Thirty to 50 percent of people develop insomnia at some point in their lives. Insomnia is a sleep disorder generally associated with a difficulty falling asleep or staying asleep, or both. Insomniacs have the time and opportunity to sleep, but still take 30 minutes or longer to fall asleep or sleep fewer than six hours a night. Around 10 percent of people may have chronic insomnia that prevents normal sleep for prolonged periods of time.
Types of Insomnia
Insomnia is categorized based on factors such as the cause or duration. There are three basic types of insomnia based on the length of time a person experiences sleep difficulties. Insomnia is sometimes broken down as short-term and long-term insomnia, but insomnia that is not long-term may actually be classified as either short-term insomnia or transient insomnia.
Transient insomnia is a period of sleep difficulty that lasts a week or less. Some people consider transient insomnia part of short-term insomnia.
Short-term insomnia is the appearance of insomnia symptoms that last for more than one week but less than three. Short-term insomnia is also called acute insomnia. Stress is the main reason behind symptoms of short-term insomnia, including transient.
Long-term insomnia is when insomnia symptoms remain for longer than three weeks. This type of insomnia is also called chronic insomnia. The causes behind long-term insomnia are usually different than insomnia that lasts for a shorter duration.
Sleeping difficulty does not happen every night for someone to have insomnia. Even if a person only has difficultly falling or staying asleep three nights out of seven they are still said to have insomnia for that week.
Insomnia may also be categorized as either primary or secondary insomnia. Primary insomnia is when people have difficulty sleeping that is not due to another health problem. It is also called psychophysiological insomnia. Frequently, people with this kind of insomnia cannot turn their minds off when they try to sleep; their minds race and they cannot relax.
Secondary insomnia is when people have a direct cause, such as a health condition, that leads to insomnia. A physical or mental health problem, or certain medications, could be behind secondary insomnia.
Childhood Onset Insomnia
Approximately 1 percent of people develop a difficultly falling asleep or staying asleep during childhood. They usually experience daytime sleepiness as well. This condition is called childhood onset insomnia. When young adults do not grow out of the insomnia and keep it for life the condition is called life-long insomnia. Childhood onset insomnia may be hereditary.
Some people have what is called subjective insomnia, which is when they sleep normally but think that they have insomnia. It is also known as paradoxical insomnia or sleep state misconception. Despite getting a full night’s sleep, people with this condition may end up at a sleep center complaining of insomnia only to discover after being observed all night that they slept undisturbed.
Some people become insomniacs due to poor sleeping habits and worrying about sleep. These people try too hard to fall asleep or are kept awake because they worry about being able to sleep. Often this condition goes away when someone changes their environment because this removes the stimuli that prompted the sleep difficulties. Other people with learned insomnia can find themselves unaffected when they give up trying to sleep, such as when they fall asleep during a movie.
Idiopathic insomnia is when there is no obvious cause of the insomnia symptoms.
There is no single cause of insomnia. The possible reasons for this condition are extensive. Physical, mental and emotional issues may all contribute to insomnia. Taking certain medications, experiencing certain life conditions and even having poor sleeping habits can all play a role in insomnia development.
Stress is one of the main causes of insomnia, particularly short-term insomnia. Insomnia may result from stress linked to specific events or can result from ordinary stresses of daily living. A traumatic or challenging event that could cause insomnia include:
- Death of a loved one
- Being laid off or fired
- Studying for an exam or presentation
Short-term insomnia may also result from worrying about normal life concerns. A person’s mind may be unable to shut off because of concerns regarding health, family, school, work or other responsibilities.
Anxiety and Depression
Although several mental disorders may cause problems sleeping, anxiety and depression are two of the most frequent causes of insomnia, especially long-term insomnia. Anxiety disorders or simply feeling anxious about aspects of daily living can both lead to insomnia.
People who are depressed frequently experience difficulty sleeping or tend to sleep more than is healthy. Depression may stem from worrying or be the result of chemical imbalances in the brain that interfere with sleep.
The feelings of anxiety or depression may get worse the longer someone has insomnia because they become more sleep deprived. Increased anxiety or depression may make sleeping even more difficult.
Drugs and Stimulants
Certain substances may be at the root of some people’s insomnia. Both prescription medications, such as heart or allergy medications, and over-the-counter drugs from pain killers to decongestants may all interfere with natural sleep. Stimulants in foods and drugs are also potential causes of insomnia.
