Insomnia, meaning “no sleep” in Latin is common to all people, often starting as children or teens. Short term insomnia is usually related to emotional stress such as school or job stress, financial stress, marital or relationship stress, or grief. It can also be caused by abrupt changes in sleep schedules such as with travel, or with work or school shift change. Short term insomnia usually resolves by itself as the initial problem goes away. Aids to help include keeping a regular sleep schedule, avoiding caffeine for six hours before bedtime, afternoon exercise, and having an emotional wind down time for 30 minutes before bedtime. This includes avoiding TV and computer games. Reading is good. Alcohol within 2-3 hours before bedtime makes insomnia worse, not better, and should be avoided. Over the counter sleeping medications may be of some benefit and mostly consist of anti-histamines. Benadryl would be the least expensive and of moderate benefit. As with all drugs, there may be side effects including excessive sleepiness the next morning, and mental confusion or memory problems. See medication warnings.
Long term insomnia is a more serious problem. It frequently starts as short term insomnia but becomes long term due to persistence of the initiating problem such as stress, compounded by the development of personal habits which actually worsen the problem. This includes worrying about not being able to sleep, clock watching, and bedtime sleep rituals. Long term insomnia is often associated with other disorders including anxiety and depression. It may in part be related to other medical problems including heart and lung disease and chronic pain conditions. Some medications can make insomnia worse. Occasionally, other sleep disorders such as sleep apnea or narcolepsy masquerade as insomnia. Diagnosis depends on a good sleep history and sleep diary (sleep times for 1 week). Occasionally blood tests or sleep tests may be recommended, but are not required for most cases of insomnia. Treatment usually involves a combination of factors including:
Sleep medications are called hypnotics. Older medications have been shown to have problems with dependency and withdrawal side effects, and do not promote normal sleep. Some of the newer medications can improve sleep quality and have been shown in recent studies to retain long term effectiveness without development of dependency. Withdrawal side effects, or dose escalation. A physician’s help is often needed for long term insomnia treatment. A psychiatric or sleep specialist consult may be beneficial at times.