Chronic insomnia is defined as having symptoms at least three nights per week for more than one month. Most cases of chronic insomnia are secondary, which means they are due to another disorder or medications. Primary chronic insomnia is a distinct sleep disorder; its cause is not yet well understood. About 30 percent to 40 percent of adults say they have some symptoms of insomnia within any given year, and about 10 percent to 15 percent of adults say they have chronic insomnia. Chronic insomnia becomes more prevalent with age, and women are more likely than men to report having insomnia.

Insomnia often causes problems during the day, such as excessive sleepiness, fatigue, a lack of energy, difficulty concentrating, depressed mood and irritability. Due to all of these potential consequences, untreated insomnia can impair quality of life as much as, or more than, other chronic medical problems.

Chronic insomnia often is caused by one or more of the following:

• Another disease or mood disorder. The most common causes of insomnia are depression and/or anxiety disorders. Neurological disorders such as Alzheimer's or Parkinson's disease also can have insomnia as a symptom. Chronic insomnia can result from arthritis, asthma or other medical conditions in which symptoms become more troublesome at night, making it difficult to fall asleep or stay asleep.

• Various prescribed and over-the-counter medications that can disrupt sleep, such as decongestants, certain pain relievers and steroids.

• Sleep-disrupting behavior such as drinking alcohol, exercising shortly before bedtime, ingesting caffeine late in the day, watching TV or reading while in bed, or irregular sleep schedules due to shift work or other causes.

• Another sleep disorder, such as sleep apnea or restless legs syndrome.

Doctors diagnose insomnia based mainly on sleep history, often by reviewing a sleep diary. An overnight sleep recording may be required if another sleep disorder is suspected. Doctors also will try to diagnose and treat any other underlying medical or psychological problems as well as identify behaviors that might be causing the insomnia.

Often, people who have insomnia enter into a vicious cycle — because of having trouble sleeping in previous nights, they become anxious at the slightest sign that they may not be falling asleep right away. That anxiety can make it more difficult for them to fall asleep. The more time they spend in bed not sleeping and watching the clock, the more their anxiety — and sleeplessness — increases.

To break that cycle of anxiety and negative conditioning, experts recommend going to bed only when you're sleepy. If you can't fall asleep (or fall back to sleep) within 20 minutes, get out of bed and go into another room where you can pursue a relaxing activity until you feel sleepy again. Then return to bed. This reconditioning therapy has been shown to be an effective way to treat insomnia.

Another effective behavioral strategy for some people is relaxation therapy. For example, progressively tense and then relax each of the muscle groups in your body before sleep. Another method is to focus on breathing deeply. Relaxation therapy can provide a needed slowing down period so that you are indeed sleepy when the desired bedtime arrives.

Sleep restriction therapy also works for some people who have insomnia. First, limit your night's sleep to four to five hours, then gradually add more sleep time each night until you achieve a more normal night's sleep. Daytime naps should be avoided during this sleep restriction therapy because napping may prolong insomnia by making it harder to fall asleep at night. In addition, during sleep restriction therapy, avoid driving a car or operating dangerous machinery until you have obtained adequate nighttime sleep.

All these changes in behavior are part of what is called "cognitive behavioral therapy." Cognitive behavioral therapy also can be used to replace negative thinking related to sleep, such as "I'll never fall asleep without sleeping pills," with more realistic positive thinking. Cognitive behavioral therapy is effective in most people who have chronic insomnia.

Some people who have chronic insomnia that is not corrected by behavioral therapy or treatment of an underlying condition may need a prescription medication. You should talk to a doctor before trying to treat insomnia with alcohol, over-the-counter or prescribed short-acting sedatives, or sedating antihistamines that induce drowsiness. The benefits of these treatments are limited, and they have risks. Some may help you fall asleep but leave you feeling unrefreshed in the morning. Others have longer-lasting effects and leave you feeling still tired and groggy in the morning. Some also may lose their effectiveness over time. Doctors may prescribe sedating antidepressants for insomnia, but the effectiveness of these medicines in people who do not have depression is not established, and there are significant side effects.

To treat their insomnia, some people pursue "natural" remedies, such as melatonin supplements or valerian teas or extracts. These remedies are available over the counter. There is little evidence that melatonin can help relieve insomnia. Studies with valerian also have been inconclusive, and the actual dose and purity of various supplements, extracts or teas that contain valerian may vary from product to product. In addition, because melatonin, valerian and other natural remedies are not regulated by the U.S. Food and Drug Administration, their safety is not scrutinized.

Common Signs of a Sleep Disorder Look over this list of common signs of a sleep disorders, and talk to your doctor if you have any of them: It takes you more than 30 minutes to fall asleep at night. You awaken frequently in the night and then have trouble falling back to sleep again. You awaken too early in the morning. You frequently don't feel well rested despite spending seven to eight hours or more asleep at night. You feel sleepy during the day and fall asleep within five minutes if you have an opportunity to nap, or you fall asleep at inappropriate times during the day. Your bed partner claims you snore loudly, snort, gasp or make choking sounds while you sleep, or your partner notices your breathing stops for short periods. You have creeping, tingling or crawling feelings in your legs that are relieved by moving or massaging them, especially in the evening and when you try to fall asleep. You have vivid, dreamlike experiences while falling asleep or dozing. You have episodes of sudden muscle weakness when you are angry, fearful or when you laugh. You feel as though you cannot move when you first wake up. Your bed partner notes that your legs or arms jerk often during sleep. You regularly need to use stimulants to stay awake during the day. Also keep in mind that, although children can show some of these same signs of a sleep disorder, they often do not show signs of excessive daytime sleepiness. Instead, they may seem overactive and have difficulty focusing and concentrating. They also may not do their best in school.

Additional Resources

National Center on Sleep Disorders Research
National Heart, Lung, and Blood Institute
Two Rockledge Centre, Suite 7024
6701 Rockledge Drive, MSC 7920
Bethesda, MD 20892-7920
(301) 435-0199
Fax: (301) 480-3451

National Heart, Lung, and Blood Institute Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
(301) 592-8573
Fax: (301) 592-8563

Source: National Heart, Lung, and Blood Institute, National Institutes of Health

Publish Date: November 2005

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