Medications that may cause sleep problems include:
- Allergy medications
- Blood pressure medication
- Cold and flu medicines
- Dopamine agonists
- Heart medications
- Oral contraceptives
- Pain killers
- Quinolone antibiotics
- Thyroid hormones
- Weight-loss products, including appetite suppressants
Medications can contribute to insomnia because of how they affect the body while treating specific conditions. For example, dopamine agonists activate receptors for the hormone dopamine, which can promote wakefulness even in people who are sleep deprived. Some medications for Parkinson’s disease are dopamine agonists because the brains of people with Parkinson’s usually lack this hormone.
Some medications or supplements contain ingredients that interfere with sleep. Some pain killers and weight-loss products contain stimulants like caffeine. Cold and flu medications may have alcohol.
Medications like antihistamines can indirectly contribute to sleep problems. These drugs can make people tired and make urinary problems worse, which then causes people to wake up at night to urinate.
Some foods and beverages also have stimulants. Sodas, tea and coffee are typically high in caffeine. Energy drinks or other caffeine-containing products taken in the late afternoon may lead to insomnia.
Alcoholic beverages can cause people to be drowsy and fall asleep more easily, but alcohol interferes with the body’s ability to enter deep sleep states. These deep states are necessary for people to wake up feeling restful. Sometimes, alcohol makes people wake up in the middle of the night.
Withdrawal from alcohol can also cause insomnia. Even smoking cigarettes can cause insomnia in some people.
There are many conditions that may cause insomnia. Some of these conditions may be medical issues that can make it difficult to sleep, such as breathing problems or post-traumatic stress disorder. Other causes can instead be a temporary condition that affects sleep cycles, like jet lag.
The human brain has an internal clock. Within the brain are two areas responsible for alerting the rest of the brain that is is time to sleep. These include the hypothalamus and brain stem. The hypothalamus and brain stem in someone with insomnia may be overactive and interfere with the ability to sleep.
Medical conditions that can cause insomnia include:
- Acid reflux
- Alzheimer’s disease
- Breathing difficulties, such as asthma
- Chronic pain
- Chronic obstructive pulmonary disease
- Congestive heart failure
- Frequent or excessive urination
- Gastroesophageal reflux disease
- Kidney disease
- Lung disease
- Parkinson’s disease
- Urinary incontinence
Many of these conditions cause pain or discomfort that make sleeping difficult. Pain killers or medications may lessen symptoms and subsequently help improve sleep.
Mental and Emotional
Depression, anxiety and stress frequently manifest as sleep problems. Insomnia may also result from other psychological or psychiatric issues, such as:
Women are particularly vulnerable to psychiatric based causes of insomnia. Hormonal shifts often occur during pregnancy, menopause or due to the menstrual cycle. Menopause symptoms like hot flashes can also cause insomnia because of the associated discomfort.
A specific sleep disorder is frequently behind episodes of insomnia. Related sleep disorders include:
- Obstructive sleep apnea
- Periodic limb movement disorder
- Restless leg syndrome
- Sleep walking
A person’s environment affects their ability to sleep. Moving or trying to sleep in a new place, like a hotel room, can make it difficult to sleep well. Getting a new work schedule or changing timezones affects the circadian rhythms that are people’s internal clocks. These changes then affect the sleep-wake cycle. Physical discomfort and certain sensations may disrupt sleep too. Sleep disrupting stimuli include:
- Partner snoring or moving around
- Uncomfortable mattress
- Unpleasant smells
Usually, if these unpleasant stimuli are taken away people are able to sleep well again. Sometimes, people can adapt to these disturbances and resolve their insomnia that way.
Poor Sleep Hygiene
Sleep hygiene refers to habits that lead to restful sleep. A person with bad sleep habits is said to have poor sleep hygiene. Insomnia can easily result from poor hygiene. Changing sleep habits can therefore resolve insomnia.
Beds should be used for sleeping and sexual activities, nothing else. Reading, eating, working, watching TV, talking on the phone or engaging in any other stimulating activity in bed interferes with the mind’s ability to quiet down and recognize that going to bed means it is time to sleep. Even lying in bed thinking can make it difficult to fall asleep that night and in the future.
Taking naps during the day and going to bed or waking up at different times are also bad sleep habits. Exercising near bedtime may inhibit sleep. Eating dinner or a large snack close to bedtime can also cause sleep difficulties. A small snack usually does not cause problems, but eating anything that may lead to heartburn can keep people awake. On the other hand, trying to sleep while someone is hungry is difficult too.
Age-Related Insomnia Causes
The internal clock setting that controls the sleep cycle is different for all stages of life. Moving into a different life phase affects the internal clock and can lead to insomnia, especially when a person does not change their lifestyle to match their new phase.
