I need sleep!

Insomnia, or trouble sleeping, is a common problem. It can cause tiredness, irritability, and daytime sleepiness. It can also increase your risk of falls and cause problems with memory and concentration.

Many people don’t report their sleep problems to a doctor. Up to 85% of people with insomnia do not get medical treatment, or they use their own remedies that don’t work well and may not be safe (such as alcohol and over-the-counter drugs). The good news is that there are steps you can take to improve your sleep, both on your own and working together with your doctor. And not all of them require drugs. 

What causes insomnia?

Stress, medical problems (such as sleep apnea), mental health problems (such as depression), medications, substance abuse (including smoking), jet lag, and work schedules. Understanding what causes insomnia may help you and your doctor find ways solve the problem.

What should I do first?

If you are having trouble getting to sleep or staying asleep, if you are waking up early or feeling unrefreshed, or if you get drowsy during the day, your doctor might ask you to keep a sleep diary for a while, to keep track of the problem. Complicated tests are not usually needed in most people.

Some simple things can make a big difference

• Try to avoid napping during the day.
• Don’t have any caffeine after midday, and don’t smoke or drink alcohol within 4-5 hours of bedtime.
• Use your bed only for sleep (and sex) – not for reading, eating, or watching TV.
• Make sure your bedroom is at a comfortable temperature.
• Get rid of bedroom distractions or disruptions (such as a loud bedside clock, noise, lights, pets).
• Go to bed only when you’re tired.
• If you can’t fall asleep within 20 minutes, get out of bed and do something relaxing in another room; return to bed only when sleepy.
• Try to wake up at the same time every day.

Exercise can help

Regular exercise can help you sleep, but don’t exercise in the 4-5 hours before you go to bed.

Avoid late-day alcohol or caffeine

Alcohol at bedtime can help you fall asleep, but it also makes you more likely to wake up during the night, and shortens total sleep time. Alcohol can also worsen other conditions that disrupt sleep, such as heartburn and sleep apnea. The effects of caffeine can last for many hours, so avoid all caffeine-containing drinks (coffee, tea, soft drinks) after midday.

Sometimes medicines can help--if used right

If necessary, prescription drugs can sometimes help with sleep, and many of them are available as affordable generics. But these medicines should not be used every night because many of them will lose their effectiveness and just become habit-forming. If that occurs, withdrawal symptoms could result when they are discontinued. Most sleeping pills should not be used for more than about 2 weeks before being gradually stopped.

Most sleeping pills can cause side effects, including next-day drowsiness and confusion. In addition, they will only help some patients. This figure shows the benefits and harms that will occur when 100 people over 60 years of age take prescription sleeping pills for more than a week.

More information

Additional advice on sleep and insomnia is at the American Academy of Sleep Medicine website: http://www.sleepeducation.com/