| Insomnia
		
			| Topic OverviewWhat is insomnia?Insomnia (also called insomnia disorder) is a common sleep problem that can
		  affect your quality of life. People with insomnia have trouble falling asleep
		  or staying asleep. They 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.
			 This is 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.
 What causes insomnia?There are many things that can cause sleep problems. Insomnia may be
		  caused by: Stress. Stress can be
			 caused by fear about a single event, such as giving a speech. Or you may have
			 ongoing stress, such as worry about work or school. Depression, anxiety, and other mental or emotional
			 conditions.Poor sleep habits, such as
			 watching TV in bed or not having a regular bedtime schedule. If you have
			 trouble sleeping, you may worry about being able to fall asleep. This can make
			 the problem worse.Changes in your sleep habits or surroundings. This includes changes that happen where you sleep, such as
			 noise, light, or sleeping in a different bed. It also includes changes in your
			 sleep pattern, such as having jet lag or working a late
			 shift.Other health problems, such as pain,
			 breathing problems, and
			 restless legs syndrome.Stimulants, such as tobacco and caffeine, as well as certain
			 medicines, alcohol, and drugs.Lack of regular exercise.
 What are the symptoms?The symptoms of insomnia are different for each person. People with
		  insomnia may: Have trouble falling asleep. This can mean
			 lying in bed for up to an hour or more, tossing and turning, waiting to fall
			 asleep.Wake up during the night and have trouble going back to
			 sleep.Wake up too early in the morning.Feel tired
			 when they wake up, like they didn't get enough sleep.Feel grouchy,
			 sleepy, or anxious, and be unable to get things done during the daytime.
			 Find it difficult to pay attention, focus on tasks, or remember to do things.
 How is insomnia diagnosed?Insomnia is not a disease, and no test can diagnose it. But when you
		  can't sleep well, it often has to do with some other cause. Your doctor will
		  probably assess your current health and ask about any health problems you have
		  had and any medicines you are taking. Sometimes a doctor will do a
		  physical exam, blood tests, and, in some cases, sleep studies to help find out
		  if you have a health problem that may be causing the insomnia. Your doctor may also ask about your sleep history-how well you sleep, how
		  long you sleep, your bedtime habits, and any unusual behaviors you may have.
		  Your doctor may ask you to keep a sleep journal, which is a record of your sleep
		  patterns, for a week or two. He or she may recommend a counselor if your
		  symptoms point to a mental health problem, such as depression or
		  anxiety. How is it treated?Treatment for insomnia focuses on the reason why you don't sleep well. If
		  you have a medical problem, such as chronic pain, or an emotional problem, such
		  as stress, treating that problem may help you sleep better. You may be able to
		  sleep better by making some small changes. It may help to: Go to bed at the same time each
			 night.Get up at the same time each day.Avoid caffeine
			 and alcohol for several hours before bedtime.Get regular exercise. Figure out what time of day works best for your sleep
				  patterns.
			 Avoid daytime naps. 
 Some people may need medicine for a while to help them fall
		  asleep. Doctors often prescribe medicine for a short time if other treatment
		  isn't working. But medicine doesn't work as well over time as lifestyle and
		  behavior changes do. Sleep medicine can also become
		  habit-forming. Medicine works best as a short-term treatment combined with
		  lifestyle and behavior changes. Your doctor may also recommend
		  counseling, which can help you learn new habits that may help you sleep
		  better. Talk to your doctor about your sleep problems and any
		  other health issues you may have. This is important, because lack of sleep can
		  lead to depression, accidents, problems at work, marital and social problems,
		  drinking more alcohol than usual, and poor health. Treatment may help you avoid
		  these problems and feel better. Frequently Asked Questions| Learning about insomnia: |  |  | Being diagnosed: |  |  | Getting treatment: |  |  | Living with insomnia: |  | 
SymptomsEach person experiences
		  insomnia differently. People with insomnia may: Have trouble falling asleep. This can mean
			 lying in bed for up to an hour or more, tossing and turning, waiting to fall
			 asleep.Become so worried about or focused on being able to fall asleep that the worry and attention interferes with being able to fall asleep.Wake up and have trouble falling back to
			 sleep.Wake up too early in the morning.Feel tired
			 when they wake up, as if they didn't get enough sleep.Feel grouchy,
			 sleepy, or anxious, and be unable to get things done during the daytime.Find it difficult to pay attention, focus on tasks, or remember to do things.
