Insomnia is a condition in which you have trouble falling or staying asleep. Some people with insomnia may fall asleep easily but wake up too soon. Other people may have the opposite problem, or they have trouble with both falling asleep and staying asleep. The end result is poor-quality sleep that doesn't leave you feeling refreshed when you wake up.
Types of insomnia
There are two types of insomnia. The most common type is called secondary insomnia. More than 8 out of 10 people with insomnia are believed to have secondary insomnia. Secondary means that the insomnia is a symptom or a side-effect of some other problem. Some of the problems that can cause secondary insomnia include:
In contrast, primary insomnia is not a side-effect of medicines or another medical problem. It is its own disorder, and generally persists for least 1 month or longer.
Insomnia is a common health problem. It can cause excessive daytime sleepiness and a lack of energy. Long-term insomnia can cause you to feel depressed or irritable; have trouble paying attention, learning, and remembering; and not do your best on the job or at school. Insomnia also can limit the energy you have to spend with friends or family.
Insomnia can be mild to severe depending on how often it occurs and for how long. Chronic insomnia means having symptoms at least 3 nights per week for more than a month. Insomnia that lasts for less time is known as short-term or acute insomnia.
Secondary insomnia often resolves or improves without treatment if you can eliminate its cause. This is especially true if the problem can be corrected soon after it starts. Better sleep habits and lifestyle changes often help relieve insomnia. You may need to see a doctor or sleep specialist to get the best relief for insomnia that is persistent or for which the cause of the sleep problem is unclear.
Causes of secondary insomnia
Secondary insomnia is often a symptom of an emotional, neurological, or other medical disorder, or of another sleep disorder.
The emotional disorders that can cause secondary insomnia include depression, anxiety, and posttraumatic stress disorder. Alzheimer's disease and Parkinson's disease are examples of common neurological disorders that can cause secondary insomnia.
A number of other diseases and conditions can cause secondary insomnia, including:
Sleep disorders, such as restless legs syndrome, also can cause secondary insomnia. In addition, secondary insomnia can be a side-effect of certain medicines or commonly used substances, including:
Causes of primary insomnia
Primary insomnia is not due to another medical or emotional condition and typically occurs for periods of at least 1 month. Whether some people are born with a greater chance of having insomnia is not clear yet. A number of life changes can trigger primary insomnia, including:
These habits include taking naps, worrying about sleep, or going to bed early.
Who is at risk?
Insomnia is a common disorder. One in 3 adults occasionally has insomnia. One in 10 adults has chronic insomnia. Insomnia affects women more often than men, and it can occur at any age. However, older adults are more likely to have insomnia than younger people. People especially prone to insomnia include those who are:
Signs and symptoms
The main symptom of insomnia is trouble falling and/or staying asleep, which leads to lack of sleep. The lack of sleep can cause others symptoms, such as:
Your doctor will usually diagnose insomnia based on your medical history, sleep history, a physical exam, and a sleep study if the cause of your insomnia is unclear.
Your doctor will ask questions to find out whether there is a medical cause for your insomnia. These include questions about whether you:
Other questions are aimed at finding work or leisure habits that might be causing your insomnia. Your doctor may ask about your work and exercise routines; your use of caffeine, tobacco, or alcohol; and your long-distance travel history.
Your doctor also may ask whether you have any new or ongoing work, personal problems, or other stresses in your life. In addition, you may be asked whether you have other family members with sleep problems.
To get a better sense of your sleep problem, your doctor will ask you details about your sleep habits, including:
You may be asked to keep a sleep diary for 1 to 2 weeks so you can answer these questions easily. Your bed partner may help you keep the sleep diary.
To see what might be causing or worsening your insomnia, your doctor will also ask you:
Your doctor will do a physical exam to rule out other medical problems that might cause insomnia. You may also need blood tests to check for thyroid problems or other conditions that can cause sleep problems.
Sleep study (polysomnogram)
A polysomnogram is a recording of your breathing, movements, heart function, and brain activity during sleep. For this study, you sleep overnight at a special sleep center. Your doctor usually will recommend a sleep study if you have signs of another sleep disorder, such as sleep apnea or restless legs syndrome.
Making lifestyle changes that make it easier to fall asleep and/or stay asleep can often relieve insomnia. For longer lasting insomnia, a type of counseling called cognitive-behavioral therapy can help relieve the anxiety linked to your sleep problem. Anxiety tends to prolong the insomnia. Several medicines also can help relieve insomnia and re-establish a regular sleep schedule.
To relieve insomnia, you should avoid substances that make it worse and have good bedtime habits that make it easier to fall asleep and stay asleep. Make sure your bedroom is a comfortable temperature, dark, and quiet enough for sleep.
Avoid substances such as:
Good bedtime habits include:
Cognitive-behavioral therapy for insomnia targets the thoughts and actions that can disrupt sleep. Besides encouraging good sleep habits, this type of therapy may use several methods to relieve sleep anxieties, including:
For success with this type of therapy, you may need to see a therapist who is skilled in this approach weekly over 2 to 3 months. Cognitive-behavioral therapy is as effective as prescription medicine for many types of chronic insomnia. It also may provide better long-term relief than medicine alone.
Several medicines cause sleepiness. Doctors sometimes prescribe sleep-inducing medicine for 1 to 2 weeks to help establish a regular sleep schedule. Insomnia medicine helps you fall asleep, but can leave some people feeling unrefreshed or groggy in the morning. You may also be groggy and should exercise caution if you must get up before getting a full night's sleep of 7 to 8 hours while taking these medicines. The Food and Drug Administration (FDA) hasn't approved all insomnia medicines for continuous, long-term use. Your doctor can help you understand the benefits and potential problems if medicines will be needed for long periods.
Some people use natural remedies to treat their insomnia. These remedies include melatonin and L-tryptophan supplements and valerian teas or extracts. The FDA doesn't regulate these over-the-counter treatments. This means that their dose and purity can vary from product to product. Their safety and effectiveness is not well understood.
Medicines also are available to treat symptoms of excessive sleepiness if your insomnia is the result of shift work or alternating work schedules. You should discuss your situation with your doctor to determine whether these medicines, together with improving sleep habits, can help you overcome insomnia.