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Alternative Names: Insomnia; Inability to sleep; Dyssomnia; Sleeplessness; Wakefulness.

The best measure of the amount of sleep needed is how you feel. If you awaken feeling refreshed, you are getting enough sleep. For some people, this may take only 4 hours. Others can need up to 10 hours to feel rested.

Most adults do best with about 8 hours of sleep each night until age 60, after which 6 hours may be adequate. Even though the elderly need less sleep, almost one half of people over 60 experience some degree of insomnia.

Using long-acting or high-dose sedatives as a "cure" for insomnia can make the problem worse, not better, over time. Antihistamines (the main ingredient in over-the-counter sleeping pills) can lead to similar difficulties. Using antihistamines over time may also lead to memory impairment.

Strong, prescription sedatives do not produce a natural, restful sleep. In addition, you can develop tolerance or dependence on these drugs. In this case, the same dose of the drug no longer produces sleep, which may lead you to try a higher dose. The circular situation becomes worse. Higher doses worsen the chance of dependence, tolerance, and side effects. Stopping these medications can cause a rebound insomnia and withdrawal.

A life-threatening disease is rarely the cause of problems with sleep. For many people, poor sleep habits are the cause. However, because insomnia is a key symptom of depression, you should be evaluated for depression if you are having sleeping difficulties.

Insomnia may cause a reduced energy level, irritability, disorientation, dark circles under the eyes, posture changes, and fatigue. It may help to consult a psychiatrist, another physician, or another mental health practitioner for evaluating psychiatric disorders that can lead to insomnia. If you are depressed, antidepressants can help both the sleeping problem and the depression. These medications do not carry the same concerns about tolerance and dependence as sedatives. Nightmares and dreams that interfere with sleep may also respond to counseling.

Definition

Sleeping problems, called insomnia, can take several forms:

• Waking up frequently throughout the night
• Waking up too early in the morning
• Difficulty falling asleep when you first go to bed at night

All types of a sleeplessness can lead to poor concentration, daytime drowsiness and the inability to feel refreshed and rested in the morning.

Causes

Insomnia in adults may be due to:

• Aging
• Anxiety
• Alcoholism or abruptly stopping alcohol after long-term use
• Bed or bedroom does not promote sleep
• Diseases, such as an enlarged prostate, cystitis, COPD, arthritis, heartburn, and heart or lung problems
• Depression or major depression
• Exhilaration or excitement
• Illicit street drugs, such as amphetamines and cocaine
• Grief
• Lack of exposure to bright-light or sun-light
• Jet lag
• Medications, such as too much thyroid medicine, ephedrine, phenylpropanolamine, theophylline derivatives, and others
• Restless leg syndrome
• Overactive thyroid
• Sleeping too much during the day
• Shift work
• Stimulants taken in the evening, including nicotine, alcohol, caffeine, or food
• Suddenly stopping a medication (such as sleeping pills or sedatives)
• Stress and worrying
• Too much stimulation at bedtime
• Wake-sleep pattern disturbances

Home Care

Try modifying your nighttime sleeping habits and other behavior before resorting to drugs to not admit a sleeplessness:

• Establish a regular bedtime, but don't go to bed if you feel wide awake. Use the bedroom for bedroom activities only. Once in bed, use creative imagery and relaxation techniques to keep your mind off unrestful thoughts. Avoid staying in bed for long periods of time while awake, or going to bed because of boredom.
• Avoid using alcohol in the evening. Avoid caffeine for at least 8 hours before bedtime. Give up smoking, because nicotine is a stimulant.
• Relax by reading, taking a bath, or listening to soothing music before getting to bed.
• Take your TV or computer out of your bedroom. Otherwise, your brain becomes used to the stimulation and starts to expect it when you are there. This makes it harder for you to fall asleep.
• Exercise regularly, but not in the last two hours before going to bed. Exercise, especially aerobic exercise, has been show to make people fall asleep faster and benefit from deeper and more restful sleep. Sex can be a natural sleep inducer and helps some people.
• A snack before bedtime helps many people. Foods such as warm milk or turkey have a natural sleep inducer called L-tryptophan.
• Avoid emotional upset or stressful situations prior to bedtime.

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