It is common for older people to be more sedentary, develop more health problems and to be affected more by environmental issues like noise or temperature changes. Reduced physical activity may contribute to insomnia.
Older people are more likely to have health conditions that make sleeping hard, such as painful arthritis or back problems. These types of problems may make falling asleep difficult due to discomfort, as well as affect the quality of sleep.
Seniors are also more at risk for developing sleep disorders, including sleep apnea and restless leg syndrome. Both of these conditions may cause people to wake up frequently.
With more health problems often comes increased dependency on medications, including medications known to cause or contribute to insomnia. Also, many older people naturally wake up earlier and feel less rested after sleeping.
Children and teenagers may have their own issues with sleep. Many teenagers are natural night owls. Some children are too. Their bodies are unable to fall asleep before 11PM or later because their internal clocks say it is not time to sleep until late at night. It is also natural for these children and teens to naturally want to wake up later.
Unfortunately, many school systems are set to accommodate the sleep schedules of adults, not the delayed internal clocks of the larger population of young people who attend school. This scheduling may lead to insomnia among teenagers and younger children.
Short-Term Vs. Long-Term Causes
Certain causes of insomnia are more likely to be associated with short-term or long-term insomnia. Short-term is more likely to be linked to:
- Changing jobs or shifts
- Environmental factors, such as loud noises or extreme temperatures
- Events, such as divorce or losing a job
- Jet lag
- Physical discomfort
- Temporary medications, such as allergy or cold meds
Long-term causes are more likely to be associated with underlying conditions or long-term issues, such as:
- Chronic pain or stress
- Conditions that cause discomfort during the night
- Sleep disorders
- Substance abuse
Symptoms of Insomnia
Insomnia causes many symptoms besides waking up often at night or taking a long time to fall asleep. Insomnia affects mood and sleep disturbances, leading to symptoms that include:
- Daytime sleepiness
- Difficulty concentrating
- Difficulty falling asleep
- Frequent thoughts of worry related to sleep
- Increased frequency or mistakes
- Gastrointestinal problems, such as upset stomach
- Low energy
- Mood changes
- Not feeling rested after a full night’s sleep
- Poor memory
- Reduced ability to perform tasks
- Waking up throughout the night
- Waking up too early
Certain populations and individuals are at a higher risk than others for insomnia. These include:
- Adults over 60 years of age
- Drug addicts
- Frequent travelers
- Menopausal women
- Night workers
- People with mental disorders
- Pregnant women
- Shift workers
- Young adults
Insomnia Tests and Diagnosis
Doctors use several methods and tests to diagnose insomnia. Diagnosis may be an exhaustive process, including a physical examination, discussion about sleep history and a complete review of medical history and psychiatric history. In some cases, doctors have to refer patients to sleep centers.
Generally, the diagnostic process for insomnia begins with a thorough evaluation of a patient’s medical and psychiatric history. Reviewing a patient’s history can pinpoint a condition that is causing the insomnia.
When discussing medical histories, doctors may ask if patients are taking any medications, have any long-term medical conditions or are in any pain. A doctor may also evaluate a patient for signs of psychosis or mood disorders as well as determine the patient’s stress levels.
A patient’s day to day activities and details of their work and personal lives are also relevant. Part of a medical history may include determining a person’s level of physical activity, travel history, daily schedules and information about their work and personal lives.
Physical exams are an important part of the diagnostic process. Current medical issues could account for insomnia. A physical exam may include blood tests, mental assessments, body measurements and organ function.
Blood tests are a simple part of a physical exam. A blood test can identify if someone has a condition like a thyroid problem that is associated with insomnia.
More extensive tests may be performed to evaluate the functioning of the lungs and heart. An ear, nose and throat examination is also part of the process as well as an abdominal exam. Doctors may take measurements at the neck and waist too.
Doctors usually ask their patients about their specific sleeping problems using a series of specific questions. They may use questionnaires to figure out how much their patients insomnia impacts daytime fatigue and their sleep-wake schedule. Questions doctors ask include:
- How long patients sleep
- When they fall asleep
- How long it takes to fall asleep
- How often they wake up
- How long they remain awake when they do wake up during the night
- What time they wake up in the morning
- How often they take naps during the day
- If they ever wake up with shortness of breath
- How rested a patient feels in the morning and throughout the day
- What a patient’s routine is before bed
- If a bedroom has potential sleep distractions, like a TV
Doctors may speak with a patient’s partner for further information regarding sleep history. Bed partners can give insight into whether patients move a lot in their sleep or if they snore.
