Insomnia Causes and Cures:

Signs and symptoms of insomnia

Insomnia is the inability to get high-quality sleep. It can last a day or two, a month, or even months on end. Because different individuals need different amounts of sleep, insomnia is not defined by the number of hours you sleep or by how quickly you fall asleep. Instead, it depends on the quality of your sleep, and how you feel after sleeping. Even if you are sleeping eight hours a night, if you’re still feeling drowsy and fatigued during the day, you may be experiencing insomnia.

Symptoms and Effects of Insomnia
Nighttime	Daytime
Difficulty falling asleep despite being tired Using sleeping pills or alcohol to fall asleep Awakening frequently or lying awake in the middle of the night Awakening too early in the morning and not feeling refreshed	Daytime drowsiness, fatigue, or irritability Difficulty concentrating; poor job/school performance Slower reaction times and diminished mental alertness; increased likelihood of accidents Weakened immune system Increased risk of depression, anxiety and substance abuse

Causes of insomnia

Understanding the causes of your sleeplessness is a big first step in learning to overcome insomnia. The normal routines and stresses of each day present many obstacles to quality rest. Eliminating these barriers could provide an insomnia cure.

• Mental barriers - Stress (new job, family or financial problems), poor mental attitude about sleep
• Food, alcohol and supplements - Caffeine and nicotine (cause restlessness and delay sleep), alcohol (depressant; encourages light sleep but inhibits deep sleep), herbal supplements (may boost energy and keep you awake)
• Drugs - Prescription medications often contain caffeine or stimulants. Over-the-counter sleeping pills often contain antihistamines that encourage light sleep but inhibit deep sleep.
• Poor sleep hygiene - Shift work, naps, exercise or mentally intense activities before bedtime, eating too close to bedtime
• Sleep environment - Noise, light, room temperature, comfort and size of bed, disruptive sleep partner or family members
• Medical and physical obstacles - Illnesses, pain, depression, anxiety, menstruation, pregnancy, menopause, ADD/ADHD

Relaxation and stress management techniques for insomnia

Learning to be physically and mentally relaxed before going to bed will help you to fall asleep more quickly. You can’t quiet your mind and body immediately, so start winding down at least an hour before bed. Some people find that reading a book, taking a bath, playing solitaire, or working a crossword puzzle slows them down from the activity of the day. Other people benefit most from structured relaxation or stress management techniques. In addition, many relaxation techniques can help you get back to sleep when you wake up in the middle of the night.

Try some of the following techniques until you discover what works best to get you relaxed and ready for slumber.

Progressive muscle relaxation and Autogenic Training

Progressive muscle relaxation is easy to do. Starting at your toes, tense all the muscles as tightly as you can. Then, after tensing, completely relax your muscles. Continue to do this for every muscle group in your body, working your way up from your feet to the top of your head.

Autogenic Training uses specific exercises that can make your body feel warm, heavy, and relaxed. These techniques have more benefits than progressive muscle relaxation, but are more difficult to learn.

Visual imagery

Close your eyes and imagine a place or activity that is calming and peaceful for you. It could be a beach of warm sand, or your childhood bedroom, or the image of yourself golfing or horseback riding. Concentrate on how relaxed this place or activity makes you feel, and “remain” in this imaginary place until you can completely wind down from your day.

Engaging your mind in counting or spelling

Try your own variation of “counting sheep”. Engage your mind in something unimportant like spelling or counting backwards can help you relax. The secret is to numb your brain by making it perform a dull, boring task.

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.

Meditation

Meditation has been proven to induce deep relaxation, which can in turn reduce insomnia. Meditating is an active process involving focusing on breathing, a word, an object, or your body’s own sensations to “quiet your thoughts” and unwind.

Stress and anger management

Stress and anger from your day can stay with you and plague your mind consciously or unconsciously, making it hard to relax at night. Managing your time effectively, handling anger and stress in a positive way, spending time with other people, exercising, and maintaining a positive outlook, can stop stress and anger from disturbing your sleep.

Cognitive-behavioral therapy (CBT) and insomnia

The significance of one’s thinking about sleep is often underestimated. For example, on nights when you absolutely must sleep, you are apt to have a harder time sleeping. Similarly, one or two nights of sleeplessness can quickly turn into more because of your anxiety and worry about sleeping well. Sleep problems that start as isolated incidents can become chronic because of mental hang-ups.

Cognitive-behavioral therapy, including stimulus control therapy, paradoxical intention, and sleep restriction, can help you reframe your current way of thinking about sleep. Your new sleep practices can help you create positive associations about sleep.

• Stimulus Control therapy reassociates the bed and bedroom with sleeping by limiting the amount of time spent in the bedroom for non-sleep activities.
• Paradoxical Intention therapy urges you, rather than trying unsuccessfully to fall asleep night after night, to do the opposite: try to stay awake. Turning your attention to doing something else can help remove the fear of not being able to sleep.
• Sleep Restriction therapy reduces the amount of non-sleeping time a person spends in bed to strengthen the connection of the bed with sleep.

