Definition
Sleeping difficulty, called insomnia, can involve difficulty falling asleep when you first go to bed at night, waking up too early in the morning, and waking up often during the night.
Alternative Names
Considerations
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, and insomnia is a chronic problem for 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 can need up to 10 hours to feel rested.
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 affect your memory.
Strong, prescription sedatives do not produce a natural, restful sleep. In addition, you can become dependent on or tolerant of these drugs. In this case, the same dose of the drug no longer produces sleep, which may lead you to try a higher dose. 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 checked for depression if you are having trouble sleeping.
Insomnia may cause:
- Dark circles under the eyes
- Disorientation
- Fatigue
- Irritability
- Posture changes
- Reduced energy level
It may help to see a psychiatrist, doctor, or another mental health provider to evaluate 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.
Common Causes
Sleeplessness in adults may be due to:
- Aging
- Alcoholism or abruptly stopping alcohol after long-term use
- Anxiety
- Bed or bedroom that does not promote sleep
- Depression or major depression
- Diseases, such as an enlarged prostate, cystitis, COPD, arthritis, heartburn, and heart or lung problems
- Exhilaration or excitement
- Grief
- 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
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