Insomnia

Insomnia is a disorder that can make it hard to fall asleep, hard to stay asleep, or both. With insomnia, you usually awaken feeling unrefreshed, which takes a toll on your ability to function during the day. Insomnia can sap not only your energy level and mood but also your health, work performance and quality of life.

How much sleep is enough varies from person to person. Most adults need seven to eight hours a night. Many adults experience insomnia at some point, but some people have long-term (chronic) insomnia.

You don't have to put up with sleepless nights. Simple changes in your daily habits can help.

Insomnia symptoms may include:

• Difficulty falling asleep at night
• Awakening during the night
• Awakening too early
• Not feeling well rested after a night's sleep
• Daytime fatigue or sleepiness
• Irritability, depression or anxiety
• Difficulty paying attention or focusing on tasks
• Increased errors or accidents
• Tension headaches
• Gastrointestinal symptoms
• Ongoing worries about sleep

Someone with insomnia will often take 30 minutes or more to fall asleep and may get only six or fewer hours of sleep for three or more nights a week.

When to see a doctor

If insomnia makes it hard for you to function during the day, see your doctor to determine what might be the cause of your sleep problem and how it can be treated. If your doctor thinks you could have a sleep disorder, you might be referred to a sleep center for special testing.

In addition to asking you a number of questions, your doctor may have you complete a questionnaire to determine your sleep-wake pattern and your level of daytime sleepiness. You may also be asked to keep a sleep diary for a couple of weeks, if you haven't already done so.

Your doctor will do a physical exam to look for signs of other problems that may be causing insomnia. Occasionally, a blood test may be done to check for thyroid problems or other conditions that can cause insomnia.

If the cause of your insomnia isn't clear, or you have signs of another sleep disorder, such as sleep apnea or restless legs syndrome, you may need to spend a night at a sleep center. Tests are done to monitor and record a variety of body activities while you sleep, including brain waves, breathing, heartbeat, eye movements and body movements.

Treatments

Changing your sleep habits and addressing any underlying causes of insomnia can restore restful sleep for many people. Good sleep hygiene — simple steps such as keeping the same bedtime and arising time — promotes sound sleep and daytime alertness. If these measures don't work, your doctor may recommend medications to help with relaxation and sleep.

Behavior therapies

Behavioral treatments teach you new sleep behaviors and ways to improve your sleeping environment. Behavior therapies are equally or more effective than are sleep medications. Behavior therapies are generally recommended as the first line of treatment for people with insomnia.

Behavior therapies include:

Education about good sleeping habits. Sleep hygiene teaches habits that promote good sleep.

Relaxation techniques. Progressive muscle relaxation, biofeedback and breathing exercises are ways to reduce anxiety at bedtime. These strategies help you control your breathing, heart rate, muscle tension and mood.

Cognitive behavioral therapy. This involves replacing worries about not sleeping with positive thoughts. Cognitive behavioral therapy can be taught through one-on-one counseling or in group sessions.

'Stimulus control.' This means limiting the time you spend awake in bed and associating your bed and bedroom only with sleep and sex.

Sleep restriction. This treatment decreases the time you spend in bed, causing partial sleep deprivation, which makes you more tired the next night. Once your sleep has improved, your time in bed is gradually increased.

Light therapy. If you fall asleep too early and then awaken too early, you can use light to push back your internal clock. During times of the year when it's light outside in the evenings, you go outside or get light via a medical-grade light box.

Medications

Taking prescription sleeping pills, such as zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata) or ramelteon (Rozerem), also may help you get to sleep. However, in rare cases, these medications may cause severe allergic reactions, facial swelling and unusual behaviors, such as driving or preparing and eating food while asleep. Side effects of prescription sleeping medications are often more pronounced in older people and may include excessive drowsiness, impaired thinking, night wandering, agitation and balance problems.

Doctors generally don't recommend relying on prescription sleeping pills for more than a few weeks, but several newer medications are approved for indefinite use. However, some of these medications are habit-forming.

If you have depression as well as insomnia, your doctor may prescribe an antidepressant with a sedative effect, such as trazodone, doxepin or mirtazapine (Remeron).

Over-the-counter sleep aids

Sleep medications available over-the-counter contain antihistamines that can make you drowsy. But antihistamines may reduce the quality of your sleep, and they can cause side effects, such as daytime sleepiness, dry mouth and blurred vision. These effects may be worse in the elderly.