 Quality versus quantity of sleepThe quality of
			 their day is what makes people who have insomnia different from people who
			 typically sleep fewer hours or who have a different sleep disorder. With
			 insomnia, you sleep so badly that you feel grouchy and perform poorly during
			 the day. But it is possible to be a restless sleeper or to sleep less than 8
			 hours a night and yet get the amount of sleep you need. If you wake up
			 refreshed with energy and are able to get things done during the day, then you
			 are probably getting enough sleep. Not getting enough sleep can
			 affect your quality of life. It can lead to serious problems including injury,
			 accidents, anxiety, and
			 depression. Talk with your doctor if you think that
			 you have insomnia.Exams and TestsInsomnia is not
		  a disease, and no specific test can diagnose it. But it can make you feel bad,
		  and it can affect your health. It can also be a sign of other problems. Your
		  doctor may want to do blood tests to rule out certain medical conditions such
		  as thyroid problems. "Normal sleep" differs for each person. 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 and any
		  medical problems you have or any medicines you are taking. Sleep history Your doctor can learn a lot about your
			 insomnia and its causes by reviewing your
			 sleep history. He or she can look at how long you sleep each night, how well you sleep, and what unusual behaviors you may have while sleeping, like snoring or gasping. Since you may be unaware of all your sleep problems while you sleep, your doctor may ask your bed partner questions about your sleeping behavior to better understand your sleep problems. He or she may also ask you to keep a
			 sleep journal(What is a PDF document?) for 1 or 2 weeks to monitor your sleep
			 patterns and habits. Your sleep journal can help your doctor spot certain habits
			 that may affect your sleep, or even see signs of a hidden health problem that
			 may need to be checked out. If your symptoms point to mental health concerns, such as
			 depression or
			 anxiety, you may be referred to a mental health
			 professional. Sleep studiesIf 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 if you have tried
		  other treatments that haven't worked. Sleep studies are not helpful for insomnia caused by mental health
		  problems,
		  fibromyalgia, or
		  myalgic encephalomyelitis/chronic fatigue syndrome.Treatment OverviewTossing and turning during the night
		  or having trouble falling asleep can make you sleepy and grouchy during the
		  day. You may have tried some things to help your
		  insomnia that haven't worked. The good news is that
		  there are many treatments to help you sleep better. But first it helps to know
		  the reason why you don't sleep well. If you have a medical problem, such as
		  chronic pain, or an emotional problem, such as stress or
		  depression, treating that problem may help you sleep
		  better. Treatment options for insomniaTreatment options include behavior and lifestyle
		  changes, medicines, and complementary medicines. Behavior and lifestyle changesGetting ready for
		  bed means more than turning down the sheets. Sleep experts know that there are
		  many things that affect how well you sleep. Behavior and lifestyle changes improve overall sleep quality and the time it takes to fall asleep-without the side effects of sleep medicines.
		  Perhaps most important, these improvements last over time. To
		  improve your sleep, here are some things you can try: Medicines In some
		  cases, taking sleeping pills for a short time helps you get some rest, while
		  behavior and lifestyle changes can help you over the long term. Doctors
		  recommend taking sleep medicines only now and then or only for a short time.
		  They are not the first choice for treating chronic insomnia. 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 and may cause
		  withdrawal symptoms when you stop using them. Sleep medicines
		  include: Prescription sleep medicines, such as
			 eszopiclone (Lunesta), ramelteon (Rozerem), zaleplon (Sonata), and zolpidem
			 (Ambien). They are the first-choice medicines for short-term insomnia.Orexin receptor antagonists, such as suvorexant (Belsomra). These medicines block chemicals in the brain that keep you awake, helping to promote sleep.Benzodiazepines, such as diazepam (such as Valium), lorazepam (Ativan), and quazepam
			 (Doral). These medicines
			 help you fall asleep or stay asleep. You need a prescription for these
			 medicines.Antidepressants that have a calming or sedative
			 effect. These can be used to help you sleep.Antihistamines.
			 Typically used for allergies, these can provide short-term relief of
			 sleeplessness.Nonprescription medicines for sleep.
			 These can help, but they also can cause side effects, such as drowsiness the
			 next day. Over time, sleeping pills may not work as well as they did when you
			 first started using them.
