If you're an older adult struggling to get a good night's sleep, read Insomnia in Older Adults
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.
Although insomnia is the most common sleep complaint, it is not a single sleep disorder. It’s more accurate to think of insomnia as a symptom of another problem, which differs from person to person. It could be something as simple as drinking too much caffeine during the day or a more complex issue like an underlying medical condition or feeling overloaded with responsibilities.
The good news is that most cases of insomnia can be cured with changes you can make on your own—without relying on sleep specialists or turning to prescription or over-the-counter sleeping pills.
Symptoms of insomnia:
Symptoms of insomnia:
- Difficulty falling asleep despite being tired
- Waking up frequently during the night
- Trouble getting back to sleep when awakened
- Exhausting sleep
- Relying on sleeping pills or alcohol to fall asleep
- Waking up too early in the morning
- Daytime drowsiness, fatigue, or irritability
- Difficulty concentrating during the day
In order to properly treat and cure your insomnia, you need to become a sleep detective. Emotional issues such as stress, anxiety, and depression cause half of all insomnia cases. But your daytime habits, sleep routine, and physical health may also play a role. Try to identify all possible causes of your insomnia. Once you figure out the root cause, you can tailor treatment accordingly.
- Are you under a lot of stress?
- Are you depressed or feel emotionally flat or hopeless?
- Do you struggle with chronic feelings of anxiety or worry?
- Have you recently gone through a traumatic experience?
- Are you taking any medications that might be affecting your sleep?
- Do you have any health problems that may be interfering with sleep?
- Is your sleep environment quiet and comfortable?
- Are you spending enough time in sunlight during the day and in darkness at night?
- Do you try to go to bed and get up around the same time every day?
Common mental and physical 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, a painful breakup, or jet lag. Other times, insomnia is stubbornly persistent. Chronic insomnia is usually tied to an underlying mental or physical issue.
- Psychological problems that can cause insomnia: depression, anxiety, chronic stress, bipolar disorder, post-traumatic stress disorder.
- Medications that can cause insomnia: antidepressants; cold and flu medications that contain alcohol; pain relievers that contain caffeine (Midol, Excedrin); diuretics, corticosteroids, thyroid hormone, high blood pressure medications.
- Medical problems that can cause insomnia: asthma, allergies, Parkinson’s disease, hyperthyroidism, acid reflux, kidney disease, cancer, chronic pain.
- Sleep disorders that can cause insomnia: sleep apnea, narcolepsy, restless legs syndrome.
Anxiety and depression: Two of the most common causes of chronic insomnia
Most people suffering from an anxiety disorder or depression have trouble sleeping. What’s more, the sleep deprivation can make the symptoms of anxiety or depression worse. If your insomnia is caused by anxiety or depression, treating the underlying psychological issue is the key to the cure.
While treating underlying physical and mental issues is a good first step, it may not be enough to cure your insomnia. You also need to look at your daily habits. Some of the things you’re doing to cope with insomnia may actually be making the problem worse.
For example, if you’re using sleeping pills or alcohol to fall asleep, this will disrupt your sleep even more over the long-term. Or if you drink excessive amounts of coffee during the day, it will be more difficult to fall asleep later. Oftentimes, changing the habits that are reinforcing sleeplessness is enough to overcome insomnia altogether. It may take a few days for your body to get used to the change, but once you do, you will sleep better.
Using a sleep diary to identify insomnia-inducing habits
Habits that make insomnia worse:
- drinking a lot of caffeine
- drinking or smoking before bed
- taking naps during the day
- an irregular sleep schedule
Some habits are so ingrained that you may overlook them as a possible contributor to your insomnia. Maybe your daily 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.
All you have to do is jot down daily details about your daytime habits, sleep routine, and insomnia symptoms. For example, you can keep track of when you go to sleep and when you wake up, where you fall asleep, what you eat and drink, and any stressful events that occur during the day.
Adopting new habits to help you 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.
- 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. Get up at your usual time in the morning even if you’re tired. This will help you get back in a regular sleep rhythm.
- 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.
- Avoid stimulating activity and stressful situations before bedtime. This includes vigorous exercise; big discussions or arguments; and TV, computer, or video game use.
- Limit caffeine, alcohol, and nicotine. Stop drinking caffeinated beverages at least eight hours before bed. Avoid drinking alcohol in the evening; while alcohol can make you feel sleepy, it interferes with the quality of your sleep. Quit smoking or avoid it at night, as nicotine is a stimulant.
Preparing your brain for sleep
Your brain produces the hormone melatonin to help regulate your sleep-wake cycle. As melatonin is controlled by light exposure, not enough natural light during the day can make your brain feel sleepy, while too much artificial light at night can suppress production of melatonin and make it harder to sleep. To help naturally regulate your sleep-wake cycle and prepare your brain for sleep:
- Increase light exposure during the day. Take breaks outside in sunlight, remove sunglasses when it’s safe to do so, and open blinds and curtains during the day.
- Limit artificial light at night. To boost melatonin production, use low-wattage bulbs, cover windows and electrical displays in your bedroom, avoid bright light and turn off television and computer screens at least one hour before bed. If you can’t make your bedroom dark enough, try using a sleep mask.
Coping with shift work
Working nights or irregular shifts can disrupt your sleep schedule, requiring you to sleep during daylight hours. But you may be able to limit the adverse impact by practicing the healthy bedtime habits above, and following these tips:
- Adjust your sleep-wake cycle by exposing yourself to bright light when you wake up at night, use bright lamps or daylight-simulation bulbs in your workplace, and then wear 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.
