An estimated 20 to 40 percent of all adults complain about insomniaa general term that refers to difficulty falling or staying asleep. Insomnia is not really a disorder but a symptom with many causes. For example, temporary insomnia can be caused by jet lag, which upsets the body’s biological clock, or by some specific, stressful situation like a divorce or change in job. Once these situations have been resolved, sleep returns to normal.
How alert and refreshed you feel, rather than how many hours of sleep you get, is a better sign of whether insomnia is a problem for you. Not everyone needs eight hoursthe number often used as the benchmark for a good night’s sleep. Some people feel well rested after only six hours of sleep a nightthough research suggests that others who think they are doing fine on five or six hours would actually benefit from more sleep.
Age is a key factor in assessing insomnia. It’s a sign of troubled sleep if a child or young adult has difficulty falling asleep or wakes up repeatedly. But in about 80 percent of people over the age of 60, sleep becomes more fragmented. People in this age group tend to wake up more often (and for longer periods) during the night, and earlier in the morning, with generally less deep sleep and more light sleep.
Symptoms of Insomnia
- Difficulty falling asleep or getting back to sleep when awakened
- Fragmented sleep—waking frequently during the night or waking earlier than desired
- Unrefreshing sleep
- Fatigue, drowsiness, inability to concentrate, irritability and mood shifts from a lack of sleep
What Causes Insomnia?
Insomnia causes range from psychological and medical conditions to environmental factors like noise, light and room temperature. Medical problems linked to insomnia include depression, allergies, colds, high blood pressure, Parkinson’s disease, urinary frequency, kidney failure, stomach ulcers, congestive heart failure and asthma.
Insomnia can also be caused by specific sleep-related disorders, especially sleep apnea (a breathing malfunction that may interrupt sleep hundreds of times a night) and restless legs syndrome (an ailment marked by burning, prickling, and aching sensations in the legs at night).
Many medications can also disturb sleepboth prescription and nonprescription drugs, including over-the-counter sleep aids that are used improperly. Consuming caffeine or alcohol and smoking at night to induce sleep are linked to sleep interruptions and waking up feeling unrefreshed.
Many experts are convinced that in the majority of cases the original cause becomes secondary; instead, the insomnia persists because of behavioral factors that reinforce it, such as excessive time in bed, drug dependency, and napping. Also, the harder you try to fall asleep, the more anxious you become, which makes success all the more difficult.
What If You Do Nothing?
Occasional insomnia is nothing to worry about. And remember that there are wide individual differences in how much sleep people need to feel refreshed and alert. Some need nine or ten hours, others only six.
Also, don’t worry that you have to “make up” every hour of lost sleep. One good night will usually repair the fatigue.
Home Remedies for Insomnia
If you have an underlying disorder, or if insomnia is the result of medication you are taking, you need to consult your doctor. But when there is no underlying cause, rather than reach for sleeping medications, try the following self-help measures. Several studies have shown that in many, if not most, instances of insomnia, such steps are more effective at treating the problem than prescription sleeping pills.
- Don’t drink alcohol before bedtime—and don’t smoke. Alcohol can disrupt sleep patterns and make insomnia worse. Nicotine makes you wakeful, too.
- Avoid eating a heavy meal in the evening, particularly at bedtime. Don’t drink large amounts of liquids before retiring.
- Eliminate caffeinated beverages, except in the morning or early afternoon.
- Unless you’re older, try to avoid daytime naps. It’s all right to use a nap for catching up on occasional lost sleep, but naps shouldn’t become a substitute for sleep, even if you’re tired. Naps probably can be beneficial for older people whose sleep is fragmented—and certainly it’s better to nap than to rely on sleeping pills.
- Spend an hour or more relaxing before you retire. Read, listen to music, watch TV, or take a warm bath.
- Go to bed and get up on a regular schedule. Get into bed at the appointed time even if you’re not tired, and arise for the day on schedule no matter how much you haven’t slept.
