Insomnia

Insomnia Overview

Insomnia is a sleep disorder that is characterized by difficulty falling and/or staying asleep. People with insomnia have one or more of the following symptoms:

Difficulty falling asleep

Waking up often during the night and having trouble going back to sleep
Waking up too early in the morning
Feeling tired upon waking

Types of Insomnia

There are two types of insomnia: primary insomnia and secondary insomnia.

Primary insomnia: Primary insomnia means that a person is having sleep problems that are not directly associated with any other health condition or problem.
Secondary insomnia: Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition (like asthma, depression, arthritis, cancer, or heartburn); pain; medication they are taking; or a substance they are using (like alcohol).

Acute vs. Chronic Insomnia

Insomnia also varies in how long it lasts and how often it occurs. It can be short-term (acute insomnia) or can last a long time (chronic insomnia), It can also come and go, with periods of time when a person has no sleep problems. Acute insomnia can last from one night to a few weeks. Insomnia is called chronic when a person has insomnia at least three nights a week for a month or longer.

Causes of Insomnia

Causes of acute insomnia can include:

  • Significant life stress (job loss or change, death of a loved one, divorce, moving)
  • Illness
  • Emotional or physical discomfort
  • Environmental factors like noise, light, or extreme temperatures (hot or cold) that interfere with sleep
  • Some medications (for example those used to treat colds, allergies, depression, high blood pressure, and asthma) may interfere with sleep
  • Interferences in normal sleep schedule (jet lag or switching from a day to night shift, for example)

Causes of chronic insomnia include:

  • Depression and/or anxiety
  • Chronic stress
  • Pain or discomfort at night

Symptoms of Insomnia

Symptoms of insomnia can include:

  • Sleepiness during the day
  • General tiredness
  • Irritability
  • Problems with concentration or memory

Diagnosing Insomnia

If you think you have insomnia, talk to your health care provider. An evaluation may include a physical exam, a medical history, and a sleep history. You may be asked to keep a sleep diary for a week or two, keeping track of your sleep patterns and how you feel during the day. Your health care provider may want to interview your bed partner about the quantity and quality of your sleep. In some cases, you may be referred to a sleep center for special tests.

Treatment for Insomnia

Acute insomnia may not require treatment. Mild insomnia often can be prevented or cured by practicing good sleep habits (see below). If your insomnia makes it hard for you to function during the day because you are sleepy and tired, your health care provider may prescribe sleeping pills for a limited time. Rapid onset, short-acting drugs can help you avoid effects such as drowsiness the following day. Avoid using over-the-counter sleeping pills for insomnia, because they may have undesired side effects and tend to lose their effectiveness over time.

Treatment for chronic insomnia includes first treating any underlying conditions or health problems that are causing the insomnia. If insomnia continues, your health care provider may suggest behavioral therapy. Behavioral approaches help you to change behaviors that may worsen insomnia and to learn new behaviors to promote sleep. Techniques such as relaxation exercises, sleep restriction therapy, and reconditioning may be useful.

Good Sleep Habits for Beating Insomnia

Good sleep habits, also called sleep hygiene, can help you get a good night’s sleep and beat insomnia. Here are some tips:

  • Try to go to sleep at the same time each night and get up at the same time each morning. Try not to take naps during the day, because naps may make you less sleepy at night.
  • Avoid prolonged use of phones or reading devices (“e-books”) that give off light before bed. This can make it harder to fall asleep.
  • Avoid caffeine, nicotine, and alcohol late in the day. Caffeine and nicotine are stimulants and can keep you from falling asleep. Alcohol can cause waking in the night and interferes with sleep quality.
  • Get regular exercise. Try not to exercise close to bedtime, because it may stimulate you and make it hard to fall asleep. Experts suggest not exercising for at least three to four hours before the time you go to sleep.
  • Don’t eat a heavy meal late in the day. A light snack before bedtime, however, may help you sleep.
  • Make your bedroom comfortable. Be sure that it is dark, quiet, and not too warm or too cold. If light is a problem, try a sleeping mask. If noise is a problem, try earplugs, a fan, or a “white noise” machine to cover up the sounds.
  • Follow a routine to help you relax before sleep. Read a book, listen to music, or take a bath.
    Avoid using your bed for anything other than sleep or sex.
  • If you can’t fall asleep and don’t feel drowsy, get up and read or do something that is not overly stimulating until you feel sleepy.
  • If you find yourself lying awake worrying about things, try making a to-do list before you go to bed. This may help you to not focus on those worries overnight.

A lot happens in your body while you sleep. When you get your ZZZs, you cycle between REM and non-REM sleep.

