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Alternative Names Return to topInsomnia; Inability to sleep; Dyssomnia; Sleeplessness; Wakefulness
Definition Return to top
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.
Considerations Return to top
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:
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.
Causes Return to top
Sleeplessness in adults may be due to:
Most newborn babies wake several times during the night, but by the age of 6 months they usually sleep through the night. At age 1, babies will sleep an average of 16 out of every 24 hours. Two to three hours of this sleep will be during the day.
Sleeplessness in infants may be due to:
Home Care Return to top
Try changing your nighttime sleeping habits and other behavior before taking drugs for insomnia. For example:
IN INFANTS AND CHILDREN
When to Contact a Medical Professional Return to top
Call your health provider if:
What to Expect at Your Office Visit Return to top
Your health care provider will do a physical examination. To help better understand your sleeping problems, he or she may ask the following:
In some rare cases, your health care provider may want you to see a sleep medicine specialist who will perform a sleep study (polysomnography)
Most people don't need medication. Your health care provider can talk to you about using prescribed medications if everything else has failed.
Some antidepressants such as Elavil (amitriptyline) can be used at bedtime because they make you drowsy. They require a prescription. If insomnia is caused by depression, treating the depression with the right medications or therapy should solve the problem.
Benzodiazepines such as Valium (diazepam) or Ativan (lorazepam) are anti-anxiety medications that can also help people sleep. They must be used with caution because they can be addictive. They also require a prescription.
Newer sleep medicines help reduce the time it takes you to fall asleep. They are less likely to be addictive than benzodiazepines. Two examples are the prescription medicines Ambien (zolpidem) and Sonata (zaleplon).
WARNING: The FDA has asked manufacturers of sedative-hypnotic sleep medicines to put stronger warning labels on their products so that consumers are more aware of the potential risks. Possible risks while taking such medicines include severe allergic reactions and dangerous sleep-related behaviors, including sleep-driving.Update Date: 2/6/2008 Updated by: Christos Ballas, M.D., Attending Psychiatrist, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed byDavid Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.