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Insomnia is the inability to obtain an adequate amount or quality of sleep. The difficulty can be in falling asleep, remaining asleep, or both. People with insomnia do not feel refreshed when they wake up. Insomnia is a common symptom affecting millions of people that may be caused by many conditions, diseases, or circumstances.


Sleep is essential for mental and physical restoration. It is a cycle with two separate states: rapid eye movement (REM), the stage in which most dreaming occurs; and non-REM (NREM). Four stages of sleep take place during NREM: stage I, when the person passes from relaxed wakefulness; stage II, an early stage of light sleep; stages III and IV, which are increasing degrees of deep sleep. Most stage IV sleep (also called delta sleep), occurs in the first several hours of sleep. A period of REM sleep normally follows a period of NREM sleep.
Insomnia is more common in women and older adults. People who are divorced, widowed, or separated are more likely to have the problem than those who are married, and it is more frequently reported by those with lower socioeconomic status. Short-term, or transient, insomnia is a common occurrence and usually lasts only a few days. Long-term, or chronic insomnia lasts more than three weeks and increases the risk for injuries in the home, at the workplace, and while driving because of daytime sleepiness and decreased concentration. Chronic insomnia can also lead to mood disorders like depression.

Causes and symptoms

Transient insomnia is often caused by a temporary situation in a person's life, such as an argument with a loved one, a brief medical illness, or jet lag. When the situation is resolved or the precipitating factor disappears, the condition goes away, usually without medical treatment.
Chronic insomnia usually has different causes, and there may be more than one. These include:
  • A medical condition or its treatment, including sleep apnea
  • Use of substances such as caffeine, alcohol, and nicotine
  • Psychiatric conditions such as mood or anxiety disorders
  • Stress, such as sadness caused by the loss of a loved one or a job
  • Disturbed sleep cycles caused by a change in work shift
  • Sleep-disordered breathing, such as snoring
  • Periodic jerky leg movements (nocturnal myoclonus), which happen just as the individual is falling asleep
  • Repeated nightmares or panic attacks during sleep.
Another cause is excessive worrying about whether or not a person will be able to go to sleep, which creates so much anxiety that the individual's bedtime rituals and behavior actually trigger insomnia. The more one worries about falling asleep, the harder it becomes. This is called psychophysiological insomnia.

Symptoms of insomnia

People who have insomnia do not start the day refreshed from a good night's sleep. They are tired. They may have difficulty falling asleep, and commonly lie in bed tossing and turning for hours. Or the individual may go to sleep without a problem but wakes in the early hours of the morning and is either unable to go back to sleep, or drifts into a restless unsatisfying sleep. This is a common symptom in the elderly and in those suffering from depression. Sometimes sleep patterns are reversed and the individual has difficulty staying awake during the day and takes frequent naps. The sleep at night is fitful and frequently interrupted.


The diagnosis of insomnia is made by a physician based on the patient's reported signs and symptoms. It can be useful for the patient to keep a daily record for two weeks of sleep patterns, food intake, use of alcohol, medications, exercise, and any other information recommended by the physician. If the patient has a bed partner, information can be obtained about whether the patient snores or is restless during sleep. This, together with a medical history and physical examination, can help confirm the doctor's assessment.
A wide variety of healthcare professionals can recognize and treat insomnia, but when a patient with chronic insomnia does not respond to treatment, or the condition is not adequately explained by the patient's physical, emotional, or mental circumstances, then more extensive testing by a specialist in sleep disorders may be warranted.


Treatment of insomnia includes alleviating any physical and emotional problems that are contributing to the condition and exploring changes in lifestyle that will improve the situation.

Changes in behavior

Patients can make changes in their daily routine that are simple and effective in treating their insomnia. They should go to bed only when sleepy and use the bedroom only for sleep. Other activities like reading, watching television, or snacking should take place somewhere else. If they are unable to go to sleep, they should go into another room and do something that is relaxing, like reading. Watching television should be avoided because it has an arousing effect. The person should return to bed only when they feel sleepy. Patients should set the alarm and get up every morning at the same time, no matter how much they have slept, to establish a regular sleep-wake pattern. Naps during the day should be avoided, but if absolutely necessary, than a 30 minute nap early in the afternoon may not interfere with sleep at night.
Another successful technique is called sleep-restriction therapy, which restricts the amount of time spent in bed to the actual time spent sleeping. This approach allows a slight sleep debt to build up, which increases the individual's ability to fall asleep and stay asleep. If a patient is sleeping five hours a night, the time in bed is limited to 5-5 1/2 hours. The time in bed is gradually increased in small segments, with the individual rising at the same time each morning; at least 85% of the time in bed must be spent sleeping.

