Insomnia is a persistent disorder that can make it hard to fall asleep, stay asleep, or both. The person with insomnia, usually, wakes up without having rested, which takes a toll on their ability to function during the day. Insomnia can undermine not only your energy level and state of mind, but also your health, work performance and quality of life.
How much sleep is enough varies from person to person, most adults need between seven and eight hours per night. Many adults experience insomnia at some point, but some people suffer from long-term (chronic) insomnia. Insomnia can be the primary problem or it can be secondary, due to other causes, such as a disease or medication.
Guided Sleep Meditation for Insomnia (Sleep, Relaxation, Calm your Mind)
You do not have to endure sleepless nights, because simple changes in your daily habits can often help.
Symptoms of insomnia
Symptoms of insomnia may include:
- Difficulty falling asleep at night
- Waking up during the night
- Waking up too early
- Not feeling rested after a night of sleep
- Tiredness or sleepiness during the day
- Irritability, depression or anxiety
- Difficulty paying attention, focusing on tasks or remembering
- Increase of errors or accidents
- Tension headaches
- Anguish in the stomach and intestines (gastrointestinal tract)
- Concerns about sleep
A person with insomnia can take 30 minutes or more to fall asleep and may have only six or fewer hours of sleep for three or more nights a week, for a month or more.
When to see a doctor
If insomnia makes it difficult to function correctly during the day, check with your doctor to determine what might be the cause of your sleep problem and how it can be treated. If your doctor thinks you might have a sleep disorder, you may be referred to a sleep center for special tests.
Causes of insomnia
Common causes of insomnia include:
- Stress. Worries about work, school, health or family can keep your mind active at night, making it hard to fall asleep. Stressful life events – such as the death or illness of a loved one, a divorce or loss of employment – can also lead to insomnia.
- Anxiety. Everyday anxieties, as well as more serious anxiety disorders, such as post-traumatic stress disorder, can interrupt your sleep. Worrying about going to sleep can make it hard for you to fall asleep.
- Depression. It is possible that you sleep too much and that you have difficulty sleeping if you are depressed. Insomnia often occurs with other mental health disorders.
- Medical conditions. If you suffer from chronic pain, breathing difficulties or the need to urinate frequently, you may develop insomnia. Examples of conditions related to insomnia include arthritis, cancer, heart failure, lung disease, gastroesophageal reflux disease (GERD), overactive thyroid, stroke, Parkinson’s disease and Alzheimer’s disease.
- Change in the environment or work schedul . Traveling or working a shift sooner or later can alter the circadian rhythms of the body, making it difficult to fall asleep. Your circadian rhythms act like an internal clock, guiding things such as the sleep-wake cycle, metabolism and body temperature.
- Bad sleep habits. Bad sleep habits include an irregular sleep schedule, stimulating activities before bedtime, an uncomfortable environment and the use of bed for activities other than sleep or sex.
- Drugs. Many prescription medications can interfere with sleep, including some antidepressants, medications for the heart and blood pressure, allergy medications, stimulants (such as Ritalin), and corticosteroids. Many over-the-counter medications, including some combinations of pain medications, decongestants, and weight-loss products, contain caffeine and other stimulants.
- Caffeine, nicotine and alcohol. Coffee, tea, cola and other beverages that contain caffeine are known stimulants. Drinking coffee in the afternoon and later can prevent you from falling asleep at night. Nicotine in tobacco products is another stimulant that can cause insomnia. Alcohol is a sedative that can help you fall asleep, but it avoids the deeper stages of sleep and often causes you to wake up in the middle of the night.
- Eat too late at night. Taking a light snack before bed is fine, but eating too much can make you feel physically uncomfortable when lying down, which makes it hard to fall asleep. Many people also experience heartburn, acid reflux and food from the stomach into the esophagus after eating, which can keep them awake.
Insomnia and aging
Insomnia becomes more common with age. As you get older, you can experience:
- A change in sleep patterns. Sleep often becomes less restful as you get older, and noise or other changes in your environment may be more likely to wake you up. With age, your internal clock often speeds up, which means you get tired earlier in the night and wake up earlier in the morning. But older people in general still need the same amount of sleep as younger people.
