There are different types of
insomnia, most of which cause people to lay 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 medicine because they are concerned about potential addiction, or feeling spacey or drowsy throughout the day.
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,
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:
- Use of stimulants, including caffeine, nicotine, and ingredients in common drugs such as cold and weight-loss medicines. Some people have difficulty falling asleep, others wake during the night.
- Use of alcohol. While it may help you fall asleep, alcohol consumption is likely to produce interrupted sleep and is not recommended as an insomnia treatment.
- Working night or rotating shifts.
- Lack of regular exercise.
- Exercising too close to bedtime
- Eating too close to bedtime.
- Excessive time on the computer or watching television.
The most effective and frequently used conventional treatments to establish a restful sleep pattern are behavioral, not medicinal. These include achieving proper sleep hygiene, as well as making other lifestyle alterations. Good sleep hygiene includes:
- Going to bed at the same time each night
- Reserving your bed for sleep and sex
- Watching television or reading in another room
- Avoiding caffeine, alcohol, and cigarettes, especially in the afternoon and evening
- Not laying in bed watching the clock. If you cannot fall asleep 15-20 minutes, get up and listen to calming music or read
- Exercising often, but not too close to bedtime
- Limiting naps
- Sleeping in a place with very little light and noise distraction
If nothing seems to be working for you , there are treatment options available. Consider trying:
- Relaxation techniques—A multidisciplinary team, including medical doctors, specializing in sleep disturbances can train and guide people in such approaches as yoga, meditation, deep relaxation, biofeedback, hypnosis, massage, and/or guided imagery. Practicing one of these techniques within 30 minutes of bedtime may be helpful. Simple changes in bedtime routine may also be effective. These include taking a warm bath, listening to soothing music, and drinking warm milk.
- Acupuncture—Positive effects of the use of this ancient Chinese practice have been shown; however, more proof is needed before it can be recommended as an effective treatment for insomnia. A typical protocol is to receive acupuncture treatments weekly until a normal sleep pattern is achieved, followed by maintenance sessions. However, a licensed and certified acupuncturist will determine the most appropriate treatment regimen for each individual.
Light therapy—For night-shift workers suffering from insomnia, light therapy may effective. This therapy involves using very bright lights in the work setting and then, when trying to sleep during the day, doing so in a very dark room while wearing sunglasses or a sleep mask.
- Cognitive therapy—This behavioral method involves addressing misconceptions and unrealistic expectations about both insomnia and the nature of sleep. Some issues addressed during cognitive therapy include napping to compensate for poor sleep at night,
about bedtime, fear of sleeplessness, beliefs about necessary hours of sleep, and attributing insomnia to age, ability to sleep, and/ or possible chemical imbalance.
Long-term use of sleeping pills is not recommended, as addiction is possible, and more research needs to be done on safety and effectiveness. For temporary relief of insomnia, the following medicines may be prescribed:
Short-acting sedative-hypnotics known as non-benzodiazepines. Zolpidem (Ambien), Zaleplon (Sonata), and Eszopiclone (Lunesta) fall into this category.
- Melatonin receptor agonists.
The National Sleep Foundation recommends that people taking sleep medicine 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 United States 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: pregnancy, breast-feeding, autoimmune disorders,
In addition to caffeine, excessive alcohol, and particular medicines, 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 medicines (sleeping pills) may be used to achieve short-term results. However, nonprescription treatments are commonly recommended and inexpensive, and also are effective. Talk with your doctor about several strategies that may be combined to help you find relief from problems with sleeping, and to assist you in getting a restful, complete night’s sleep.