Drug therapy

Medications given for insomnia include sedatives, tranquilizers, and antianxiety drugs. All require a doctor's prescription and may become habit-forming. They can lose effectiveness over time and can reduce alertness during the day. The medications should be taken two to four times daily for approximately three to four weeks, though this will vary with the physician and patient. If the insomnia is related to depression, then an antidepressant medication may be helpful. Over-the-counter drugs such as antihistamines are not very effective in bringing about sleep and can affect the quality of sleep.

Other measures

Relaxing before going to bed will help a person fall asleep faster. Learning to substitute pleasant thoughts for unpleasant ones (imagery training) is a technique that can be very helpful in reducing worry. Another effective measure is the use of audiotapes which combine the sounds of nature with soft relaxing music. These, alone or in combination with other relaxation techniques, can safely promote sleepiness.
Changes in diet and exercise routines can also have a have a beneficial effect. Dietary items to be avoided include drinks that contain caffeine such as coffee, tea and colas, chocolate (which contains a stimulant), and alcohol, which initially makes a person sleepy but a few hours later can have the opposite effect. Maintaining a comfortable bedroom temperature, reducing noise and eliminating light are also helpful. Regularly scheduled morning or afternoon exercise can relax the body. This should be done 3-4 times a week and be sufficient to produce a light sweat.

Alternative treatments

Many alternative treatments are effective in treating both the symptom of insomnia and its underlying causes. Incorporating relaxation techniques into bedtime rituals will help a person go to sleep faster, as well as improve the quality of sleep. These methods include meditation, massage, breathing exercises, and a warm bath, scented with rose, lavender (Lavendula officinalis), marjoram, or chamomile (Matricaria recutita). Eating a healthy diet rich in calcium, magnesium, and the B vitamins is also beneficial. A high protein snack like yogurt before going to bed is recommended, or a cup of herb tea made with chamomile, hops (Humulus lupulus), passionflower (Passiflora incarnata), or St John's Wort (Hypericum perforatum) to encourage relaxation. Acupuncture and biofeedback have also proven useful.


Prevention of insomnia centers around promotion of a healthy lifestyle. A balance of rest, recreation and exercise in combination with stress management, regular physical examinations, and a healthy diet can do much to reduce the risk.



American Sleep Disorders Association. 1610 14th St. NW, Ste. 300, Rochester, MN 55901. (507) 287-6006.


"What to Do When You Can't Sleep." The Virtual Hospital Page. University of Iowa.

Key terms

Biofeedback — A training technique that enables an individual to gain some element of control over involuntary body functions.
Mood disorder — A group of mental disorders involving a disturbance of mood, along with either a full or partial excesseively happy (manic) or extremely sad (depressive) syndrome not caused by any other physical or mental disorder. Mood refers to a prolonged emotion.
Sleep apnea — A condition in which a person stops breathing while asleep. These periods can last up to a minute or more, and can occur many times each hour. In order to start breathing again, the person must become semi-awake. The episodes are not remembered, but the following day the client feels tired and sleepy. If severe, sleep apnea can cause other medical problems.
Sleep disorder — Any condition that interferes with sleep. At least 84 have been identified, according to the American Sleep Disorders Association.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.


abnormal wakefulness; a sleep disorder consisting of an inability to fall asleep easily or to remain asleep throughout the night. The frequency of persistent insomnia is high; epidemiologic data indicate that it is the most common sleep disorder in the industrialized world. The causes may be physical, psychological, psychiatric, or presence of a specific sleep disorder. adj., adj insom´niac. 

The American Academy of Sleep Medicine recommends that health care practitioners should screen all patients for symptoms of insomnia during health examinations. Fatigue, irritability, reduction in memory, and loss of ability to concentrate are among the daytime manifestations of insomnia.

