Insomnia

This factsheet is for people who have insomnia, or who would like information about it.

Insomnia is not being able to get enough sleep. It's usually related to finding it hard to get to sleep or stay asleep. People who have insomnia often wake up without having had enough sleep and don't feel refreshed.

About insomnia
Symptoms of insomnia
Causes of insomnia
Diagnosis of insomnia
Treatment of insomnia

About insomnia

The occasional night with too little sleep can make you feel very tired the following day, but it won't affect your health – although it can be dangerous if you're driving or operating machinery. However, sleeplessness that goes on for a long period of time (insomnia) may cause health problems such as high blood pressure and diabetes, or make you more likely to become overweight.

There are two types of insomnia.

• Primary insomnia has no obvious cause.
• Secondary insomnia is caused by an underlying problem, such as a health condition or psychological problems such as grief or depression.

Insomnia can also be described as either short term or long term.

• Short-term (acute) insomnia lasts for between one and four weeks.
• Long-term (chronic) insomnia lasts for more than four weeks.

About sleep

The reasons why we need to sleep aren't fully understood. However, the effects of a lack of sleep suggest that you need sleep in order to rest and repair your body and mind. Sleep is made up of a number of different stages.

• Pre-sleep is when your muscles are relaxed and your heart rate and breathing slow down.
• Light sleep is when you're lightly asleep, you can still be woken up easily and won't feel confused.
• Slow wave sleep is when it's hard to wake up and, if someone does wake you, you may feel disorientated and confused. Slow wave sleep is the time when you might sleepwalk or talk in your sleep.
• Rapid eye movement (REM) sleep is when your eyes move from side-to-side and your brain is very active but your muscles are totally relaxed. You dream mostly during REM sleep.

The stages of sleep occur in cycles, usually lasting between one to two hours, moving from pre-sleep, light sleep, to slow wave sleep, then to REM sleep and back again during the course of a night. You may have up to five cycles of sleep during a typical night.

The amount of sleep you need varies from person to person. Most adults need seven to eight hours but some people can manage with much less. People of different ages need different amounts of sleep. A baby needs about 17 hours a day, whereas an older child needs about nine to 10 hours a day.

Symptoms of insomnia

The symptoms of insomnia may include:

• difficulty getting to sleep
• difficulty staying asleep (frequently waking up and finding it difficult to get back to sleep)
• waking up early in the morning
• feeling tired, irritable and unable to concentrate the next day

If you consistently don't get enough sleep, you can feel irritable, anxious and depressed.

If you have any of these symptoms, see a doctor for advice.

Causes of insomnia

There is usually no single cause of insomnia, but there are a number of factors that can contribute to you getting it. Some of the main causes are listed below.

• Psychological health problems such as stress, anxiety, depression, grief or alcoholism.
• Physical health problems such as pain, asthma or heart disease.
• Medicines such as slimming medicines, antidepressants or medicines to treat high blood pressure.
• Jet lag, a temporary condition that can cause disturbed sleep patterns, digestion problems and a lack of energy (fatigue) following air travel across a number of time zones.
• Environmental factors such as noise, an uncomfortable bed or being too hot or cold.
• Lifestyle habits, for example not having a regular sleep routine, eating late at night, drinking excessive amounts of alcohol or using stimulants such as nicotine.

Diagnosis of insomnia

If your lack of sleep is affecting your quality of life, see your doctor.
Your doctor will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your doctor may ask you to keep a sleep diary for at least two weeks. You may be asked to record things like the time you go to bed, how long you think it takes you to get to sleep and how often you wake. Your doctor may also ask you to record what you're doing during the day and just before you go to bed, for example, when you have your meals or whether you have drinks with caffeine in them.

Most people don't need to have special sleep tests. Your doctor will often be able to diagnose the type and cause of your insomnia by the description of your sleep pattern.

Treatment of insomnia

Self-help

There are a number of things that you can do to help overcome insomnia. These are known as sleep hygiene measures that promote a healthy sleep routine. Some examples are listed below.

• Don't have drinks that contain caffeine or alcohol six hours before going to bed.
• Don't smoke or take nicotine replacement medicines before going to bed.
• Take regular exercise, but don't do strenuous activity immediately before going to bed as this may increase the amount of adrenaline your body produces, making it difficult to get to sleep. But you can have sex before going to sleep.
• Don't take naps during the day.
• Take a warm bath, have a milky drink, read or listen to soothing music to create a relaxed mood before going to bed. Consider relaxation therapy if you're stressed.
• Try to get into a daily routine to establish a sleep pattern. Go to bed at the same time each night and get up at the same time each morning.
• Don't have heavy or rich meals, especially within a few hours before going to bed.
• If you can't sleep, get up and read until you feel sleepy or do something you find relaxing. Don't watch television in the bedroom as this can stimulate your mind. Try not to lie in bed thinking about how much sleep you're missing, otherwise your mind may start to associate your bedroom as a place of frustration and poor sleep.
• Mentally dealing with the day's unfinished business is also helpful. Write down any worries to deal with the next day, before you go to bed. This may help to clear them from your mind and prevent them resurfacing in the early hours.
• Make sure your room isn't too hot or cold, or too noisy. Have a comfortable, supportive mattress on your bed. Wear ear plugs or an eye mask if necessary.
• Use your bedroom for sleep and sex only – try not to use it to work or watch television.

Medicines

Medicines can treat insomnia, but they are often considered a last resort. This is because they may not work for very long and can sometimes make you feel drowsy the following day. Once you start taking medicines to help you sleep you will need to take more and more to get the same effect. These medicines can also be addictive. It's important to discuss your options with your doctor.

There are two main types of medicines for insomnia – hypnotics such as the medicines zaleplon, zolpidem, zopiclone and benzodiazepines, such as diazepam or lorazepam. Your doctor can prescribe these for a short period of time (less than two weeks) to treat severe insomnia. Be careful not to drive if you still feel sleepy in the morning after taking these medicines.

If you're over 55 your doctor may prescribe you a long-acting melatonin, which is a type of hormone that your body produces. Melatonin is important in controlling your sleep pattern – it activates parts of your brain that encourage sleep.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Complementary therapies

There is some research that shows that the herb valerian may be effective for insomnia, but more research is needed to confirm this. Currently there isn't enough good quality medical evidence to show that valerian, or any other herbal remedy, can treat insomnia.

You may find herbal remedies helpful but there is limited evidence to show they work. Herbal remedies often contain active ingredients and may interact with other medicines or cause side-effects. Don't start taking any herbal remedies without speaking to your doctor or pharmacist first.

Other treatments

Other therapies that can help you to learn how to improve your sleep include the following.

• Stimulus-control therapy can help you to connect your bed with going to sleep and to create a regular sleep routine. This therapy may involve getting out of bed and doing something relaxing if you're unable to fall asleep within 15 to 20 minutes.
• Relaxation therapy can help you to relax your muscles and to clear your mind of distracting thoughts.
• Cognitive behavioural therapy (CBT) can help you deal with anxieties that may be stopping you getting to sleep. It can also help to develop positive ideas about sleep, which aims to reduce concerns about not getting enough sleep. CBT teaches you to understand what healthy sleep is and how to deal with any negative thoughts about sleep.
• Sleep-restriction therapy limits the amount of time you spend in bed to the time when you're actually asleep. You may go to sleep later and wake up earlier to make you spend more time in bed asleep.

Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.