Insomnia Overview:

What is  the definition of Insomnia?

According to guidelines from a physician group, insomnia is difficulty falling asleep or staying asleep, even when a person has the chance to do so. People with insomnia can feel dissatisfied with their sleep and usually experience one or more of the following symptoms: fatigue, low energy, difficulty concentrating, mood disturbances, and decreased performance in work or at school.

How long does insomnia last?

Insomnia may be characterized based on its duration. Acute insomnia is brief and often happens because of life circumstances (for example, when you can't fall asleep the night before an exam, or after receiving stressful or bad news).

Many people may have experienced this type of passing sleep disruption, and it tends to resolve without any treatment. Chronic insomnia is disrupted sleep that occurs at least three nights per week and lasts at least three months. Chronic insomnia disorders can have many causes. Changes in the environment, unhealthy sleep habits, shift work, other clinical disorders, and certain medications could lead to a long-term pattern of insufficient sleep.

People with chronic insomnia may benefit from some form of treatment to help them get back to healthy sleep patterns.
Chronic insomnia can be comorbid, meaning it is linked to another medical or psychiatric issue, although sometimes it's difficult to understand this cause and effect relationship.

People with insomnia tend to have difficulty falling asleep (onset), staying asleep (maintenance), and/or they wake up too early in the morning. Treatment for insomnia can include behavioral, psychological, medical components or some combination thereof. You and your doctor will need to talk about your particular situation and history of insomnia, as well as its causes, to decide on the best treatment plan.

What are some facts about insomnia?

Insomnia is a common sleep problem for adults. The National Institutes of Health estimates that roughly 30 percent
of the general population complains of sleep disruption, and approximately 10 percent have associated symptoms of daytime functional.

What are Different Types of Insomnia?

There are multiple ways to describe insomnia:

1. Acute insomnia:

A brief episode of difficulty sleeping. Acute insomnia is usually caused by a life event, such as a stressful change in a person's job, receiving bad news, or travel. Often acute insomnia resolves without any treatment.

2. Chronic insomnia:

A long-term pattern of difficulty sleeping. Insomnia is usually considered chronic if a person has trouble falling asleep or staying asleep at least three nights per week for three months or longer. Some people with chronic insomnia have a long-standing history of difficulty sleeping. Chronic insomnia has many causes.

3. Comorbid insomnia:

Insomnia that occurs with another condition. Psychiatric symptoms such as anxiety and depression are known to be associated with changes in sleep. Certain medical conditions can either cause insomnia or make a person uncomfortable at night (as in the case of arthritis or back pain, which may make it hard to sleep.

4. Onset insomnia:

Difficulty falling asleep at the beginning of the night.

5. Maintenance insomnia:

The inability to stay asleep. People with maintenance insomnia wake up during the night and have difficulty returning to sleep.

What Causes Insomnia? 

Sleep habits we learned as children may affect our sleep behaviors as adults. Poor sleep or lifestyle habits that may cause insomnia or make it worse include:

  • Going to bed at a different time each night.
  • Daytime napping.
  • Poor sleeping environment, such as too much noise or light.
  • Spending too much time in bed while awake.
  • Working evenings or night shifts.
  • Not getting enough exercise.
  • Using the television, computer, or a mobile device in bed.

 The use of medicines and drugs may also affect sleep, including:

  • Alcohol or other drugs.
  • Heavy smoking.
  • Too much caffeine throughout the day or drinking caffeine late in the day.
  • Getting used to certain types of sleep medicines.
  • Some cold medicines and diet pills.
  • Other medicines, herbs, or supplements.

Physical, social, and mental health issues can affect sleep patterns, including:

  • Bipolar disorder.
  • Feeling sad or depressed. (Often, insomnia is the symptom that causes people with depression to seek medical help).
  • Stress and anxiety, whether it is short-term or long-term. For some people, the stress caused by insomnia makes it even harder to fall asleep.

Health problems may also lead to problems sleeping and insomnia:

  • Pregnancy.
  • Physical pain or discomfort.
  • Waking up at night to use the bathroom, common in men with enlarged prostate.
  • Sleep apnea.

With age, sleep patterns tend to change. Many people find that aging causes them to have a harder time falling asleep, and that they wake up more often.

Insomnia & Depression:

Insomnia can be caused by psychiatric conditions such as depression. Psychological struggles can make it hard to sleep,
insomnia itself can bring on changes in mood, and shifts in hormones and physiology can lead to both psychiatric  issues and insomnia at the same time.

Sleep problems may represent a symptom of depression, and the risk of severe insomnia is much higher in patients with major depressive disorders. Studies show that insomnia can also trigger or worsen depression.

It's important to know that symptoms of depression (such as low energy, loss of interest or motivation, feelings of sadness or hopelessness) and insomnia can be linked, and one can make the other worse. The good news is that both are treatable regardless of which came first.

Insomnia & Anxiety:

Most adults have had some trouble sleeping because they feel worried or nervous, but for some it's a pattern that interferes with sleep on a regular basis.