- A change in activity. You can be less physically or socially active. Lack of activity can interfere with a good night’s sleep. Also, the less active you are, the more likely you are to take a long nap every day, which can interfere with your sleep at night.
- A change in health. Chronic pain, from conditions such as arthritis or back problems, as well as depression, anxiety and stress can interfere with sleep. Older men usually develop noncancerous enlargement of the prostate gland (benign prostatic hyperplasia), which can cause the need to urinate frequently, interrupting sleep. In women, the hot flashes of menopause can be equally damaging.
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. The restless legs syndrome causes unpleasant sensations in the legs and an almost irresistible desire to move them, which can prevent you falling asleep.
- More drugs. Older people tend to use more prescription drugs than younger people, which increases the likelihood of insomnia caused by medications.
Sleep problems can be a concern for children and adolescents as well. However, some children and adolescents simply have trouble sleeping or resisting a regular bedtime because their internal clocks are more delayed. Then they want to go to bed later and sleep until later in the morning.
Risk factors for insomnia
Almost everyone has a night of occasional insomnia. But the risk of insomnia is greater if:
- You’re a woman . Women are much more likely to experience insomnia. Hormonal changes during the menstrual cycle and at menopause may play a role. During menopause, night sweats and hot flashes often disturb sleep. Insomnia is also common with pregnancy.
- If you’re older than 60 years. Due to changes in sleep patterns and health, insomnia increases with age.
- You have a mental health disorder. Many disorders – including depression, anxiety, bipolar disorder and post-traumatic stress disorder – interrupt sleep. Waking up early in the morning is a classic symptom of depression.
- You are under a lot of stress. Stressful events can cause temporary insomnia. And the greater the stress or its duration, such as the death of a loved one or a divorce, can lead to chronic insomnia. Being poor or unemployed also increases the risk.
- You work at night or change shifts. Working at night or changing shifts frequently increases the risk of insomnia.
- You travel long distances. Jet lag traveling through multiple time zones can cause insomnia.
How does insomnia affect a person’s health? –Complications of insomnia
Sleep is as important to your health as a healthy diet and regular exercise. Whatever the reason for the loss of sleep, insomnia can affect you both mentally and physically. People with insomnia report a lower quality of life compared to people who are sleeping well.
Complications of insomnia may include:
- Low performance at work or at school
- Increased reaction time during driving and an increased risk of accidents
- Psychiatric problems, such as depression or an anxiety disorder
- Overweight or obesity
- Increased risk and severity of long-term diseases or conditions, such as high blood pressure, heart disease and diabetes
- Substance abuse
Preparing for your medical appointment
If you are having trouble sleeping, you are likely to start by talking with your primary care doctor.
What you can do to prepare for your appointment:
- Ask your doctor if there is anything you should do in advance, such as keeping a sleep diary. In a dream journal, you should record your sleep patterns – bedtime, number of sleeping hours, night awakenings and waking time – as well as your daily routine, naps and how you feel during the day.
- Make a list of the symptoms you are experiencing, including those that may seem unrelated to the reason for the appointment.
- Record key personal information, including new or health problems, your major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements you are taking, including doses. Tell your doctor about anything you have taken to help you sleep.
- Take your partner. Your doctor may want to talk with your partner to learn more about how much and how well you are sleeping.
- Have a list of questions to ask your doctor.
For insomnia, some basic questions to ask your doctor include:
- What is the probable cause of my insomnia?
- Which is the best treatment?
- I have these other health conditions. How can I handle them better?
- Should I go to a sleep clinic? Will my insurance cover it?
- Are there brochures or other printed material that you may have? What websites do you recommend?
Do not hesitate to ask more questions at any time during your appointment.
What to expect from your doctor?
A key part of the insomnia assessment is a detailed history, so your doctor will ask you many questions.
About your insomnia:
- How often do you have trouble sleeping, and when did your insomnia start?
- How long does it take you to fall asleep?
- Do you snore or wake up suffocated by breathing?
- How often do you wake up during the night, and how long does it take you to go back to sleep?
About your day:
- Do you feel rested when you wake up, or are you tired during the day?
- Do you sleep or have trouble keeping awake while sitting quietly or driving?
- All naps during the day?
- What kind of work do you do?
- What is your exercise routine?
