Medically reviewed by Dr. C.H. Weaver M.D. updated 2/2021
Insomnia is a sleep disorder that is characterized by sleeplessness, inadequate sleep, or poor quality sleep. The amount of sleep needed varies from person to person. In general, however, most people function best with seven or eight hours of sleep. Insomnia can be a serious health and wellness concern because lack of sleep, especially good quality sleep, can affect your ability to function at work, in other daily activities, and in personal relationships.
Some people experience short-term insomnia, while others are affected for longer periods. Short-term insomnia that lasts for a few days or weeks is considered acute insomnia and is generally associated with a traumatic or stressful event. Chronic insomnia, on the other hand, is longer-term issue, with sleep disturbances occurring at least three nights a week for a month or longer. Insomnia can also vary in severity—some cases are mild, whereas others are severe.
Some people develop habits as a result of insomnia or in response to drowsiness; these habits may worsen sleeplessness. They include taking naps, worrying about sleep, and going to bed early.
Who experiences insomnia?
Both men and women can experience insomnia, but it tends to affect more women than men. Possible explanations for the higher frequency among women include hormonal changes associated with the menstrual cycle and menopause; hormonal, physical, and emotional changes experienced during pregnancy; and a higher prevalence among women of medical conditions that can cause secondary insomnia (including depression, anxiety, and sleep disorders).
Risk factors for insomnia include: stress, depression, and emotional distress (such as divorce or death of a loved one), night work, travel with time changes, and an inactive lifestyle.
Types of Insomnia
Insomnia is divided into two types: primary insomnia and secondary insomnia.
Primary insomnia is not a symptom or side effect of another medical condition but occurs independently of other illnesses, meaning that it is a condition of its own. Primary insomnia may affect an individual throughout life or may be triggered by stressful events, an unconventional work schedule (such as night work), travel, or other disruptive circumstances.
Unlike primary insomnia, secondary insomnia is a symptom or side effect of another health condition. Underlying medical causes of secondary insomnia include depression or anxiety, chronic pain, overactive thyroid, gastrointestinal problems, other sleep disorders (such as sleep apnea or restless leg syndrome), stroke, Alzheimer’s disease, or menopause.
Environment and lifestyle factors may also cause secondary insomnia. Examples of these factors include: certain medications (such as asthma, heart, allergy, and cold medicines); use of caffeine, tobacco, and alcohol; and poor sleep environment (a bedroom that’s too noisy or not dark enough, for example).
Secondary insomnia may go away once the issue causing sleeplessness is treated. In some cases, however, further treatment of insomnia itself is required.
Symptoms of insomnia include the following:
- Lying awake for long periods with difficulty falling asleep
- Waking up during the night and having trouble getting back to sleep
- Waking up too early in the morning
- Feeling like you haven’t slept at all
If you’re not sleeping well or enough, you may feel sleepy, have low energy, have trouble thinking clearly and staying focused, and feel irritable or depressed.
Your doctor can help you determine if you are experiencing insomnia. If you feel that you are having trouble sleeping, such as falling asleep or staying asleep, and that lack of sleep is affecting your daily activities, you may want to consult your doctor.
A sleep diary may help you and your doctor understand and treat insomnia. This diary should include a daily record of what time you fall asleep and wake up, any changes in your sleep and bedtime routines, and how you feel during the day. Also be prepared to tell your doctor about factors that may be affecting the quality of your sleep; these may include your bedtime routine, habits before bedtime (such as eating, drinking, watching TV), and bedroom environment (light, noise, temperature).
Sometimes a doctor will also recommend a physical exam and additional medical history to determine if other health conditions may be affecting sleep.
If you and your doctor aren’t able to identify a cause of your insomnia, your doctor may recommend a sleep study, or polysomnogram (PSG). A PSG usually requires an overnight stay at a sleep center. During your stay, a PSG records brain electrical activity, eye movements, heart rate, breathing, muscle activity, blood pressure, and blood oxygen levels. The goal is to diagnose an underlying sleep disorder that is causing your insomnia.
Treatment & Management of Insomnia
Treatment for insomnia may start with lifestyle changes, especially to habits and behaviors directly affecting sleep (see “Lifestyle” below for more information). As well, medications are sometimes prescribed to treat insomnia, and over-the-counter (OTC) sleep aids may also be used (find more information under “Medication”).
