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Insomnia 

Introduction
Insomnia is the inability to achieve a restful and sustained night’s sleep.  You may have trouble falling asleep, staying asleep, or waking up too early in the morning.  A lack of sleep may make you feel tired during the day, moody, and cause problems with your ability to think.  Insomnia may be short or long-term.  Treatments usually include lifestyle changes, medications, therapy, or a combination of treatments.

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Anatomy
Sleep is vital for life, just like eating and breathing.  Sleep allows your body to rest and recover.  It is believed that during sleep your brain performs important functions, such as storing memory and processing brain chemicals.
 
In a way, your body goes on “auto-pilot” while you sleep.  Your brain regulates automatic functions for you, such as breathing, heart rate, and blood pressure.  The average adult needs about eight hours of healthy sleep.  Although sleep is a complex process that is not fully understood, it is known that a good night’s sleep is important for optimal health and functioning.

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Causes
Insomnia occurs when you cannot fall asleep, remain asleep during the night, or if you awake too early in the morning.  There are different types of insomnia and a variety of causes for sleeplessness.  Acute insomnia is short-term and temporary.  It may result after a stressful event or from jet lag.  Chronic insomnia is ongoing and lasts for more than a month.  Chronic insomnia may be caused by another condition, including anxiety, depression, hormonal changes, alcoholism, substance abuse, thyroid conditions, medications, and sleep disorders.  Primary insomnia does not result from other conditions, but may occur because of poor sleep habits or your body metabolism.

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Symptoms
Insomnia may cause you to have difficulty falling asleep or remaining asleep.  You may wake up during the night or too early in the morning.  The lack of sleep may cause you to feel tired during the day, moody, and irritable.  You may have a harder time concentrating, performing your usual tasks, solving problems, and remembering things. 

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Diagnosis
You should talk to your doctor if you experience insomnia.  Your doctor will review your medical history, medication list, and conduct evaluations as necessary.  Depending on the suspected cause of your insomnia, you may be referred to other specialists, such as a sleep medicine doctor or psychiatrist.

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Treatment
Insomnia may be treated with lifestyle changes, medications, or a combination of both.  If you have an underlying medical disorder, such as an overactive thyroid, your doctor will treat that as well.  Treatment for psychiatric and sleep disorders vary according to the cause of the problem, and may include use of prescription medication.
 
Many cases of insomnia can be corrected with lifestyle changes.  It can be helpful to establish a consistent bedtime routine, eat a healthy diet, exercise regularly, and practice relaxation techniques.  You should refrain from using tobacco products, alcohol, and illegal drugs.  Your bedroom should be used for sleeping and not other activities such as watching television, playing video games, or computer work.  A behavioral therapist, counselor, or psychiatrist may help you resolve issues and guide you to a healthier lifestyle. 
 
Prescription medication may be used to help you sleep better.  Some sleep medications are used on an as needed basis and others are for long or short-term use.  You should consult your doctor before trying over-the-counter sleep aids.  Some over-the-counter medications have side effects or interactions with other types of medications.

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Prevention
You may prevent insomnia by reducing the risk factors that you can control.  It can be helpful to eat healthy, exercise regularly, and practice relaxation techniques.  Counseling may help as well.  Establish a regular bedtime routine and use your bedroom only for sleep and sexual activity.  It is helpful to not use alcohol, cigarettes or nicotine products, caffeine products, illegal drugs, or other stimulants.  If you are diagnosed with a psychiatric disorder such as anxiety or depression, follow you psychiatrist’s recommendations for taking your medication.

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Am I at Risk

There are many possible risk factors for insomnia including:

_____  Alcoholism and substance abuse increases the risk of insomnia.
_____ Older adults may experience insomnia with increasing age.
_____ Anxiety, depression, grief, and stress can contribute to insomnia.
_____ Shift work is a risk factor for insomnia.
_____ Jet lag is a risk factor for insomnia.
_____ People that are not exposed to sunlight or bright light may develop insomnia.
_____ Sleeping disorders, such as restless legs syndrome, can cause insomnia.
_____ Some medical conditions, such as an overactive thyroid, arthritis, enlarged prostate, heart disease, lung disease, and heartburn can contribute to insomnia.
_____ Cigarettes, tobacco products, and caffeine products such as coffee, soda pop, and chocolate, are stimulants and increase the risk of insomnia.
_____ Hormonal changes during menopause or in the days before menstruation begins can cause insomnia.
_____ Sleeping during the day can cause insomnia at night.
_____ Too much activity or excitement before bedtime, irregular bedtime routines, and lack of a bedroom just for sleep are risk factors for insomnia.  It is suggested that televisions, computers, and video games be removed from bedrooms to help reduce stimulating the brain before sleep.
_____ Some over-the-counter medications and prescription medications increase the risk of insomnia.  It is helpful to make a list of all of the prescription and nonprescription medications that you take for your doctor’s review.  If necessary, your doctor may be able to substitute another similar medication that does not contribute to insomnia.
_____ Nightmares or night terrors may interrupt sleep and increase the risk of insomnia.

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Complications
Lack of sleep can cause problems with thinking and behaving.  You may find it more difficult than before to solve problems, pay attention, remember things, and perform your daily tasks at home or at work.  You may feel moody and irritable.  A lack of sleep can contribute to depression, and insomnia can be a symptom of depression.  Researchers are finding that a lack of sleep is associated with an increased risk of injury and car crashes.

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Advancements
Insomnia is the most common sleep disorder.  A small portion of those who have difficulty falling or staying asleep have a problem with their 'internal clock.'  These are called circadian rhythm disorders.  Research has shown that bright light therapy and the use of melatonin can adjust the timing of sleep onset and wake time.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.