There are different types of insomnia, most of which cause people to lie in bed awake, frustrated that they are unable to fall asleep or stay asleep. As a result, they toss and turn, and irritability increases. Insomnia can take various forms, including early morning arousal (difficulty staying asleep), sleeping latency (difficulty falling asleep), fragmented sleep (waking up multiple times during the night), and sleeping very lightly and waking feeling unrefreshed. Many people with insomnia want to avoid medication because they are concerned about potential addiction, or feeling spacey or drowsy the next day.
Insomnia can be categorized as:
Sleep-wake cycles are dictated by internal circadian rhythms. These rhythms are strongly influenced by light entering through the eyes, which signals the brain to regulate production of certain hormones, including one called melatonin. Circumstances that unnaturally diminish the entrance of light into the eyes can disrupt the natural circadian rhythm, the production of necessary hormones, and therefore, an individual's proper sleep-wake cycle. Such circumstances include blindness and failing eyesight due to aging. Traveling to different time zones and jet lag, as well as working the night shift, disturb the natural circadian rhythm as well.
Insomnia can also be a sign of an underlying medical condition such as depression, an over-active thyroid, high blood pressure, heart disease, asthma, sleep apnea, restless leg syndrome, dementia, or pain disorders.
Several lifestyle factors can contribute to sleep disturbance. Keeping a sleep-wake diary is helpful in identifying and modifying these factors, which include:
The most effective and frequently used conventional treatments to establish a restful sleep pattern may include a combination of approaches. These include achieving proper sleep hygiene, making other lifestyle alterations, and possibly medications.
Good sleep hygiene includes:
If nothing seems to be working for you, there are treatment options available. These may include:
Long-term use of sleeping pills is not recommended, as dependence is possible with some classes of drugs. Research on safety and effectiveness is ongoing. For temporary relief of insomnia, the following medications offer a solution:
The National Sleep Foundation recommends that people taking sleep medications begin with the lowest possible dose that is effective, use the drugs on a short-term basis, and take the drugs intermittently if they are using them on a long-term basis.
While some cultures have a long history of using supplements and herbal remedies for the treatment of insomnia, such practices have only gained popularity over the last few decades in the US and other Western nations. Check with your doctor before trying herbs or supplements to make sure they are safe. Some have serious side effects and others may mix poorly with medication you are already taking. Although herbal remedies may be helpful for some people, most scientific studies have been unable to prove them effective in treating insomnia. Some that may hold promise are:
This neurotransmitter is secreted by the pineal gland and it regulates the sleep cycle. Melatonin is secreted at night, and the secretion is suppressed by bright light during the day. When melatonin secretion is not synchronized with the light-dark cycle, sleep disturbances occur. Frequently touted as a valuable supplement for insomnia, melatonin has shown only mixed results for insomnia in studies.
Melatonin may be useful for temporary sleep disturbances from a change in schedule (daytime work to nighttime) or sudden disruption of the circadian rhythm as with jet lag. Speak with your doctor if you would like to try it, particularly because there are certain circumstances in which it should not be used until more information is available. These may include pregnancy, breastfeeding, autoimmune disorders, leukemia, and lymphoma.
In addition to caffeine, excessive alcohol, and particular medications, certain herbs sold over the counter can induce wakefulness. These include ginseng, ephedra, yohimbe, and cola nut. The hormonal supplement DHEA may also contribute to insomnia.
Insomnia is a common problem that results not only in personal frustration and discomfort, but also is associated with decreased work performance, lost productivity, accidents, and hospitalization. Treatment for insomnia must be specific to the individual to achieve optimal results. Prescription medications may be used to achieve short-term results. However, nonprescription treatments are commonly recommended, inexpensive, and effective. Talk with your doctor about different strategies that may be combined to help you find relief from insomnia.
National Heart, Lung, and Blood Institute
National Sleep Center
Better Sleep Council Canada
Canadian Sleep Society
Insomnia in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114839/Insomnia-in-adults. Updated January 17, 2017. Accessed February 1, 2017.
Light therapy for insomnia sufferers. National Sleep Foundation website. Available at: https://sleepfoundation.org/insomnia/content/light-therapy-insomnia-sufferers. Accessed February 1, 2017.
Sleep disorders: In depth. National Center for Complementary and Integrated Health website. Available at: https://nccih.nih.gov/health/sleep/ataglance.htm?nav=gsa. Updated October 2015. Accessed February 1, 2017.
Sleep drive and your body clock. National Sleep Foundation website. Available at: http://www.sleepfoundation.org/article/sleep-topics/sleep-drive-and-your-body-clock. Accessed February 1, 2017.
Valerian. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/biomedical-libraries/natural-alternative-treatments. Updated December 15, 2015. Accessed February 1, 2017.
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11/5/2010 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114839/Insomnia-in-adults: Fernández-San-Martín MI, Masa-Font R, Palacios-Soler L, Sancho-Gómez P, Calbó-Caldentey C, Flores-Mateo G. Effectiveness of valerian on insomnia: a meta-analysis of randomized placebo-controlled trials. Sleep Med. 2010;11(6):505-511.
Last reviewed February 2017 by Michael Woods, MD, FAAP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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