If other medical conditions may be affecting your ability to sleep or the quality of your sleep, addressing these may help relieve insomnia. A physical exam with your doctor will identify or rule out potential medical causes of insomnia.
Cognitive behavioral therapy (CBT) may be used to treat insomnia. This approach addresses thoughts and actions that prevent or interrupt sleep while encouraging good sleep habits. For example, by teaching patients ways of dealing with worries that keep them awake, they may find it easier to fall and stay asleep. CBT may involve one-on-one consultations with a therapist or group sessions. The following approaches may also be used as part of CBT:
- Sleep hygiene—efforts to improve habits that allow and encourage better sleep; examples include setting regular bedtime and wake-up times, not smoking, avoiding alcohol and caffeine late in the day, and getting regular exercise
- Sleep restriction—going to bed later and waking up earlier in an effort to limit time spent in bed not sleeping; time in bed is gradually increased until you are sleeping all night (In other words, you maximize the time spent in bed actually sleeping rather than lying awake.)
- Stimulus control—conditioning a positive association with going to bed; this is done by using the bed only for sleep and sex
- Relaxation training—using methods like meditation, hypnosis, and muscle relaxation to reduce stress and body tension
- Remaining passively awake—trying not to fall asleep in order to stop worries about falling asleep
These lifestyle measures may help you sleep better:
- Go to bed at the same time each night and get up at the same time each morning.
- Avoid naps late in the afternoon, such as after 3 p.m.
- Exercise regularly. Don’t exercise, however, too late in the day—as activity close to bedtime may make it difficult to fall asleep.
- Eat dinner two or three hours before you plan to go to bed.
- Make sure your bedroom is dark, cool, and quiet. If the room isn’t dark or quiet enough, try an eye mask or earplugs.
- Establish a relaxing bedtime routine. Examples include taking a bath, listening to music, or reading a book.
- Don’t lie in bed for more than 20 minutes if you can’t fall asleep. Try getting out of bed, sitting in a comfortable place, and doing a quiet activity such as reading until you feel sleepy.
- If you find yourself lying away and worrying about things you have to do, considering making a to-do list before you go to bed.
- Use your bed only for sleeping and sex. Do not read extensively, work, or watch TV in bed.
Medications to Help with Insomnia
Medications for insomnia are available by prescription and over the counter. Talk with your doctor about the type of medication that may be right for you. Even if you are considering over-the-counter (OTC) sleep aids, it’s important to consult your doctor; you’ll want to discuss side effects associated with these medications as well as address medical issues that may be affecting your sleep.
Basic guidelines for using any medication to relieve sleeplessness include: using the medication only as directed by your doctor and taking only the prescribed dose; not driving or performing other activities that require you to be alert; telling your doctor about other medications you are using; calling your doctor immediately if you have problems related to the medication; avoiding alcohol and drugs; and talking to your doctor about how to stop using the medication.
Prescription Sleep Medication
Doctors sometimes prescribe medication for insomnia. In many cases, prescription sleep medicines are used for short periods, though they may be used longer for treatment of severe chronic insomnia.
Prescription sleep medications are often helpful in the treatment of insomnia, but it’s important to know about the risks associated with these drugs. They can become habit forming; may mask a medical problem causing insomnia and thus delay treatment; can interact poorly with other medications; and can cause grogginess or even worsen insomnia. The following less common but serious side effects are also associated with sleep medicines: severe allergic reactions, facial swelling, high blood pressure, dizziness, weakness, nausea, confusion, short-term memory loss, and sleep-related behaviors such as binge eating or driving while asleep. Talk with your doctor about any side effects you experience while taking prescription sleep medication.
Drugs to Treat Insomnia
Medications can also be used to help manage insomnia. Medications should be used in combination with good sleep practices and under the supervision of a physician. All of the following medications are taken shortly before going to bed.
- Zolpidem (Ambien, Edular, Intermezzo): These medicines help individuals fall asleep but often don't help them stat asleep. There is now an extended release version of Ambien that helps individuals stay asleep longer.