- Avoid a long commute that cuts into your sleep time. The more time you spend traveling home in daylight, the more awake you’ll become and the harder you’ll find it is to get to sleep.
- Make sleep a priority at the weekends or on your days off so you can pay off your sleep debt.
- 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.
The more trouble you have with sleep, the more it starts to invade your thoughts. You may dread going to sleep because you just know that 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 you’ll blow your presentation. But agonizing and expecting sleep difficulties only makes insomnia worse; worrying about getting to sleep or how tired you’re going to be floods your body with adrenaline, and before you know it, you’re wide-awake.
Learning to associate your bed with sleeping and sex, not sleeplessness
Self-help strategies for chronic worriers
Do you lie awake at night worrying about “what ifs” and worst-case scenarios? Constant worrying can keep you up at night and make you tense and edgy during the day. But chronic worrying is a mental habit you can learn how to break.
If sleep worries are getting in the way of your ability to unwind at night, the following strategies may help. The goal is to train your body to associate the bed with sleep, sex, and nothing else—especially not frustration and anxiety.
- 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 and sex, so that when you get in bed your brain and body get a strong signal that it’s time to nod off or be romantic.
- 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. The key is to recognize self-defeating thoughts and replace them with more realistic ones.
|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. I shouldn’t have a problem!
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.
|Challenging self-defeating thoughts that fuel insomnia|
Unrealistic expectations - I should be able to sleep well every night like a normal person. I shouldn’t have a problem!
Sleep-promoting comeback: 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.
Sleep-promoting comeback: 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.
Sleep-promoting comeback: 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.
Sleep-promoting comeback: 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.
Sleep-promoting comeback: I don’t know what will happen tonight. Maybe I’ll get to sleep quickly if I use the strategies I’ve learned.
Remember, replacing self-defeating thoughts takes time and practice. You may find it helpful to jot down your own list, taking note of the negative thoughts that pop up and how you can dispute them. You may be surprised at how often these negative thoughts run through your head. Be patient and ask for support if you need it.
If you're easily wound and unable to let go of stress at the end of the day, you may benefit from relaxation techniques that take advantage of the body’s natural relaxation response, a state of restfulness that is the opposite of the stress response. 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 awaken in the middle of the night. And all without the side effects of sleep medication!
A variety of relaxation techniques help you achieve the relaxation response, including:
- deep breathing
- progressive muscle relaxation
- tai chi
Relaxation techniques that can help you sleep
- A relaxing bedtime routine. As a start to your relaxation practice, develop a calming bedtime routine. Focus on quiet, soothing activities, such as reading, knitting, or listening to soft music. Keep the lights low.
- Abdominal breathing. Most of us don’t breathe as deeply as we should. When we breathe deeply and fully, involving not only the chest, but also the belly, lower back, and ribcage, it can actually help our parasympathetic nervous system, which controls relaxation. Close your eyes and try taking deep, slow breaths, making each breath even deeper than the last. Breathe in through your nose and out through your mouth. You can try making each exhale a little longer than each inhale.
- Progressive muscle relaxation. Lie down or 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.
A step-by-step guide to developing a daily relaxation practice
It takes regular practice to learn these techniques and harness their stress-relieving power. Stick with it because 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.
When you’re tossing and turning at night, it can be tempting to turn to sleep aids for relief. But before you do, here’s what you need to know.
Dietary supplements for insomnia
There are many dietary and herbal supplements marketed for their sleep-promoting effects. Although they may be described as “natural,” be aware that sleep remedies can still have side effects and interfere with other medications or vitamins you’re taking. For more information, talk to your doctor or pharmacist.
While scientific evidence is still being gathered for alternative sleep remedies, you might find that some of them work wonderfully for you. The two supplements with the most evidence supporting their effectiveness for insomnia are melatonin and valerian.
- Melatonin is a naturally occurring hormone that your body produces at night. While melatonin supplements—available as an over-the-counter supplement—don't work for everyone, they may be an effective insomnia treatment for you—especially if you’re an extreme “night owl” with a natural tendency to go to bed and get up much later than others.
- Valerian is an herb with mild sedative effects that may help you sleep better. However, the quality of valerian supplements varies widely.
Prescription sleeping pills for insomnia
While prescription sleep medications can provide temporary relief, it’s important to understand that sleeping pills are not a cure for insomnia. And if not used carefully, they actually 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. First, try changing your sleep habits, your daily routine, and your attitudes about sleep. Evidence shows that lifestyle and behavioral changes make the largest and most lasting difference when it comes to insomnia.
If you’ve tried the insomnia cures and treatments listed above and are still having trouble getting the sleep you need, a doctor or sleep disorder specialist may be able to help.
When to seek professional help for insomnia:
- If your insomnia doesn’t respond to self-help strategies
- If your insomnia is causing major problems at home, work, or school
- If you’re experiencing scary symptoms like chest pain or shortness of breath
- If your insomnia occurs almost every night and is getting worse
Self Help for a Good Night's Rest
Resources & References
General information about insomnia
What is 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)
Can't Sleep? What to Know About Insomnia – 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)
Insomnia 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)
Insomnia Treatment – Covers a wide range of insomnia treatments and cures, including sleep restriction, stimulus control, cognitive behavioral therapy, and relaxation techniques. (QualityHealth.com)
Ten Natural Sleep 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)
CBT for Insomnia Program – Online, interactive treatment program for insomnia from sleep doctor Gregg Jacobs. A Harvard Medical School study found this program to be more effective than Ambien. (cbtforinsomnia.com)
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)