How to Recognize and Treat Insomnia
Do you struggle to get to sleep no matter how tired you are? Or do you wake up in the middle of the night and lie awake for hours, anxiously watching the clock? Insomnia is a common problem that takes a toll on your energy, mood, health, and ability to function during the day. Chronic insomnia can even contribute to serious health problems. But you don’t have to resign yourself to sleepless nights. Simple changes to your lifestyle and daily habits can put a stop to insomnia—without the need for medication.
Understanding insomnia and its symptoms
Insomnia is the inability to get the amount of sleep you need to wake up feeling rested and refreshed. Because different people need different amounts of sleep, insomnia is defined by the quality of your sleep and how you feel after sleeping—not the number of hours you sleep or how quickly you doze off. Even if you’re spending eight hours a night in bed, if you feel drowsy and fatigued during the day, you may be experiencing insomnia.
|Symptoms of insomnia can include:|
Difficulty falling asleep despite being tired
Trouble getting back to sleep when waking up in the night
Waking up too early in the morning
Relying on sleeping pills or alcohol to fall asleep
Not feeling refreshed after sleep
Daytime drowsiness, fatigue, or irritability
Difficulty concentrating during the day
Figuring out why you can’t sleep
In order to properly resolve your insomnia, you need to become a sleep detective. Emotional issues such as stress, anxiety, and depression cause about half of all insomnia cases. But your daytime habits, bedtime routine, and physical health can also play a major role.
Common causes of insomnia
Sometimes, insomnia only lasts a few days and goes away on its own, especially when the insomnia is tied to an obvious temporary cause, such as stress over an upcoming presentation or a painful breakup. Chronic insomnia, however, is usually tied to an underlying psychological or medical issue.
Psychological problems and emotional distress. Anxiety and depression are two of the most common causes of chronic insomnia. Other common emotional and psychological causes include chronic or significant life stress, anger, worry, grief, bipolar disorder, and trauma.
Medical problems or illness. Many medical conditions and diseases can contribute to insomnia, including asthma, allergies, Parkinson’s disease, hyperthyroidism, acid reflux, kidney disease, and cancer. Chronic pain is also a very common cause of insomnia.
Medications. Many prescription drugs can interfere with sleep, including antidepressants, stimulants for ADHD, corticosteroids, thyroid hormone, high blood pressure medications, and some contraceptives. Common over-the-counter culprits include cold and flu medications that contain alcohol, pain relievers that contain caffeine (Midol, Excedrin), diuretics, and slimming pills.
Sleep disorders. Insomnia is itself a sleep disorder, but it can also be a symptom of other sleep disorders, including sleep apnea, restless legs syndrome, and circadian rhythm disturbances tied to jet lag or late-night shift work.
Causes of insomnia you may overlook (and that are within your power to change!)
It’s important to identify all possible causes of your insomnia, including things you’re doing during the day or leading up to bedtime that interfere with quality sleep.
- Is your sleep environment noisy, too bright, or not very comfortable?
- Do you watch TV, play video games, or use a computer, tablet or smartphone in bed?
- Do you drink caffeinated beverages (coffee, tea, soda) within eight hours of bed?
- Do you keep an irregular sleep schedule?
- Do you exercise or eat late in the evening?
- Do you use alcohol to fall asleep?
Changing habits that disrupt sleep
If medical or emotional problems are contributing to your insomnia, treating them first is essential. But you also need to look at daytime habits and bedtime routines that contribute to sleeplessness.
Using a sleep diary to identify insomnia-inducing habits
Some habits are so ingrained that you may overlook them as a possible contributor to your insomnia. Maybe your Starbucks habit affects your sleep more than you realize. Or maybe you’ve never made the connection between your late-night TV viewing or Internet surfing and your sleep difficulties. Keeping a sleep diary is a helpful way to pinpoint habits and behaviors contributing to your insomnia.
Adopting new habits to help you sleep
Stick to a regular sleep schedule. Support your biological clock by going to bed and getting up at the same time every day, including weekends.
Avoid naps. Napping during the day can make it more difficult to sleep at night. If you feel like you have to take a nap, limit it to 30 minutes before 3 p.m.