A sleep diary is often a diagnostic tool. Doctors may advise their patients to write down information about their sleeping patterns in a diary for one to two weeks. Patients record their sleep quality, when they fall asleep, how often they wake up and what time they awaken each morning. Sleep diaries also record how patients feel during the day and if they have any difficulties with focusing on daily tasks. Other pertinent information includes consumption of stimulants like caffeine and medications.
Some patients may need to visit a sleep center where staff can perform less common tests and observe patients’ sleeping patterns. Sometimes patients are sent to sleep centers to confirm or rule out a suspected diagnosis, but other times doctors refer patients when they have no idea what could be causing the insomnia.
One diagnostic test sleep centers use is a polysomnograpy (PSG). This test is sometimes recommended if a person is suspected of having obstructive sleep apnea, a condition whereby someone stops breathing while asleep. A PSG involves hooking patients up to machines that monitor their breathing, heart rate, brain waves, eye movements, blood pressure, oxygen levels and chest movements. Observing a person’s chest movements and oxygen levels gives information that can confirm sleep apnea if a person ceases to breathe or is not taking in enough oxygen. Trained physicians, including lung specialists, evaluate the data to determine if sleep apnea is present.
Another test that sleep center specialists may use is an actigraphy. Like a PSG, this test is not routine but is ordered under certain circumstances. Most often, an actigraphy is performed to ascertain whether someone has a circadian rhythm disorder, is suffering from subjective insomnia or has primary insomnia. An actigraphy involves wearing a device called an actigraph. This device is worn on the wrist. It records movement all the time, including when a patient is awake and sleeping. Actigraphs also have an on-board memory and microprocessor to record data.
Specialists may also evaluate daytime fatigue using a questionnaire called the Epworth Sleepiness Scale. Results may indicate insomnia or rule it out.
Sleep center specialists also consider any recent weight gain or chronic snoring when making a diagnosis.
Insomnia treatment covers a range of options because of the variety of causes. Transient insomnia usually goes away once the trigger is removed, but first the trigger needs to be identified. Treatment for insomnia that lasts longer must address the underlying cause. Simply addressing the symptoms does not actually treat insomnia, but treating the underlying problem may cause insomnia symptoms to disappear.
Treatment programs typically include both medical and non-medical treatments. Combining these two aspects usually is more successful than just one type. Non-medical treatments include therapies such as sleep restriction, sleep hygiene, relaxation therapy and other behavioral therapies.
Sleep hygiene is one of the main behavioral therapy treatments. Adopting healthy sleeping habits may be enough to cure insomnia in some people. Some potentially beneficial sleep hygiene modifications include:
- Engaging in consistent physical activity for a minimum of 20 minutes per day
- Working out more than four hours before bedtime
- Avoiding sleeping too much
- Creating an ideal sleep environment, such as setting a comfortable room temperature and blocking out light
- Following a set sleep schedule every day
- Avoiding caffeinated products in the afternoon and at night
- Avoiding alcoholic drinks before bedtime
- Quitting smoking
- Eating a large enough dinner or a light snack to avoid hunger at bedtime
- Dealing with stress or worries before bedtime
- Getting out of bed if one cannot fall asleep after 20 minutes
- Doing something relaxing before bed, such as a warm bath, yoga or deep breathing exercises
- Performing all activities other than sleep or sexual activities somewhere other than the bed
- Limiting naps to at most 30 minutes in duration
- Napping before 3 PM
- Removing distracting items like computers and TVs from the bedrooms
- Drinking or eating less before bedtime to avoid frequent urination or digestion issues
- Hiding clocks in the bedroom
- Wearing earplugs or creating white noise with a fan or sound machine
- Making a to-do list before bedtime to decrease worrying
Relaxation therapy is another non-medical treatment method for insomnia. The goal of relaxation therapy is teaching people how to regulate their mood, breathing, heart rate and tension levels. Muscle tension may be just as troublesome for sleeping as a mind that cannot shut down.
Some types of relaxation therapy include:
- Breathing exercises
- Dimming the lights up to an hour before bedtime
- Progressive muscle relaxation
- Soothing music before bedtime
Individuals may find different activities relaxing so it is important to tailor relaxation therapy based on how a person responds. It may take individuals a few weeks to learn the relaxation therapy techniques well enough to reduce insomnia.
