Insomnia Defined

Forget counting sheep: Scientific insights offer help in getting a good night’s rest and avoiding insomnia.

Categorizing Insomnia

Doctors can categorize insomnia in two ways — what causes the disease and how condition lasts. Categorizing insomnia by its cause includes:

  • Primary insomnia Primary insomnia isn’t caused by other known conditions, but this form of restlessness produces regular symptoms and usually responds to treatment.
  • Secondary insomnia Secondary insomnia stems from other illnesses, either physical or psychiatric. Medication or other sleep disorders might also be at the root of this condition.

Categorizing insomnia by the duration of the condition includes:

  • Acute insomnia Acute insomnia usually is caused by a temporary, outside event. Emotional trauma, a dramatic change in schedule, or some other disruption of your daily routine might trigger bouts of poor or disturbed sleep. If you can anticipate a break in routine that might bring about insomnia, like an upcoming trip, a doctor can help you plan for and prevent any potential loss of sleep.
  • Chronic insomnia Chronic insomnia lasts anywhere between one to six months. People dealing with chronic insomnia lose sleep at least three times per week, and the condition can cause problems functioning during the day.

Keep Track of Your Sleep History

If you are having trouble sleeping, a health care provider probably will look first for distractions that can interfere with rest, like light and noise. A bedroom should be cool, dark, quiet, and free of disturbances. Bedtimes and wake-up times should be regular and respectful of your body’s natural desire for sleep, which can vary from person to person.

There are things you can do during the day to ensure a good night’s sleep. Don’t exercise or eat close to bedtime, especially avoiding caffeine. While short naps might be refreshing, don’t sleep more than 40 minutes, advises Carol Ash, DO, medical director of Sleep for Life in Hillsborough, N.J. Maintain a sleep diary, including information about how well you sleep, how long you sleep, and your sleep habits, in the event you want to talk to a health care provider.

A detailed history and physical exam will uncover any underlying physical or emotional problems that are fueling insomnia, says Dr. Ash. When emotional problems or worries interfere with sleep, mental health counseling to help treat insomnia may be the first step toward solving the problem. Ash says, “I tell my patients, ‘You can’t solve the problems in the middle of the night.’”

Cognitive-behavioral therapy (CBT), a type of psychological counseling based on a patient’s beliefs and behaviors, has been evaluated extensively for its use in sleep disorders. CBT has been shown to produce slight gains in the amount of time someone sleeps, and somewhat better results in improving the quality of sleep and reducing anxiety about sleep.

Insomnia Medication

A popular treatment for insomnia is medication. Drug treatment should be used only if the lack of sleep is affecting daytime activities and a health care provider has evaluated the cause of the insomnia and suggested changes to sleep habits.

Popular sleep medication includes:

  • Sedative hypnotics Hypnotics are prescription drugs and classified in two groups. Benzodiazepines, such as temazepam (Restoril) and triazolam (Halcion), are effective but have a risk of causing dependency. Non-benzodiazepines, such as zolpidem (Ambien) and eszopiclone (Lunesta), have a lower risk of dependency.
  • Antihistamines Antihistamines are usually sold over the counter as treatment for allergies, but some, such as doxylamine (Unisom), that cause drowsiness are marketed as sleeping aids. The evidence that they work is limited, but some reports suggest diphenhydramine (Benadryl) can be used for mild insomnia.
  • Antipsychotics and antidepressants Antidepressants and antipsychotics such as trazadone (Desyrel), nortriptyline (Pamelor), and thioridazine (Mellaril) have long been used to treat insomnia, but side effects and their possible effect on cardiac functioning limits their use.
  • Melatonin receptor medication Melatonin, a naturally occurring hormone sold as a nutritional supplement, does not appear to help primary insomnia, but might be of help with temporary disorders such as jet lag. Melatonin helps regulate your sleep cycle. A prescription medication called ramelteon (Rozerem) mimics the effects of melatonin and may be useful for people who have trouble falling asleep. Regardless of the treatment, it’s crucial to take insomnia seriously and get restful sleep every 24 hours, says Ash. “It’s optimum for best health,” she says.

By Elizabeth Connor – Medically reviewed by Lindsey Marcellin, MD, MPH