One in three American adults has trouble falling or staying asleep at night or waking up too early in the morning. This condition, known as insomnia, affects people of all ages and has many causes. We can have occasional difficulty falling asleep, or it can be a chronic problem.

How we approach the treatment of insomnia is based on how long the problem has been present. Short-term insomnia is usually related to obvious events that affect us, such as illness, personal problems and family issues. Jet lag, shift work and traveling to very high altitudes can also cause difficulty with sleep. Temporary measures such as sleeping aids (medication) and emotional support are usually all that is required to address the insomnia.

Chronic insomnia (lasting more than one month) can lead to serious problems with drowsiness, irritability and depression. In this case a multi-faceted approach to treatment is needed. To develop an effective treatment plan tailored to the individual, it is important to recognize the pattern of the insomnia that is involved.

Patterns of Insomnia
Difficulty falling or staying asleep is a common problem, but one that can often be helped. The first step is to analyze the problem itself. Insomnia is easier to understand when it is broken down into individual problems. For example, when does it occur–once or twice a week or every night? Is the problem falling asleep, staying asleep or both? Is the person able to fall asleep only to wake some time during sleep and then is unable to fall back to sleep? Or is the problem waking too early in the morning and being unable to go back to sleep?

Knowing a person’s individual pattern(s) of insomnia helps the sleep physician and patient determine the possible cause(s) for the insomnia which in turn directs the course of treatment.

Not able to fall asleep?
Personal problems and anxieties affect all of us from time to time and can result in difficulty falling asleep. There are other common reasons for having trouble falling asleep such as attempting to sleep at a time that is not appropriate for your body’s internal clock. Those who have trouble getting comfortable in bed because of conditions like Restless Legs Syndrome or chronic pain also experience insomnia. Other issues that might need to be addressed are prescription medications, the use of stimulants like caffeine, gastric reflux and poor sleeping environment to name a few.

Not able to stay asleep?
As with difficulty falling asleep, those who are unable to stay asleep might have problems with chronic pain, the use of stimulants (caffeine) or depressants (alcohol), and poor sleeping environment. In addition, a disorder such as Periodic Limb Movements or depression may be the culprit.

What can you do?
Prepare for your evaluation by a sleep specialist! The most important thing you can do if you are suffering from insomnia is keep a personal sleep diary of your sleep experiences. For difficulty falling asleep, note the approximate time you think you were able to relax and drift off to sleep. For difficulty staying asleep, write down the time(s) at which you awoke and whether or not you were able to go back to sleep. Do the same for waking too early in the morning.

Other important pieces of information to include in your sleep diary are the following: a description of your sleep environment (room temperature, light exposure, noise exposure, pets, etc.), any movements you are aware of making while you sleep, observations of your sleep behaviors by your bed partner (kicking, snoring, talking, breathing difficulty, etc.), your daytime activities, and times of caffeine and/or alcohol intake.

If you suffer from chronic insomnia, be prepared to participate in your plan of care.

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