Insomnia Causes and Cures

Signs and symptoms of insomnia

Simply defined, insomnia is the inability to get high-quality sleep. It can last a day or two, a month, or even months on end. Because different individuals need different amounts of sleep, insomnia is not defined by the number of hours you sleep or by how quickly you fall asleep. Instead, it depends on the quality of your sleep, and how you feel after sleeping. Even if you are sleeping eight hours a night, if you’re still feeling drowsy and fatigued during the day, you may be experiencing insomnia.

Symptoms and Effects of Insomnia
Nighttime	Daytime
Difficulty falling asleep despite being tired Relying on sleeping pills or alcohol to fall asleep Awakening frequently or lying awake in the middle of the night Awakening too early in the morning and not feeling refreshed	Daytime drowsiness, fatigue, or irritability Difficulty concentrating; poor job/school performance Lower reaction times and diminished mental alertness; increased likelihood of accidents Weakened immune system Increased risk of depression, anxiety and substance abuse

Causes of insomnia

Take a look at your life and sleeping habits to see what might be causing your insomnia. Sometimes the answer might be as simple as getting some dark shades to block out light or eliminating a nightcap before bed.

For comprehensive information about how daily habits and your sleep environment can cause sleepless nights, as well as simple steps to change them, visit Sleep Tips.

Food, drink and medications

What you eat and drink during the day can affect your sleep at night. Too much caffeine, smoking, and alcohol before bed all contribute to poor sleep. Additionally, some prescription medications can interfere with sleep. Ironically, if not managed carefully or stopped abruptly, sleep medications can cause rebound insomnia.

Your sleep environment

Your room may be too bright. Or excess noise during the night may be waking you frequently. A quiet dark environment is best for sleep.

Your daily habits

Too much stimulating activity before bed, be it vigorous exercise or watching violent stories and images on the nightly news, can make it hard to sleep. TV is best avoided altogether.

Your mental and physical condition

Life stress, like a new job, family conflict, or financial worries can keep you up at night. Or you may have a disease where sleeplessness is a common symptom. Chronic pain may also be keeping you awake.

You might find it very difficult to wind down at the end of the day. How can you stop thinking about tomorrow’s big deadline, or worrying about an ill parent who is steadily getting worse? Relaxation and stress management techniques can help quiet your mind and improve your sleep. They do require some practice and time, but the benefits are better sleep and better health without the side effects of sleep medications.

Insomnia treatment tips I: Relaxation and stress management

In general, the more relaxed you are before bed, the better your sleep will be. Aside from engaging in quiet activity before bed, the following relaxation and stress management techniques can help you enter a more relaxed state. Consistent practice will help you to relax even when you are thinking about a stressful event.

Engaging your mind in counting or spelling 

Try your own variation of “counting sheep”. Engage your mind in something unimportant like spelling or counting backwards can help you relax. The secret is to numb your brain by making it perform a dull, boring task.

Abdominal breathing

Most of us don’t breathe as deeply as we should. When we breathe deeply and fully, involving not only the chest, but also the belly, lower back, and ribcage, it can actually help our parasympathetic nervous system, which controls relaxation. Close your eyes, and try taking deep, slow breaths, making each breath even deeper than the last. Breathe in through your nose and out through your mouth. You can try making each exhale a little longer than each inhale.

Progressive muscle relaxation

Progressive muscle relaxation is easy to do. Lie down or make yourself comfortable. Starting at your toes, tense all the muscles as tightly as you can. Then, after tensing, completely relax your muscles. Continue to do this for every muscle group in your body, working your way up from your feet to the top of your head.

Visual imagery

Close your eyes and imagine a place or activity that is calming and peaceful for you. It could be a beach of warm sand, or your childhood bedroom, or the image of yourself golfing or horseback riding. Concentrate on how relaxed this place or activity makes you feel, and “remain” in this imaginary place until you can completely wind down from your day.

Guided relaxation

Guided relaxation can be very helpful in learning relaxation techniques. It involves a script that you follow step by step to relax. It may include a combination of deep breathing, muscle relaxation and visual imagery. Listening to a script before bed is a good way to incorporate several techniques. An example of guided relaxation is autogenic training, specific exercises that can make your body feel warm, heavy, and relaxed.

