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Insomnia

Insomnia is repeated difficulty going to sleep or staying asleep, or both. Whether you have insomnia is not defined by a specific amount of sleep. Different people need different amounts of sleep, and you may need more or less sleep at different times of your life.

There are 3 major types of insomnia:  short-term, chronic, and “other.”  Short-term, or acute insomnia lasts less than 3 months.  The symptoms are temporary and can be linked directly to a stressor, such as the death of a loved one, financial problems, or a new physical problem.  Short-term insomnia stops when the stressor resolves or the person adapts to its presence.

Chronic insomnia occurs at least 3 times a week and lasts longer than 3 months.  Chronic insomnia can occur when either the cause of the sleeping problem is not clear, or the insomnia does not get better when the stressor is resolved. A number of other criteria are also used to make the diagnosis of chronic insomnia. 

“Other insomnia” is the third type of insomnia-related sleep disorders.  This description applies to people who have problems getting to sleep or staying asleep, but do not meet all of the factors that describe either short-term or chronic insomnia.  

Many things cause insomnia. Different people may have different causes. It can be from an underlying medical or psychological condition, or lifestyle. It can also be primary insomnia, which means no cause can be found.

Causes of insomnia include:

  • Chronic medical problems- heart disease, gastrointestinal problems, hormonal changes, breathing problems

  • Anxiety

  • Stress

  • Depression

  • Pain

  • Work schedule

  • Sleep apnea

  • Illegal drugs

  • Certain medicines

Many different medidcines can affect your sleep, such as stimulants, caffeine, alcohol, some decongestants, and diet pills. Other medicines may include some types of blood pressure pills, steroids, asthma medicines, antihistamines, antidepressants, seizure medicines and statins. Not all of these will affect your sleep, and they shouldn’t be stopped without talking to your doctor.

Symptoms of insomnia can include:

  • Lying awake for long periods at night before falling asleep

  • Waking up several times during the night

  • Waking up early in the morning and not being able to get back to sleep

  • Feeling tired and not refreshed by sleep

  • Not being able to function properly during the day and finding it hard to concentrate

  • Irritability

  • Tiredness and fatigue during the day

Home care

  1. Review your medicines with your doctor or pharmacist to find out if they can cause insomnia. Not all medicines will affect your sleep, but they shouldn't be stopped without reviewing them with your doctor. There may be serious side effects and consequences from suddenly stopping your medicines. Not taking them may cause strokes, heart attacks, and many other problems.

  2. Caffeine, smoking and alcohol also affect sleep. Limit your daily use and do not use these before bedtime. Alcohol may make you sleepy at first, but as its effects wear off, you may awaken a few hours later and have trouble returning to sleep.

  3. Do not exercise, eat or drink large amounts of liquid within 2 hours of your bedtime.

  4. Improve your sleep habits. Have a fixed bed and wake-up time. Try to keep noise, light and heat in your bedroom at a comfortable level. Try using earplugs or eyeshades if needed. 

  5. Avoid watching TV in bed.

  6. If you do not fall asleep within 30 minutes, try to relax by reading or listening to soft music.

  7. Limit daytime napping to one 30 minute period, early in the day.

  8. Get regular exercise. Find other ways to lessen your stress level.

  9. If a medicine was prescribed to help reset your sleep patterns, take it as directed. Sleeping pills are intended for short-term use, only. If taken for too long, the effect wears off while the risk of physical addiction and psychological dependence increases.

Sleep diary

If the cause isn’t obvious and it is not improving, try keeping a “sleep diary” for a couple of weeks. Include in it:

  • The time you go to bed

  • How long it takes to fall asleep

  • How many times you wake up

  • What time you wake up

  • Your meal times and what you eat

  • What time you drink alcohol

  • Your exercise habits and times

Follow-up care

Follow up with your healthcare provider, or as advised. If X-rays or CT scans were done, you will be notified if there is a change in the reading, especially if it affects treatment.

Call 911

Call 911 if any of these occur:

  • Trouble breathing

  • Confusion or trouble waking

  • Fainting or loss of consciousness

  • Rapid heart rate

  • New chest, arm, shoulder, neck or upper back pain

  • Trouble with speech or vision, weakness of an arm or leg

  • Trouble walking or talking, loss of balance, numbness or weakness in one side of your body, facial droop

When to seek medical advice

Call your healthcare provider right away if any of these occur:

  • Extreme restlessness or irritability

  • Confusion or hallucinations (seeing or hearing things that are not there)

  • Anxiety, depression

  • Several days without sleeping

 

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