- Eszopiclone (Lunesta): Lunesta helps individuals both fall asleep quickly, and studies show people sleep an average of 7 to 8 hours. ·
- Doxepine (Silenor): Silenor blocks histamine and is approved for use in people who have trouble staying asleep.
- Suvorexant (Belsomra): Belsomra blocks a hormone that promotes wakefulness and causes insomnia but often causes individuals to feel sleepy the following day.
- Ramelteon (Rozerem): Works by targeting the sleep-wake cycle, not by depressing the central nervous system like many of the other medications. It is often prescribed for long-term use, and the drug has shown no evidence of abuse or dependence.
- Zaleplon (Sonata): Sonata stays active in the body for the shortest amount of time which makes it useful for falling asleep but not for staying asleep.It should be noted the certain anti-depressant and anti-anxiety medications can also be helpful sleep aids as can come over the counter medications. Most over the counter sleep aids are antihistamines which cause drowsiness.
- Dayvigo (lemborexant): The Food and Drug Administration (FDA) approved Dayvigo (lemborexant) for the treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance in adult patients in January 2020.
Over-the-counter Sleep Aids
Over-the-counter sleep aids may help relieve occasional sleeplessness. They are, however, not recommended for regular or long-term use. As well, OTC sleep aids are associated with certain risks: many contain antihistamines, which are not safe for some people, and they can cause side effects including dry mouth, dizziness, and grogginess.
Additional OTC sleep aids include dietary supplements such as melatonin and valerian. Be aware, however, that dietary supplements are not monitored for safety or effectiveness by the U.S. Food and Drug Administration. As a safety precaution, it’s therefore important to discuss use of dietary supplements as sleep aids with your doctor, just as you would prescription or OTC medicines.
The Pros and Cons of Sleep Hygiene
Sleep hygiene—or healthy behaviors meant to support adequate, restorative sleep—is a widely recommended way to enable good sleep. Though these practices can contribute to quality sleep, Dr. Siebern explains that once a real sleep issue has developed, sleep hygiene may be frustrating. She says that she sometimes sees patients who have followed sleep hygiene recommendations and still can’t sleep and are thus not only sleep deprived but exasperated as well. “Sleep hygiene in essence is preventive,” Dr. Siebern says, explaining that following these recommendations when you don’t have a sleep issue can help you maintain sleep. Once you have a sleep issue, however, professional treatment may be the only way that you find relief.
Sleep hygiene remains, however, a potentially important part of a good night’s sleep. Keep up your good habits but know that if you do have a sleep disorder, your best chance of finding relief is likely with professional help.
Here are a few tips for sleep hygiene:
- Go to bed at the same time each night and wake up at the same time each morning.
- Make sure that your bedroom is quiet and dark.
- Use your bed only for sleep and intimacy.
- Avoid caffeine late in the day.
- Avoid alcohol before bedtime.
- Relax before bedtime—taking a warm bath, listening to calming music, or stretching may help you unwind.
- Avoid taking naps after 3 p.m., and when you do nap, do so for no more than an hour.
- Make a Sleep Plan: Make sleep a priority by creating a sleep plan for yourself. Schedule sleep just as you would schedule any other appointment—and honor it! Determine how much sleep you need and what time you need to arise and then count backwards to determine your bedtime. Be sure to allow an extra 15 minutes for your bedtime ritual so that you’re not short-changing yourself on sleep.
- Create a Bedtime Ritual: Establish a bedtime ritual for yourself. Create a calm, soothing routine that you carry out each evening. This might flow from face washing to teeth brushing to reading to writing in a gratitude journal. Find a routine that works for you and helps you achieve a state of calm.
- Maintain Good Sleep Hygiene: Sleep hygiene refers to our behavioral approaches to sleep. Our contemporary habits make it difficult to wind down. Start a “slowdown” process in the evening by turning off cell phones, computers, and televisions. Dim the lights for several hours prior to sleep. Avoid working late or other activities that will stimulate your mind.
- Set Yourself Up for Success: Create an oasis of calm in your bedroom. Invest in a quality mattress, pillows, and sheets. Make sure the room is cool and dark. Eliminate anything stimulating such as computers or bright clocks. Consider incorporating some white noise into the room with the use of a fan or noise machine.
- Avoid Stimulants: For several hours prior to bedtime, avoid anything that may interfere with sleep, including alcohol, caffeine, nicotine, exercise, and large meals.
