What is insomnia?

This is when a person has trouble falling or staying asleep, or they do not feel rested when they wake up. Insomnia is not about the number of hours of sleep a person gets. Everyone needs a different amount of sleep.

Short-term insomnia is when a person has trouble sleeping for a few days or weeks. This is usually related to temporary stress and often gets better on its own. Long-term, or "chronic," insomnia is when sleep problems last for 3 months or longer.

What are the symptoms of insomnia?

People with insomnia often:

• Have trouble falling or staying asleep

• Feel tired during the day

• Forget things, or have trouble thinking clearly

• Are cranky, anxious, irritable, or depressed

• Have less energy or interest in doing things

• Make mistakes or get into accidents more often than normal

• Worry about their lack of sleep

These symptoms can be so bad they affect a person's relationships or work. They can happen even in people who seem to be sleeping enough hours.

Will I need tests?

Probably not. Your doctor or nurse will probably be able to tell if you have insomnia by asking about your symptoms. They might ask you to keep track of your sleep each night for 1 to 2 weeks. This includes when you slept, how well you slept, and how many times you woke up. Your doctor or nurse will also ask about things like your exercise habits, whether you drink alcohol or caffeine, and your medicines.

In some cases, people do need special sleep tests, such as:

• Polysomnography – Monitors attached to your body record your movement, brain activity, breathing, and other body functions while you sleep, usually for a full night. This can be done in a sleep lab or at home.

• Actigraphy – You wear a monitor or motion detector (usually on your wrist) at home for several days and nights. It records your movement and activity, and shows how much you actually sleep and when.

How is insomnia treated?

It depends. If your insomnia is related to stress, pain, or a medical problem, treating that problem can help you sleep better. If you have chronic insomnia (insomnia that lasts longer than 3 months), there are specific treatments that can help. They include:

• Cognitive behavioral therapy for insomnia, or "CBT-I" – This involves working with a counselor or therapist over several weeks. You work on understanding your insomnia, learning ways to build better sleep habits, and changing negative thinking patterns that can make insomnia worse. Your therapist can also teach you relaxation exercises that can help.

  Part of CBT-I involves learning about "sleep hygiene." These things can also help for people who don't have chronic insomnia but have trouble sleeping sometimes. Good sleep hygiene means you:

  • Sleep only long enough to feel rested, and then get out of bed.

  • Go to bed and get up at the same time every day.

  • Do not try to force yourself to sleep. If you can't sleep, get out of bed and try again later.

  • Have coffee, tea, and other things with caffeine only in the morning.

  • Avoid alcohol in the late afternoon, evening, and bedtime.

  • Avoid smoking, especially in the evening.

  • Keep your bedroom dark, cool, quiet, and free of reminders of work or other things that cause you stress.

  • Solve problems before you go to bed.

  • Get plenty of physical activity, but avoid heavy exercise right before bed.

  • Avoid looking at phones, computer screens, or reading devices ("e-books") that give off light before bed. This can make it harder to fall asleep.

• Medicines – There are also medicines that can help with sleep. But doctors usually recommend trying CBT-I first. They might recommend starting both at the same time. If your doctor or nurse thinks medicine might help you, they will talk to you about your options. Some medicines come with serious risks. For example, they can make you groggy or off-balance when you wake up. Sometimes, they cause behaviors like walking, eating, or driving in your sleep. These things could cause an accident or serious injury.

  Doctors generally do not recommend over-the-counter "sleep aids" for treating chronic insomnia.

  If your insomnia is related to problems like depression or anxiety, it can help to treat those problems directly.

Do not use alcohol as a sleep aid. Even though alcohol makes you sleepy at first, it disrupts sleep later in the night.

When should I call the doctor?

Call your doctor or nurse for advice if:

• Your sleep problems are making it hard for you to do your normal activities.

• You think your insomnia might be caused by a health problem.

• You are struggling with depression or anxiety.

Get help right away if you are thinking of hurting or killing yourself!

If you ever feel like you might hurt yourself or someone else, help is available:

• In the US and Canada, contact the 988 Suicide & Crisis Lifeline:

  • To speak to someone, call or text 988.

  • To talk to someone online, go to chat.988lifeline.org.

• Call your doctor or nurse, and tell them it is urgent.

• Call for an ambulance (in the US and Canada, call 9-1-1).

• Go to the emergency department at the nearest hospital.