- Are you worried about falling asleep or staying asleep?
About your routine before going to bed:
- What is your routine before you go to bed?
- What do you usually eat and drink at night?
- Do you currently take medications or sleeping pills before going to bed? Have you used sleeping pills in the past?
- What time do you go to bed at night and wake up in the morning? Is it different on weekends?
- Where you sleep? What is the level of noise, temperature and lighting in this room?
- How many hours can you sleep at night?
About other issues that may affect your dream:
- Have you recently experienced stressful events, such as divorce, loss of a job or increased demand at work?
- Do you use tobacco or alcohol?
- Do you have any family members with sleep problems?
- Have you traveled recently?
- What medications do you take regularly?
Tests and diagnosis for insomnia
In addition to asking you a series of questions, your doctor may want you to complete a questionnaire to determine your sleep-wake pattern and your level of sleepiness during the day. You may also be asked to keep a sleep diary for a couple of weeks if you have not already done so.
Your doctor will probably do a physical exam to look for signs of other problems that may cause insomnia. Occasionally, a blood test may be required to check for thyroid problems or other conditions that may cause insomnia.
If the cause of your insomnia is not clear, or if you have signs of other sleep disorders, such as sleep apnea or restless legs syndrome, you may have to spend a night in a sleep center, where tests are done to control and record a variety of activities of your body during sleep, including brain waves, breathing, heartbeat, eye movements and body movements.
Treatments and drugs for insomnia
Changing sleep habits and addressing the underlying causes of insomnia, such as medical conditions or medications, can restore restful sleep for many people. If these measures do not work, the doctor may recommend medications to help with relaxation and sleep.
Behavioral therapies Behavioral treatments teach you new sleep behaviors and ways to improve your sleep environment. Good sleep habits promote nighttime sleep and be alert during the day. Behavioral therapies are generally recommended as the first line of treatment for people with insomnia. They are usually as or more effective than sleep medications.
Behavioral therapies include:
- Education about good sleep habits. Good sleep habits include having a regular sleep schedule, avoiding stimulating activities before bedtime, and having a comfortable sleep environment.
- Cognitive behavioral therapy. This type of therapy helps you control or eliminate the negative thoughts and worries that keep you awake. It may also involve eliminating false or worrying beliefs about sleep, such as the idea that a single restless night will make you sick.
- Relaxation techniques. Muscle relaxation, meditation and progressive breathing exercises are ways to reduce anxiety before going to bed. These strategies help control your breathing, heart rate, muscle tension and mood.
- Control of stimuli. This means limiting the time you spend awake in bed and associate bed and bedroom only with sleep and sex.
- Sleep restriction. This treatment decreases the time you spend in bed, making the partial sleep deprivation make you feel more tired the next night. Once your sleep has improved, your time in bed gradually increases.
- Stay passive awake Also called paradoxical intention, this treatment for learned insomnia aims to reduce the worry and anxiety about being able to fall asleep by staying in bed trying to stay awake instead of waiting to fall asleep.
- Light therapy If you fall asleep too soon and then wake up too early, you can use the light to push back the internal clock. You can go outside during the time of year when there is still light at night, or you can use the lighting through a medical grade lightbox.
Prescription medications for insomnia
Taking sleeping pills – such as zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata) or ramelteon (Rozerem) – can help you fall asleep. Generally, doctors do not recommend relying on sleeping pills for more than a couple of weeks, but several medications are approved for long-term use.
Over-the-counter medications to help you sleep
Over-the-counter sleeping medications contain antihistamines that can cause drowsiness. Antihistamines will initially make you feel numb, but they can also reduce the quality of your sleep, and can cause side effects, such as daytime drowsiness, dizziness, urinary retention, dry mouth and confusion. These effects may be worse in older adults. Antihistamines can also worsen urinary problems, causing you to rise to urinate more during the night.
Lifestyle and home remedies for insomnia
No matter what your age, insomnia is usually treatable. The key is often found in the changes in your routine during the day and when you go to bed. Good sleep habits promote nighttime sleep and remain alert during the day. These tips can help.
- Exercise and stay active. The activity helps to promote a good night’s sleep. Perform at least 20 to 30 minutes of vigorous exercise daily, at least five to six hours before bedtime.