- Make a Waking Plan: Establish a standard waking time that you adhere to daily—even on weekends. This will help train your body to stay on a sleep schedule.
- Manage Stress: Incorporate practices into your life to help manage stress. Some people find that a daily meditation practice helps alleviate stress, while others prefer yoga, tai chi, or relaxation techniques. Find something that works for you.
- Follow the 15-Minute Rule: If you can’t fall asleep within 15 minutes, get up. You may wish to try a quick yoga pose, a few minutes of meditation, or a walk around the block. Do something to take your mind off the fact that you can’t sleep—and then try again when you’re ready.
- Seek Help: If you have an ongoing struggle with insomnia, consider seeking help from a sleep expert. Often they can identify a physiological cause for sleep disruption (such as sleep apnea) and can offer many remedies, including herbal sleep aids.
Eat Right to Sleep Through the Night
Choose foods that will help, not hinder, your sleep.
With over 70 million Americans affected by intermittent or chronic sleep problems, we are a nation awake. If you are one of the many people suffering through sleepless nights, your diet may hold a clue to your sleep patterns. Stop counting sheep and instead, start making your calories count. Incorporate the right foods into your diet—and eliminate the wrong ones—to ensure a sound slumber every night.
The Carbohydrate Connection
Carbs have gotten a bad rap recently, but they do have their merits. Carbohydrates boost serotonin, a hormone that helps you feel calm, peaceful, and even sleepy. If you’re battling insomnia, a small meal that’s high in carbohydrates before bedtime might help promote sleep. Consider snacking on cheese and crackers, toast, yogurt, or cereal and milk before turning in for the evening. Just remember to keep it small, simple, and easily digestible, as large meals tax the digestive system and actually interfere with sleep.
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Tryptophan is an essential amino acid that has been shown to have a sleep-inducing effect. While many people once believed that the tryptophan in turkey was the cause of post-Thanksgiving sleepiness, newer research indicates that might not be the case. Still, tryptophan does have its place as a sleep aid. The trick is that tryptophan needs to be consumed on an empty stomach without the interference of other amino acids and proteins. Turkey isn’t the only source of tryptophan—try chicken, pork, cheese, milk, and eggs as well.
More Melatonin Please
Melatonin is a hormone produced in the brain that controls the body’s sleep and wake cycles. Melatonin can be found in cherries, oats, sweet corn, rice, and nuts. When included as part of the regular diet, these foods might help regulate the body’s natural sleep cycle.
In addition to incorporating the right foods into your diet to promote sleep, you’ll want to eliminate some sleep stoppers. Here’s what to avoid:
- Caffeine: Caffeine lurks in many places—coffee, tea, chocolate, and more. Some people need 24 hours to eliminate the effects of caffeine, whereas others only need a few hours. Each individual is different. If you’re having trouble sleeping, consider cutting caffeine—either altogether, or stopping it earlier in the day—to see if you can reclaim precious sleep.
- Alcohol: Alcohol is deceiving. We feel relaxed and mellow after we drink it, but in truth, it interferes with sleep cycles and results in lighter sleep.
- Sugar: If you want to sleep, get off the sugar roller coaster. Sugar affects our blood sugar levels, causing highs and lows throughout the day. Get off the sugar to stabilize blood sugar levels and become a sound sleeper.
- Liquids: What’s true for toddlers is true for everyone—avoid consuming too many liquids before bed. This will prevent your body from waking you up to use the bathroom.
- Large Meals: Large meals require a lot of digestive activity, a sure sleep stopper. Keep it light in the evenings to ensure a good night’s sleep.
Try these pre-bedtime snacks to help promote sleep:
- Mashed potatoes
- Cereal and milk
- Cheese and crackers
Insomnia in Depth
- Insomnia. National Heart Lung and Blood Institute Web site. Available at:. Accessed August 2020.
- Insomnia. Womenshealth.gov. Available at:. Accessed August 2020.
by Dr. Teofilo L. Lee-Chiong Jr., MD, of The National Jewish Hospital in Denver.
