Insomnia

Insomnia

Alternate Names

  • sleeplessness
  • primary insomnia
  • wakefulness
  • inability to sleep

Definition

Insomnia includes difficulty falling asleep or staying asleep, and early morning awakening. Insomnia can be a symptom of another disorder. It may vary from restlessness or disturbed sleep to a shortened length of sleep. Some individuals suffer complete wakefulness. Primary insomnia is diagnosed if sleep should normally occur, and two possible influences are ruled out. The first influence is something external, like noise or bright light that hinders sleep. The second influence is any disorder, medication, or other substance that might be causing the sleep problem.

What is going on in the body?

Sleeplessness is considered to be a problem when it is severe enough to prevent the brain from getting enough rest on a consistent basis. An occasional sleepless night is not usually considered a problem. However, when sleeping problems last 2 weeks or more, the insomnia becomes more serious. Insomnia can be a short-term problem. If insomnia extends beyond 3 to 4 weeks, it is considered chronic.

Risks

What are the causes and risks of the condition?

Insomnia can be caused by many factors, or a combination of factors. Causes of insomnia may include:
  • side effects of medications, especially amphetamines, excessive thyroid replacement, and many decongestants and antihistamines
  • caffeine intake within 4 to 6 hours of sleep (i.e., coffee, tea, chocolate)
  • nicotine
  • alcohol
  • some drugs of abuse
  • some pharmaceutical drugs
  • some herbs or supplements
  • stress
  • anxiety
  • depression
  • poor sleep surroundings
  • chronic illness
  • chronic pain
  • daytime napping
  • poor sleep routine or sleep habits
  • grief
  • withdrawal of certain drugs (stopping abruptly)
  • restless leg syndrome

Prevention

What can be done to prevent the condition?

Methods to prevent insomnia are the same as those used to treat insomnia. The best prevention is to develop good sleep habits.

Diagnosed

How is the condition diagnosed?

Primary insomnia is diagnosed when difficulty falling asleep or staying asleep becomes a persistent problem. If there are decreases in work productivity, increased health problems, or difficulties in concentration and memory, a diagnosis of insomnia may be made.
A complete medical history will be taken, and a physical exam will be done. The healthcare professional will ask about average sleep habits and about anything that might be interfering with the ability to sleep.

Long Term Effects

What are the long-term effects of the condition?

The persistent loss of sleep may result in:
  • decreased work productivity
  • increased risk of injuries
  • decreased concentration
  • short-term and long-term memory problems
  • irritability
  • fatigue

Other Risks

What are the risks to others?

Insomnia is not contagious. A sleep-deprived person might cause injury to someone else in a motor vehicle crash.

Treatments

What are the treatments for the condition?

The best way to prevent insomnia is to develop good sleep habits. This includes maintaining a regular and predictable sleep schedule. Substances known to cause insomnia, such as nicotine, caffeine and alcohol, should be avoided. Creation of a quiet, comfortable sleep environment is also useful.
Regular exercise is important, but should not be done within 2 hours of going to bed. Quiet, relaxing activities before bedtime, such as reading, listening to music, or watching TV, can help.
Non-prescription medications, such as diphenhydramine (i.e., Benadryl), may be helpful for short-term situations. There is data that controlled-release Melatonin may be helpful for some people—especially the elderly. The Natural Database rates valerian (with or without lemon balm) as possibly effective for insomnia; however, they have found insufficient evidence to recommend Indian snakeroot.
Using prescription medications such as chloral hydrate (i.e., Noctec), fluraxepam (i.e., Dalmane), triazolam (i.e., Halcion), zolpidem (i.e., Ambien), zaleplon (i.e., Sonata), or temazepam (i.e., Restoril) to induce sleep should be considered a last resort in any setting except short-term hospitalization, when a normal night's sleep is virtually impossible. Long-term use of these medications can actually cause more sleep problems.
Some physicians will use tricyclic antidepressants, such as amitriptyline (i.e., Elavil), for insomnia due to their sedating side effects.
A newer prescription medication, eszopiclone (i.e., Lunesta) has been approved by the FDA for long-term use.

Side Effects

What are the side effects of the treatments?

Side effects of the many medications used to induce sleep include:
  • day time sleepiness
  • physical tolerance to and dependence on some of the medications
  • memory impairment
  • rebound insomnia when medication is stopped
  • psychological dependence on the medication
  • poor quality sleep produced by some medications

After Treatment

What happens after treatment for the condition?

Good sleep habits should be followed for life. Early identification and resolution of contributing factors may help reduce the number of sleepless nights.

Monitor

How is the condition monitored?

Insomnia may be self-monitored. Healthcare professionals can be notified of persistent sleeping problems.

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