Meditation

Meditation has been proven to induce deep relaxation, which can in turn reduce insomnia. Meditating is an active process involving focusing on breathing, a word, an object, or your body’s own sensations to “quiet your thoughts” and unwind.

Stress and anger management

Stress and anger from your day can stay with you and plague your mind consciously or unconsciously, making it hard to relax at night. Managing your time effectively, handling anger and stress in a positive way, spending time with other people, exercising, and maintaining a positive outlook, can stop stress and anger from disturbing your sleep.

Insomnia treatment tips II: Cognitive-behavioral therapy (CBT)

The significance of worrying about sleep is often underestimated. For example, on nights when you absolutely must sleep, you are apt to have a harder time sleeping. The more you think about how you should be sleeping, the harder it can be to sleep! Or you might be dreading sleep because you know you will wake up in the middle of the night, exhausted but unable to get back to sleep. One or two nights of sleeplessness can quickly turn into more because of your anxiety and worry about sleeping well.

Cognitive-behavioral therapy (CBT) involves confronting, and changing, your beliefs, assumptions, and behaviors regarding sleep, all of which may be preventing you from getting the sleep you need. CBT can reduce your misconceptions about sleep, as well as teaching you positive sleep behaviors.

The first part of CBT is modifying your thoughts, or cognitions, to create more positive sleep associations. The following are examples of thoughts common to those suffering from insomnia, and how using CBT can help alleviate these worries:   

Redirecting your thoughts takes practice, and the more you try it, the more you will reap the benefits.

The second part of cognitive-behavioral therapy involves changing behaviors and habits that may be affecting your sleep. For example, you might be used to falling asleep in front of the TV with a glass of wine. When you try to sleep a different way, you have trouble. This is because our bodies rely on specific routines and times of day to sleep. However, changing the behaviors of watching TV and drinking alcohol before bed will lead to better sleep, because both TV and alcohol before bed will disrupt sleep. Instead, you could try drinking a warm cup of non-caffeinated tea and reading a book before bed. It may take a few days for your body to get used to the change, but once you do, you will sleep better.  Sleep tips provides comprehensive information on how daily habits and behaviors affect sleep and how to make a sleep plan that is right for you.

Insomnia treatment tips III: Alternative therapies and herbal remedies

There are several alternative treatments that have been used for insomnia. While scientific evidence is still being gathered for these remedies, you may find that some of them work wonderfully for you.

Herbal Supplements and Hormones

• Herbal supplements. There are several herbal remedies thought to help sleep. Examples include chamomile, valerian root, kava kava, chamomile, lemon balm, passionflower, lavender, and St. John’s Wort. These remedies have not yet been scientifically proven to work, although many do try them. Note that the effectiveness of herbal supplements has not been evaluated by the Food and Drug Administration. Herbal supplements can have side effects. Check with your healthcare professional if you are trying these, as they may interfere with some prescribed medications. St. John’s Wort, for example, can limit the effectiveness of many prescribed medications such as blood thinners, birth control pills and some anticancer medications.
• Melatonin. Melatonin is a naturally occurring hormone whose levels peak at night. It is triggered by dark and levels remain elevated throughout the night until light decreases it. For this reason, melatonin has been studied for use as a sleep aid. However, most study results have not found it to be beneficial when compared to a sugar pill (placebo). Some positive results have been shown in helping adjustment to jet lag and shift workers who work nights. However, it’s unclear whether simple exposure to light at the right time is more effective, and there is no risk of side effects with light exposure.  Long term uses of melatonin are unknown.

Alternative therapies

• Bright light therapyuses artificial light to simulate the effects of sunlight on the body’s circadian rhythms. It is generally used to treat people who have circadian rhythm sleep disorders or sleep problems associated with jet lag or shift work. 
• Acupunctureinvolves the insertion of very fine needles into the body at specific points. It can have a calming effect on your nervous system and also stimulates the production of brain chemicals, including serotonin, which promote sleep. Similarly, acupressure involves finger pressure on the same body points as acupuncture. The advantage of acupressure over acupuncture is that you can do acupressure on yourself. Massage may also help you to relax and sleep better.
• Aromatherapy involves the use of certain scents from herbs, usually distilled into essential oils. The smell is thought to affect the body and is used to treat a wide variety of ailments. Common essential oils for aromatherapy include lavender, jasmine, clary sage, and chamomile. Although research has not conclusively shown aromatherapy to be effective, a scent that you find pleasant can be a cue for sleep in your bedtime routine.

