Patient education: Insomnia (The Basics)

What is insomnia? — 

This is a problem with sleep. People with insomnia have trouble falling or staying asleep, or they do not feel rested when they wake up. Insomnia is not about the number of hours of sleep a person gets. Everyone needs a different amount of sleep.

Short-term insomnia is when a person has trouble sleeping for a few days or weeks. This is usually related to temporary stress and often gets better on its own. Long-term, or "chronic," insomnia is when sleep problems last for 3 months or longer.

What are the symptoms of insomnia? — 

People with insomnia often:

●Have trouble falling or staying asleep

●Feel tired during the day

●Forget things or have trouble thinking clearly

●Get cranky, anxious, irritable, or depressed

●Have less energy or interest in doing things

●Make mistakes or get into accidents more often than normal

●Worry about their lack of sleep

These symptoms can be so bad that they affect a person's relationships or work life. They can happen even in people who seem to be sleeping enough hours.

Will I need tests? — 

Probably not. Most people with insomnia do not need tests. Your doctor or nurse will probably be able to tell what is wrong just by talking to you. They might ask you to keep a daily log for 1 to 2 weeks, where you keep track of your sleep each night. This includes when you slept, how well you slept, and how many times you woke up. Your doctor or nurse will also ask you questions about things like your exercise habits, whether you drink alcohol or caffeine, and any medicines you take.

In some cases, people do need special sleep tests, such as:

●Polysomnography – This test usually lasts all night. It can be done in a sleep lab or in your home. During the test, monitors are attached to your body to record movement, brain activity, breathing, and other body functions.

●Actigraphy – This records activity and movement with a monitor or motion detector that is usually worn on the wrist. The test is done at home, over several days and nights. It records how much you actually sleep and when.

How is insomnia treated? — 

It depends. If your insomnia is related to stress, pain, or a medical problem, treating that problem can help you sleep better. If you have chronic insomnia, meaning insomnia that lasts longer than 3 months, there are specific treatments that can help. They include:

●Cognitive behavioral therapy for insomnia, or "CBT-I" – This involves working with a counselor or therapist over several weeks. You work on understanding your insomnia, learning ways to build better sleep habits, and changing negative thinking patterns that can make insomnia worse. Your therapist can also teach you relaxation exercises that can help.

Part of CBT-I involves learning about "sleep hygiene." These things can also be helpful for people who don't have chronic insomnia but have trouble sleeping sometimes. Having good sleep hygiene means that you:

•Sleep only long enough to feel rested, and then get out of bed.

•Go to bed and get up at the same time every day.

•Do not try to force yourself to sleep. If you can't sleep, get out of bed and try again later.

•Have coffee, tea, and other foods with caffeine only in the morning.

•Avoid alcohol in the late afternoon, evening, and bedtime.

•Avoid smoking, especially in the evening.

•Keep your bedroom dark, cool, quiet, and free of reminders of work or other things that cause you stress.

•Solve problems before you go to bed.

•Get plenty of physical activity, but avoid heavy exercise right before bed.

•Avoid looking at phones, computer screens, or reading devices ("e-books") that give off light before bed. This can make it harder to fall asleep.

●Medicines – There are also medicines that can help with sleep. But doctors usually recommend trying CBT-I first. In some cases, they might recommend starting both at the same time. If your doctor or nurse thinks that medicine might help you, they will talk to you about your options. Some medicines come with serious risks. For example, they can make you groggy or off-balance when you wake up. Sometimes, they cause behaviors like walking, eating, or driving in your sleep. These things could cause an accident or serious injury.

Doctors generally do not recommend over-the-counter "sleep aids" for treating chronic insomnia.

If your insomnia is related to problems like depression or anxiety, it can help to treat those problems directly.

Can I use alcohol to help me sleep? — 

No, do not use alcohol as a sleep aid. Even though alcohol makes you sleepy at first, it disrupts sleep later in the night.

When should I call the doctor? — 

Call your doctor or nurse for advice if:

●Your sleep problems are making it hard for you to do your normal activities.

●You think that your insomnia might be caused by a health problem.

●You are struggling with depression or anxiety.

Get help right away if you are thinking of hurting or killing yourself! — 

If you ever feel like you might hurt yourself or someone else, help is available:

●In the US, contact the 988 Suicide & Crisis Lifeline:

•To speak to someone, call or text 988.

•To talk to someone online, go to www.988lifeline.org/chat.

●Call your doctor or nurse, and tell them that it is urgent.

●Call for an ambulance (in the US and Canada, call 9-1-1).

●Go to the emergency department at the nearest hospital.

More on this topic

Patient education: Good sleep hygiene (The Basics)
Patient education: Daytime sleepiness (The Basics)
Patient education: Sleep insufficiency (The Basics)
Patient education: Restless legs syndrome (The Basics)
Patient education: Jet lag (The Basics)
Patient education: What is a sleep study? (The Basics)
Patient education: Psychotherapy (The Basics)

Patient education: Insomnia (Beyond the Basics)
Patient education: Insomnia treatments (Beyond the Basics)