Insomnia

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Medical Author: Siamak Nabili, MD, MPH
Medical Editor: Melissa Conrad Stöppler, MD

• What is insomnia?
• What causes insomnia?
• What are other causes of insomnia?
• What are the risk factors for insomnia?
• What are the symptoms of insomnia?
• When should I call the doctor about insomnia?
• How is insomnia diagnosed?
• How is insomnia treated?
• What are non-medical treatments for insomnia?
• What is sleep hygiene?
• How can stimulus control help with insomnia?
• What is sleep restriction?
• What medications are used to treat insomnia?
• What is the outlook for insomnia?
• Insomnia At A Glance
• Patient Discussions: Insomnia - Describe Your Treatment
• Find a local Sleep Specialist in your town

What is insomnia?

Insomnia is defined as difficulty initiating or maintaining sleep, or both, despite adequate opportunity and time to sleep, leading to impaired daytime functioning. Insomnia may be due to poor quality or quantity of sleep.

Insomnia is very common and occurs in 30% to 50% of the general population. Approximately 10% of the population may suffer from chronic (long-standing) insomnia.

Insomnia affects people of all ages including children, although it is more common in adults and its frequency increases with age. In general, women are affected more frequently than men.

Insomnia may be divided into three classes based on the duration of symptoms.

• Insomnia lasting one week or less may be termed transient insomnia;
  
  
• short-term insomnia lasts more than one week but resolves in less than three weeks; and
  
  
• long-term or chronic insomnia lasts more than three weeks.

Insomnia can also be classified based on the underlying reasons for insomnia such as sleep hygiene, medical conditions, sleep disorders, stress factors, and so on.

It is important to make a distinction between insomnia and other similar terminology; short duration sleep and sleep deprivation.

• Short duration sleep may be normal in some individuals who may require less time for sleep without feeling daytime impairment, the central symptom in the definition of insomnia.
  
  
• In insomnia, adequate time and opportunity for sleep is available, whereas in sleep deprivation, lack of sleep is due to lack of opportunity or time to sleep because of voluntary or intentional avoidance of sleep.

What causes insomnia?

Insomnia may have many causes and, as described earlier, it can be classified based upon the underlying cause.

Situational and stress factors leading to insomnia may include:

• jet lag,
  
  
• physical discomfort (hot, cold, lighting, noise, unfamiliar surroundings),
  
  
• working different shifts,
  
  
• stressful life situations (divorce or separation, death of a loved one, losing a job, preparing for an examination),
  
  
• illicit drug use,
  
  
• cigarette smoking,
  
  
• caffeine intake prior to going to bed,
  
  
• alcohol intoxication or withdrawal, or
  
  
• certain medications.

Most of these factors may be short-term and transient, and therefore insomnia may resolve when the underlying factor is removed or corrected.

Sleep hygiene

Sleep hygiene can play an important role in insomnia. Poor sleep hygiene includes physical factors such as:

• using the bedroom for things other than sleeping,
  
  
• eating or exercising prior to sleep,
  
  
• going to bed hungry,
  
  
• sleeping in a room with too much noise or lighting, or
  
  
• doing work in bed.

Medical and psychiatric conditions

Medical and psychiatric conditions may also contribute to insomnia.

Some of these common medical conditions may include:

• breathing problems from chronic heart or lung disease (asthma, chronic obstructive pulmonary disease (COPD),
  
  
• congestive heart failure,
  
  
• obstructive sleep apnea),
  
  
• obesity,
  
  
• acid reflux,
  
  
• hyperthyroidism,
  
  
• urinary problems (frequent urination, urinary incontinence),
  
  
• chronic pain,
  
  
• fibromyalgia,
  
  
• Parkinson's disease, or
  
  
• dementia.

Common psychiatric problems can be responsible for insomnia including:

• depression,
  
  
• psychosis,
  
  
• mania,
  
  
• anxiety, or
  
  
• posttraumatic stress disorder (PTSD).

Some common physiologic conditions can lead to insomnia such as:

• menopause,
  
  
• menstrual cycle,
  
  
• pregnancy,
  
  
• fever, or
  
  
• pain.

Other causes of insomnia may be related to sleep disorders including:

• sleep walking,
  
  
• sleep apnea,
  
  
• restless leg syndrome (creeping sensations in the leg during sleep, relieved by leg movement),
  
  
• periodic limb movement disorder (involuntary repeated leg movement during sleep), or
  
  
• circadian sleep disturbance (unusual sleep time due to disturbed biological clock).

Insomnia - Describe Your Treatment

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Please describe your effective treatments with insomnia.

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