when you eat and drink, and being more active. It's also important to keep regular bedtimes and wake times—7 days a week—and to try to avoid taking naps during the day.
In some cases, taking sleeping pills for a short time helps you get some rest, while behaviour and lifestyle changes can help you over the long term. Doctors recommend taking sleep medicines only now and then or only for a short time. They are not the first choice for treating chronic insomnia.
Many sleep medicines cause side effects, such as low blood pressure, anxiety, and nausea. These medicines also may become less effective when your body gets used to them and may cause withdrawal symptoms when you stop using them.
Sleep medicines include:
Prescription sleep medicines, such as zopiclone (Imovane) and zolpidem (Sublinox). They are the first-choice medicines for short-term insomnia.
Benzodiazepines, such as lorazepam (Ativan) and temazepam (Restoril). These medicines help you fall asleep or stay asleep. You need a prescription for these medicines.
Antidepressants that have a calming or sedative effect. These can be used to help you sleep.
Antihistamines. Typically used for allergies, these can provide short-term relief of sleeplessness.
Non-prescription medicines for sleep. These can help, but they also can cause side effects, such as drowsiness the next day. Over time, sleeping pills may not work as well as they did when you first started using them.
To help you decide if you should use sleeping pills to treat insomnia, see:
While Cort does have a prescription for sleeping pills, he uses the medicine only when he needs to be well rested the next day, such as when he has to give a presentation at work. Cort heeds his doctor's warning about becoming dependent on sleeping pills.
"I have a prescription for 5 mg tablets, and I never take a full one. I break them in half, and I never take them more than once in 2 weeks." — Cort, 64
Read more about Cort and how he learned to cope with insomnia.
Complementary medicine
Other treatments for insomnia may include complementary medicine. Two of the most popular natural health products used for insomnia are:
Melatonin, a hormone produced by the brain. You can also buy it as a natural health product. Melatonin has also been used to treat jet lag and poor sleep from working the night shift. The long-term effects of taking melatonin are unknown. If you are using melatonin regularly, talk to your doctor.
Valerian, an herbal sleep remedy. Valerian appears to be safe, and it may improve sleep when taken for a week or two.footnote 1
Don't rely on alcohol
Some people use alcohol to help them sleep, but that's not a good idea. At first, drinking alcohol may make you sleepy and help you fall asleep. But when you drink alcohol, you are more likely to wake up later in the night and have a hard time falling back asleep. This can leave you feeling tired the next day.
Home Treatment
After you and your doctor have treated any health problems related to your insomnia, there are many steps you can take to improve your sleep. Here are a few examples:
Avoid or limit caffeine, nicotine, and alcohol. Don't use them at all late in the day or in the evening.
Check all of your medicines with your doctor to see if they could be affecting your sleep. To help avoid sleep problems, you may be able to adjust your dose or change the time of day you take your medicine.
Use the evening hours for settling down. Avoid watching TV and using the computer or phone if they keep you from getting to sleep.
Create a bedtime routine that you do each night to help teach your body and mind that it is time to wind down. For example, before bed, take a warm shower, listen to soothing music, or have a cup of herbal tea.
Make exercise a regular part of your life. Figure out what time of day works best for your sleep patterns.
Keep your bedroom quiet, dark, and cool. Try using a sleep mask and earplugs to help you sleep.
If you can't fall asleep (or fall back to sleep) after 20 minutes, get out of bed and do a quiet task. This will help you to not link being in bed with not being able to sleep.
If you are overweight, set goals to manage your weight. Being overweight can be linked with sleep problems.
Older adults, especially those living in nursing homes or who are cared for by others, often have ongoing sleep problems. It's natural for your sleep patterns to change as you get older, but it doesn't mean that you need less sleep or that the sleep you do get is enough.
Be sure to talk to your doctor if your sleep problems get worse, you feel very tired, or have a hard time functioning during the day. Also, let your doctor know if your symptoms become more severe or happen more often.
Valerian (2010). In A DerMarderosian et al., eds., Review of Natural Products. St. Louis: Wolters Kluwer Health.
Other Works Consulted
Morin CM, et al. (2009). Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: A randomized controlled trial. JAMA, 301(19): 2005–2015.
Ropper AH, et al. (2014). Sleep and its abnormalities. In Adams and Victor's Principles of Neurology, 10th ed., pp. 395–418. York: McGraw-Hill Education.
Schutte-Rodin S, et al. (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of Clinical Sleep Medicine, 4(5): 487–503.
Credits
Current as of:
August 31, 2020
Author: Healthwise Staff Medical Review: Kathleen Romito MD - Family Medicine Donald Sproule MDCM, CCFP - Family Medicine Adam Husney MD - Family Medicine E. Gregory Thompson MD - Internal Medicine Lisa S. Weinstock MD - Psychiatry Hasmeena Kathuria MD - Pulmonology, Critical Care Medicine, Sleep Medicine
Medical Review:Kathleen Romito MD - Family Medicine & Donald Sproule MDCM, CCFP - Family Medicine & Adam Husney MD - Family Medicine & E. Gregory Thompson MD - Internal Medicine & Lisa S. Weinstock MD - Psychiatry & Hasmeena Kathuria MD - Pulmonology, Critical Care Medicine, Sleep Medicine
