Sleep Disorders

Insomnia

Insomnia

A common sleep disorder defined by persistent difficulties falling and/or staying asleep and/or non-restorative sleep.

Insomnia is a common sleep problem that can affect your quality of life. It can cause you to have trouble falling asleep or staying asleep. You may wake up during the night or wake up too early the next morning.

Your sleep problems may come and go, or they may be ongoing.

  • A short-term sleep problem is often linked to short-term stress. This short-term insomnia can last for days to weeks. It often gets better in less than a month.
  • A chronic sleep problem is ongoing. It's called chronic insomnia. It is often a symptom of another health problem, such as depression or chronic pain. Chronic insomnia is less common than short-term sleep problems.

Insomnia is also called insomnia disorder.

The everyday stresses of life—your job, your family or relationships, money problems, jet lag—can keep you from sleeping well. It's also common to have trouble sleeping when you have a fever or an injury. These stresses are often temporary.

Your habits and activities before bedtime, such as drinking coffee, watching TV, or using the computer, can also affect how well you sleep.

And some medical conditions, medicines, and other substances can cause sleep problems that last a long time. These include:
Sleep apnea.
Sleep apnea is breathing that stops during sleep. The problem can be mild or severe, based on how often your lungs don't get enough air. People with sleep apnea often have sleep problems. They also have a higher risk of high blood pressure.
Restless legs syndrome.
This is a problem that produces strong discomfort, aching, or twitching deep in the toes, ankles, knees, or hips—often during sleep. The symptoms can wake you up.
Heart failure.
Many people with heart failure have trouble sleeping. This may be because of trouble breathing or because of depression or anxiety. Many people with heart failure also have sleep apnea.
Ongoing (chronic) pain.
Pain can make it hard to sleep, and chronic pain can lead to sleep deprivation, or sleep debt. Chronic pain has many causes, such as back problems or arthritis.
Mental health problems.
Anxiety, depression, and mania can cause sleep problems.
Medicines and other substances.
Many medicines can cause sleep problems. Examples include antidepressants, cold medicines, steroids, and nonprescription diet aids. Alcohol, caffeine, nicotine, and illegal drugs can also interfere with your sleep.

If you have an illness that's keeping you from sleeping, it can sometimes become a bad cycle. The illness keeps you from sleeping well. And without enough sleep, your body can't fight the illness as well.

Insomnia is most often classified by duration:

  • Transient insomnia - Less than one month
  • Short-term insomnia – Between one and six months
  • Chronic insomnia – More than six months

Insomnia However, insomnia can also be classified as:

  • Primary insomnia – Insomnia that is present with no other co-existing disease. Most of the studies on treating insomnia have been done with people who have primary insomnia.
  • Co-morbid insomnia – When insomnia exists in conjunction with another medical or psychiatric condition. Co-morbid insomnia does not have to be caused by or change with the co-existing disorder. Most cases of insomnia belong to this category. Sometimes, having insomnia can make the medical or psychiatric condition worse and hinder its treatment. For example, people with depression and insomnia do not respond as well to depression treatment as depressed people without insomnia.

Insomnia is not a disease, so no specific test can diagnose it. But when you can't sleep well, it often has to do with some other cause.

"Normal sleep" differs for each person, so checking your health and sleep history is an important first step to finding a cause for poor-quality sleep. Talk with your doctor about your medical history, any medical problems you have, and any medicines you are taking. Your doctor may also want to do blood tests to rule out certain medical conditions such as thyroid problems.

Sleep history
Your doctor can learn a lot about your insomnia and its causes by reviewing your sleep history. Your sleep history can show how long you sleep each night, how well you sleep, and whether you snore or gasp for air. Your doctor may ask your bed partner questions about your sleep.

You may also be asked to keep a sleep journal for 1 or 2 weeks to track your sleep patterns and habits. Your sleep journal can help your doctor spot certain habits that may affect your sleep. He or she may even see signs of a hidden health problem that may need to be checked.

Sleep studies
If your doctor thinks that you have a sleep disorder, he or she may refer you for a sleep study. When you have a sleep study, you stay overnight in a special sleep lab.

Your doctor may recommend a sleep study if your insomnia seems to be caused by breathing problems (such as sleep apnea) or periodic limb movement disorder. Or your doctor may suggest a sleep study if you have tried other treatments that haven't worked.

Making behavior and lifestyle changes can improve your overall sleep quality and help you fall asleep faster. These changes don’t have the side effects that sleep medicines can cause. And the improvements last longer over time.

Cognitive therapy
Cognitive-behavioral therapy for insomnia (CBT-I) is a type of therapy specifically used for insomnia. It can help improve your sleep patterns until you’re able to get more quality sleep.

One part of CBT-I is learning to have good sleep hygiene, which includes getting rid of distractions in your room and keeping a consistent sleep schedule. You also focus on goals such as:

  • Changing thoughts and behaviors that interfere with good sleep.
  • Creating a sleep schedule that gradually helps you sleep more over time.

You can work with a therapist who helps you identify and change thoughts and behaviors that keep you from getting good sleep.

Lifestyle changes
Making simple lifestyle changes may help you sleep better. These may include:

  • Changing your sleep area or schedule. Keep regular bedtimes and wake times every day, and try not to nap during the day.
  • Avoiding big meals or too much fluid later in the evening.
  • Staying active.
  • Avoiding alcohol before bed. Drinking alcohol may make you sleepy. But when you drink alcohol, you are more likely to wake up later in the night and have a hard time falling back asleep.
  • Doing relaxation exercises. For example, you can try progressive muscle relaxation. This may help if you lie in bed with your mind racing.

Medicines
Behavior and lifestyle changes can best help you improve your sleep over the long term. In some cases, though, taking sleeping pills for a short time can help you sleep. Doctors recommend taking sleep medicines only now and then or only for a short time. They are not the first choice for treating ongoing (chronic) insomnia.

Your doctor may recommend prescription or nonprescription sleep medicines. Or you may take other medicines that can help you relax and fall asleep, such as benzodiazepines or antidepressants.

Many sleep medicines cause side effects, such as low blood pressure, anxiety, and nausea. These medicines also may become less effective when your body gets used to them. They may cause withdrawal symptoms when you stop using them.

Complementary medicine
Complementary medicines are sometimes used to treat insomnia. They include dietary supplements, such as melatonin or valerian.

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