Keeping a sleep diary

A sleep diary can be a helpful way to keep track of your sleeplessness. Although a sleep diary is not a cure in itself, awareness of your sleep patterns can help you discover the cause of your insomnia. The details can be important, and a sleep diary might reveal that your pre-bedtime behavior is thwarting your chance for a good night’s sleep.

Learn about your sleep patterns and habits by keeping a daily sleep diary. See Helpguide's sample sleep diary or make up your own, and include:

• Time you went to bed and woke up;
• Total sleep hours;
• Quality of sleep;
• Times that you were awake during the night and what you did (e.g. stayed in bed with eyes closed or got up, had a glass of milk and meditated);
• Amount of caffeine or alcohol you consumed and times of consumption;
• Types of food and drink and times of consumption;
• Feelings - happiness, sadness, stress, anxiety;
• Drugs or medications taken, amounts taken and times of consumption.

Seeking professional help

Medical Doctor

Check with your doctor if you suspect you have a medical problem that may be contributing to your insomnia. Additionally, some prescription medications may cause insomnia as a side effect. Persistent insomnia may also be a sign of an underlying sleep disorder, which may require additional treatment.

Mental Health Professional

Insomnia is very common in psychological conditions such as depression or anxiety. A sudden unexpected stressor such as a job loss or death in the family may also cause sleepless nights. Effective treatment of the psychological condition, or short term counseling for a sudden stressful event, can help lessen the insomnia.

What about sleep medication?

Learning about options for sleep aids and medications can help you make an informed choice about treating your sleep problems. Behavioral modifications often make the largest difference in good sleep. Visit Sleeping Aids & Sleep Medications  for more information. 

Related links for insomnia causes and cures

General information on Insomnia

What Is Insomnia? – A series of articles covering the forms of insomnia; the causes of transient and chronic insomnia; and the treatments for insomnia. (University of Maryland Medical Center)

Sleeping Difficulty – Overview of causes and treatment for insomnia (Medline Plus)

Can’t Sleep? Learn about Insomnia (National Sleep Foundation)

CBT and other behavioral therapies

Cognitive Behavioral Therapy for Insomnia - Describes medicine-free approaches to treating insomnia   (National Sleep Foundation)

Gregg D. Jacobs' CBT for Insomnia program – Program was developed from research funded by the National Institutes of Health; cost is $19.95 (commercial site).

Insomnia treatment: Cognitive Behavioral Therapy for insomnia (The Mayo Clinic)

Relaxation and meditation techniques

Progressive Muscle Relaxation (PMR) – Describes PMR and provides instruction for performing the relaxation technique. (A Guide to Psychology and Its Practice)

Abdominal breathing – Information sheet with instructions on deep abdominal breathing. (QUT Counseling Services)

Meditation – Overview of meditation for insomnia and links to different types of meditation exercises which might be helpful for insomnia. (ABC of Meditation)

Visual imagery relaxation – Handout with step-by-step instructions for a variety of relaxation exercises. (University of Michigan Health Services)

Alternative Therapies

Natural Sleep Aids  - Discusses alternative remedies such as aromatherapy, acupuncture and yoga (How Stuff Works, commercial site)

Acupuncture – Overview of acupuncture and how to find a reputable practitioner. (National Center for Complementary and Alternative Medicine)

Acupressure – Information about how to use acupressure to relieve insomnia. (Holistic Health Tools)

Self-massage – Self massage techniques for the back, legs, feet and hands. (commercial site) (Cool Nurse).

Herbs and supplements

Melatonin: The Basic Facts – Discussion of melatonin’s effects on insomnia. (National Sleep Foundation)

Herbal remedies and supplements for sleep - Provides more information about some herbal remedies and dietary supplements for treating insomnia. (University of Maryland Medical Center)

Questions and Answers About Valerian for Insomnia and Other Sleep Disorders – A review of the use of valerian for treating insomnia and other sleep disorders. (Office of Dietary Supplements, National Institutes of Health)

Joanna Saisan, MSW, Gina Kemp, M.A., Tina de Benedictis, Ph.D,  Robert Segal, M.A., and Suzanne Barston  contributed to this article. Last modified 07/03/2008.