 To help you decide if you should use sleeping pills to treat
		  insomnia, see: Insomnia: Should I Take Sleeping Pills?
 | One Man's Story: While Cort
				  does have a prescription for sleeping pills, he uses the medicine only when he
				  needs to be well rested the next day, such as when he has to give a
				  presentation at work. Cort heeds his doctor's warning about becoming dependent
				  on sleeping pills.  "I have a prescription for 5 mg tablets, and I
				  never take a full one. I break them in half, and I never take them more than
				  once in 2 weeks." -Cort, 64 Read more about Cort and how he learned to cope with insomnia. | 
 Complementary medicineOther treatments for insomnia may include complementary medicine. Two of the most popular dietary supplements used for insomnia are: Melatonin, a hormone produced by the brain. You can
			 also buy it as a supplement. Melatonin has also been used to treat
			 jet lag and poor sleep from working the
			 night shift. The long-term effects of taking melatonin are unknown. If you are using melatonin regularly, talk to your doctor.Valerian, an herbal sleep remedy.
			 Valerian appears to be safe, and it may improve sleep when taken for a week or
			 two.footnote 1
 Don't rely on alcohol
		  Some people use alcohol to help them sleep, but that's not a good idea. At
		  first, drinking alcohol may make you sleepy and help you fall asleep. But when
		  you drink alcohol, you are more likely to wake up later in the night and have a
		  hard time falling back asleep. This can leave you feeling tired the next
		  day.Home TreatmentAfter you and your doctor have treated
		  any health problems related to your
		  insomnia, there are many steps you can take to improve
		  your sleep. Here are a few examples: Avoid or limit caffeine, nicotine, and alcohol.
			 Don't use them at all late in the day or in the evening.Check all
			 of your medicines with your doctor to see if they could be affecting your
			 sleep. To help avoid sleep problems, you may be able to adjust your dose or
			 change the time of day you take your medicine.Use the evening
			 hours for settling down. Avoid watching TV and using the
computer or phone if they keep you from getting to sleep.Create a bedtime routine that you do each night to help teach your body and mind that it is time to wind down. For example, before bed, take a warm shower, listen to soothing music, or have a cup of herbal tea.Make exercise a regular part of your life. Figure out what time of day works best for your sleep
				  patterns.Keep your bedroom quiet, dark, and cool. Try using a sleep mask
			 and earplugs to help you sleep.If you can't fall asleep (or fall back to sleep) after 20 minutes, get out of bed and do a quiet task. This will help you to not link being in bed with not being able to sleep.If you are overweight, set goals to manage your weight. Being overweight can be linked with sleep problems.Try to avoid napping during the day.
 For more tips on how to improve your sleep, see: Insomnia: Improving Your Sleep.Shift Work Sleep Disorder.Sleep: Helping Your Children-and Yourself-Sleep Well.Sleep Problems: Dealing With Jet Lag.
 Sleep tips for older adultsOlder adults, especially those living in nursing homes or who are cared
		  for by others, often have ongoing sleep problems. It's natural for your sleep
		  patterns to change as you get older, but it doesn't mean that you need less
		  sleep or that the sleep you do get is enough. There are things you
		  can do to
		  cope with changing sleep patterns as you get older, such as having familiar
		  evening and nighttime routines. Treatment if sleep problems don't get betterBe sure to talk to your doctor if
		  your sleep problem gets worse, if it lasts for more than 2 weeks, or if your
		  symptoms become more severe or happen more often.Other Places To Get HelpOrganizationsAmerican Academy of Sleep Medicine: Yoursleep
					 http://yoursleep.aasmnet.orgCenters for Disease Control and Prevention: Sleep and Sleep Disorders (U.S.) www.cdc.gov/sleepReferencesCitationsValerian (2010). In A DerMarderosian et al., eds., Review of Natural Products. St. Louis: Wolters Kluwer Health.
 Other Works ConsultedMorin CM, et al. (2009). Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: A randomized controlled trial. JAMA, 301(19): 2005-2015.Ropper AH, et al. (2014). Sleep and its abnormalities. In Adams and Victor's Principles of Neurology, 10th ed., pp. 395-418. York: McGraw-Hill Education.Schutte-Rodin S, et al. (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of Clinical Sleep Medicine, 4(5): 487-503.
CreditsByHealthwise StaffPrimary Medical ReviewerKathleen Romito, MD - Family Medicine
 Adam Husney, MD - Family Medicine
 E. Gregory Thompson, MD - Internal Medicine
 Specialist Medical ReviewerHasmeena Kathuria, MD - Pulmonology, Critical Care Medicine, Sleep Medicine
Current as of:
                May 3, 2017Valerian (2010). In A DerMarderosian et al., eds., Review of Natural Products. St. Louis: Wolters Kluwer Health. Last modified on: 8 September 2017  |  |