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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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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



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There are many causes of insomnia.  Transient and



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*   stress



*   environmental noise



*   extreme temperatures



*   change in the surrounding environment



*   sleep/wake schedule problems such as those due to jet



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*   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
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