Limit caffeine, alcohol, and nicotine. Stop drinking caffeinated beverages at least eight hours before bed. While alcohol can make you feel sleepy, it interferes with the quality of your sleep, and nicotine is a stimulant.
Avoid late meals. Try to avoid heavy, rich foods within two hours of bed. Fatty foods can take a lot of work for your stomach to digest and spicy or acidic foods can cause heartburn.
Get regular exercise. Regular exercise can improve the symptoms of insomnia, but it’s not a quick fix. It takes several months to feel the full effects. Aim for 30 minutes or more of activity on most days—but not too close to bedtime.
Develop a better bedtime routine
It’s not just what you do during the day that affects the quality of your sleep, but also those things you do to prepare your mind and body for sleep.
Make sure your bedroom is quiet, dark, and cool. Noise, light, and heat can interfere with sleep. Try using a sound machine or earplugs to hide outside noise, an open window or fan to keep the room cool, and blackout curtains or a sleep mask to block out light.
Avoid stimulating activity and stressful situations before bedtime. This includes vigorous exercise, big discussions or arguments, or catching up on work. Instead, focus on quiet, soothing activities, such as reading, knitting, or listening to soft music, while keeping lights low.
Turn off screens one hour before bedtime.The light emitted from TV, tablets, smartphones, and computers suppresses your body’s production of melatonin and can severely disrupt your sleep. Instead of emailing, texting, watching TV, or playing video games, try listening to a book on tape, a podcast, or reading by a soft light.
Coping with shift work
Working nights or irregular shifts can disrupt your sleep schedule. You may be able to limit the adverse impact with these tips:
- Adjust your sleep-wake cycle by exposing yourself to bright light when you wake up at night, using bright lamps or daylight-simulation bulbs in your workplace, and then wearing dark glasses on your journey home to block out sunlight and encourage sleepiness.
- Limit the number of night or irregular shifts you work in a row to prevent sleep deprivation mounting up.
- Avoid frequently rotating shifts so you can maintain the same sleep schedule.
- Eliminate noise and light from your bedroom during the day. Use blackout curtains or a sleep mask, turn off the phone, and use ear plugs or a soothing sound machine to block out daytime noise.
Neutralize sleep anxieties
The more trouble you have with sleep, the more it starts to invade your thoughts. You may dread going to sleep because you’re going to toss and turn for hours or be up at 2 a.m. again. Or maybe you’re worried because you have a big day tomorrow, and if you don’t get a solid eight hours, you’re sure to blow it. But agonizing about sleep only makes insomnia worse. Worrying floods your body with adrenaline, and before you know it, you’re wide-awake.
Learn to associate your bed with sleeping, not sleeplessness
Use the bedroom only for sleeping and sex. Don’t work, read, watch TV, or use your computer in bed or the bedroom. The goal is to associate the bedroom with sleep alone, so that your brain and body get a strong signal that it’s time to nod off when you get in bed.
Get out of bed when you can’t sleep. Don’t try to force yourself to sleep. Tossing and turning only amps up the anxiety. Get up, leave the bedroom, and do something relaxing, such as reading, drinking a warm cup of caffeine-free tea, taking a bath, or listening to soothing music. When you’re sleepy, go back to bed.
Move bedroom clocks out of view. Anxiously watching the minutes tick by when you can’t sleep—knowing that you’re going to be exhausted when the alarm goes off—is a surefire recipe for insomnia. You can use an alarm, but make sure you can’t see the time when you’re in bed.
It’s also helpful to challenge the negative attitudes about sleep and your insomnia problem that you’ve developed over time.
|Challenging self-defeating thoughts that fuel insomnia|
|Self-defeating thought||Sleep-promoting comeback|
Unrealistic expectations: I should be able to sleep well every night like a normal person.
Lots of people struggle with sleep from time to time. I will be able to sleep with practice.
Exaggeration: It’s the same every single night, another night of sleepless misery.
Not every night is the same. Some nights I do sleep better than others.
Catastrophizing: If I don’t get some sleep, I’ll tank my presentation and jeopardize my job.
I can get through the presentation even if I’m tired. I can still rest and relax tonight, even if I can’t sleep.
Hopelessness: I’m never going to be able to sleep well. It’s out of my control.
