Charlotte, NC
Dale Menard, MD
Roshni Bhandari, MD
Mrs. Amelia, a 40-year-old schoolteacher, complains of her inability to sleep. She’s experiencing fatigue and cannot concentrate on work. She regularly goes to bed at 10 PM but cannot fall asleep until 1 AM. Her general health is good. How can we help her sleep?
Anyone can have sleeping problems. You can have trouble falling asleep, staying asleep, or getting a night of good quality sleep. This is insomnia, a sleep disorder that disrupts your sleep pattern. Poor sleep can cause fatigue, moodiness, or trouble functioning during the day. Insomnia can come and go, but it can also last for a long time.
Sleep is a vital aspect of life, whether it is the quantity or quality of sleep. Sometimes, we are so busy with life that we barely have time to stop and rest. Getting a good night’s sleep can be a dream when we are so busy taking care of our careers and families and trying to make ends meet. We often think sleep is “downtime” in which our tired brains get to rest. However, we often overlook that sleep is vital, and without regular quality sleep, we are at risk of many diseases, including heart disease, stroke, or even dementia.
Acute insomnia is short-term insomnia that lasts several days to a few weeks. These short episodes of poor sleep are often triggered by recent stressful events that can be physical, psychological, or related to family and friends. These short bursts of sleepiness usually improve as the stress goes away, but they can also be a chronic sleeping issue.
While we may sometimes have difficulty falling asleep, waking up in the early morning, or being unable to go back to sleep, chronic insomnia occurs if this sleeping pattern occurs for at least three nights per week over at least three months. You should talk to a healthcare provider if you have chronic insomnia.
Insomnia can occur due to various factors and can happen to anyone. Here are some factors that may cause insomnia.
Age: Insomnia is more common in older adults.
Sex: Insomnia is more common in women than in men. This could be due to hormonal changes during pregnancy or menopause which can cause problems with sleep.
Certain medical conditions: If you have conditions such as pulmonary disease, heart failure, cancer, or chronic pain, you are at higher risk of sleep problems, depression, or anxiety disorder.
Use of certain medications: You are at higher risk if you are on blood pressure drugs, corticosteroids, and antidepressants.
Your job can affect your sleep health: You may have insomnia if you shift or night work or travel often to different time zones.
A loud noise or distracting sleep environment can cause insomnia: This happens when your sleep-wake cycle (a pattern that your body uses to figure out when to sleep and when to be awake) is disturbed. If you have to sleep in noisy places or very high or low temperatures, it can affect your sleep quality.
Stress: Insomnia is common when you overthink work, school, or money.
If you have trouble sleeping for more than a few weeks and your sleeping problem has affected your lifestyle, performance, and work life, do not hesitate to seek help from your doctor.
Your doctor will need to know about your sleep habits and could ask questions about your regular health as well.
The doctor can question you about your sleep habits. Some potential questions are:
Your doctor may inquire regarding your regular health to look for any medical reason that could have caused your sleeping problems. The questions may include:
Your doctor may ask you to write a sleep diary to know more about your sleep pattern.
A sleep diary can help your doctor understand your sleep pattern and activities that have affected your sleep, but you might not have noticed them. A sleep diary is a daily log of when you go to sleep, wake up, and take naps. You will also need to write down how sleepy you feel throughout the day. You need to include when you drink caffeine or alcohol and exercise in the sleep diary. Maintaining a sleep diary will help your doctor determine the severity of your sleep problem. It is advised to keep a sleep diary for at least one to two weeks before seeing your doctor.
There is no specific blood test to diagnose insomnia. A sleep study is not generally recommended but may be considered if sleep apnea is suspected (such as for people with obesity or those who snore loudly during sleep).
The main goal while treating insomnia is to improve your sleep and quality of life as safely as possible. Your doctor will discuss healthy lifestyle habits such as maintaining a regular sleep schedule, cognitive behavioral therapy for insomnia, and medicines to help you manage your insomnia.
If you have had insomnia for a short period,your doctor will talk with you about relaxation strategies and ways to help with the stressor causing you to have difficulty sleeping. Sometimes, your doctor might advise the short-term usage of medications to help with sleep.
If you have chronic Insomnia, the first line of treatment is Cognitive Behavior Therapy Insomnia (CBTI). CBTI can teach you how to improve your sleep habits and help you cope with stress or anxiety, affecting sleep. You will need to learn bedtime relaxation strategies that best suit and help you.
CBTI also gives behavioral recommendations, including establishing a wake-up time, restricting time in bed, reserving the bed strictly for sleeping and intimacy, avoiding naps, and recommending against caffeine, alcohol, use of electronic screens, and exercise close to bedtime.
The CBTI lasts 4 to 8 weeks and can be combined with medications. Nondrug treatment is preferred because of its long-term effectiveness and safety.
There are various over-the-counter (OTC) medications available in your local pharmacies solely for insomnia, and your doctor has various options to prescribe , but these are not always effective.
Melatonin is an OTC drug used by older adults and residents of long-term care facilities. Although heavily used by many, it is not a panacea for insomnia experienced by elderly patients. However, melatonin can be helpful in specific clinical situations and replace other hypnotic agents, given its comparatively favorable side effect profile. Most medications used for sleep also have risks (especially in older people), including increased frequencies of falls, confusion, daytime sleepiness, and later dependence on the medicine. Please talk with your doctor about the medication that best suits you (if at all) and how to use them safely.
Good sleep is always a top priority for best health practices. Sleep is a biological necessity we can not undermine. Following healthy sleep habits and a regular schedule is vital to maintaining a regular sleep-wake cycle. Simple lifestyle changes can improve your odds of having a restful night’s sleep.
Sleep schedule: Ensure a regular sleep schedule by going to bed at the same time and waking up around the same time every day. You will need to stick to this routine, even on the weekends.
Sleep-friendly bedroom:
Ensure the bedroom is calm, quiet, and dark. It is essential to avoid looking at electronic devices or watching TV before sleep. The bright light from these sources can disrupt your sleep-wake cycle.
Avoid caffeine, nicotine, and alcohol close to your bedtime. These habits are unhealthy for your sleep as they can stimulate your body and make it more difficult for you to fall asleep. Although alcohol can sometimes make it easier to fall asleep, it tends to cause a lighter than usual sleep, and you are more likely to wake up during the night.
Get regular physical activity during the daytime. Exercise at least 5 to 6 hours before bed. Exerting your body closer to bedtime can make it harder to fall asleep. Try to exercise for 30 minutes every day.
Avoid naps, especially in the afternoon, if you have problems sleeping during the night. Staying awake throughout the day may help you sleep longer at night.
Eat daily meals on a regular schedule. Avoid late-night dinners and snacks.
Limit water intake close to bedtime: This may help you sleep longer without waking up and in the bathroom during the night.
Stress management: Follow a routine that helps you wind down and relax before bed. You can start by picking up a habit of reading a book and listening to soothing music before bed. You might try massage therapy, meditation, or yoga to help you relax.
Avoid certain over-the-counter and prescription medicines as much as possible. Talk with your healthcare provider about which treatments will not disrupt your sleep and which could help you sleep well.