- If you can’t sleep, get up and do something. If you’ve gotten into bed and after 20 minutes still can’t sleep, get up and read or do some other quiet activity for a short time. However, don’t bring work into bed with you; go somewhere else to do it. If you wake up in the middle of the night and can’t fall asleep, try reading for a bit. Counting sheep (or flowers or whatever appeals to you) or reconstructing a happy event or narrative in your mind may also lull you to sleep.
- Try to correct any stress that’s keeping you awake. If your sleeplessness arises from worry or grief, it may be hard to return to your regular sleeping schedule until you’ve done something to relieve the problem. If you can’t do anything about the situation right away on your own, try confiding in a friend, joining a support group, or finding a qualified counselor.
Supplements That Promise Sleep
Melatonin and valerian are two popular dietary supplements promoted as sleeping aids. Melatonin is actually a human hormone that seems to play a role in synchronizing circadian rhythms, and it is widely marketed in health-food stores as a jet lag cure. There is evidence that melatonin helps people fall asleep faster, but it may not help them stay asleep. Like many prescription sleeping pills, it can also produce drowsiness the next day.
Similarly, a dose of valerian before retiring seems to reduce the time it takes to fall asleep. But it has yet to be shown in a well-designed trial that valerian improves the quality of sleep. And there is no method for standardizing doses of either of these substances.
If you decide to try valerian or melatonin, treat it like any sleeping medication—don’t combine it with alcohol, tranquilizers, or barbi-
Medications for Insomnia
Prescription sleeping pills—known as hypnotics—and other sleeping aids are among the most frequently taken medications in the United States. But how effective and safe are they—and what, if anything, should you take?
- Over-the-counter sleeping pills. Most such drugs are antihistamines (just like many hay fever remedies, which may also induce drowsiness) and at the suggested dosage are probably harmless. It won’t hurt to try them for occasional sleeplessness—they may work for a night or two—but studies show that they quickly lose their effectiveness.
- Benzodiazepines (tranquilizers). Marketed under such names as Valium, Xanax, Dalmane, Restoril, and Halcion, these prescription-only antianxiety drugs act as sedatives and are widely prescribed for people suffering from insomnia. They are less likely than barbiturates (which are no longer used as sleeping pills) to be lethal in overdose or to create physical dependency. But long-term users of benzodiazepines do experience some dependency and will usually have withdrawal symptoms when they stop taking the drugs. Many side effects have been reported for all benzodiazepines—disorientation, confusion, “hangover” the next day, blurred vision, nightmares, and daytime depression.
- Nonbenzodiazepines. Two newer medications, zolpidem (Ambien) and zaleplon (Sonata), belong to a class of medicines that have a shorter “half-life” than benzodiazepines—meaning the new drugs quickly dissipate in the body and the natural sleep cycle takes over. They are also are far less likely to produce next-day grogginess and other side effects associated with benzodiazepines.
- If, for some reason, you and your doctor decide you need one of these drugs, try a low dose first, and don’t take it for more than three or four nights in a row. Also, never combine it with alcohol. Your goal should be to reestablish normal sleeping habits without any drugs.
The measures described above will also help prevent insomnia. In addition, try to avoid taking sleeping pills. Not only can they produce daytime drowsiness and other side effects, but they lose their effectiveness if you take them every night.
Beyond Home Remedies: When To Call Your Doctor
If chronic insomnia persists for more than a week or two after you have tried self-help measures, you should see a doctor or visit a sleep disorders clinic for a professional evaluation. Stress, an underlying medical condition, or a medication you are taking may be the cause of your sleep problem. In addition, while increasingly fragmented sleep in many older people may be normal, it can also result from a specific sleep disorder such as sleep apnea, a potentially dangerous condition that requires medical diagnosis and treatment.
What Your Doctor Will Do
Your doctor will ask you about your sleeping routine and possible sources of stress in your life, and about medications or other substances (including alcohol) that might interfere with your sleep.
For short-term treatment, your doctor may prescribe a sleeping medication. For elusive or persistent sleep disorders, you may be referred to a sleep disorders clinic, where a detailed evaluation of your sleeping and waking patterns can be obtained. Treatment may entail behavioral strategies such as relaxation training and restricting your sleeping time, and medication may also be recommended. Many major medical centers have such clinics; evaluation and treatment is often covered by health insurance.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media