Insomnia

Question 1

What is insomnia?

Accepted Answer

Insomnia is a sleep disorder. If you have insomnia, you may find it hard to fall asleep or stay asleep. Most Australians experience insomnia at some point in their lives. More than 1 in 10 people have at least mild insomnia at any given time. It is more common in females and older people.  Insomnia can include:  difficulty falling asleep waking up during the night and having trouble going back to sleep waking up too early and not being able to go back to sleep Sometimes people experience all 3 of these.  You might experience insomnia for a short time. This can happen if you’re worried or stressed. Sometimes insomnia can become long term (known as chronic insomnia disorder).  This is defined as having trouble falling asleep or staying asleep at least 3 nights per week, for at least 3 months, that affects how you function during the day.

Question 2

What are the symptoms of insomnia?

Accepted Answer

Symptoms of insomnia include:  difficulty falling asleep waking up often during the night waking up too early, and not being able to go back to sleep not feeling refreshed when you wake up Insomnia can also lead to symptoms during the day, making it harder to function. These may include:  tension headaches low energy, feeling tired or being too sleepy to do normal activities poor memory and concentration worrying about sleeping feeling irritable, moody or losing interest in doing things feeling restless, being aggressive or impulsive feeling sleepy when sitting quietly People experience insomnia differently, and you might only have some of these symptoms.

Question 3

What causes insomnia?

Accepted Answer

There are many different causes of insomnia. Sometimes there is no clear cause. In other cases insomnia is caused by an underlying health condition. There are many factors which can cause or worsen insomnia.  Causes of insomnia and factors that can make it worse include:  medical issues — in particular conditions causing chronic pain, hormone changes (such as hot flushes and night sweats during menopause), and breathing, urinary or digestive problems sleep disorders — such as obstructive sleep apnoea, circadian rhythm disorders caused by irregular sleep patterns and restless legs syndrome substances — including caffeine, nicotine, alcohol, amphetamines and some medicines mental health conditions — such as anxiety, depression, PTSD (post-traumatic stress disorder) or other disorders, stress caused by work or financial problems, relationship issues or grief unhealthy sleep habits — known as poor sleep hygiene Some people are more likely to experience insomnia, including:  older people people with dementia shift workers people who often travel across time zones people who have a genetic basis for insomnia

Question 4

How is insomnia diagnosed?

Accepted Answer

There is no specific test to diagnose insomnia. Your doctor may ask you to keep a sleep diary or answer a questionnaire to help them understand your sleep problems. Your doctor will ask you about your:  sleep habits medicines caffeine and alcohol use other symptoms (such as pain) Your doctor may examine you to rule out underlying conditions or other sleep disorders that may be causing your insomnia. In some situations, your doctor may refer you for tests at a specialist sleep clinic.

Question 5

How is insomnia treated?