REM stands for rapid eye movement. During REM sleep, your eyes move quickly in different directions. That doesn’t happen during non-REM sleep.

First comes non-REM sleep, followed by a shorter period of REM sleep, and then the cycle starts over again. Dreams typically happen during REM sleep.

What Happens During Non-REM Sleep?

There are three phases of non-REM sleep. Each stage can last from 5 to 15 minutes. You go through all three phases before reaching REM sleep.

Stage 1: Your eyes are closed, but it’s easy to wake you up. This phase may last for 5 to 10 minutes.

Stage 2: You are in light sleep. Your heart rate slows and your body temperature drops. Your body is getting ready for deep sleep.

Stages 3: This is the deep sleep stage. It’s harder to rouse you during this stage, and if someone woke you up, you would feel disoriented for a few minutes.

During the deep stages of NREM sleep, the body repairs and regrows tissues, builds bone and muscle, and strengthens the immune system.

As you get older, you sleep more lightly and get less deep sleep. Aging is also linked to shorter time spans of sleep, although studies show you still need as much sleep as when you were younger.

What Is REM Sleep?

Usually, REM sleep happens 90 minutes after you fall asleep. The first periodof REM typically lasts 10 minutes. Each of your later REM stages gets longer, and the final one may last up to an hour. Your heart rate and breathing quickens.

You can have intense dreams during REM sleep, since your brain is more active.

Babies can spend up to 50% of their sleep in the REM stage, compared to only about 20% for adults.

The amount of sleep a person needs depends on many factors, including age. In general:

  • Infants require about 12-15 hours a day.
  • Toddlers require about 11-14 hours a day.
  • Pre-school children require 10-13 hours a day.
  • School-age children require 9-11 hours a day.
  • Teenagers need about 8.5-9.5 hours on average.
  • Most adults need 7 to 9 hours a night for the best amount of sleep, although some people may need as few as 6 hours or as many as 10 hours of sleep each day.
  • Women in the first 3 months of pregnancy often need several more hours of sleep than usual.

However, experts say that if you feel drowsy during the day, even during boring activities, you haven’t had enough sleep.

Sleep Debt

The amount of sleep a person needs also increases if he or she has been deprived of sleep in previous days. Getting too little sleep creates a “sleep debt,” which is much like being overdrawn at a bank. Eventually, your body will demand that the debt be repaid.

We don’t seem to adapt to getting less sleep than we need. While we may get used to a sleep-depriving schedule, our judgment, reaction time, and other functions are still impaired.

Consequences of Too Little Sleep

Too little sleep may cause:

  • Memory problems
  • Depression
  • A weakening of your immune system, increasing your chance of becoming sick
  • Increase in perception of pain

Dangers of Sleep Deprivation

Many studies make it clear that sleep deprivation is dangerous. Sleep-deprived people who are tested by using a driving simulator or by performing a hand-eye coordination task perform as badly as or worse than those who are intoxicated.

Sleep deprivation also magnifies alcohol’s effects on the body, so a fatigued person who drinks will become much more impaired than someone who is well rested.

Driver fatigue is responsible for an estimated 83,000 motor vehicle accidents and about 850 deaths each year, according to the
National Highway Traffic Safety Administration. Some researchers, though, believe the numbers are actually much higher. Since drowsiness is the brain’s last step before falling asleep, driving while drowsy can — and often does — lead to disaster. Caffeine and other stimulants cannot overcome the effects of severe sleep deprivation.

The National Sleep Foundation says you are probably too drowsy to drive safely if you:

  • Have trouble keeping your eyes focused
  • Can’t stop yawning
  • Can’t remember driving the last few miles
  • Are daydreaming and have wandering thoughts
  • Have trouble holding your head up
  • Are drifting in and out of lanes

Always exhausted? You’re not alone.

Almost half of Americans don’t get enough sleep, or what they get isn’t good enough. Whether you struggle to fall asleep or can’t seem to stay that way, there’s a reason why the sleep you need is so elusive. Such as:

1. You check your phone before bed.

Social media and email can bring stress. That can make you struggle to sleep, says Joseph Chandler, PhD, an assistant professor of psychology at Birmingham-Southern College.

The other issue with phone time before bedtime? Your brain thinks the artificial light from the screen is daylight. So, your body doesn’t make as much of something called melatonin. That’s a chemical that helps you sleep. If you don’t have enough of it, you may get insomnia — the inability to fall or stay asleep.

The fix: Shut off all digital devices — including your cellphone, computer, and television — at least an hour before you end your day.

