It's three o'clock in the morning, and you can't sleep. You stare at the clock, aware that the alarm will go off in a few hours, but you can't sleep. You know you have a busy day ahead and need to be rested, but you can't sleep. No matter how hard you try, you can't sleep. You have insomnia.

What Is Insomnia?

According to the National Institutes of Health, insomnia affects more than 70 million Americans. Insomnia is an experience of inadequate or poor quality sleep as characterized by one or more of the following sleep complaints:

  • Difficulty initiating sleep
  • Difficulty maintaining sleep
  • Waking too early in the morning

For a long time, doctors were taught, "insomnia is a symptom, not a disease (or disorder)." However, new evidence suggests insomnia is a disorder in its own right. Regardless of whether it occurs with other medical conditions or by itself, insomnia tends to have a consistent set of nighttime and daytime symptoms.

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Who Has Insomnia?

NSF's 2002 Sleep in America poll shows that 58% of adults in the U.S. experience symptoms of insomnia a few nights a week or more. Although insomnia is the most common sleep problem among about one half of older adults (48%), they are less likely to experience frequent symptoms of insomnia than their younger counterparts (45% vs. 62%), and their symptoms are more likely to be associated with medical conditions, according to the 2003 poll of adults between the ages of 55 and 84.

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Two Types of Insomnia

Sleep specialists classify insomnia in two primary categories: acute and chronic.

  • Short term or acute insomnia , which is often due to a temporary situation, can last up to one month and is treatable. It is important to address the underlying cause. Effective and safe prescription medications can help.
  • Long-term, or chronic insomnia , which is experienced for a month or longer, can be secondary to causes such as medical, physical or psychological conditions, another sleep disorder, or medications and substances. It is essential to get a medical diagnosis. In addition to appropriate use of medications, education on behavioral and other techniques are well as good sleep practices can improve sleep.

In addition, chronic insomnia may be "primary," which means that it is not caused by other medical, psychiatric, sleep, or medication factors. Primary insomnia may be caused by factors such as increased body temperature, metabolic rate, or brain metabolism . Poor sleep habits may also contribute to primary and other forms of insomnia.

Some consequences of insomnia include:

  • Depression and psychological distress
  • Poor quality of life
  • Daytime fatigue
  • Impaired mood
  • Inability to concentrate, problem-solve and make decisions
  • Risk for injury, driving drowsy, and illness

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Available Treatments for Insomnia

Treatments range from behavioral therapy to prescription medicines or a combination of the two.

Behavioral therapy
Specialists can help with behavioral therapy approaches including:

  • Stimulus control, which trains people to use their bed and bedroom for sleep and sex only. Persons with insomnia are encouraged to go another room and engage in a relaxing activity until they are sleepy and ready to return to bed
  • Cognitive therapy, which is conducted with a therapist who helps the patient with attitudes and beliefs that may contribute to poor sleep
  • Relaxation training including tension reducing and muscular relaxation techniques

Prescription medications that promote sleep are managed by your physician.

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Managing Your Insomnia

Although the specific causes of insomnia differ from one person to the next, there are some general habits you can adopt that may help you sleep better. Sleep experts recommend the following tips for good sleep:

At night:

  • Establish a regular bedtime routine and a regular sleep-wake schedule.
  • Don't spend too much time in bed—you can't force yourself to sleep by spending more time in bed
  • Do not eat or drink too much before bedtime
  • Create a sleep-promoting environment that is quiet, dark, cool and comfortable

During the day:

  • Consume less or no caffeine, particularly late in the day
  • Avoid alcohol and nicotine, especially close to bedtime
  • Exercise, but not within three hours before bedtime
  • Avoid naps, particularly in the late afternoon or evening
  • Establish a regular bedtime and get up at the same time every day. Do not stay in bed to make- up for lost sleep or beyond your regular rise time
  • Keep a sleep diary to identify your sleep habits and patterns that you can share with your doctor

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Heartland Healthcare Network National Sleep Foundation