Sleeping difficulty can involve difficulty falling asleep when you first go to bed at night, waking up too early in the morning, or waking up often during the night. It can also involve combinations of these patterns.
See also: Insomnia
Inability to sleep; Dyssomnia; Sleeplessness; Wakefulness
Everyone has an occasional sleepless night, and this is not a problem for most people. However, as many as 25% of Americans report occasional sleeping problems. Chronic sleeping problems affect about 10% of people.
The lack of restful sleep can affect your ability to carry out daily responsibilities because you are too tired or have trouble concentrating. All types of insomnia can lead to daytime drowsiness, poor concentration, and the inability to feel refreshed and rested in the morning.
Most adults do best with about 8 hours of sleep each night until age 60, after which 6 hours may be enough. Even though the elderly need less sleep, almost one half of people over 60 experience some degree of insomnia.
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 may need up to 10 hours to feel rested.
Using medications to treat insomnia can be useful in certain situations, but there are potential risks. Antihistamines (the main ingredient in over-the-counter sleeping pills) can lead to dependence, tolerance and over time may affect your memory. Sedative medication should be used under the close care of a physician because they can also cause dependence and tolerance. Stopping these medications can cause rebound insomnia and withdrawal.
It is rare for a life-threatening disease to be 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 checked for depression if you are having trouble sleeping.
Insomnia may cause:
- Dark circles under the eyes
- Posture changes
- Reduced energy level
It may help to see a psychiatrist or another mental health provider to evaluate for 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.
Counseling may help with nightmares and dreams that interfere with sleep.
Sleeplessness in adults may be due to:
- Alcoholism or abruptly stopping alcohol after long-term use
- Bed or bedroom that does not promote sleep
- Diseases, such as an enlarged prostate, cystitis, COPD, arthritis, heartburn, and heart or lung problems
- Exhilaration or excitement
- Frequent urination
- Illicit street drugs, such as amphetamines and cocaine
- Jet lag
- Lack of exposure to bright light or sunlight
- Medications, such as too much thyroid medicine, ephedrine, phenylpropanolamine, theophylline derivatives, and others
- Overactive thyroid
- Restless leg syndrome
- Shift work
- Sleeping too much during the day
- Stimulants taken in the evening, including nicotine, alcohol, caffeine, or food
- Stress and worrying
- Suddenly stopping a medication (such as sleeping pills or sedatives)
- Too much stimulation at bedtime
- Wake-sleep pattern disturbances
Most newborns wake several times during the night, but by the age of 6 months they usually sleep through the night. At age 1, babies will sleep an average of 16 out of every 24 hours. Two to three hours of this sleep will be during the day.
Sleeplessness in infants may be due to:
Try changing your nighttime sleeping habits and other behavior before taking drugs for insomnia. For example:
- Avoid emotional upset or stressful situations before bedtime.
- Avoid using alcohol in the evening. Avoid caffeine for at least 8 hours before bedtime. Give up smoking, because nicotine is a stimulant.
- Eat a light snack before bedtime.
- Establish a regular bedtime, but don't go to bed if you feel wide awake.
- Exercise regularly, but not in the last 2 hours before going to bed. Exercise, especially aerobic exercise, has been shown to make people fall asleep faster and get deeper and more restful sleep. Sex can be a natural sleep inducer for some people.
- Relax by reading, taking a bath, or listening to soothing music before going 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.
- 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.
IN INFANTS AND CHILDREN
- Avoid going in to your child's room throughout the night.
- Avoid sending your child to bed as punishment, which can lead to poor sleep.
- For children who have trouble falling asleep, try to make the bedroom as quiet as possible. A sound machine can help mask outside noises.
- Never give a child sleeping medicine without asking the doctor first. It's usually not a good idea to treat the problem with drugs.
When to Contact a Medical Professional
Call your health provider if:
- Your sleeping problem becomes persistent and affects your quality of life, despite behavior changes
- Your sleeping problem occurs more than 3 nights per week for more than 1 month
- You have other worrisome symptoms, such as chest pain or shortness of breath
What to Expect at Your Office Visit
Your health care provider will do a physical examination. To help better understand your sleeping problems, he or she may ask the following:
- Do you have difficulty falling asleep, staying asleep, or awakening too early?
- Do you wake up feeling unrested?
- How often do you wake up at night?
- How long have you had the problem?
- Have you taken any over-the-counter sleeping products?
- What medications do you take?
- Do you take any herbal supplements or alternative remedies?
- Do you drink much coffee or alcohol? Have you recently cut down on your coffee or alcohol?
- Do you have any excessive stress or anxiety?
- How much do you normally sleep? What hours?
- What do you do during the few hours before you go to bed?
- Does your sleep schedule change often? (shift work)
- Do you fall asleep at the wrong times or places?
- Does your sleep schedule change a lot on weekends?
- Do you worry too much about sleep?
- Do you have breath-holding spells, or do you snore?
- Do you have any aches or pains that prevent you from sleeping?
In some cases, the health care provider may recommend the following:
- Sleep log record
- Thyroid tests (TSH, T3, T4)
In some rare cases, your health care provider may want you to see a sleep medicine specialist who will perform a sleep study (polysomnography)
Some people may need medications to help with sleep for a period of time. Your health care provider can talk to you about using prescribed medications if they think it will be helpful
Some antidepressants such as Trazadone can be used at bedtime because they make you drowsy. If insomnia is caused by depression, treating the depression with the right medications or therapy should solve the problem.
Benzodiazepine sedatives such as clonazepam (Klonopin) or lorazepam (Ativan) are anti-anxiety medications that can also help people sleep. They must be used with caution because they can cause addiction.
Newer sleep medicines called hynpotics help reduce the time it takes you to fall asleep. They are less likely to be addictive than benzodiazepines. Two examples are the prescription medicines zolpidem (Ambien) and zaleplon (Sonata).
WARNING: The FDA has asked manufacturers of sedative-hypnotic sleep medicines to put stronger warning labels on their products so that consumers are more aware of the potential risks. Possible risks while taking such medicines include severe allergic reactions and dangerous sleep-related behaviors, including sleep-driving.
Mahowald MW. Disorders of sleep. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 429.
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Michelle Benger Merrill, MD, Instructor in Clinical Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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