Definition

Insomnia is a poor quality sleep. This may mean a lack of sleep or difficulty staying asleep. Some have trouble falling asleep, or problems waking in the middle of the night or very early in the morning. It may be characterized as:

• Transient—lasts from a single night to a few weeks
• Intermittent or short term—episodes of transient insomnia occur from time to time
• Chronic—if it occurs on most nights and lasts a month or more; this form usually needs treatment

Causes

There are many causes.

Transient and intermittent insomnia generally occur in people who are temporarily experiencing one or more of the following:

• A life crisis or stress, including the loss of a life partner, divorce, or loss of a job
• Environmental noise
• Extreme temperatures (like a room that is too hot or too cold)
• Change in the surrounding environment (one of the most common causes)
• Sleep/wake schedule problems such as those due to jet lag
• Hormonal shifts during the menstrual cycle, pregnancy, perimenopause, or menopause
• Side effects of medicine
  • Nonprescription: diet aids, decongestants, cold and cough remedies
  • Prescription: steroids, theophylline, phenytoin (Dilantin), levodopa

Chronic insomnia sometimes results from the following conditions:

• Depression
• Mania
• Anxiety
• Arthritis
• Kidney disease
• Fibromyalgia
• Liver failure
• Heart disease
• Asthma
• Sleep apnea
• Narcolepsy
• Parkinson's disease
• Alzheimer's disease
• Hyperthyroidism
• Gastroesophageal reflux disease (GERD) or ulcer
• Restless legs syndrome—a creeping sensation in the lower legs, which only improves when you move your legs; an important cause of insomnia

Chronic insomnia may also be due to behavioral factors, including:

• Misuse of caffeine, alcohol, or other substances
• Disrupted sleep/wake cycles from shift work or other nighttime activities
• Chronic stress

In addition, the following behaviors have been shown to perpetuate insomnia in some people:

• Expecting to have difficulty sleeping and worrying about it—usually starts in young adults
• Smoking cigarettes before bedtime
• Excessive napping in the afternoon or evening

Risk Factors

Factors that increase your chance of getting the condition include:

• Age: 50 or older
• Sex: female (especially during and after menopause)
• Stress
• A history of mental disorders (eg, anxiety, depression)
• Chronic pain
• Alcohol, drugs, or certain medicines
• Shift work
• Obesity
• Use of multiple medicines
• Obstructive airway disease (eg, chronic obstrucive pulmonary disease [COPD])
• Prostate enlargement
• High blood pressure

Symptoms

Symptoms include:

• Difficulty falling asleep
• Waking up frequently during the night with difficulty returning to sleep
• Waking up too early
• Feeling unrefreshed after sleep
• Irritability, anxiety, inability to concentrate, unexplained symptoms like muscle aches or pains

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. You will also be asked about your job, eating habits, and drug and alcohol use. The doctor will also ask about your schedule and travel patterns. You may be asked to keep a sleep diary. This will include information about your naps, bedtime, and how often you awaken during the night. Your doctor will review the medicines you take, including over-the-counter medicines and herbal supplements, to see if any of these may be contributing to your insomnia.

Laboratory Testing

Polysomnography

Certain types of insomnia or severe daytime sleepiness may be observed in a sleep lab. This is called polysomnography. You will spend the night in a special center. Your movements, breathing, and brain activity are monitored. This will allow your doctor to identify a treatable condition that is affecting your sleep.

Monitored Breathing During Polysomnography

© 2009 Nucleus Medical Media, Inc.

Your doctor may also check to make sure that your thyroid is functioning properly.

Treatment

Prevention

To reduce your chance of having insomnia:

• Minimize intake of caffeinated food and drinks after lunch (like coffee, tea, chocolate, cola drinks).
• Avoid eating too fast or too much. Do not eat too close to bedtime.
• Avoid drinking fluids before bedtime.
• Do not smoke.
• Exercise regularly, but not within less than three hours of bedtime.
• Use the bedroom only for sleep and sex.
• Schedule relaxing bedtime routines. Listen to quiet music or soak in warm water.
• Make sure that the bedroom is not too cold or too hot.
• Use a humidifier or dehumidifier as needed.
• Get more sunlight or ultraviolet light during the day.
• Use shades or lined drapes. Or wear an eye mask to reduce sleep disruption.
• Use earplugs, or listen to relaxing music or white noise. This helps reduce the disturbing effects of noise.
• Make sure your mattress is supportive and the bedding is comfortable.
• Avoid "clock watching" after going to bed.
• Keep bedtimes and wake-times consistent throughout the week.
• If you cannot avoid naps, keep them short.