Accepted Answer

There are many treatments for insomnia. Your doctor will help you choose a treatment plan based on your situation. Treatments include one or more of the following:  Treating an underlying condition If your insomnia is caused by an underlying condition such as:  pain hormone changes digestive problems a mental health condition other sleep disorders, such as sleep apnoea Your doctor may suggest treating those conditions or recommend tests to find other ways to improve your symptoms.  If a medicine is causing your insomnia, your doctor may be able to give you a different medicine or help you reduce the dose.  Sleep hygiene Good sleep hygiene includes forming good habits that will help you sleep well.  If your insomnia is caused by poor sleep hygiene, the first step in treatment is to learn to adopt healthy sleep habits and change any lifestyle factors that may contribute to the insomnia. Sleep hygiene is often used alongside other approaches to treat insomnia.  Good sleep habits include the following:  Keep regular sleep patterns. Try to go to bed and wake up at around the same time every day and avoid daytime naps. Don’t spend too long in bed — most people should aim for 8 ½ hours or less. Staying in bed for longer can lead to broken sleep. Make sure your bedroom is comfortable. It should be quiet and dark, not too hot or too cold. Consider removing clocks from your bedroom, so you don’t keep checking the time. Avoid having screens in your bedroom, and don’t use screens for one hour before going to bed. Cut out nicotine, reduce or cut out alcohol and limit caffeine to mornings only. Exercise regularly, but not in the evening. If you can’t sleep, go to another room and engage in a quiet activity (such as reading) until you feel tired, and then try again. Try to reduce the time you spend in bed if you cannot sleep. Do something you find relaxing before bed. Try to manage anything that is worrying you earlier in the day, rather than at bedtime. Relaxation techniques Learn how to relax your body and mind before bed. This can help you let go of worries and prepare your body for sleep. Useful techniques to try before sleep include:  breathing exercises muscle relaxation meditation Cognitive behaviour therapy (CBT) Cognitive behaviour therapy (CBT) is usually the first type of treatment to try if sleep strategies and relaxation techniques have not helped you. CBT is a treatment that helps you change how you think about sleep and feel less anxious or worried about it. It is usually provided by a psychologist and can be done individually or in a group. CBT is effective for insomnia, anxiety and depression.  Medicines Prescription medicines In the case of chronic insomnia, where other treatments have not helped, your doctor may prescribe medicines. Sleeping pills are less effective than CBT and are not a cure for insomnia, as they do not target the underlying problem. They can be useful for a short period of time, but become less effective if you take them too often. Long-term medicine use can also lead to addiction and side effects.  Your doctor may prescribe a medicine for insomnia (for example temazepam, zopiclone or zolpidem). They will recommend you use medicines at the lowest possible dose and for a short time. These medicines may cause side effects, especially among older people, like an increased risk of falling.  Other medicines (for example suvorexant and lemborexant) may help people stay asleep or fall asleep, but they’re not suitable for everyone — your doctor will prescribe these if they are a good option for you.  Many other prescription and over-the-counter medicines are sometimes used for sleep, but they’re not recommended — especially for older adults. These include antidepressants, some antihistamines and antipsychotics. They can cause serious side effects and often don’t work well for insomnia.  Side effects of some medicines could include:  night wandering agitation excessive drowsiness during the day impaired thinking balance problems and dizziness allergic reactions Sometimes, sleeping tablets can make insomnia worse, especially if you take them regularly.  Ask your pharmacist for advice if you are worried about the side effects of your medicines.  Another option your doctor may recommend is melatonin, a hormone that controls the body’s night and day cycles. It can be used:  as a sedative (to help you feel calm) to make you feel sleepy to reset your internal body clock Melatonin is taken as a pill — there are different options your doctor can prescribe, based on the reason for your insomnia. The best time to take melatonin is 1 to 2 hours before you go to bed. You should not take melatonin before you drive or operate machinery, as it can make you sleepy. Melatonin is generally recommended for people over the age of 55 years. It should only be used for a 3 week period, and then reviewed by your doctor.  Over-the-counter sleep aids You can buy herbal remedies over the counter that are promoted to help people sleep. These include kava, valerian, passionflower, hops, sour date, mimosa, lavender, California poppy and chamomile.  There is little scientific evidence about whether these remedies work and about the effects of taking them for a long time.  It is important to talk to your doctor before you take any sleeping aid, including any over-the-counter or herbal remedies, as they may interact with your other medicines. Always follow the instructions on the label carefully and do not take them for a long period of time. You should avoid alcohol when you are taking medicines, including over-the-counter sleeping aids.  LOOKING FOR A MEDICINE? — To search by brand name or active ingredient, use the Medicines information search feature.  Other treatments Light therapy: uses bright light exposure and darkness to reset your internal body clock and improve sleep. Sleep restriction: this method reduces your time spent in bed, causing sleep deprivation. Once your sleep improves, you can gradually go back to sleeping normal hours.

Healthdirect Free Australian health advice you can count on.

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Need more information?

Sleep - insomnia | Better Health Channel

Sleep problems – insomnia | National Centre for Farmer Health

Insomnia | Sleep Health Foundation

Preventing Chronic Insomnia | Sleep Health Foundation

What is Insomnia? | Causes & Treatment Explained

Insomnia Treatment Program| THIS WAY UP

Cognitive Behavioural Therapy for Insomnia (CBT-I) | Sleep Health Foundation

Insomnia in children and teenagers | Raising Children Network

Insomnia | What is insomnia? | Insomnia symptoms

Insomnia in pregnancy and breastfeeding

Management of insomnia in primary care