Alternate Names: Insomnia; Inability to sleep; Dyssomnia; Sleeplessness; Wakefulness
Considerations: Insomnia is not by itself a disease, but it is an occasional problem for as many as 25% of Americans and a chronic problem for about 10% of the population. It is the most common of the sleep disorders.
Everyone has sleepless nights occasionally, and it is nothing to worry about; however, there are some people who have chronic insomnia where the brain is not getting the rest it needs.
Most adults do best with about 8 hours of sleep a night until age 60, after which 6 hours may be adequate. Even though the elderly need less sleep, almost one-half of people over 60 experience some degree of insomnia.
The best measure of the amount of sleep needed is how the individual feels. If you awaken feeling refreshed, you are getting enough sleep.
The use of long-acting or high-dose sedatives as a cure for insomnia can increase daytime drowsiness and actually create the illusion that a sleep problem is getting worse rather than better. The use of antihistamines as a cure for insomnia can increase daytime drowsiness and also create the illusion that a sleep problem is getting worse rather than better. Chronic antihistamine usage may also lead to reversible memory impairment. Stronger tranquilizers, available by prescription, often induce drug tolerance and do not produce a natural, restful sleep. As a result, one may feel more dependent on the drug and may conclude that more of the drug is needed. The more drug used, the more side effects and tolerance develop. Upon discontinuation of these tranquilizers, rebound worsening of insomnia is very common.
A life-threatening disease is rarely the cause of problems with sleep. Typically, poor sleep habits are the cause.
Insomnia may cause a reduced energy level, irritability, disorientation, dark circles under the eyes, posture changes, and fatigue.
Counseling may be helpful for psychological disorders that lead to insomnia. Nightmares and dreams that interfere with sleep may respond to psychological interventions.
Common Causes:
- jet lag
- shift work
- wake-sleep pattern disturbances
- grief
- depression or major depression
- worry
- anxiety or stress
- exhilaration or excitement
- bed or bedroom not conducive to sleep
- nicotine, alcohol, caffeine, food, or stimulants at bedtime
- aging
- excessive sleep during the day
- excessive physical or intellectual stimulation at bedtime
- overactive thyroid (hyperthyroidism)
- taking a new drug.
- alcoholism or abrupt cessation of alcohol after long-term use
- inadequate bright-light exposure during waking hours
- abruptly stopping a medication (such as sleeping pills).
- medications (for example, excessive thyroid replacement hormone, amphetamines, caffeine-containing beverages, cocaine, ephedrine, phenylpropanolamine, theophylline derivatives)
- withdrawal of medications (such as sedatives or hypnotics)
- interference with sleep by various diseases, including an enlarged prostate (men), cystitis (women), COPD, pain of arthritis, heartburn, and heart or lung problems
- restless leg syndrome
In infant’s:
Most newborn babies wake several times during the night, but by the age of 6 months they typically sleep through the night. At one year, babies will sleep an average of about 16 hours in every 24. Two to three hours of this sleep will be during the day. Causes of sleeplessness in infants may include:
Home Care: ADULTS
Exhaust every possible option before resorting to drugs to cure insomnia.
Avoid using alcohol in the evening. Avoid caffeine for at least 8 hours before bedtime. Give up smoking.
Establish a regular bedtime, but don’t go to bed if you feel wide awake. Use the bedroom for bedroom activities only. Once in bed, use creative imagery and relaxation techniques to keep your mind off unrestful thoughts. Avoid staying in bed for long periods of time while awake, or going to bed because of boredom. If too much time is spent reading or watching TV while in bed, the body becomes accustomed to being awake in bed.
Relax by reading, watching TV, taking a bath, or listening to soothing music before getting to bed.
A snack before bedtime helps many people. Foods such as milk or meat have a natural sleep inducer called L-tryptophan.
Exercise regularly, but not in the last two hours before going to bed. Sex can be a natural sleep inducer and helps some people.
Avoid emotional upset or stressful situations prior to bedtime.
INFANTS
Avoid being readily available to a child during the night; otherwise, the child may become dependent on attention and become sleepless if deprived of it.
CHILDREN
For children who have trouble falling asleep, try to make sure that the child is not disturbed by unnecessary noise. Leaving a radio playing soft music may help cover up disturbing noises.
Avoid sending a child to bed as punishment which can result in poor sleep caused by fear.
Never give a child sleeping medicine without consulting the doctor first. Generally, it is unwise to treat the problem with drugs.
MEDICATION
Medication should be a last resort.
Antihistamines (Sominex, Nytol, and Compoz are all approved by the FDA) are available without a prescription.
Antidepressants such as Elavil require a prescription. Benzodiazepines such as Valium require a prescription. A newer sleeping pill called Ambien also requires a prescription, but is somewhat less addicting than benzodiazepine drugs.
Remember, every drug (over-the-counter or prescription) has potential side effects.
Avoid all sedatives, including the benzodiazepines, during the first 3 months of pregnancy.
Call If:
- a sleeping problem becomes persistent and unbearable.
- home treatment has been tried unsuccessfully for three weeks or more.
- if the insomnia is accompanied by other symptoms such as chest pain or shortness of breath.
What To Expect: The medical history will be obtained and a physical examination performed.
Medical history questions documenting your symptom in detail may include:
- type
- Do you have difficulty falling asleep or staying asleep (insomnia)?
- Do you awaken from sleep not feeling rested?
- Is there difficulty initiating sleep?
- Do you awaken many times at night?
- time pattern
- Is the problem persistent?
- For how long?
- Did the problem seem to be resolving after changing your work shift pattern?
- aggravating factors
- Did it begin after stopping the use of alcohol at bedtime?
- Did it begin after stopping the use of a hypnotic (sleeping pill)?
- What medications do you take?
- Is there any excessive stress or anxiety?
- sleep schedule
- How much do you normally sleep? What hours?
- associated complaints
- Does it occur in response to reminders of a traumatic event?
- Does it occur around the time you ingest some form of a stimulant substance?
- Does it occur around the time you use a hypnotic medication?
- Are you associating the bedroom with insomnia?
- Do you worry excessively about sleep?
- Are there also breath holding spells or times of snoring?
- What other symptoms are also present?
Diagnostic tests that may be performed include:After seeing your health care provider:
If a diagnosis was made by your health care provider related to sleeping difficulty, you may want to note that diagnosis in your personal medical record.
