Condition Basics

What is insomnia?

Insomnia is a common sleep problem that affects your daily life. It can cause you to have trouble falling asleep or staying asleep. You may wake up during the night or wake up too early the next morning. These sleep problems may come and go, or they may be ongoing.

What causes it?

Insomnia is linked to many things. These include health problems, medicines, and stressful events. Your habits before bedtime may also affect how well you sleep.

What are the symptoms?

People with insomnia may have trouble falling asleep, staying asleep, or they may wake up too early and have trouble falling back to sleep. They may feel tired when they wake up. And they have trouble doing daily activities because they're not sleeping well.

How is it diagnosed?

Your doctor will ask about your sleep history, bedtime habits, and how your sleep problems are affecting your daily life. You may be asked to keep a sleep journal to record your sleep patterns. Your doctor will ask about any health problems you have and what medicines you take.

How is insomnia treated?

Treatment for insomnia includes behaviour and lifestyle changes. Treatment may include cognitive behavioural therapy for insomnia (CBT-I). You and your doctor can make a treatment plan that includes things you can try at home. Some people decide to take medicine for a while to help with sleep.

Cause

Insomnia is linked to many things. These include health problems and medicines. Your habits before bedtime may also affect how well you sleep.

A stressful event or a change in your usual habits can also lead to insomnia. Examples include a death in your family or loss of a job. Short-term stress is often linked with short-term insomnia.

Many medical conditions are linked to insomnia. Examples include:

• Anxiety.
• Chronic pain.
• Depression.
• Heart failure.
• Sleep apnea.

Many prescription and over-the-counter medicines are also linked to insomnia. Examples include antidepressants, steroids, and over-the-counter allergy medicines. Alcohol, caffeine, and tobacco can also lead to insomnia.

Your bedtime habits may make insomnia last a long time. Examples include drinking caffeine before bedtime, watching TV or using your phone in bed, and not having a regular schedule for bedtime and waking up. Worrying about not sleeping can also keep you from sleeping well.

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Symptoms

People who have insomnia may:

• Have trouble falling asleep. This can mean lying in bed for about 20 to 30 minutes, tossing and turning, waiting to fall asleep.
• Become so focused on being able to fall asleep that the worry and attention interfere with being able to fall asleep.
• Wake up too early in the morning.
• Wake up and have trouble falling back to sleep.
• Feel tired when they wake up.
• Feel grouchy, sleepy, or anxious and be unable to get things done during the daytime.
• Find it hard to pay attention, focus on tasks, or remember to do things.

What Happens

When you have insomnia, your sleep problems may come and go, or they may be ongoing. You may not sleep well for at least 3 nights per week.

• Short-term insomnia can last for days to weeks. It may get better in less than a month.
• Chronic insomnia is ongoing. It lasts at least 3 months.

Insomnia affects your quality of life. You have trouble doing your daily activities. You may feel grouchy, sleepy, or anxious and be unable to get things done during the daytime. You may find it hard to pay attention, focus on tasks, or remember to do things.

How sleep problems affect your health

Having a few sleepless nights may leave you feeling tired and grumpy, but it probably won't affect your health. But when you don't sleep well night after night, you can have what's called sleep deprivation or sleep debt.

Not getting enough sleep can affect your energy and mood. Lack of sleep is linked with some chronic diseases and conditions, including diabetes, obesity, and depression. It also can lead to injuries.

Lack of sleep affects your body in other ways too.

• You may feel pain more easily.
• Your risk for heart disease is higher.
• Your immune system has a harder time fighting infection.
• You may have mood swings.
• You may have trouble learning, solving problems, and remembering.

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Examinations and Tests

Your doctor will probably check your current health and ask about any health problems you've had and any medicines you take. Your doctor may ask if you've had a recent stressful event.

Your doctor will also ask about your sleep history and if your sleep problems are affecting your daily life. You may talk about how well you sleep, how long you sleep, your bedtime habits, and how you feel when you're awake. Your doctor may ask you to keep a sleep journal for a week or two. This journal is a record of your sleep patterns.

Sometimes a doctor will do a physical examination, blood tests and, in some cases, a sleep study to help find out if you have a health problem that may be causing the insomnia.

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Treatment Overview

Treatment for insomnia includes behaviour and lifestyle changes. Treatment may include cognitive behavioural therapy for insomnia (CBT-I).

CBT-I can help you identify and change thoughts and behaviours that keep you from getting good sleep. You also focus on goals such as having healthy sleep habits and creating a sleep schedule. These things can gradually help you sleep better over time. Your treatment plan will include things to try at home. These may be lifestyle changes or changes in your bedtime routine. Examples include doing relaxation exercises, keeping regular bedtimes and wake times, and not drinking caffeine or alcohol before bed.

Some people decide to take medicine for a while to help with sleep. Medicine is used along with lifestyle and behaviour changes.

Self-Care

There are many steps you can take that may improve your sleep. Follow the treatment plan that you and your doctor made to help you sleep better. Here are a few examples.

• If your doctor recommends cognitive behavioural therapy for insomnia, follow your treatment plan.

  Your plan will likely include a few things that you can try at home.

• Make a sleep schedule.

  Go to bed at the same time every night, and wake up at the same time every morning. Do not take naps during the day.

• Use your bedroom only for sleeping and sex.

  Don't read, watch TV, or use your phone in bed.

• Give yourself about 15 to 20 minutes to fall asleep.

  If you can't fall asleep (or fall back to sleep) after about 15 to 20 minutes, get out of bed and do a quiet task until you feel sleepy. This will help you to not link being in bed with not being able to sleep.

• Create a relaxing bedtime routine.

  It can help teach your body and mind that it is time to wind down. For example, before bed, take a warm shower, listen to soothing music, or have a cup of herbal tea.

• Try meditation or other relaxation techniques before you go to bed.
• Keep your bedroom quiet, dark, and cool.

  If that's not possible, try using a sleep mask and earplugs to help you sleep.

• Avoid or limit caffeine, nicotine, and alcohol.

  Don't use them at all late in the day or in the evening.

• If you take medicine to help you sleep, take it exactly as prescribed.

  Call your doctor if you think you are having a problem with your medicine.

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Medicines

In some cases, taking medicine for a while helps you get some rest. Doctors may recommend taking sleep medicines only now and then or only for a short time. They aren't the first choice for treating chronic insomnia. Medicines are used along with behaviour and lifestyle changes that can help you over the long term.

Many sleep medicines cause side effects. These medicines also may not work as well when your body gets used to them. And they may cause withdrawal symptoms when you stop using them.

Sleep medicines include:

• Prescription sleep medicines. There are different kinds. Examples include eszopiclone (Lunesta) and zolpidem.
• Prescription depression or anxiety medicines that have a calming or sedative effect. These can be used to help you sleep.
• Over-the-counter medicines for sleep. They can provide short-term relief of sleeplessness. Examples include melatonin and diphenhydramine (Sleep-Eze).

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Complementary Medicines

Some people who have insomnia take natural health products to try to help them sleep better. Talk with your doctor before you try a natural health product. Your doctor can recommend how much to take and when to take it. Make sure your doctor knows all of the medicines and natural health products you take.

Melatonin is one example. It may help some people sleep better. It's a hormone produced by the brain. You can buy this as a supplement. It has also been used to treat jet lag and poor sleep from working the night shift. The long-term effects of taking melatonin are unknown. If you use it regularly, talk to your doctor.

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