Stimulus Control Therapy
Stimulus control therapy is a treatment for long-term insomnia. It involves following simple steps to promote healthy sleep, such as:
- Exposing oneself to natural sunlight daily
- Going to bed when a person feels sleepy
- Practicing good sleep hygiene
- Taking short naps in a darkened room every afternoon
Sleep Restriction Therapy
Sleep restriction therapy is a method for improving sleep quality by restricting time spent in bed. This therapy is dependent upon following a strict regimen of waking up at the same time each morning and going to bed at the same time. It actually begins by creating sleep deprivation by letting people spend little time in bed. Even if someone is tired when they awake at their set time, that person must get up.
The main idea is that someone will be better able to fall asleep eventually if they are forced to spend little time in bed. As a person’s sleep quality improves, their time spent in bed is gradually increases.
Sleep restriction also works to improve sleep quality by following specific guidelines. Sleep restriction advises patients to:
- Avoid drinking large amounts of fluid before bed
- Avoid eating large meals before bed
- Control the bedroom environment
- Conduct business or stressful activities somewhere other than the bedroom
- Follow sleep hygiene guidelines and use relaxation therapy
A central component of sleep restriction therapy is controlling lighting because the circadian rhythms that regulate sleep are extremely light sensitive. People who work nights or who need to sleep during the day for other reasons may need to block out light from their bedrooms with sleep shades. If they have children, they may need childcare services so their children cannot disturb their sleep.
Cognitive Behavioral Therapy
Some people’s insomnia may be caused by excessive worrying before bed. Cognitive behavioral therapy teaches people to replace their worries with positive thoughts. Therapists work with people individually or in group therapy.
Light therapy can reprogram a person’s biological clock. People who wake up or fall asleep too early can use light therapy to adjust their circadian rhythms and improve sleep patterns. Going out into the sunlight in the early evening or using a medical-grade light box at night can help people stay up later. People can then awaken later and get onto a normal sleep schedule.
Medications treat insomnia in some cases by treating underlying causes. Medications may also reduce insomnia symptoms.
Prescription sleeping pills make it easier for some people to fall asleep. These medications include:
- Clonazepam (Klonopin)
- Estazolam (ProSom)
- Flurazepam (Dalmane)
- Temazepam (Restoril)
- Triazolam (Halcion)
- Eszopiclone (Lunesta)
- Zaleplon (Sonata)
- Zolpidem (Ambien)
Sleeping pills can cause side effects resulting from an allergic reaction. Side effects may include:
- Abnormal behavior
- Difficulty balancing
- Facial swelling
- Impaired thinking
- Night wandering
Instead of the above sedatives, doctors may prescribe L-trytophan (Tryptan) or ramelteon (Rozerem). Ramelteon stimulates melatonin receptors to help people fall asleep. L-tryptophan is both a naturally occurring amino acid and a medication.
L-tryptophan is an essential amino acid, which means that the body needs to get it from an outside source like food or supplements. L-tryptophan medications decrease sleep latency and help insomniacs fall asleep easier. The body converts L-trypotphan to 5-hydroxytryptophan, which is the precursor to serotonin, a chemical that induces sleep.
L-tryptophan was sold as a sleep aid in the United States until 1989, but is now available by prescription only. However, 5-hydroxytryptophan is currently available as an over-the-counter sleep aid. This supplement may also be beneficial for weight loss and depression.
L-tryptophan may cause side effects, including:
- Abdominal gas
- Abdominal pain
- Appetite loss
- Blurry vision
- Sexual problems
Older people are more at risk for side effects from prescription pills than younger people. Some of these pills are habit-forming. A few sleeping pills are able to be used over the long-term, but most are only supposed to be used for a few weeks at a time.
Treatment is generally most successful when medications are combined with behavioral therapy, which eventually allows people to stop taking prescription sleep aids.
Over-The-Counter Sleeping Medications
Medications to improve sleep are also available without a prescription. Popular over-the-counter sleep medications include nonprescription antihistamines and melatonin.
Antihistamines include medications like doxylamine and diphenhydramine (Benadryl). Antihistamines do produce a sedative effect, which allow may cause drowsiness. However, they actually reduce sleep quality. They may also cause side effects, such as:
- Blurry vision
- Daytime fatigue
- Dry mouth
Antihistamines should not be used for long-term insomnia because of the negative effect they have on sleep quality.
Many over-the-counter sleep aids contain a substance called melatonin. The pineal gland in the brain secretes melatonin when it is dark. By increasing melatonin levels, the brain tells the body that it is time to sleep.
Some people do not have normal amounts of melatonin and may benefit from taking melatonin supplements. Older adults may also be low in melatonin. A typical dosage of melatonin is between 0.3 and 5 milligrams daily.