Insomnia can be cured. If I stop worrying so much and focus on positive solutions, I can beat it.
Fortune telling: It’s going to take me at least an hour to get to sleep tonight. I just know it.
I don’t know what will happen tonight. Maybe I’ll get to sleep quickly if I use the strategies I’ve learned.
Tackle daytime stress and worries
Residual stress, worry, and anger from your day can make it difficult to fall asleep as night.
Get help with stress management.If the stress of managing work, family, or school is keeping you awake at night, learning how to handle stress in a productive way and to maintain a calm, positive outlook can help you sleep better at night.
Talk over your worries during the day with a friend or loved one. Talking face to face with someone who cares about you is a great way to relieve stress and stop you rehashing worries when it’s time to sleep. The person doesn’t need to be able to fix your problems, but just needs to be an attentive, nonjudgmental listener.
Harnessing your body's relaxation response
If you feel wound up much of the time and unable to let go of stress at the end of the day, you may benefit from relaxation techniques such as meditation, yoga, and deep breathing. Not only do relaxation techniques help you quiet your mind and relieve tension in the body, but they also help you fall asleep faster and get back to sleep more quickly if you wake up in the middle of the night. Some popular smartphone apps can help guide you through the different relaxation methods, or you can follow these techniques:
Abdominal breathing. Breathing deeply and fully, involving not only the chest, but also the belly, lower back, and ribcage, can help relaxation. Close your eyes and take deep, slow breaths, making each breath even deeper than the last. Breathe in through your nose and out through your mouth.
Progressive muscle relaxation. Make yourself comfortable. Starting with your feet, tense the muscles as tightly as you can. Hold for a count of 10, and then relax. Continue to do this for every muscle group in your body, working your way up from your feet to the top of your head.
Mindfulness meditation. Sit quietly and focus on your natural breathing and on the way your body feels in the moment. Allow thoughts and emotions to come and go without judgment, always returning to focus on breath and your body.
It takes regular practice to learn these techniques and harness their stress-relieving power. But the benefits can be huge. You can do them as part of your bedtime routine, when you are lying down preparing for sleep, and if you wake up in the middle of the night.
Getting back to sleep if you wake up
While it’s normal to wake briefly during the night, if you’re having trouble falling back to sleep, the following tips may help.
Stay out of your head. The key to getting back to sleep is continuing to cue your body for sleep. Hard as it may be, try not to stress over your inability to fall asleep again, because that only encourages your body to stay awake. A good way to stay out of your head is to focus on the feelings and sensations in your body or to practice breathing exercises. Take a breath in, then breathe out slowly while saying or thinking the word, “Ahhh.” Take another breath and repeat.
Make relaxation (not sleep) your goal. If you find it hard to fall back asleep, try a relaxation technique such as visualization, progressive muscle relaxation, or meditation, which can be done without even getting out of bed. Remind yourself that although they’re not a replacement for sleep, rest and relaxation still help rejuvenate your body.
Do a quiet, non-stimulating activity. If you’ve been awake for more than 15 minutes, get out of bed and do a quiet, non-stimulating activity, such as reading a book. Keep the lights dim so as not to cue your body clock to wake up. Avoid using electronic screens of any kind as the light they emit stimulates the brain.
Postpone worrying and brainstorming. If you wake at night feeling anxious about something, make a brief note of it on paper and postpone worrying about it until the next day when it will be easier to resolve. Similarly, if a great idea is keeping you awake, make a note of it and postpone thinking more about it until morning.
What about sleep aids and sleeping pills?
When you’re tossing and turning at night, it can be tempting to pop a pill for relief. However, no sleeping pill will cure the underlying cause of your insomnia, and some can even make the problem worse in the long run.
Dietary supplements for insomnia
There are many herbal supplements marketed for their sleep-promoting effects. Some remedies, such as lemon balm or chamomile tea, are generally harmless, while others can have side effects and interfere with other medications and vitamins you’re taking.
Two supplements for insomnia that are considered to be safe and effective are melatonin and valerian.
Melatonin is a naturally occurring hormone that your body produces at night. Melatonin supplements may be effective for short-term use, especially in reducing jet lag. However, there are potential side effects, including next-day drowsiness.
