What is insomnia?

A person with insomnia has frequent trouble falling and/or staying asleep. Insomnia can be either a long-term or a short-term problem.

Insomnia affects one in three adults every year in the U.S.

How does it occur?

Causes include:

• acute stress such as hospitalization or illness of a relative

• depression, anxiety, and other behavior-related problems

• underlying medical problems such as sleep apnea or hyperthyroidism

• use of caffeine or other stimulants

• use of alcohol, other depressants, or sedatives, which can relax you but lead to shallow, fragmented sleep, especially if used on a long-term basis

• pain, shortness of breath, and other discomfort caused by an illness such as arthritis or congestive heart failure

• poor sleep habits, including going to bed at different times at night or a noisy environment, or eating or working in bed prior to sleeping

• changes in sleep patterns because of different work hours or travel

• rare conditions like restless leg syndrome or nocturnal myoclonus (your legs move continuously or jerk when you go to sleep).

What are the symptoms?

Symptoms include:

• difficulty falling asleep

• waking frequently in the night

• waking early in the morning and being unable to return to sleep

• not feeling rested in the morning and/or feeling tired during the day

• restlessness, anxiety as bedtime approaches.

How is it diagnosed?

Your health care provider will ask you about:

• your sleep patterns

• use of any medications

• eating habits

• your mental and physical condition

• your medical and psychiatric history, and your family's history

• your job and travel patterns.

Your provider may also ask your spouse, bed partner, or other family members about your sleep habits. After this interview, you may have a physical exam and a blood sample may be taken for lab analysis.

You may be asked to write down the following when you get up each morning:

• how long you were in bed

• how much time you think you actually slept

• how many times and what times you awoke

• what time you woke up in the morning

• your thoughts about the quality of your sleep

• whether anything unusual happened.

Your health care provider may suggest that you sleep overnight in a sleep center where you might have a continuous, all-night recording of your breathing, eye movements, muscle tone, blood oxygen levels, heart rate and rhythm, and brain waves during sleep.

How is it treated?

When appropriate, your health care provider will prescribe treatment for any underlying medical disorder. If drug or alcohol abuse is the cause of your insomnia, the treatment is to stop using these substances.

Your provider may recommend relaxation techniques, changes in diet, and a generally healthy lifestyle that includes exercise. Your provider also will probably recommend a regular sleep routine. In some situations, a medication may be prescribed to help you sleep. Other times, counseling is recommended to help resolve psychological problems or reduce stress that may contribute to or underlie your insomnia.

How long will the effects last?

Often insomnia lasts for just a few nights. If you cannot sleep almost every night for two weeks, tell your health care provider. Insomnia that lasts this long usually continues until the cause is identified and corrected.

How can I take care of myself?

• Tell your health care provider if the treatment plan doesn't help.

• Tell your provider if you have side effects from medicine prescribed for the insomnia.

• Follow your provider's instructions for scheduling follow-up visits.

What can I do to help prevent insomnia?

Practice good 'sleep hygiene':

• Establish a regular bedtime and wake-up time and stick to them even on weekends.

• Avoid taking naps, especially in the afternoon.

• Exercise regularly during the day.

• Keep light levels very low after sunset and keep the bedroom very dark.

• Use the bed only for sleep and sex, not for reading or watching television.

• Go to bed when you are drowsy and get up when you are wide awake.

• Avoid caffeine, other stimulants, cigarettes, and alcohol. (If you smoke, try to quit smoking entirely. Cutting back on smoking without quitting may lead to nicotine withdrawal in the middle of the night that awakens you.)

• Learn to use relaxation exercises.

• Try to reduce stress in your life by changing those things causing the stress.

• Read something light or entertaining just before you go to bed, to get your mind off the day's troubles.

• Consider using white noise, such as a fan blowing.

• Try not to focus on falling asleep, for example, by 'clock watching.'