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Insomnia

  • Having difficulty falling or staying asleep for an extended amount of time
  • Symptoms include difficulty falling asleep, trouble staying asleep, or waking up too early
  • Treatment includes cognitive behavioral therapy and/or sedatives
  • Involves sleep medicine program

Overview

Everyone has trouble sleeping at times, but for some the inability to fall asleep or stay asleep causes a significant decline in performance and functioning during the day and even brings a range of associated health problems. 

Some 30 percent of Americans report experiencing some form or sleep disruption. “As big a problem as insomnia is in this country, what we call voluntary sleep restriction – that means people choosing not to get enough sleep – that’s almost worse,” says Yale Medicine psychiatrist Peter Thomas Morgan, MD, PhD. If left untreated, insomnia can worsen into a chronic condition. With treatment, though, there can be relief, and a future of restful and rejuvenating sleep.

What are the symptoms of insomnia?

What’s considered a full night of sleep can differ from person to person, Dr. Morgan explains. "Most people need between seven and nine hours.”

When you’re doing all the right things and still having trouble sleeping – whether that’s difficulty falling asleep, trouble staying asleep or waking up too early – it could be insomnia. Other symptoms include trouble concentrating and performing well during your waking hours. An insomniac may notice he or she feels overly emotional and experiences headaches or stomachaches.

“If someone comes to me and they complain that they’re having trouble falling asleep, or they’re not sleeping well, but it doesn’t seem to be affecting them during the day, then they might be getting enough sleep,” Dr. Morgan says. “I wouldn’t necessarily call it insomnia. If it were insomnia, it would have some consequence on the day.”

What are the risk factors for insomnia?

When there isn’t an underlying cause, doctors refer to the condition as primary insomnia. “There are some people who don’t sleep well, and it’s hard to understand what could be causing that,” Dr. Morgan says. “In my experience, there’s usually something. It’s a question of how much time you spend trying to figure it out, and how open the person is to thinking about what’s causing it.”

Those causes can include physical, mental and environmental factors, and lead to what’s called secondary insomnia. Risk factors can include: 

  • Pain. All sorts of physical pain, from backaches to pain associated with conditions such as cancer, can disrupt a person’s sleep.
  • Mental Health. Mental health issues, including anxiety, depression and post-traumatic stress disorder, can undermine a person’s ability to sleep. Even regular, everyday stress can negatively affect a person’s sleeping patterns.
  • Stress. From daily stressors to major emotional traumas such as the death of a loved one or the loss of a job, stress can affect a regular night’s sleep.
  • Environment. The place in which a person sleeps can affect sleep quality. Everything from the room’s temperature to noise and light levels can contribute to sleeplessness.
  • Age. Insomnia seems to be more common as people get older. Our natural sleep patterns change as we age, so we don’t get as much deep sleep, and it’s harder to stay asleep all night.

How is insomnia treated?

Cognitive behavioral therapy (CBT) is one of the best treatments for insomnia and can lead to improved sleep without the use of medication. The therapy involves planning and tracking a person’s sleep, and it often begins with intentional sleep restriction. The patient will wait an hour or more before going to sleep rather than doing so when he or she first feels tired (while avoiding naps during the day). For the first few nights, the person may go to bed while giving him or herself fewer hours of sleep – say, six or seven – than actually needed. This strategy can make the person tired enough to sleep through the whole night, without a chance to wake up in the middle. After a few days, bedtime is moved back until it allows for a full eight hours of sleep.

Sedating medications are another option, but because of risks that include physiological dependency, most are not approved by the Food and Drug Administration for long-term use. The types of medications most often used to treat insomnia include benzodiazepines and benzodiazepine-like medications, which include brand-name drugs such as Ambien, Lunesta, Sonata and Restoril.