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National Institutes of Health
National Heart, Lung, and Blood Institute
Facts About Insomnia
WHAT IS INSOMNIA?
Insomnia is the perception or complaint of inadequate or
poor-quality sleep because of one or more of the following:* difficulty falling asleep
* waking up frequently during the night with difficulty
returning to sleep
* waking up too early in the morning
* unrefreshing sleep
Insomnia is not defined by the number of hours of sleep a
person gets or how long it takes to fall asleep.
Individuals vary normally in their need for, and their
satisfaction with, sleep. Insomnia may cause problems
during the day, such as tiredness, a lack of energy,
difficulty concentrating, and irritability.
Insomnia can be classified as transient (short term),
intermittent (on and off), and chronic (constant). Insomnia
lasting from a single night to a few weeks is referred to as
transient. If episodes of transient insomnia occur from
time to time, the insomnia is said to be intermittent.
Insomnia is considered to be chronic if it occurs on most
nights and lasts a month or more.
WHAT CAUSES IT?
Certain conditions seem to make individuals more likely to
experience insomnia. Examples of these conditions include:
* advanced age (insomnia occurs more frequently in those
over age 60)
* female gender
* a history of depression
If other conditions (such as stress, anxiety, a medical
problem, or the use of certain medications) occur along with
the above conditions, insomnia is more likely.
There are many causes of insomnia. Transient and
intermittent insomnia generally occur in people who are
temporarily experiencing one or more of the following:
* stress
* environmental noise
* extreme temperatures
* change in the surrounding environment
* sleep/wake schedule problems such as those due to jet
lag
* medication side effects
Chronic insomnia is more complex and often results from a
combination of factors, including underlying physical or
mental disorders. One of the most common causes of chronic
insomnia is depression. Other underlying causes include
arthritis, kidney disease, heart failure, asthma, sleep
apnea, narcolepsy, restless legs syndrome, Parkinson’s
disease, and hyperthyroidism. However, chronic insomnia may
also be due to behavioral factors, including the misuse of
caffeine, alcohol, or other substances; disrupted sleep/wake
cycles as may occur with shift work or other nighttime
activity schedules; and chronic stress.
In addition, the following behaviors have been shown to
perpetuate insomnia in some people:
* expecting to have difficulty sleeping and worrying about
it
* ingesting excessive amounts of caffeine
* drinking alcohol before bedtime
* smoking cigarettes before bedtime
* excessive napping in the afternoon or evening
* irregular or continually disrupted sleep/wake schedules
These behaviors may prolong existing insomnia, and they can
also be responsible for causing the sleeping problem in the
first place. Stopping these behaviors may eliminate the
insomnia altogether.
WHO GETS INSOMNIA?
Insomnia is found in males and females of all age groups,
although it seems to be more common in females (especially
after menopause) and in the elderly. The ability to sleep,
rather than the need for sleep, appears to decrease with
advancing age.
HOW IS IT DIAGNOSED?
Patients with insomnia are evaluated with the help of a
medical history and a sleep history. The sleep history may
be obtained from a sleep diary filled out by the patient or
by an interview with the patient’s bed partner concerning
the quantity and quality of the patient’s sleep.
Specialized sleep studies may be recommended, but only if
there is suspicion that the patient may have a primary sleep
disorder such as sleep apnea or narcolepsy.
HOW IS IT TREATED?
Transient and intermittent insomnia may not require
treatment since episodes last only a few days at a time.
For example, if insomnia is due to a temporary change in the
sleep/wake schedule, as with jet lag, the person’s
biological clock will often get back to normal on its own.
However, for some people who experience daytime sleepiness
and impaired performance as a result of transient insomnia,
the use of short-acting sleeping pills may improve sleep and
next-day alertness. As with all drugs, there are potential
side effects. The use of over-the-counter sleep medicines
is not usually recommended for the treatment of insomnia.
Treatment for chronic insomnia consists of:
* First, diagnosing and treating underlying medical or
psychological problems.
* Identifying behaviors that may worsen insomnia and
stopping (or reducing) them.
* Possibly using sleeping pills, although the long-term
use of sleeping pills for chronic insomnia is
controversial. A patient taking any sleeping pill
should be under the supervision of a physician to
closely evaluate effectiveness and minimize side
effects. In general, these drugs are prescribed at the
lowest dose and for the shortest duration needed to
relieve the sleep-related symptoms. For some of these
medicines, the dose must be gradually lowered as the
medicine is discontinued because, if stopped abruptly,
it can cause insomnia to occur again for a night or two.
* Trying behavioral techniques to improve sleep, such as
relaxation therapy, sleep restriction therapy, and
reconditioning.
Relaxation Therapy. There are specific and effective
techniques that can reduce or eliminate anxiety and body
tension. As a result, the person’s mind is able to stop
“racing,” the muscles can relax, and restful sleep can
occur. It usually takes much practice to learn these
techniques and to achieve effective relaxation.
Sleep Restriction. Some people suffering from insomnia
spend too much time in bed unsuccessfully trying to sleep.
They may benefit from a sleep restriction program that at
first allows only a few hours of sleep during the night.
Gradually the time is increased until a more normal night’s
sleep is achieved.
Reconditioning. Another treatment that may help some people
with insomnia is to recondition them to associate the bed
and bedtime with sleep. For most people, this means not
using their beds for any activities other than sleep and
sex. As part of the reconditioning process, the person is
usually advised to go to bed only when sleepy. If unable to
fall asleep, the person is told to get up, stay up until
sleepy, and then return to bed. Throughout this process,
the person should avoid naps and wake up and go to bed at
the same time each day. Eventually the person’s body will
be conditioned to associate the bed and bedtime with sleep.
Other Sleep Publications available from the National Heart,
Lung, and Blood Institute Information Center:
* Facts About Sleep Apnea–A four-page brochure that
discusses sleep apnea and how it is treated. (NIH
Publication No. 95-3798)
* Test Your Sleep I.Q.–This quiz tests your knowledge about
sleep and sleep-related disorders. (NIH Publication No.
95-3797)
NATIONAL CENTER ON SLEEP DISORDERS RESEARCH (NCSDR)
The mission of the NCSDR is to support research, training,
and education about sleep disorders. The center is located
within the National Heart, Lung, and Blood Institute (NHLBI)
of the National Institutes of Health. The NHLBI supports a
variety of research and training programs focusing on
cardiopulmonary disorders in sleep, designed to fill
critical gaps in the understanding of the causes, diagnosis,
treatment, and prevention of sleep-disordered breathing.
WHERE TO GET MORE INFORMATION
Talk to your doctor if you are having trouble getting good,
refreshing sleep each night. Together you can identify
possible reasons for your sleeping difficulty and then try
appropriate measures to correct the problem. For additional
information on sleep and sleep disorders, contact the
following offices of the National Heart, Lung, and Blood
Institute of the National Institutes of Health.
* National Center on Sleep Disorders Research (NCSDR)
The NCSDR, located within the National Heart, Lung, and
Blood Institute, supports research, scientist training,
dissemination of health information, and other activities on
sleep disorders and related concerns. The NCSDR also
coordinates sleep research activities with other Federal
agencies and with public and nonprofit organizations.
National Center on Sleep Disorders Research
Two Rockledge Centre
Suite 7024
6701 Rockledge Drive, MSC 7920
Bethesda, MD 20892-7920
Information provided on this site is for informational purposes only. It is not meant to substitute the advice provided by your own physician or other medical
professional. You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication.
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