Insomnia

Insomnia is a common sleep disorder. If you have insomnia, you may:

* Lie awake for a long time and have trouble falling asleep
* Wake up a lot and have trouble returning to sleep
* Wake up too early in the morning
* Feel like you haven’t slept at all

Lack of or poor quality sleep causes other symptoms that can affect daytime function. You may feel very sleepy and have low energy throughout the day. You may have trouble thinking clearly or staying focused. Or, you might feel depressed or irritable.

Insomnia is defined as short and poor quality sleep that affects your functioning during the day. Although the amount of sleep a person needs varies, most people need between 7 and 8 hours of sleep a night to feel refreshed.

Insomnia can be mild to severe and varies in how often it occurs and how long it lasts. Acute insomnia is a short-term sleep problem that is generally related to a stressful or traumatic life event and lasts from a few days to a few weeks. Acute insomnia might happen from time to time. With chronic insomnia, sleep problems occur at least 3 nights a week for more than a month.

Insomnia tends to increase as women and men age.

Women are more likely to have insomnia than men. One reason is that hormonal changes during the menstrual cycle and menopause can affect sleep. During perimenopause, women may have trouble falling asleep and staying asleep. Hot flashes and night sweats often can disturb sleep.

During pregnancy, hormonal, physical, and emotional changes can disturb sleep. Pregnant women, especially in the third trimester, may wake up frequently due to discomfort, leg cramps, or needing to use the bathroom.

Some medical conditions that can cause secondary insomnia also are more common in women than men. These include depression, anxiety, fibromyalgia, and some sleep disorders, such as restless leg syndrome.

How is insomnia treated?

If insomnia is caused by a short-term change in the sleep/wake schedule, as with jet lag, your sleep schedule may return to normal on its own. Making lifestyle changes to help you sleep better can also help. If your insomnia makes it hard for you to function during the day, talk to your doctor.

Treatment for chronic insomnia begins by:

* Finding and treating any medical or mental health problems
* Stopping or reducing behaviors that may lead to the insomnia or make it worse, like drinking moderate to large amounts of alcohol at night

Other treatments are:

* Cognitive behavioral therapy (CBT)
* Medication

Cognitive behavioral therapy (CBT)

Research shows that CBT is an effective and lasting treatment of insomnia. CBT helps you change thoughts and actions that get in the way of sleep. This type of therapy is also used to treat conditions such as depression, anxiety, and eating disorders.

CBT consists of one or more approaches. These are:

* Cognitive control and psychotherapy — Controlling or stopping negative thoughts and worries that keep you awake.
* Sleep hygiene — Taking steps to make quality sleep more likely, such as going to bed and waking up at the same time each day, not smoking, avoiding drinking too much coffee or alcohol late in the day, and getting regular exercise.
* Sleep restriction — Matching the time spent in bed with the amount of sleep you need. This is achieved by limiting the amount of time spent in your bed not sleeping. You go to bed later and get up earlier then you would normally, and then slowly increase the time in bed until you are able to sleep all night.
* Stimulus control — Conditioning a positive response with getting into bed. For example, using the bed only for sleep and sex.
* Relaxation training — Reducing stress and body tension. This can include meditation, hypnosis, or muscle relaxation.
* Biofeedback — Measuring body actions, such as muscle tension and brain wave frequency, to help you control them.
* Remain passively awake — Trying not to fall asleep, thereby stopping any worries you might have about falling asleep easily.

Medication
In some cases, insomnia is treated with medicine:

* Prescription sleep medicines — Prescription sleep medicines can help some people get much-needed rest. Most sleep medicines are used for short-term treatment, though some people with severe chronic insomnia may benefit from longer treatment. It is important to understand the risks before using a sleep medicine. In some cases, sleep medicines may:
o Become habit-forming
o Mask medical problems that may be causing the insomnia, and delay treatment
o Interact with other medicines you use and cause serious health problems
o Cause grogginess or rebound insomnia, where the sleeping problems get worse

Uncommon side-effects of sleep medicines include:
o Severe allergic reactions or facial swelling
o High blood pressure, dizziness, weakness, nausea, confusion, or short-term memory loss
o Complex sleep-related behaviors, such as binge eating or driving while asleep

* Over-the-counter (OTC) sleep aids — OTC sleep aids may help on an occasional sleepless night, but they are not meant for regular or long-term use. Most OTC sleep aids contain antihistamines (ant-ih-HISS-tuh-meenz). Antihistamines are not safe for some people to use. OTC sleep aids also can have some unpleasant side-effects, such as dry mouth, dizziness, and prolonged grogginess.

Some dietary supplements claim to help people sleep. Some are “natural” products like melatonin (mel-uh-TOH-nuhn). Others are food supplements such as valerian (an herb) teas or extracts. The U.S. Food and Drug Administration does not regulate dietary supplements as it does medicine. It is unclear if these products are safe or if they actually work.

Talk to your doctor about sleep problems before using an OTC sleep aid. You may have a medical issue that needs to be treated. Also, the insomnia may be better treated in other ways.
If you decide to use a sleep medicine, experts advise you to:
o Read the Medication Guide first.
o Use the medicine at the time of day directed by your doctor.
o Do not drive or engage in activities that require you to be alert.
o Always take the dose prescribed by your doctor.
o Tell your doctor about other medicines you use.
o Call your doctor right away if you have any problems while using the medicine.
o Avoid drinking alcohol and using drugs.
o Talk to your doctor if you want to stop using the sleep medicine. Some medicines must be stopped gradually.