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Sleeping difficulty

• Overview
• Treatment

Alternative Names:

Insomnia; Inability to sleep; Dyssomnia; Sleeplessness; Wakefulness

Home Care:

Try modifying your nighttime sleeping habits and other behavior before resorting to drugs to cure insomnia. For example:

• Avoid using alcohol in the evening. Avoid caffeine for at least 8 hours before bedtime. Give up smoking, because nicotine is a stimulant.
• Establish a regular bedtime, but don't go to bed if you feel wide awake. Use the bedroom for bedroom activities only. Once in bed, use creative imagery and relaxation techniques to keep your mind off unrestful thoughts. Avoid staying in bed for long periods of time while awake, or going to bed because of boredom.
• Take your TV or computer out of your bedroom. Otherwise, your brain becomes used to the stimulation and starts to expect it when you are there. This makes it harder for you to fall asleep.
• Relax by reading, taking a bath, or listening to soothing music before getting to bed.
• A snack before bedtime helps many people. Foods such as warm milk or turkey have a natural sleep inducer called L-tryptophan.
• Exercise regularly, but not in the last two hours before going to bed. Exercise, especially aerobic exercise, has been show to make people fall asleep faster and benefit from deeper and more restful sleep. Sex can be a natural sleep inducer and helps some people.
• Avoid emotional upset or stressful situations prior to bedtime.

IN INFANTS AND CHILDREN

• Avoid being readily available to a child during the night. Otherwise, the child may become dependent on attention and become sleepless if deprived of it.
• For children who have trouble falling asleep, try to make sure that the child is not disturbed by unnecessary noise. Leaving a radio playing soft music may help cover up disturbing noises.
• Avoid sending a child to bed as punishment which can result in poor sleep caused by fear.
• Never give a child sleeping medicine without consulting the doctor first. Generally, it is unwise to treat the problem with drugs.

MEDICATION

• Medication should be a last resort.
• Over-the-counter sleep medicines can have side-effects, including a "hangover" effect the next morning.
• If these fail, you may want to ask you health care provider to recommend other options.
• Avoid all sedatives, including the benzodiazepines, during pregnancy.

Call your health care provider if:

Call your health provider if:

• A sleeping problem becomes persistent and unbearable, despite home treatment
• A sleeping problem occurs more than 3 nights per week for more than 1 month
• The insomnia is accompanied by other worrisome symptoms, such as chest pain or shortness of breath

What to expect at your health care provider's office:

Your provider will perform a physical examination. To help better understand your sleeping problems, he or she may ask the following:

• Do you have difficulty falling asleep or staying asleep (insomnia)?
• Do you awaken from sleep not feeling rested?
• How often do you awaken at night?
• How long have you had the problem?
• Have you taken any over-the-counter sleeping products?
• What medications do you take?
• Do you take any herbal supplements or alternative medicine remedies?
• Do you drink much coffee or alcohol? Have you recently cut down on your coffee or alcohol?
• Do you have any excessive stress or anxiety ?
• How much do you normally sleep? What hours?
• What do you do during the few hours before you go to bed?
• Do your sleep schedule change frequently? (shift work)
• Do you fall asleep at inappropriate times or places?
• Does your sleep schedule change drastically on weekends?
• Do you worry excessively about sleep?
• Do you have breath-holding spells or do you snore ?
• Do you have any aches or pains that prevent you from sleeping?

In some cases, the following tests may be recommended:

• Sleep log record
• Psychological tests
• Thyroid tests ( TSH , T3 , T4 )

In some rare cases, your health care provider may want you to see a sleep medicine specialist who will perform a sleep study (polysomnography)

MEDICATIONS

In most cases, medication will not be necessary. Your health care provider can explore with you the possibility of using prescribed medications if everything else has failed.

Some antidepressants such as Elavil (amitriptyline) can be used at bedtime because they are sedating. They require a prescription. If insomnia is caused by depression, proper treatment of the depression with other appropriate medications or therapy should solve the problem. Benzodiazepines such as Valium (diazepam) or Ativan (lorazepam) are anti-anxiety medications that can also help induce sleep. They must be used with caution because they can be addictive. They too require a prescription.

Newer sleep medicines help reduce the time it takes you to fall asleep. They are less likely to be addictive than benzodiazepines. Two examples are the prescription mediciness Ambien (zolpidem) and Sonata (zaleplon).

WARNING: The FDA has asked manufacturers of sedative-hypnotic sleep medicines to put stronger warning labels on their products so that consumers are more aware of the potential risks. Possible risks while taking such medicines include severe allergic reactions and dangerous sleep-related behaviors, including sleep-driving.

• Review Date: 3/22/2007
• Reviewed By: Daniel Kantor, M.D., Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network.

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