- Check your medications. If you take medications regularly, check with your doctor to see if these may be contributing to your insomnia. You can also see the labels on over-the-counter products to see if they contain caffeine or other stimulants, such as pseudoephedrine.
- Avoid or limit naps. Naps can make it hard to fall asleep at night. If you can not get through without one, try to limit your nap to no more than 30 minutes and do not nap after 3:00 p.m.
- Avoid or limit caffeine and alcohol and do not use nicotine. All of these can make it hard for you to fall asleep. Avoid caffeine after lunch. Avoiding alcohol can help you prevent restless sleep and frequent awakenings.
- Do not end the day with pain. If a painful condition bothers you, make sure that the pain reliever you are taking is effective enough to control the pain while you are sleeping.
- Keep a sleep schedule. Keep your bedtime and wake up at a constant hour every day, including weekends.
- Avoid large meals and drinks before bedtime. A light snack is fine. But avoid eating too late at night to reduce the likelihood of gastroesophageal reflux disease (GERD) and improve sleep. Drink less before bed so you do not have to urinate so often.
- Use the bed and the bedroom only to sleep or sex. Do not read, work or eat in bed. Avoid TV, computers, video games, smart phones or other screens just before going to bed, because light can interfere with your sleep cycle.
- Make your bedroom comfortable for sleeping. Close your bedroom door or create a subtle background noise, like a working fan, to help drown out other noises. Keep the temperature of your room comfortable, usually cooler than during the day, and dark. Do not have a computer or a television in your bedroom.
- Hide the bedroom clocks. Put your alarm clock so you know when to get up, but then hide all the clocks in your bedroom, including your watch and cell phone, so you do not worry about the time it is.
- Look for ways to relax. Try to put your worries and planning aside when you get into bed. A warm bath or a massage before bed can help you prepare for sleep. Create a relaxing sleep routine, such as reading, soft music, breathing exercises, yoga or prayer.
- Avoid trying too hard to sleep. The more you try, the more awake you will be. Read in another room until you feel sleepy, and then go to bed to sleep.
- Get out of bed when you are not sleeping. Sleep all you need to feel rested, and then get out of bed. If you can not sleep, get out of bed after 20 minutes and have something relaxing, like reading. Then try again to fall asleep.
Alternative medicine for insomnia
Many people never visit their doctor for insomnia and try to cope with lack of sleep on their own. Although in many cases, safety and efficacy have not been proven, some people try therapies such as:
- Melatonin. This over-the-counter supplement is marketed as a way to help overcome insomnia. Your body naturally produces melatonin, releasing it into the bloodstream in increasing amounts from dusk and decreasing towards dawn. Older people seem to have a greater benefit from melatonin, but there is no convincing evidence to show that melatonin is an effective treatment for insomnia. It is generally considered safe to use for a few weeks, but long-term safety is unknown.
- Valerian. This dietary supplement is sold as an aid to sleep, as it has a slightly sedative effect, although it has not been well studied. Discuss valerian with your doctor before trying. Some people who have used high or long-term doses may have increased their risk of liver damage, although it is not clear if Valerian has caused the damage. When it is time to stop using Valerian, you should do it little by little to avoid withdrawal symptoms.
- Acupuncture. During an acupuncture session, a doctor places many fine needles on the skin at specific points on the body. There is some evidence that this practice may be beneficial for people with insomnia, but more research is needed. If you decide to try acupuncture, along with conventional treatment, ask your doctor how to find a qualified doctor.
- Yoga. Some studies suggest that regular yoga practice can help improve the quality of sleep, and the risks are limited. Make sure you start slow and work with an instructor who listens to you and helps you adapt the poses to your needs and limitations.
- Meditation. Several small studies suggest that meditation, along with conventional treatment, can help improve sleep. Some research suggests that regular meditation practice can have other positive health effects, such as reducing stress and reducing blood pressure.
Because the Food and Drug Administration Federation does not require manufacturers to show proof of efficacy or safety before marketing dietary supplements and sleeping pills, talk to your doctor before taking any herbal supplements or other supplements. OTC products. Some products may interact with other medications, and others – such as L-tryptophan, kava, or 5-hydroxytryptophan (5-HTP) – can be dangerous without medical supervision.