Aparajitha Verma, MD, a sleep neurologist at Houston Methodist Hospital in Texas, says you shouldn’t keep your phone near your bed, either, “especially if you’re tempted to check it before you turn out the lights, or worse, in the middle of the night.”

2. You go to bed at different times all week long.

Hitting the hay at 9:30 on Wednesday and midnight on Saturday can throw off your body’s internal clock. That can make it harder for you to fall and stay asleep. It can also make you groggy when you wake up, Verma says.

The fix: You may not be able to go to bed at the same time every day, “but try not to vary by more than 30 to 45 minutes, even on the weekend,” Verma says.

3. You power through your late afternoon slump with a cup of coffee.

Caffeine has many health perks. One major downside? “It disrupts your brain’s ability to keep track of how long it has been awake, making you more alert than you should be,” says Chandler.

If you’re a coffee lover, or you regularly down other drinks with caffeine, you might think that you’ve built up a tolerance to it and that you can still have a cup of coffee before bed.

Chandler says that would have a bad effect on even the most experienced caffeine fiend’s sleep.

The fix: Stop the jolt flow at least 5 hours before you go to bed — sooner if you know you’re especially sensitive. “Most caffeine leaves your system within 7 hours. But if you get really jittery after a single cup of coffee, stick to one before lunch,” Verma says.

4. You wind down with a few adult beverages.

A drink in the evening is fine for most adults (ask your doctor if you’re not sure it’s a good idea for you). Several, or a true before-bed nightcap, can help you fall asleep but can also keep you from getting the deep, restful sleep we’re all after.

What’s more, alcohol is a diuretic that leads to middle-of-the-night trips to the bathroom.

The fix: Stick to one drink per day if you’re a woman, or two drinks max if you’re a man. That’s not only for sleep, but for general health, too. Try to make sure your last sip of beer, wine, or liquor happens at least 2 hours before you plan to hit the sheets.

5. Your bed is anything but dreamy.

If you toss and turn, it could be your mattress, says Robert Rosenberg, DO, medical director of the Sleep Disorders Center in Prescott Valley, AZ.

“The position you sleep in can also make you uncomfortable, which can make it hard to sleep,” he says.

Your dog or cat may also be the cause of your blurry-eyed mornings. Pets that share your bed with you can wake you through the night, even if you don’t remember it the next day.

A partner who kicks or takes up more than half the bed could be the offender, too. They may be rousing you and keeping you from getting the quality sleep you need.

The fix: Kick your pet out of your bed — and make sure they stay out. And if your partner takes up a lot of the bed, consider a bigger mattress. You’ll sleep better if you have room to move.

In the market for a new mattress? Consider a medium-firm model, believed to be the best for preventing back pain. But if, after you make the switch, you’re still feeling that twinge, Rosenberg suggests you sleep on your side with a thin pillow between your legs and knees.

6. Your bedroom is too warm or bright.

A cool room mirrors the natural drop in body temperature you have when you’re sleeping. If your room is too toasty, it becomes harder for your body to cool down the way it needs to. That can make you restless.

The same goes for light. Even small amounts can give you less melatonin, which’ll make you feel alert at bedtime.

But the darker your room, the easier it is for your brain to enter “sleep mode.”

The fix: “Most research shows around 68 degrees is ideal for sleep, but it’s different for everyone,” Verma says. “You may have to play with the thermostat and test having different layers of blankets to figure out what’s right for you.”

If your window coverings let light in, think about light-blocking shades or curtains. You could hang a sheet or blanket over the window.

7. You’re stressed.

If you have a lot on your mind when you get into bed, it’ll be tough for you to fall or stay asleep.

The fix: Get a relaxing pre-bed ritual — and stick to it, even on days when you’re not tense.

“Taking a shower, stretching, or reading a physical book — not a book on a tablet — before bed are all good ways to help your brain wind down,” Verma says.

Meditating can help ease the minds of people who have trouble sleeping. Or you could jot down a few things you’re thankful for. Not only will this simple exercise keep worries at bay; research shows that grateful people are more likely to sleep easier.

8. Your partner saws logs.

You may be used to your partner’s snoring, but that doesn’t mean it doesn’t affect your sleep.

“Most people don’t snore continually, and the volume may vary. So when your partner’s snoring changes, it can wake you up momentarily,” Rosenberg says. That can keep you from the deep, restorative sleep that gives you that refreshed feeling.

The fix: Encourage your partner to see a sleep specialist. Loud snoring can signal a dangerous condition called sleep apnea that causes people to stop breathing for short periods while they sleep.

In the meantime, think about earplugs. Sleep in a separate room, if you must.​ For more information, please visit our LEARN section.

Back To Glossary Index Pg.