Insomnia

Overview

With insomnia, you may lie awake for a long time, wake up often, or wake up too early and not get back to sleep. You may feel tired, unfocused, or irritable during the day.

Short-term insomnia often comes from stress or a change in schedule and goes away on its own. Long-term insomnia can come from health problems, medicines, or habits, and it raises the risk of high blood pressure, heart disease, diabetes, and depression. It's very treatable.

Symptoms

Insomnia affects both nights and days.

• Trouble falling asleep: lying awake for a long time
• Waking up often during the night
• Waking up too early and not getting back to sleep
• Feeling tired or unrested after sleep (fatigue)

Less common

• Trouble focusing or remembering
• Feeling irritable, anxious, or down
• Worrying about sleep, or watching the clock
• Daytime sleepiness

How it usually goes

• Days to weeks: Short-term insomnia often follows stress or a change in schedule.
• 1 to 2 weeks: Keep a sleep diary and try healthy sleep habits.
• 3 months or more: Insomnia that happens 3 or more nights a week for 3 months is long-term; see a healthcare professional about CBT-I.

When to get medical care

Causes

Short-term insomnia often comes from stress, illness, or changes in schedule or surroundings, like jet lag or noise.

Long-term insomnia is often linked to depression or anxiety, other health problems like pain, asthma, or reflux, some medicines like decongestants and steroids, other sleep disorders like sleep apnea or restless legs, and habits like irregular schedules, late caffeine, and screens in bed.

Does it spread or run in families?

• It isn't contagious. You can't catch it from someone else.
• It can run in families. Tell your doctor if a parent, brother, or sister has it.

Who is more likely to get it

• Women, especially during pregnancy and menopause
• Older adults
• Stress, worry, depression, or anxiety
• Shift work or travel across time zones
• Family history of insomnia

Possible complications

• Depression: Insomnia and depression often happen together
• Accidents: Drowsy driving and falls
• Heart and metabolic problems: Higher risk of high blood pressure, heart disease, and diabetes

Diagnosis

A healthcare professional diagnoses insomnia mainly from your sleep history. Keeping a sleep diary for 1 to 2 weeks before your visit helps a lot.

Questions you may be asked

• How often you have trouble sleeping and for how long
• When you go to bed and get up, on workdays and days off
• How long it takes to fall asleep and how often you wake
• Whether you snore, gasp, or have restless legs at night
• Your caffeine, alcohol, nicotine, and screen use, and your medicines

The exam

They'll do a physical exam and listen to your heart and lungs, and look for signs of sleep apnea, like large tonsils.

Tests

Tests are only needed if another problem is suspected:

• Sleep study: An overnight test that looks for sleep apnea, restless legs, or other sleep disorders.
• Actigraphy: A small motion sensor worn on the wrist for 3 to 14 days to track sleep and activity.
• Blood tests: To check for thyroid problems or other conditions that affect sleep.

Treatment

Healthy sleep habits are the first step. For insomnia that lasts, cognitive behavioral therapy for insomnia (CBT-I) is the treatment experts recommend most. Sleep medicines may help for a short time.

Self-care

• Keep the same sleep schedule every day, even on weekends
• Make your bedroom cool, quiet, and dark, and put away screens before bed
• Avoid caffeine, nicotine, and alcohol close to bedtime; caffeine can last up to 8 hours
• Get out of bed if you can't sleep after about 20 minutes, and do something relaxing until you're sleepy
• Be active during the day, but finish exercise at least 5 to 6 hours before bed
• Avoid naps, especially in the afternoon

Medicines

Sleep medicines can help for a short time but don't fix the cause. Ask your healthcare professional before using any sleep aid.

Medicine names link to drug information from the U.S. National Library of Medicine (MedlinePlus). OwieClear doesn't give doses: follow the label or your healthcare professional.

CBT-I teaches you to change thoughts and habits that keep you awake. It includes sleep education, relaxation, and setting a fixed time in bed. If other problems like depression, pain, or sleep apnea are causing your insomnia, treating them helps you sleep.

How it compares

Prevention

Healthy sleep habits help prevent insomnia:

• Keep a regular sleep schedule
• Spend time outside in daylight and be active
• Avoid caffeine late in the day, and alcohol before bed
• Use the hour before bed for quiet time
• Keep your bedroom for sleep, and keep it cool, quiet, and dark

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to a sleep medicine specialist.

Living with it

Support groups and helplines

• Sleep Foundation of the American Academy of Sleep Medicine (sleepeducation.org): Sleep center finder and patient guides.

Children, pregnancy, and older adults

• Children and teens: Set a regular bedtime and routine, and keep screens out of the bedroom. Don't give melatonin to children without asking their healthcare professional.
• Pregnancy and menopause: Hormone changes often affect sleep. Ask your healthcare professional before taking any sleep aid.
• Older adults: Waking during the night is the most common problem. Sleep aids like diphenhydramine can cause confusion and falls; ask about CBT-I first.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

Outlook

Short-term insomnia usually gets better on its own. Long-term insomnia is very treatable, and CBT-I helps most people sleep better over time.

Myths and facts

Getting ready for your visit

A sleep diary for 1 to 2 weeks is the most helpful thing to bring.

What to bring

• A sleep diary: bedtime, wake time, naps, caffeine, alcohol, and exercise
• All medicines and supplements you take
• Notes from your bed partner about snoring or movements

Questions to ask

• What might be causing my insomnia?
• Can I try CBT-I, and where can I find it?
• Could any of my medicines be keeping me awake?
• Do I need a sleep study?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Insomnia