What Is Insomnia?

It is not unusual to have sleep troubles from time to time, but if you feel that you do not get enough sleep or satisfying sleep, you may have insomnia. Symptoms include:

  • difficulty falling asleep
  • waking up often during the night and having trouble going back to sleep
  • waking up too early in the morning
  • unrefreshing sleep
  • daytime sleepiness
  • fatigue
  • difficulty concentrating
  • irritability
  • mood fluctuations

It is not defined by the number of hours you sleep, because the amount of sleep a person needs varies. While most people need between 7 and 8 hours of sleep, some people do well with less, and some need more.

Types and Causes of Insomnia

Primary insomnia is a physiological problem with the body's normal system for regulating sleep. This type is less common effecting less than 10% of people. Causes might include hyper-arousal, or problems with circadian rhythm or other neuro-hormonal systems.

Secondary insomnia is caused by other medical, psychological, or environmental causes and is more common than primary insomnia. Causes might include:

  • Medical: respiratory problems, pain, medications that interfere with sleep, etc.
  • Psychological: stress, anxiety, depression, etc.
  • Environmental factors: noise, light, extreme temperatures, schedule changes, etc.


Treatment always begins with promoting good sleep habits, called sleep hygiene. Mild insomnia often can be prevented or cured by practicing good sleep habits. If this does not work, medications or other treatment may be needed.

Good Sleep Habits (Sleep Hygiene)

Try to go to sleep at the same time each night and get up at the same time each morning.

Avoid caffeine, nicotine, and alcohol late in the day. Caffeine and nicotine are stimulants and can interfere with sleep. Alcohol can cause waking in the night and interferes with sleep quality.

Get regular exercise. Try not to exercise close to bedtime, because it may stimulate you and make it hard to fall asleep. Experts suggest not exercising for 3 hours before the time you go to sleep.

Don't eat a heavy meal at night; however, a light snack before bedtime may help you sleep.

Make your sleeping place comfortable. Be sure that it is dark, quiet, and not too warm or too cold. If light is a problem, try a sleeping mask. If noise is a problem, try earplugs, a fan, or a "white noise" machine to cover up the sounds.

Follow a routine to help relax and wind down before sleep, such as reading a book, listening to music, or taking a bath.

Avoid using your bed for anything other than sleep or sex. If you can't fall asleep and don't feel drowsy, read or do something that is not overly stimulating until you feel sleepy.

Try not to take naps during the day because naps may make you less sleepy at night.

Try making a to-do list before you go to bed, if you have trouble lying awake worrying about things. This may help you to "let go" of those worries overnight.

Medical Treatments

"Over the Counter" medications. Common non-prescription sleep aids include melatonin, diphenhydramine (Benadryl, ZZZQuil), and doxylamine (Unisom), but should be used on short-term basis.

Prescription medications. If the above strategies fail, your doctor may try prescription sleep aids. These may be beneficial, but may have side effects.

Other treatments. If good sleep hygiene or medication fail, you may need to see a sleep specialist for a sleep study to rule out sleep apnea and other causes of insomnia. Behavioral approaches to treatment focus on changing behaviors that may worsen insomnia and learning new behaviors to promote sleep. Techniques such as relaxation exercises, sleep restriction therapy, and reconditioning may be useful.