Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 31, 2016

Adequate sleep helps improve a variety of physiological and mental functions ranging from memory and learning to immunity and metabolism. On the contrary, insufficient or disturbed sleep can worsen stress levels and lead to poor quality life. Insomnia is a sleep disorder that prevents people from falling asleep and/or staying asleep for a significant period of time.


Definition & Facts

Individuals with insomnia tend to wake up several times during the night and feel tired upon waking up in the morning. While the amount of optimal sleep may vary from one individual to another, the Center for Disease Control and Prevention (CDC) estimates that about 50 to 70 million American adults complain of insufficient sleep and are concerned about it.

Insomnia can be acute or chronic. The acute form of this disorder is temporary and may last for one or a few nights. People with chronic insomnia suffer from poor or disturbed sleep for more than four weeks.

Symptoms & Complaints

Most people with insomnia seek medical help due to daytime symptoms such as difficulty concentrating, impaired memory, irritability, fatigue, impaired motor skills, stress and inconsistent social behavior. Patients may also experience gastrointestinal distress, tension headaches, and increased tendency to make mistakes.

These symptoms occur due to one's inability to fall asleep for 30 minutes or more after lying down on the bed, waking up several times during the night, and eventually waking up very early in the morning with only six or fewer hours of sleep.

People with insomnia start experiencing stress just before bedtime as they begin to worry about their inability to fall asleep. This anxiety worsens the condition and transforms it into a chronic one. This type of insomnia can trigger anxiety and contribute to mental disturbances as well. A person with insomnia may also have difficulty with intentional daytime naps, which can cause further frustration.


Identifying the cause for a person's insomnia is crucial for effective treatment and prognosis. A small change in lifestyle or an increase in stress can lead to short-term insomnia. This condition is also known as adjustment disorder and may occur due to an acute illness, injury, job loss, examinations, excessive travel, relationship issues, or loss of a loved one.

Some women experience poor sleep during menstruation, pregnancy, or menopause. Other causes include jet lag, excessive sunlight during the summer months, and insufficient exposure to sunlight during the day. Temporary insomnia will usually improve in a few days once the individual's body adjusts to the change.

Chronic insomnia tends to run in families. It is also associated with several mental disorders such as anxiety, depression, bipolar disorder, posttraumatic stress disorder, and attention deficit hyperactivity disorder. Risk factors may also include excessive nicotine intake, use of illegal drugs, alcohol abuse, and certain medications such as antidepressants, beta blockers, and felbamate.

Many people experience sleep issues due to their partner's poor sleeping habits. Medical conditions ranging from asthma and acid reflux to cancer and arthritis can also lead to or worsen insomnia.

Diagnosis & Tests

Most people suffer from insomnia at some point in their lives. However, healthcare professionals do not recommend visiting a doctor unless the condition starts having a detrimental impact on the individual's life. Women and the elderly are at a higher risk of being diagnosed with a sleep disorder.

The doctor will usually conduct a detailed interview that will include questions regarding the individual's lifestyle, sleep habits, work and relationships. The patient may be required to complete a questionnaire, such as the Epworth Sleepiness Scale, to help the physician analyze the person's sleep-wake pattern.

Some clinicians also rely on actigrapy to assess the patient's condition. Actigraphs are small devices that resemble a wrist-watch, and they contain a microprocessor that tracks one's daytime activity accurately. The physician will also review the patient's medical history and overall health before diagnosing the sleep disorder and identifying the underlying cause. The professional may prescribe a treatment or refer the person to a sleep specialist.

Treatment & Therapy

Insomnia is a common problem and most people will benefit from simple lifestyle changes and good sleep habits. Abstaining from alcohol, caffeinated beverages and nicotine, especially before going to bed , can also help a person fall asleep quickly and stay asleep. However, some patients may require additional help.

Behavioral therapy has helped millions of men and women with insomnia achieve the desired results without any adverse reactions. The techniques may include stimulus control, cognitive behavioral therapy, relaxation techniques, and biofeedback.

People with insomnia may also rely on over-the-counter sleep medications containing antihistamines. While they may be effective, patients often experience a variety of side effects ranging from daytime drowsiness, cognitive impairment, and dizziness to blurred vision and dry mouth.

Prescription-only sedative] hypnotics are usually given to individuals with serious secondary medical conditions and to individuals over the age of 60. They may increase the risk of dependence, tolerance, or rebound insomnia when a person finds it difficult to sleep after stopping sleeping pills.

Prevention & Prophylaxis

The American Academy of Sleep Medicine provides simple sleep hygiene tips that can help prevent insomnia. These include:

  • Establishing a regular time for going to bed and waking up in the morning.
  • Avoiding naps, especially in late afternoons and evenings.
  • Using the bed only for sleeping and not for other activities such as reading, watching television, and serious discussions.
  • Exercising before dinner but not before bedtime.
  • Taking a hot bath two to three hours before bedtime and indulging in activities that relax both mind and body.
  • Creating the right environment in the bedroom with optimum temperature and good ventilation.
  • Eating dinner 4 to 5 hours before the bedtime and following it up with a light snack just before going to the bed.
  • Avoiding fluids just before bedtime.

Insomnia is not a life-threatening condition, but it can have a debilitating impact on the individual's quality of life and increase the risk of accidents. Accurate diagnosis and prompt treatment can help manage the condition effectively.

Retrieved from ""