Some insomniacs are also depressed. These people may be prescribed antidepressants that have a sedative effect. Antidepressants include:
Medical Therapies for Specific Conditions
People with insomnia from working new shifts or varying shifts can treat insomnia with specific techniques. Some experts recommend taking sedatives for a few days after being assigned a new shift to adjust to the different sleep schedule. Naps to make up for lost sleep due to shift changes are also recommended by some, but not all, doctors.
Behavioral therapy is often useful for this type of insomnia. Sticking to firm bedtimes and waking up at the same time is especially important for shift workers, though the times change with the shift changes.
People who need to change shifts are least disturbed when shifts change in a forward direction, such as first working mornings and then starting a midday or afternoon shift. From working afternoons, people can then adapt to working evenings before they start working nights. Each of these shifts may require a week to adapt to the new work schedule.
Short-Term Insomnia from Stress
People who have insomnia because of stress may respond well to using a low-dose sedative on a short-term basis as they work to relieve their stress. Experts report that reassurance and support help to resolve many of the stressors that inhibit proper sleep. Learning good sleep hygiene is also beneficial.
Alternative treatments from herbs to acupuncture are used to treat insomnia. Some people may be able to treat their insomnia without pharmaceuticals or professional help. However, people should still consult their doctors first in case they have a condition or are taking medications that contraindicate usage of certain alternative medicines.
Herbal Remedies for Insomnia
Many people use herbs for insomnia, with varying degrees of success. Some of the popular herbal remedies in the United States for insomnia include:
Valerian root (Valeriana officinalis) is one of the most frequently used herbs taken for insomnia. It produces a mild sedative effect that can help people fall asleep and remain sleeping through the night. Valerian may be beneficial for long-term insomnia, but there have not been a lot of studies done to determine its effectiveness.
Valerian is one of the herbs approved by the German government for sale as a sleep remedy, along with hops and lemon balm. Valerian is approved for sale in the United States as a dietary supplement. A typical dosage of valerian is between 400 and 900 milligrams per day, which contains around 0.4 to 0.6 percent valerenic acid.
Chamomile is another popular herb for insomnia, although there is little evidence that is works. The U.S. Food and Drug Administration (FDA) states that chamomile is generally safe and has no side effects.
Passion flower (Passiflora incarnata) is commonly used for insomnia. In animal studies, passionflower has been shown to increase sleeping time though there are few human trials that show how well it works for insomnia. No side effects are known, though it is not recommended for pregnant women. A typical dosage for passionflower is between 4 and 8 grams.
Hops (Humulus lupulus) is a traditional medicine for sleep difficulties as well as intestinal problems. Hops has a sedative effect and is an approved sleep aid in Germany. For insomnia treatment, hops may be mixed into a tea or in capsule form. A standard dose is 0.5 grams. Hops is contraindicated for pregnant women and women with certain breast cancer.
Kava Kava (Piper methysticum)is an herb used for restlessness, stress and anxiety, all potential causes of insomnia. Kava kava has a sedative and relaxant effect. It is also an antispasmodic and anticonvulsive. Clinical studies have shown that kava kava can be beneficial for insomnia. A dosage of 180 to 210 milligrams is recommended as a sleep aid.
Ginseng is one of the most popular herbs in the United States, but its usage dates back at least 2,000 years. Ginseng contributes to normal sleep. It can also promote wakefulness. There are many different types of ginseng. The ones associated with sleep benefits include American ginseng, Asian ginseng and Vietnamese ginseng.
A dose of of 200 to 600 milligrams of ginseng extract or 1 to 2 grams of the root is the recommended dose. Some people experience excitation and nervousness, but ginseng is generally safe.
St. John’s Wort
St. John’s Wort (Hypericum perforatum) supplements are frequently used for insomnia, depression, anxiety and seasonal affective disorder (SAD). St. John’s Wort may help maintain serotonin in the brain. Low levels of serotonin are associated with depression. St. John’s Wort can also reduce amounts of interleukin-6, a protein linked to depression.
Taking St. John’s Wort may help relieve insomnia, but sometimes when taken for depression people develop insomnia. The insomnia could be a side effect of using St. John’s Wort or a complication of the depression. Many people find insomnia relief from switching the time they take St. John’s Wort to a few hours earlier, or ideally in the morning.
Use of lemon balm (Melissa officinalis) dates back to at least the Middle Ages. It helps to improve sleep and appetite, decrease anxiety and stress, plus relieve indigestion and pain. The German government approves lemon balm as a sleep aid.
