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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
Your sleep problems may come and go, or they may be
There are many things that can cause sleep problems. Insomnia may be
The symptoms of insomnia are different for each person. People with
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 exam, 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 behaviors 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 counselor if your
symptoms point to a mental health problem, such as depression or
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:
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
behavior changes do. Sleep medicine can also become
habit-forming. Medicine works best as a short-term treatment combined with
lifestyle and behavior changes.
Your doctor may also recommend
counseling, which can help you learn new habits that may help you sleep
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, accidents, 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.
Learning about insomnia:
Living with insomnia:
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Each person experiences
insomnia differently. People with insomnia may:
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.
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 injury,
accidents, anxiety, and
depression. Talk with your doctor if you think that
you have insomnia.
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.
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 behaviors 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 behavior to better understand your sleep problems. He or she may also ask you to keep a
sleep journal(What is a PDF document?) 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
anxiety, you may be referred to a mental health
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.
Sleep studies are not helpful for insomnia caused by mental health
chronic fatigue syndrome.
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
Treatment options include behavior and lifestyle
changes, medicines, and complementary medicines.
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. Behavior 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.
improve your sleep, here are some things you can try:
Try these relaxation exercises:
cases, taking sleeping pills for a short time helps you get some rest, while
behavior 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.
advice about medicines applies to everyone, but especially to older adults.
Anyone can become dependent on sleep medicines, and these
medicines can affect how well older people think during and after long-term
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.
To help you decide if you should use sleeping pills to treat
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
Other treatments for insomnia may include complementary and alternative
medicines. Two of the most popular alternative medicines are:
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
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:
For more tips on how to improve your sleep, see:
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.
There are things you
can do to
cope with changing sleep patterns as you get older, such as having familiar
evening and nighttime routines.
Be sure to talk to your doctor if
your sleep problem gets worse, if it lasts for more than 2 weeks, or if your
symptoms become more severe or happen more often.
Martin JL, et al. (2007). Sleep disorders. In RJ Ham et al., eds., Primary Care Geriatrics: A Case-Based Approach, 5th ed., pp. 391–400. St. Louis: Mosby Elsevier.
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, Samuels MA (2009). Sleep and its abnormalities. In Adams and Victor's Principles of Neurology, 9th ed., pp. 374–396. New York: McGraw-Hill.
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.
Current as of:
April 23, 2014
Kathleen Romito, MD - Family Medicine
& Lisa S. Weinstock, MD - Psychiatry
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