Trouble falling asleep or staying asleep – commonly called insomnia – plagues one in three American adults. The result is a feeling of fatigue during day, and trouble focusing on tasks.

Insomnia comes in many different forms and afflicts people of all ages – most commonly for just a night or two, but sometimes for weeks, months, even years. 

People with insomnia commonly exhibit these three symptoms:

• Difficulty falling asleep
• No problem falling asleep, but difficulty staying asleep
• Waking up too early
  

BASIC TYPES OF INSOMNIA

Insomnia can occur in people of all ages. Usually it’s just for a night or two…but sometimes it can be for weeks, months or even years. Insomnia is most common among women and older adults.

Transient insomnia is the inability to sleep well over a period of a few nights, but lasts less than four weeks. This type of insomnia is usually brought on by excitement or stress. Adults often sleep poorly before a key meeting at work or after a spat with a family member or close friend. People are often likely to have trouble sleeping away from home, particularly if they have traveled across time zones. Working out too close to bedtime or being sick can also cause this type of insomnia.

Short-term insomnia is caused by periods of ongoing stress at work or at home, resulting in four weeks to six months of poor sleep. When the stressful situation eases up, or when the sleeper adjusts to it, sleep will usually return to normal.

Chronic insomnia is poor sleep every night or most nights for more than six months. While most insomniacs worry about their sleep, it's wrong to blame all troubled sleep on worrying. According to a study by the Association of Sleep Disorders Centers, physical ailments – such as disorders of breathing or muscle activity – are often mistaken for insomnia and may account for a large number of self-diagnosed cases of insomnia.

WHAT CAUSES INSOMNIA?

Insomnia is a symptom of another problem, much like a fever or a stomachache. It can be caused by any of a number of factors.

Psychological Factors

• Vulnerability to Insomnia. Some people are just more likely than others to experience insomnia during times of stress.
• Persistent Stress. Relationship problems, chronic illness in the family or an unrewarding career may contribute to sleep problems. 
• Learned Insomnia. If you sleep poorly during times of stress, you may try harder to sleep at night…but this can often make you more alert and cause even more sleep loss.

Lifestyle Factors

• Use of Stimulants. Caffeine near bedtime, even when it doesn’t interfere with your falling asleep, can trigger awakenings later in the night. Caffeine related components are also found in soft drinks, chocolate, and strong tea. Nicotine is also a stimulant, and smokers may take longer to fall asleep than non-smokers. Ingredients in many commonly used drugs (including nonprescription drugs for weight loss, asthma and colds) can disrupt sleep.
• Use of Alcohol. You may think having a glass of wine will help you sleep. But alcohol, while it may help you fall asleep quickly, is likely to make your sleep more broken throughout the night.
• Erratic Hours. If you do shift work (such as nights or rotating shifts), or maintain later hours on weekends than during the week, you are more likely to experience sleep problems. Maintaining regular hours can help program your body to sleep at certain times and stay awake at others.
• Inactive Behavior. You may think a quiet lifestyle would be healthy, but people whose lifestyles are very quiet or restricted may find it difficult to sleep at night because of their inactivity during the day.
• Misuse of Sleeping Pills. If you use sleeping pills every night, they will stop helping you after a few weeks. This problem can be reduced by gradually cutting back on their use. Studies have found that after gradual withdrawal of sleep medication, a person’s sleep is no worse than when the individual was taking sleeping pills.

Environmental Factors
These factors should be considered if you find yourself feeling tired even though you thought you slept soundly all night.

• Noise. Passing traffic, airplanes, television and other noises can disturb your sleep even when they don’t cause you to wake up.
• Light. Light comes through your eyelids even when your eyes are closed.

Physical/Psychiatric Illness

• Other sleep disorders and physical illnesses may occur during sleep, disrupt sleep and produce symptoms that can easily be mistaken for insomnia. These other disorders require medical attention and common treatments for insomnia will not help them.
• Psychiatric Problems. Insomnia – especially with awakenings earlier than desired – is one of the most common symptoms of depression.
• Breathing Disorders. Certain disorders, such as sleep apnea, produce restless sleep.
• Periodic Leg Movements. These movements can cause hundreds of brief interruptions of sleep each night.
• Waking Brain Activity that Persists During Sleep. Some people who complain of light or less restful sleep fail to sink fully into sleep.
• Gastroesophageal Reflux (Heartburn). Back-up of stomach contents into the esophagus can awaken a person several times a night.
  

TREATMENT OPTIONS

If your sleep has been disturbed for more than a month and interferes with the way you feel or function during the day, see your health care provider or ask for a referral to a sleep disorders specialist. Your medical history, a physical exam and some blood tests may help identify certain causes. If you get an evaluation at the Evergreen Sleep Disorders Center, you’ll be asked to keep a sleep diary showing sleeping and waking patterns for a week or two. You’ll also receive a thorough physical examination.

There are four suggested behavioral  treatments that have been well-tested with insomnia:

• Sleep Restriction aims to shrink the margin between bedtime and morning awake time so the sleep period follows your own biological sleep need.
• Stimulus Control seeks to set up the bedroom as an inviting setting for sleep by eliminating things like paperwork, television viewing and other activities that cause worry or stimulation.
• Relaxation refers to a group of activities (such as focusing on pleasant thoughts in a quiet setting) that result in a feeling of calm at bedtime.
• Cognitive Therapy uses methods of reasoning to correct faulty ideas/thoughts in order to relieve daytime worrying and bedtime wakefulness.