There has been little research done on the use of lemon balm by itself, but evidence does show that using lemon balm along with other herbs like hops and valerian is beneficial for sleep and anxiety. However, one study showed that 600 milligrams of lemon balm improves calmness, mood and alertness.
Jamaica dogwood (Piscidia erythrina or Piscidia piscipula) is an herb used traditionally for insomnia as well as anxiety, migraine headaches, nervous tension and nerve pain. It has a sedative effect. People need to be careful using dogwood with other insomnia medications or supplements because it can increase their effects. Specifically, dogwood is known to interact with central nervous system depressants.
Dogwood may be toxic if someone overdoses. Symptoms of dogwood toxicity include salivation, perspiration, tremors and numbness. Seniors and women who are pregnant or breastfeeding should not take any amount of Jamaica dogwood. This supplement is also contraindicated for use in people who are scheduled for surgery within two weeks time because it can interact with anesthesia.
Skullcap (Scutellaria lateriflora) is an herb used primarily for anxiety and insomnia, though it may benefits other conditions. How skullcap works is not entirely understood, but it does seem to enhance effects of a calming brain chemical called gamma-aminobutyric acid. This may explain why skullcap has a sedative effect.
Acupuncture is becoming more common in the United States, but it has been part of traditional Chinese medicine for thousands of years. Acupuncture uses thin needles on specific spots of the body called acupoints. Sticking the needles in certain spots influences energy flow and how the body functions. Studies have shown that acupuncture improves sleep quality in insomniacs. However, not enough evidence exists in the Western world to prove that acupuncture is an effective for of treatment. There are numerous articles in Chinese that document success for insomnia treatment with acupuncture.
Acupuncture is painless and noninvasive. It is an individualized treatment, but research shows that using acupoints on the ears, scalp and body may bring quick relief.
Brain Music Therapy
Brain music therapy is a neurofeedback technique that is used to help people sleep, focus and relax. It is similar to meditation in that brain music therapy works to change brain waves into a more positive state. However, brain music only requires listening to specific tracks and not learning meditation techniques. Brain music therapy is unique to each person and what helps one person may hurt another.
Brain music therapy uses a electroencephalogram, or EEG, to record the electrical activity in people’s brains when they are relaxed and when they are stimulated. The EEG uses a computer algorithm to create a musical score based on a person’s brainwaves. The score mimics the tempo and rhythm of the electrical activity, with different notes representing differences in the changes of the brainwaves.
A CD is created with tracks for relaxation and stimulation that are unique to the person they were made for. Listening to the relaxation track may be beneficial for insomnia, anxiety and headaches as well as trauma. These issues may all contribute to sleep issues. Brain music therapy helps people fall asleep more quickly and wake up fewer times. It may be as beneficial as prescription drugs like Ambien but without the habit-forming side effects.
The stimulation track of the brain music therapy CD can also help people to focus and increase alertness. It is being explored as a way to give emergency response personnel an edge when they work to fight fatigue and be more effective.
There are no reported side effects for brain music therapy. However, listening to someone else’s brainwave therapy music can result in adverse effects, like headache.
Low Energy Emission Therapy
Low energy emission therapy (LEET) is a type of alternative insomnia treatment involving amplitude-modulated radio frequency electromagnetic fields. Treatment uses a machine called a LEET device that delivers low level signals through a mouthpiece. Standard treatment frequencies are between 20 and 100 MHz. Sessions may last as little as 15 minutes and be done every other day.
LEET treatments promote relaxation and may cure chronic insomnia. LEET treatments are given at sleep centers. There are no known side effects.
Meditation may help treat insomnia through promoting relaxation and increasing production of melatonin. Studies show that meditating regularly with or without the accompaniment of yoga results in higher levels of melatonin in the blood. Yoga offers the additional benefits of exercise, which is also known to promote healthy sleep.
There are many forms of meditation, some that work better than others for different people. A basic form of meditation is to just sit and focus on nothing. Any thoughts that enter the mind should be released. This type of meditation may be particularly helpful for people who cannot sleep because they are distracted by their thoughts.
Another basic type of meditation is called focused attention, which covers several different techniques that all involve concentrating on either an object or an emotion, such as compassion. Mindfulness meditation is a blend of focused attention and basic meditation. Practitioners focus on the present moment without allowing thoughts of the past or present to distract them. This may relieve worry about the past or future.
Like with other forms of relaxation therapy, people may not see results from meditation practice until after they become proficient at their chosen technique.
Consistent exercise may improve sleep in older adults and help younger adults achieve deeper sleep. This includes young adults who have sleep disorders and those who do not. Exercise may be low, moderate or vigorous to affect sleep, though vigorous exercise should not be performed right before bed.