Anxiety symptoms that can lead to insomnia include:

  • Tension.
  • Getting caught up in thoughts about past events.
  • Excessive worrying about future events.
  • Feeling overwhelmed by responsibilities.
  • A general feeling of being revved up or overstimulated.

It's not hard to see why these symptoms of general anxiety can make it difficult to sleep. Anxiety may be associated with onset insomnia (trouble falling asleep), or maintenance insomnia (waking up during the night and not being able to return to sleep). In either case, the quiet and inactivity of night often brings on stressful thoughts or even fears that keep a person awake.

When this happens for many nights (or many months), you might start to feel anxiousness, dread, or panic at just the prospect of not sleeping. This is how anxiety and insomnia can feed each other and become a cycle that should be interrupted through treatment.

There are cognitive and mind-body techniques that help people with anxiety settle into sleep, and overall healthy sleep practices that can improve sleep for many people with anxiety and insomnia.

Insomnia & Lifestyle:

Insomnia can be triggered or perpetuated by your behaviors and sleep patterns. Unhealthy lifestyles and sleep habits can create insomnia on their own (without any underlying psychiatric or medical problem), or they can make insomnia caused by another problem worse.

Examples of how specific lifestyles and sleep habits can lead to insomnia are:

  • You work at home in the evenings.
  • You take naps (even if they are short) in the afternoon.
  • You sometimes sleep in later to make up for lost sleep.
  • You are a shift worker (meaning that you work irregular hours).


The most common complaints or symptoms in people with insomnia are:

  • Trouble falling asleep on most nights.
  • Feeling tired during the day or falling asleep during the day.
  • Not feeling refreshed when you wake up.
  • Waking up several times during sleep.

People who have insomnia are sometimes consumed by the thought of getting enough sleep. But the more they try to sleep, the more frustrated and upset they get, and the harder sleep becomes.

Lack of restful sleep can:

  • Make you tired and unfocused, so it is hard to do daily activities.
  • Put you at risk for auto accidents. If you are driving and feel sleepy, pull over and take a break.

Exams and Tests:

Your health care provider will do a physical exam and ask about your current medications, drug use, and medical history. Usually, these are the only methods needed to diagnose insomnia.


Not getting 8 hours of sleep every night does not mean your health is at risk. Different people have different sleep needs. Some people do fine on 6 hours of sleep a night. Others only do well if they get 10 to 11 hours of sleep a night.

Treatment often begins by reviewing any drugs or health problems that may be causing or worsen insomnia, such as:

  • Enlarged prostate gland, causing men to wake up at night.
  • Pain or discomfort from muscle, joint, or nerve disorders.

You should also think about lifestyle and sleep habits that may affect your sleep. This is called sleep hygiene. Making some changes in your sleep habits may improve or solve your insomnia. Some people may need medicines to help with sleep for a short period of time. But in the long run, making changes in your lifestyle and sleep habits is the best treatment for problems with falling and staying asleep.

  • Most over-the-counter (OTC) sleeping pills contain antihistamines. These medicines are commonly used to treat allergies. Your body quickly becomes used to them.
  • Sleep medicines called hypnotics can be prescribed by your provider to help reduce the time it takes you to fall asleep. Most of these can become habit-forming.
  • Medicines used to treat anxiety or depression can also help with sleep Different methods of talk therapy may help you gain control over anxiety or depression.

Outlook (Prognosis):

Most people are able to sleep by practicing good sleep hygiene.

When to Contact a Medical Professional:

Call your provider if insomnia has become a problem.

Alternative Names:

Sleep disorder - insomnia; Sleep issues; Difficulty falling asleep; Sleep hygiene - insomnia.

Changing your sleep habits:

Email this page to a friend Print Facebook Twitter Bookmark & Share Sleep patterns are often learned as children. When we repeat these patterns over many years, they become habits.

Insomnia is difficulty falling asleep or staying asleep. In many cases, you can relieve insomnia by making a few simple lifestyle changes. However, it may take some time if you've had the same sleep habits for years.

How much sleep is enough?

People who have insomnia are often worried about getting enough sleep. The more they try to sleep, the more frustrated and upset they get, and the harder it becomes to sleep.

  • While 7 to 8 hours a night is recommended for most people, children and teenagers need more.
  • Older people tend to do fine with less sleep at night. But they may still need about 8 hours of sleep over a 24-hour period.

Remember, the quality of sleep and how rested you feel afterward is as important as how much sleep you get.

Change your lifestyle:

Before you go to bed:

  • Write down all the things that worry you in a journal. This way, you can transfer your worries from your mind to paper, leaving your thoughts quieter and better suited for falling asleep.

During the day:

  • Be more active. Walk or exercise for at least 30 minutes on most days.
  • Do not take naps during the day or in the evening.
  • Stop or cut back on smoking and drinking alcohol. And reduce your caffeine intake.
  • If you are taking any medications, diet pills, herbs, or supplements, ask your health care provider about the effects they may have on your sleep.
  • Find ways to manage stress.
  • Learn about relaxation techniques, such as guided imagery, listening to music, or practicing yoga or meditation.
  • Listen to your body when it tells you to slow down or take a break.

