According to guidelines from a physician group, people with insomnia have one or more of the following symptoms:
- Difficulty falling asleep
- Difficulty staying asleep (waking up during the night and having trouble returning to sleep)
- Waking up too early in the morning
- Unrefreshing sleep (also called "non-restorative sleep")
- Fatigue or low energy
- Cognitive impairment, such as difficulty concentrating
- Mood disturbance, such as irritability
- Behavior problems, such as feeling impulsive or aggression
- Difficulty at work or school
- Difficulty in personal relationships, including family, friends and caregivers
The duration of insomnia is important. Doctors consider insomnia chronic if it occurs at least three nights per week for three months or longer. At this point, your insomnia may be a behavioral pattern (for example, your nighttime routines do not cue your body for sleep, or your sleep schedule is out of sync with your biological clock), or it could be comorbid, meaning it is linked to another medical or psychiatric issue that needs to be addressed. Recently, researchers have begun to think about insomnia as a problem of your brain being unable to stop being awake. Your brain has a sleep cycle and a wake cycle—when one is turned on the other is turned off. Insomnia can be a problem with either part of this cycle: too much wake drive or too little sleep drive. Regardless of its cause, if insomnia has become a regular occurrence, talking to your doctor about treatment may be a good idea.
You may also want to consider whether and to what degree insomnia is affecting your life. If you feel fatigued or have low energy during the day and it gets in the way of your productivity and enjoyment of friends, family, or hobbies that probably means you could benefit from talking to your doctor. If you've tried on your own to make adjustments to your sleep routines and it hasn't worked, you may want to enlist the help of a sleep specialist.
In addition to asking you a number of questions, your doctor may have you complete a questionnaire to determine your sleep-wake pattern and your level of daytime sleepiness. You may also be asked to keep a sleep diary for a couple of weeks if you haven't already done so.
Your doctor will likely do a physical exam to look for signs of other problems that may be causing insomnia. Occasionally, a blood test may be done to check for thyroid problems or other conditions that can cause insomnia.
If the cause of your insomnia isn't clear, or you have signs of another sleep disorder, such as sleep apnea or restless legs syndrome, you may need to spend a night at a sleep center. Tests are done to monitor and record a variety of body activities while you sleep, including brain waves, breathing, heartbeat, eye movements and body movements.
You should seek help if your insomnia has become a pattern, or if you often feel fatigued or unrefreshed during the day and it interferes with your daily life. Many people have brief periods of difficulty sleeping (for example, a few days after starting a new job), but if insomnia lasts longer or has become a regular occurrence, you should ask for help.
Start by calling your primary care physician or bringing up the topic of sleep at your next well visit if you have one scheduled. If your doctor is knowledgeable about sleep disorders, he or she will guide you through the next steps, which may involve an assessment and further testing, or a referral to a sleep specialist. Your doctor may also start by giving you some basic information and resources about healthy sleep habits—these behavioral tips may help certain people with insomnia—or discussing potential medical treatment options to consider. Your doctor could refer you to a psychotherapist if your sleep struggles seem connected to anxiety, depression, or a major life adjustment.
If you don't feel satisfied after your conversation with your primary care physician, ask for a referral to a doctor who specializes in sleep medicine or consult other available resources. It's important to find a doctor who has the proper knowledge and training to treat your insomnia.
Many cities also have sleep centers and clinics (sometimes connected to a hospital) that offer assessments, testing, and treatment. An Internet search will help you locate the nearest center.
NON-MEDICAL (COGNITIVE & BEHAVIORAL) TREATMENTS FOR INSOMNIA
There are psychological and behavioral techniques that can be helpful for treating insomnia. Relaxation training, stimulus control, sleep restriction, and cognitive behavioral therapy are some examples.
Some of these techniques can be self-taught, while for others it's better to enlist the help of a therapist or sleep specialist.
Relaxation training, or progressive muscle relaxation, teaches the person to systematically tense and relax muscles in different areas of the body. This helps to calm the body and induce sleep. Other relaxation techniques that help many people sleep involve breathing exercises, mindfulness, meditation techniques, and guided imagery. Many people listen to audio recordings to guide them in learning these techniques. They can work to help you fall asleep and also return to sleep in the middle of the night.
Stimulus control helps to build an association between the bedroom and sleep by limiting the type of activities allowed in the bedroom. An example of stimulus control is going to bed only when you are sleepy, and getting out of bed if you've been awake for 20 minutes or more. This helps to break an unhealthy association between the bedroom and wakefulness. Sleep restriction involves a strict schedule of bedtimes and wake times and limits time in bed to only when a person is sleeping.
Cognitive behavioral therapy (CBT) includes behavioral changes (such as keeping a regular bedtime and wake up time, getting out of bed after being awake for 20 minutes or so, and eliminating afternoon naps) but it adds a cognitive or "thinking" component. CBT works to challenge unhealthy beliefs and fears around sleep and teach rational, positive thinking. There is a good amount of research supporting the use of CBT for insomnia. For example, in one study, patients with insomnia attended one CBT session via the internet per week for 6 weeks. After the treatment, these people had improved sleep quality.
MEDICAL TREATMENTS FOR INSOMNIA
There are many different types of sleep aids for insomnia, including over-the-counter (non-prescription) and prescription medications
Determining which medication may be right for you depends on your insomnia symptoms and many different health factors. This is why it's important to consult with a doctor before taking a sleep aid.
Major classes of prescription insomnia medications include benzodiazepine hypnotics, non-benzodiazepine hypnotics, and melatonin receptor agonists.
There are alternative medicines that may help certain people sleep. It's important to know that these products are not required to pass through the same safety tests as medications, so their side effects and effectiveness are not as well understood.
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