Low intensity exercise includes working out gently enough that people can speak easily, even sing. Tai Chi and some forms of yoga can be low intensity forms of exercise. Moderate exercise increases breathing rate but not enough to inhibit carrying on a conversation. Walking or playing doubles tennis can be moderate intensity activities. Vigorous exercise makes carrying on a conversation too difficult, but a person should not be gasping for air. Running, swimming laps and many sporting activities are vigorous exercises.
Exercise for insomnia is most effective when concluded at least three hours before a person goes to bed. Regular exercise is typically defined as working out on most days of the week. Thirty minutes of moderate exercise five or more days of the week is also beneficial for general health. Longer and more vigorous exercise can promote weight loss, which may help insomnia in people who are obese.
Diet can have a positive impact on insomnia. Magnesium in particular may play an important role in preventing sleep difficulties. Women seem to be more at risk for insomnia when their estrogren levels are low, such as during menopause. Soft tissues need estrogen to uptake magnesium; therefore, lower than normal levels of estrogen may result in less than optimal levels of the mineral in the body.
Magnesium helps muscles to relax. It also stops the fight or flight response, which is a process the body goes through when it perceives a threat. The flight or flight response releases hormones that make people alert and increase energy in case there is a need to run away or fight off an attacker. These hormones are counterproductive to sleep.
Magnesium deficiencies may also make some conditions worse, including anxiety, heart failure, restless leg syndrome, PMS, migraines and fibromyalgia, all causes of insomnia.
A diet that is high in magnesium and low in aluminum is linked with good quality sleep and low instances of waking up at night. Aluminum is present in water and food additives, as well as some herbs and teas in low amounts. Foods that have been cooked or stored in aluminum containers or using aluminum utensils contain higher aluminum levels and may need to be avoided if on a low aluminum diet.
Eating foods rich in magnesium along with taking magnesium supplements increases magnesium levels. Foods rich in magnesium include:
- Bran cereal
- Green leafy vegetables
- Pistachio nuts
- Oat flour
- Wheat bran
- Whole grains
Although whole wheat is a source of magnesium, eating whole grain products may contribute to insomnia in some people.
Magnesium deficiency changes brain waves, which can lead to waking up frequently, low quality sleep and other sleep disturbances. Symptoms of a magnesium deficiency include:
- Irregular heart beat
- Low blood pressure
- Mental confusion
- Muscle spasms
- Restless leg syndrome
Alternative Therapy Considerations
Alternative therapies are not approved by the FDA. Not all “natural” cures are safe. Some supplements can interact with medications or contribute to other issues. Some general guidelines for using alternative therapies safely are:
- Avoid supplementary blends containing more than one herb
- Choose products that list important information on their labels, such as an expiration date, manufacture’s name and address, side effects and a batch and lot number
- Consult a doctor before using alternative therapy
- Do not believe manufacture claims, especially over clinical study results
- Stop taking herbal supplements if there are any side effects, such as anxiety, rash, diarrhea or nausea
Insomnia causes direct symptoms like daytime fatigue, yet it can also lead to serious complications. Lack of sleep may not only make people feel tired during the day, it may also lead to car accidents, falls and severe difficultly performing their usual routines.
Nearly 20 percent of automotive accidents are caused by drivers who are sleepy. Insomnia is likely behind some of these accidents. Not enough sleep slows reaction time as well.
Insomnia also increases the risk of falls for older women. Older women are a high risk group for bone loss and even osteoporosis, which makes falling a serious problem as falls can easily lead to bone fractures when the bones are weak.
People who do not get enough restful sleep say that it lowers their quality of life.
Insomnia may contribute to other health problems. It can contribute to becoming overweight or obese, which is a risk factor for serious conditions like heart disease. It also may lead to psychiatric problems like an anxiety disorder.
Lack of sleep leads to poor immune system function, leaving people open to issues like catching viral infections. Insomnia also can worsen long-term conditions and increase risk of diseases like diabetes and high blood pressure.
People can frequently prevent insomnia by adopting correct sleeping habits and learning to relax. Refraining from engaging in any activities other than sleep or sex in the bed and following a set sleep schedule even on their days off help most people sleep better. Other guidelines include:
- Avoiding vigorous exercise prior to bedtime
- Controlling the environment, including temperature, light and noise
- Getting out of bed after 20 minutes instead of lying in bed awake
- Limiting naps to 15 minutes or less
- Refraining from eating large meals, drinking a lot of fluids or using stimulants like nicotine and caffeine before bedtime
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