An Outline to Improve your Sleep Hygiene
Getting Regular Sleep Isn’t Easy. Work demands, worries about finances or family, or a busy schedule can push back your bedtime. According to a recent nationwide study by the Centers for Disease Control and Prevention, more than one-third of US adults report not getting enough sleep on a regular basis; however, getting enough high-quality sleep is critical for maximizing work or school performance.1
Recognizing that insufficient sleep is a problem is the first step to putting yourself on a path to better sleep. By incorporating a few simple tips into your nighttime routine, consistent, good sleep can become a reality.
1. Figure out why you aren’t sleeping well.
To make improvements to your sleep habits, you need to start by identifying the different factors that might be contributing to unhealthy or inadequate sleep. Tracking your sleep with a sleep diary for a few weeks can help reveal practices that might be keeping you up at night.
For example, by writing down that you had a hard time sleeping after you had two glasses of wine or after you watched an intense television show, you’ll be able to see unrecognized patterns of disrupted sleep. Understanding your individual sleep habits, including stress triggers that give you anxiety before bedtime, will help you figure out what solutions you should look for to help you sleep better.
2. Take time to prepare yourself for sleep.
Many of us go, go, go during the day and then simply fall into bed, hoping to fall asleep instantly. But to get the best-quality sleep, you need to prepare yourself for bedtime. Wind down for an hour or two before going to bed and avoid exercising, worrying about your fears or getting into an argument during this time frame. To help calm an otherwise overactive mind, try meditation for a bit of quiet time; relaxation exercises can provide that same bit of downtime for the body.
3. Revamp your personal sleep space.
Technology has altered almost every aspect of our waking lives and will do the same to our sleep if we don’t intervene. Our bedrooms are filled with smartphones, tablets, computers, televisions, and gaming systems. Not only do these devices cut into the time that in the past was solely reserved for sleep but they also provide an easy distraction from quality sleep—not to mention that the blue light from our phones can actually tell our brains to be more active, making it even harder to get to sleep. Make a conscious effort to turn off all devices close to bedtime and create an ideal dark, quiet environment for sleep.
4. Prioritize good sleep.
In our society sleep is often undervalued. Once you start taking steps to make better sleep a priority, encourage your family members to do the same. Think about how your choices affect others’ sleep schedules and explore ways for your family members and colleagues to protect against interruptions to the sleep schedule, including unnecessary calls or messages at bedtime and recurring late-night or unreasonably early morning activities.
5. Talk to your doctor if your sleep isn’t improving.
If you have significant difficulties falling or staying asleep, or if you are excessively sleepy during the day, you may have an underlying sleep disorder. If left undiagnosed or untreated, many sleep disorders tend to persist and lead to other health consequences, such as cardiovascular challenges and an increased risk of comorbid conditions. If you struggle with falling or staying asleep, avoid taking medications that can cause insomnia, and talk to your physician about alternative regimens that are less disruptive. It is important to consider an evaluation by a healthcare professional to determine if your lack of sleep is related to a sleep disorder.
6. There is no time like the present.
There are several things that you can start doing tonight to improve your sleep:
- Keep a regular schedule of your sleep and wake times.
- Engage in moderate-intensity aerobic exercise during the day to help wind down at night.
- Avoid taking prolonged naps during the day and engaging in stimulating activities late in the evening, such as smoking cigarettes or drinking alcohol or caffeinated beverages close to bedtime.
Following these practices will open up opportunities to sleep longer with each passing night.
Dr. Teofilo L. Lee-Chiong Jr., MD*, is a professor of medicine at National Jewish Health in Denver and at the University of Colorado Denver School of Medicine. Dr. Lee-Chiong has authored or edited 16 textbooks on sleep medicine and pulmonary medicine. In addition, he developed and serves as the consulting editor of Sleep Medicine Clinics and is a member of the editorial board and a reviewer of several medical journals and publications. He served as the chair of the Nosology Committee of the American Academy of Sleep Medicine, vice-chair of the Associated Professional Sleep Societies LLC Program Committee since 2009, and chair of both the Sleep Medicine Network and the Sleep Institute steering committees of the American College of Chest Medicine (ACCP). He also has served on the Council of Governors for the ACCP.*
- 1 in 3 Adults Don’t Get Enough Sleep [news release]. US Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/media/releases/2016/p0215-enough-sleep.html. February 18, 2016.