Insomnia

Although sleep is an essential part of life, for many people restful sleep is elusive. Insomnia, the most common sleep disorder, includes having difficulty falling asleep, waking often during the night, waking up too early, or just feeling that your sleep isn't refreshing.

Almost everyone has insomnia sometimes. But insomnia can be a chronic problem that has a major impact on how you function during the day. It can make you irritable, impair your judgment, and increase your risk of accidents by making you sleepy during the day. It also can worsen existing medical problems and lead to new ones.

Insomnia should not be ignored or dismissed as merely a nuisance. Those who seek treatment can get relief. First, there is a lot you can do at home to improve your chances of getting a good night's sleep. Also, a variety of therapies can help, as can new drugs that make it easier for insomnia sufferers to fall asleep and stay asleep.

This section has more on:

• Need-to-know anatomy
• Causes
• Risk factors

Need-to-know anatomy

The brain has an internal clock that controls the rhythm of the day. Small areas in the brain stem and hypothalamus are responsible for telling the rest of the brain when it's time to sleep. These areas may be more active during sleep in people with insomnia.

Causes

Insomnia can be a disorder on its own or a symptom of any number of other medical problems, from chronic pain to depression. Many common over-the-counter and prescription medications also can cause insomnia.

Stress, prompted by major life events such as a tragic loss, marriage, a job change, or an important exam, can lead to insomnia. It can also result from sleeping in new settings, such as a hotel room. With these types of sleep disturbances, sleep tends to return to normal once the stress is removed or the person learns to cope with it.

Other things that can disturb sleep include:

• Loud noise, bad odors, bright lights, and extremes in room temperature
• A snoring sleep partner or an uncomfortable bed
• Concerns about safety in the house
• Caring for a family member who often wakes up during the night
• Moving to a high altitude

Insomnia can result from poor sleep hygiene, which includes:

• Using caffeine, alcohol, or tobacco close to bedtime
• Physical or mental exercise close to bedtime
• Frequent changes in bedtime or awakening times
• Frequent napping during the day
• Spending a lot of time in bed doing homework or watching television.

The stress caused by insomnia can turn it into a chronic problem. A person with trouble sleeping may try "too hard" to sleep. He or she may become tense and more aroused. This, in turn, increases anxiety about not being able to sleep, creating a vicious cycle. A person with these problems may sleep better, at least in the short term, anywhere other than his or her own bedroom.

This section has more on:

• Medical conditions that can cause insomnia
• Medicines that can cause insomnia

Medical conditions that can cause insomnia

Insomnia is often a symptom of other medical problems. The first symptom of major depression, for instance, may be insomnia. People with bipolar disorder, anxiety, or other mood disorders often have insomnia, too. Disorders for which pain is a constant companion, such as arthritis and fibromyalgia, can cause insomnia. Similarly, medical problems that cause itching may disturb sleep.

People with Alzheimer's often have trouble with sleep. Many Alzheimer's patients have "sundown syndrome," in which they get confused and agitated around sunset. This can continue into the night, disrupting sleep. The motor symptoms of Parkinson's disease can cause patients to awaken repeatedly during the night, and some Parkinson's medications also interfere with sleep. Many patients getting dialysis for endstage renal disease experience insomnia. If you have a chronic illness and you are having sleep disturbances, talk with your doctor.

Many sleep disorders can have insomnia as a symptom. In circadian rhythm disorders, the rhythm of the internal "clock" that controls timing of sleep and wakefulness is altered. People with narcolepsy may wake up frequently at night in addition to falling asleep at inappropriate times during the day. Restless leg syndrome causes an overwhelming urge to move the legs, which can interfere with sleep.

Some people who complain of insomnia are eventually diagnosed with obstructive sleep apnea, a disorder in which patients stop breathing repeatedly as they sleep, causing them to wake up over and over. They may not remember waking up, but often feel that they aren't getting a good night's sleep. A bed partner may notice choking sounds or loud snoring.

In some cases, treating the underlying medical problem will take care of the insomnia, but this isn't always true. And for some diseases, the medications used for treatment may also cause insomnia.

Medicines that can cause insomnia

Many medicines cause wakefulness and alertness. These can cause insomnia when taken close to bedtime or when the dose is increased. Also, stopping medications that help induce sleep after long-term use can lead to severe insomnia. If you take any of the following medicines and are having sleep disruptions, talk with your doctor. Do not stop any medicines if you have not consulted with your doctor.Medications that can cause insomnia include:

• Oral contraceptives
• Selective serotonin reuptake inhibitors (antidepressants such as Prozac and Zoloft)
• Dopamine agonists (includes some medications for Parkinson's disease)
• Psychostimulants and amphetamines
• Anticonvulsants
• Cold medicines
• Decongestants
• Ephedrine and pseudoephedrine
• Cortisone and adrenocorticotropin
• Beta agonists
• Theophylline
• Medications to lower blood pressure (alpha agonists, beta blockers)
• Lipid and cholesterol-lowering agents (statins)
• Diuretics
• Appetite suppressants
• Caffeine
• Alcohol
• Niacin
• Quinolone antibiotics
• Antineoplastic agents

Risk factors

Insomnia is more common among women and older people.