Insomnia: What You Should Know

Am Fam Physician. 2007;76(4):527-528

See related article on insomnia.

What is insomnia?

Insomnia is when you often can';t fall asleep or when you wake up in the night and can';t go back to sleep. Most people need seven to eight hours of sleep every night. People 65 years and older may sleep less at night and nap during the day.

Who gets it and why?

Insomnia is very common. More than one in three adults have it every year. Many things can cause insomnia. Illness, some medicines, too much caffeine, too much noise, and stress can cause insomnia that lasts a few days or up to several weeks. Another common cause is an irregular sleep schedule (sleeping and waking up at different times), especially for people who work different shifts at their jobs.

How can I find out why I have it?

Your doctor will ask you questions and examine you. You may be asked to keep a sleep diary. This is a two-week record of the times you go to bed and get up, how long it takes to go to sleep, if you take naps during the day, how often you wake up during the night, total sleep time, and your mood when you wake up in the morning.

Your doctor may talk to your family about your sleeping habits. You may need a test called a sleep study to see if something else is keeping you awake.

How is it treated?

If an illness or medicine is keeping you from sleeping, treating the illness or changing the medicine may help.

These steps may help you get a good night';s sleep:

Follow a bedtime routine. Go to bed and wake up at the same time every day. Sleep only as much as you need to feel refreshed the next day.
Keep your bedroom dark, quiet, and at a comfortable temperature.
Exercise regularly. It helps you go to sleep and also to have deeper sleep. Don';t exercise just before bedtime.
Drink less caffeine (found in many coffee, tea, and cola drinks). Caffeine can make it hard to fall asleep and can wake you up in the night. Even having caffeine early in the day can affect your sleep.
Avoid alcohol, especially late in the evening. Alcohol may help you fall asleep more easily, but it also can make you wake up in the night.
Avoid smoking. Smoking can disturb sleep.
Eat regular meals and do not go to bed hungry. A light snack at bedtime may help you sleep, but avoid heavy meals before bedtime.
Use the bedroom for sleep and intimacy only. Don';t watch television or eat while you are in bed.
Do not try to fall asleep. This only makes the problem worse. If you can';t sleep, leave the bedroom and do something different, such as reading. Don';t do things that could keep you awake, such as watching TV, drinking coffee, eating, or worrying. Go back to bed only when you are sleepy.

Will I need to take sleeping pills?

Your doctor may prescribe sleeping pills for a few weeks until you have a regular sleep routine. Be sure to tell your doctor if you are taking any over-the-counter sleep aids or other medicines. These may cause serious side effects (see below). You can also have side effects if you drink alcohol while taking sleeping pills.

Tell your doctor if you feel dizzy, confused, or tired during the day, or if you have vision changes, dry mouth or throat, constipation, or trouble urinating. Sleeping pills may affect your driving.

Do not stop taking the sleeping pills without talking to your doctor if you have been taking them for more than a few weeks. If you do, your trouble sleeping may get worse. You also may have symptoms of withdrawal such as anxiety, nausea, memory loss, and nightmares.