Valerian is an herb with mild sedative effects that may help you sleep better. However, the quality of valerian supplements varies widely.
Over the counter (OTC) sleep aids
The main ingredient in over-the-counter (OTC) sleeping pills is an antihistamine, generally taken for allergies, hay fever, and cold symptoms. Sleep experts generally advise against their use because of side effects, questions about their effectiveness, and lack of information about their safety over the long term.
Prescription sleeping pills
Prescription sleep medications may provide temporary relief, but can have serious side effects and make insomnia worse in the long run. It’s best to use medication only as a last resort, and then, only on a very limited, as-needed basis. Evidence shows that lifestyle and behavioral changes make the largest and most lasting difference when it comes to insomnia.
When to seek professional treatment
If you’ve tried the insomnia self-help strategies above and are still having trouble getting the sleep you need, a doctor or sleep disorder specialist may be able to help. Seek professional help for insomnia if:
- Your insomnia doesn’t respond to self-help
- Your insomnia is causing major problems at home, work, or school
- You’re experiencing scary symptoms like chest pain or shortness of breath
- Your insomnia occurs almost every night and is getting worse
Bring a sleep diary with you. Your doctor may be able to diagnose an illness or sleep disorder that's causing your insomnia, or refer you to a sleep specialist or cognitive behavioral therapist.
Cognitive behavioral therapy (CBT)
CBT is aimed at breaking the cycle of insomnia. Poor sleep tends to lead to stress and anxious thoughts about not being able to sleep. This in turn leads to stress and tension, which leads to poor sleeping habits, such as the use of sleeping pills. This leads to worsening insomnia and so on.
The Vicious Cycle of Insomnia
In addition to improving sleep habits, CBT is aimed at changing thoughts and feelings about sleep that may be causing stress and contributing to your insomnia. A therapist may also recommend sleep restriction therapy, whereby you initially shorten your sleep time. The idea is that by limiting the time you spend in bed to the number of hours you actually sleep, say from 1 a.m. to 6 a.m., you'll spend less time awake and more time asleep. As your sleep efficiency increases you'll gradually start going to bed earlier and getting up later until you reach your optimum sleep schedule.
If stress, worry or relationship issues are making it harder for you to sleep, read FEELING LOVED.
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Resources and references
General information about insomnia
Insomnia – A series of articles covering different types of insomnia, the causes of transient and chronic insomnia, self-help cures, and professional treatment. (University of Maryland Medical Center)
Facts About Insomnia (PDF) – Fact sheet describes the symptoms and common causes of insomnia, as well as proven treatments and cures. (National Institutes of Health)
Insomnia: What it is, How it Affects You, and How to Help You Get Back Your Restful Nights – An overview of insomnia including common causes, signs, symptoms, and what to do (National Sleep Foundation)
Insomnia – Discusses insomnia symptoms, types, causes, and treatments, including what you can do to stop sleepless nights. (University of Cambridge)
Treatments and cures
Insomnia Treatment: Cognitive Behavioral Therapy Instead of Sleeping Pills – Your attitudes about sleep and certain behaviors are often the root cause of insomnia. (The Mayo Clinic)
Natural Sleep Aids & Tips – Describes ten natural remedies for insomnia, including lifestyle changes, herbal supplements, and relaxation strategies. (Dr. Weil)
Sleep Restriction Therapy: When Nothing Else Works – Step-by-step guide to sleep restriction therapy, an effective insomnia treatment that involves limiting time spent in bed. (Talk About Sleep)
Cognitive Behavioral Therapy for Insomnia – Describes how cognitive behavioral therapy works treating insomnia, and provides a case study as an example. (National Sleep Foundation)
Online CBT for insomnia
Online Treatment May Help Insomniacs – Article about the success of online CBT applications to treat insomnia. (New York Times)
Insomnia? Get Some SHUTi – Information about current and future Sleep Healthy Using The Internet (SHUTi) online research studies. (University of Virginia)
Herbs and supplements for when you can’t sleep
Melatonin and Sleep – Discussion of melatonin’s use in the treatment of insomnia and how it may help when you can’t sleep. (National Sleep Foundation)
Valerian – A review of the use of valerian for treating insomnia and other sleep disorders. (Office of Dietary Supplements, National Institutes of Health)
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