Insomnia: Trouble Sleeping, Causes and When to Be Seen

What it involves

NHLBI describes insomnia as a common sleep disorder in which you have trouble falling asleep, staying asleep, or getting good quality sleep, even when you have the time and the right environment to sleep well. It can interfere with daily activities and cause sleepiness in the daytime. Short-term insomnia can last days or weeks, while NHLBI defines chronic insomnia as occurring three or more nights a week for more than three months.

Who this is for

• Adults who have had trouble sleeping for several weeks and are tired during the day
• Patients whose sleep changed after a new medicine, a stressful event, or a shift in work hours
• Patients with high blood pressure, diabetes, pain, or low mood who also sleep badly
• Patients who want to understand their options before trying over-the-counter sleep aids

What to expect

• Questions about bedtime, wake time, caffeine, alcohol, naps, screens, and what keeps you awake
• A review of your medicines and any conditions that can disturb sleep
• A physical exam, and a sleep diary for a week or two if your provider asks for one
• A plan that may combine sleep habits, counseling, a medicine, or a referral for a sleep study

What insomnia looks like

MedlinePlus lists the symptoms of insomnia:

• Lying awake for a long time before you fall asleep
• Sleeping for only short periods, or being awake for much of the night
• Waking up too early
• Feeling as if you have not slept at all

Short-term and long-term insomnia

MedlinePlus says acute insomnia is common and usually lasts days or weeks, with stress at work, family pressures, or a traumatic event among the causes. It says chronic insomnia lasts a month or longer and that most chronic cases are secondary, meaning they are a symptom or side effect of another problem such as a medical condition, a medicine, or another sleep disorder. Caffeine, tobacco, and alcohol can also be causes. Sometimes chronic insomnia is the primary problem, and its cause is not well understood.

Who is more likely to have it

MedlinePlus says insomnia affects women more often than men, can occur at any age, and is more likely in older adults. It also lists a lot of stress, depression or other emotional distress, working at night or having frequent big shifts in work hours, traveling across time zones, and an inactive lifestyle as risk factors. Because the causes are so varied, a good visit spends as much time on your day as on your night. Waking several times a night to urinate is a different problem from trouble falling asleep, and the frequent urination guide explains the causes and what to bring to a visit.

Why it is worth a visit and not just a pill

NHLBI says insomnia can affect memory and concentration, and that chronic insomnia raises your risk of high blood pressure, coronary heart disease, diabetes, and cancer. MedlinePlus warns that drowsiness can make driving dangerous. Sleep, blood pressure, and weight often move together, so it is worth reading about blood pressure readings and the obesity and BMI guide alongside this one, and about fatigue and tiredness if the daytime effect is what bothers you most. Intense itching from eczema can disrupt sleep, and the eczema guide lists the bathing and moisturizing habits that MedlinePlus says can calm the skin.

How a provider works it out

NHLBI says a provider may ask about your sleep habits and ask you to keep a sleep diary. MedlinePlus says the provider takes a medical and sleep history, does a physical exam to rule out other medical problems, and may recommend a sleep study that measures how well you sleep and how your body responds to sleep problems. A sleep study is an outside referral, not something this practice lists as a service. Bring a list of your medicines, since some can keep you awake. Loud snoring with gasping or pauses in breathing points to a different problem than trouble falling asleep, and the sleep apnea guide explains how it is evaluated.

Treatments that exist

MedlinePlus says treatment includes lifestyle changes with good sleep habits, counseling, and medicines. It describes cognitive behavioral therapy as a type of counseling that can relieve the anxiety linked to chronic insomnia, and says medicines can help re-establish a regular sleep schedule. If insomnia is the symptom or side effect of another problem, it is important to treat that problem if possible. NHLBI lists a regular sleep schedule among healthy habits. Ask your provider before starting a sleep aid or combining one with alcohol or other medicines.

Sources

• NHLBI — Insomnia
• MedlinePlus — Insomnia