Change your bedtime habits:

Your bed is for sleeping. Do not do things like eat or work while in bed.

Develop a sleep routine:

  • If possible, wake up at the same time each day.
  • Go to bed around the same time every day, but not more than 8 hours before you expect to start your day.
  • Avoid beverages with caffeine or alcohol in the evening.
  • Avoid eating heavy meals at least 2 hours before going to sleep.
  • Find calming, relaxing activities to do before bedtime.
  • Read or take a bath so that you don't dwell on worrisome issues.
  • Do not watch TV or use a computer near the time you want to fall asleep.
  • Avoid activity that increases your heart rate for the 2 hours before going to bed.
  • Make sure your sleep area is quiet, dark, and is at a temperature you like.

If you can't fall asleep within 30 minutes, get up and move to another room. Do a quiet activity until you feel sleepy.

When to call the doctor?

Talk to your doctor if:

  • You're feeling sad or depressed.
  • Pain or discomfort is keeping you awake.
  • You're taking any medicine that may be keeping you awake.
  • You have been taking medicines for sleep without talking to your doctor first.

Medicines for sleep:

Email this page to a friend Print Facebook Twitter Bookmark & Share, Some people may need medicines to help with sleep for a short period of time. But in the long run, making changes in your lifestyle and sleep habits is the best treatment for problems with falling and staying asleep.

Before using medicines for sleep, talk to your doctor about treating other issues, such as:

  • Anxiety.
  • Sadness or depression.
  • Alcohol or illegal drug use.

Over-the-counter sleep medicines:

Most over-the-counter (OTC) sleeping pills contain antihistamines. These medicines are commonly used to treat allergies. While these sleep aids are not addictive, your body becomes used to them quickly. Therefore, they are less likely to help you fall asleep over time.

These medicines can also leave you feeling tired or groggy the next day and can cause memory problems in the elderly.

Sleep medicine from your doctor

Sleep medicines called hypnotics can be prescribed by your doctor to help reduce the time it takes you to fall asleep.
The most commonly used hypnotics are:

  • Zolpidem (Ambien).
  • Zaleplon (Sonata).
  • Eszoicolone (Lunesta).
  • Ramelteon (Rozerem).

Most of these can become habit-forming. Only take these medicines while under the care of a doctor. You will likely be started with the lowest dose possible.

While taking these medicines:

  • Try not to take the sleeping pills more than 3 days per week.
  • Do not stop these medicines suddenly. You may have symptoms of withdrawal and have more trouble falling asleep.
  • Do not take other medicines that can cause you to become drowsy or sleepy.

Side effects of these medicines include:

  • Feeling drowsy or dizzy during the day.
  • Becoming confused or having problems remembering.
  • Balance problems.
  • Rarely, behaviors such as driving, making phone calls, or eating -- all while asleep .

Before taking birth control pills, cimetidine for heartburn, or medicines used to treat fungus infections, tell your doctor you are also taking sleeping pills.

Other medicines for sleep:

Some depression medicines can also be used at lower doses at bedtime, because they make you drowsy. Your body is less likely to become dependent on these medicines. Your doctor will prescribe these drugs and monitor you while you take them.

When to call the doctor?

Side effects to watch out for include:

  • Confusion or euphoria.
  • Increased nervousness.
  • Problems focusing, performing, or driving.
  • Addiction/dependency on medicines for sleep.
  • Morning drowsiness.
  • Increased risk of falls in the elderly.
  • Problems with thinking or memory in the elderly.

Insomnia And You:

Insomnia & Women:

Women are more likely than men to experience insomnia A 2005 National Sleep Foundation poll found that 57% of women and 51% of men said they experienced a symptom of insomnia at least a few nights per week. Unfortunately, only seven percent of women reported receiving treatment for insomnia, according to a separate National Sleep Foundation poll.

This is why keeping good sleep practices is important for women. In addition to general sleep hygiene recommendations, there are many steps that can improve your sleep:

If your insomnia is caused by hormonal fluctuations and hot flashes, keep your room temperature cool and comfortable,
and have a glass of water, a change of pajamas and an extra pillowcase by the bed if you sweat during the night.

  • For insomnia during pregnancy, keep multiple pillows on hand during the night. Try sleeping on your side with one pillow at your back, one between your legs, and one to rest your arms on. Limit your fluid intake during the evening.
  • For many women, insomnia is linked with depression. Relaxation exercises can help, but it's important to see your doctor or a psychotherapist to address these symptoms as well.

There are both medical and non-medical treatment options for insomnia.

Insomnia & Older Adults:

Older adults need seven to nine hours of sleep per night. It's a misconception that as we get older, our sleep needs decline. However, it can be harder for men and women ages 65+ years to stay asleep throughout the night.

There are certain biological changes that make sleep more difficult as we age.

Medical conditions and other sleep disorders can also cause insomnia.

For example, health issues such as gastrointestinal and respiratory problems can disrupt sleep.
Sleep apnea in which a person briefly but repeatedly stops breathing during sleep can also cause insomnia.


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