Cognitive-behavioral therapy (CBT) involves confronting, and changing, your beliefs, assumptions, and behaviors regarding sleep, all of which may be preventing you from getting the sleep you need. CBT can reduce your misconceptions about sleep, as well as teach you positive sleep behaviors. It is often used in conjunction with stimulus control, sleep restriction, and good sleep hygiene.

The following are examples of thoughts common to those suffering from insomnia, and how using CBT can help alleviate these worries:

Foods, supplements, and alternative therapies for insomnia

Various foods, herbal remedies, and alternative treatments have been proposed as “cures” for insomnia. While none are proven remedies, you may find that some of them work wonderfully for you. Since they are all drug- and prescription-free, and for the most part very economical, they are definitely worth a try.

Food and Herbs

• Foods with tryptophan, and the supplements L-tryptophan and 5-HTP. Foods such as turkey, chicken, milk, cheese, and beans contain tryptophan, a chemical that is converted in the brain to serotonin, which promotes relaxation and sleepiness. However, you need to eat foods containing tryptophan on an empty stomach.
• Foods high in carbohydrates. Carbohydrates are also thought to boost the production of serotonin and melatonin. Try a carbohydrate snack of cereal or crackers with milk before bed.
• Warm milk. Many people swear by a cup of warm milk before bed to make them feel sleepy. Whether the tryptophan in milk in milk helps you sleep or it is the placebo effect, it may be worth a try.
• Hormones and herbal supplements. Sleep remedies such as melatonin, valerian root, kava kava, chamomile, lemon balm, St. John’s Wort, and passionflower are often used to treat insomnia, but have not been scientifically proven to work.

Alternative therapies

Bright light therapy uses artificial light to simulate the effects of sunlight on the body’s circadian rhythms. It is generally used to treat people who have circadian rhythm sleep disorders or sleep problems associated with jet lag or shift work.

Acupuncture involves the insertion of very fine needles into the body at specific points. It can have a calming effect on your nervous system and also stimulates the production of brain chemicals, including serotonin, which promote sleep. Similarly, acupressure involves finger pressure on the same body points as acupuncture. The advantage of acupressure over acupuncture is that you can do acupressure on yourself. Massage may also help you to relax and sleep better.

Keeping a sleep diary

A sleep diary can be a helpful way to keep track of your sleeplessness. Although a sleep diary is not a cure in itself, awareness of your sleep patterns can help you discover the cause of your insomnia. The details can be important, and a sleep diary might reveal that your pre-bedtime behavior is thwarting your chance for a good night’s sleep.

Learn about your sleep patterns and habits by keeping a daily sleep diary. See Helpguide's sample sleep diary or make up your own, and include:

• Time you went to bed and woke up;
• Total sleep hours;
• Quality of sleep;
• Times that you were awake during the night and what you did (e.g. stayed in bed with eyes closed or got up, had a glass of milk and meditated);
• Amount of caffeine or alcohol you consumed and times of consumption;
• Types of food and drink and times of consumption;
• Feelings - happiness, sadness, stress, anxiety;
• Drugs or medications taken, amounts taken and times of consumption.

Related links for insomnia causes and cures

General information on Insomnia

What Is Insomnia? – A series of articles covering the forms of insomnia; the causes of transient and chronic insomnia; and the treatments for insomnia. (University of Maryland Medical Center)

CBT and other behavioral therapies

Cognitive Behavioral Therapy for Insomnia - Describes medicine-free approaches to treating insomnia (National Sleep Foundation)

Gregg D. Jacobs' CBT for Insomnia program – Program was developed from research funded by the National Institutes of Health; cost is $19.95 (commercial site).

Relaxation and meditation techniques

Progressive Muscle Relaxation (PMR) – Describes PMR and provides instruction for performing the relaxation technique. (A Guide to Psychology and Its Practice)

Abdominal breathing – PDF Information sheet with instructions on deep abdominal breathing. (QUT Counseling Services)

Meditation – Overview of meditation for insomnia and links to different types of meditation exercises which might be helpful for insomnia. (ABC of Meditation)

Visual imagery relaxation – Handout with step-by-step instructions for a variety of relaxation exercises. (University of Michigan Health Services)

Self-guided imagery – Detailed instruction handout for relaxation using self-guided imagery.

Acupuncture, acupressure and massage to help cure Insomnia

Acupuncture – Overview of acupuncture and how to find a reputable practitioner. (National Center for Complementary and Alternative Medicine)

Acupressure – Information about how to use acupressure to relieve insomnia. (Holistic Health Tools)

Self-massage – Self massage techniques for the back, legs, feet and hands. (commercial site) (Cool Nurse).

Foods and supplements to help cure Insomnia

Melatonin: The Basic Facts – Discussion of melatonin’s effects on insomnia. (National Sleep Foundation)

Herbal remedies and supplements for sleep - Provides more information about some herbal remedies and dietary supplements for treating insomnia. (University of Maryland Medical Center)

Questions and Answers About Valerian for Insomnia and Other Sleep Disorders – A review of the use of valerian for treating insomnia and other sleep disorders. (Office of Dietary Supplements, National Institutes of Health)

Gina Kemp, M.A., Tina de Benedictis, Ph.D, Robert Segal, M.A., and Suzanne Barston contributed to this article. Last modified on: 10/12/07.