The treatment of insomnia must be individualized, based on the underlying cause. Physical and mental health problems must be addressed, although they cannot always be successfully treated. Specific medications for sleep, such as sedatives, hypnotics, and other agents are frequently used but are often asociated with development of tolerance, or with rebound insomnia when they are discontinued. Nonpharmacologic treatments that have strong research support include the following: stimulus control to retrain the person who is unable to sleep so that he or she re-associates the bed and bedroom with sleep; progressive muscle relaxation; paradoxical intention therapy where the patient stays awake to eliminate performance anxiety related to sleep; biofeedback; and multi-component (cognitive) therapy.

Numerous papers and guidelines to support evidence-based practice in the management of insomnia are available by writing to the American Academy of Sleep Medicine, 6301 Bendel Road NW, Suite 101, Rochester, MN 55901 or looking at their web site at
fatal familial insomnia an inherited prion disease, transmitted as an autosomal dominant trait. The cause is unknown, but it seems to affect primarily the thalamus with disruptions in the sleep-wake cycle. Onset is typically in midlife, characterized by progressive insomnia, hallucinations, and motor abnormalities followed by stupor and coma ending in death within 6 months to 3 years of onset. There may also be excessive sweating, elevated body temperature and blood pressure, and tachycardia.
primary insomnia a dyssomnia characterized by persistent difficulty initiating or maintaining sleep or by persistently nonrefreshing sleep, but not due to any other psychological or physical condition.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.


Inability to sleep, in the absence of external impediments (for example, noise, a bright light) during the period when sleep should normally occur; may vary in degree from restlessness or disturbed slumber to a curtailment of the normal length of sleep or to absolute wakefulness.
Synonym(s): sleeplessness
[L. fr. in- priv. + somnus, sleep]
Farlex Partner Medical Dictionary © Farlex 2012


Chronic inability to fall asleep or remain asleep for an adequate length of time.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.


Sleep disorders The perceived or actual inability to sleep one's usual amount of time; a condition characterized by any combination of difficulty with falling asleep, staying asleep, intermittent wakefulness, and early-morning awakening; episodes may be transient, short-term–lasting 2 to 3 wks, or chronic Triggers Illness, depression, anxiety, stress, poor sleep environment, caffeine, abuse of alcohol, heavy smoking, physical discomfort, daytime napping, medical conditions, poor sleep habits–eg, early bedtime, excessive time awake in bed Examples Psychophysiologic–learned insomnia, delayed sleep phase syndrome, hypnotic dependent sleep disorder, stimulant dependent sleep disorder. See Circadian rhythm, Conditioned insomnia, Familial fatal insomnia, Jet lag, Pseudoinsomnia, Rebound insomnia, REM sleep, Sleep disorder, Sleep-onset insomnia.
Chronologic classification
• Transient–eg, 'jet lag'; does not require treatment
• Short term < 3 weeks in duration, due to travel to high altitudes, grieving loss of loved one, hospitalization, pain
• Long term > 3 weeks in duration, eg related to medical, neurologic or psychiatric disorders or addiction
• Pharmacologic Due to coffee, nicotine, alcohol
• Rebound (withdrawal) Related to abrupt discontinuation of hypnotic drugs
• Delayed sleep phase Due to shift work, chronic pain, sleep apnea and restless leg syndrome
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.


Inability to sleep, in the absence of external impediments (e.g., noise, a bright light) during the period when sleep should normally occur; may vary in degree from restlessness or disturbed slumber to a curtailment of the normal length of sleep or to absolute wakefulness.
[L. fr. in- priv. + somnus, sleep]
Medical Dictionary for the Health Professions and Nursing © Farlex 2012


Difficulty in falling asleep or in remaining asleep for an acceptable period. Insomnia is very common and is often caused by worry, tension, depression, pain or old age. Sleep requirements vary widely from person to person and those who sleep for apparently short periods seldom, if ever, suffer any harmful effects.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005


Inability to sleep, without external impediments when sleep should normally occur.
[L. fr. in- priv. + somnus, sleep]
Medical Dictionary for the Dental Professions © Farlex 2012

Patient discussion about insomnia

Q. Is this a kind of Insomnia...? It's hard to explain my situation. I've always had a horrible sleeping pattern ever since I was really little. In fact, I've never really had a bed time. I always go to bed really early in the mornings, like 7, 8, 9 am. If I want to put myself on a normal sleeping schedule, I stay up all day and I manage to conk out around 10 pm...sometimes even later. But then, the next couple of days, I'm doing the same exact thing again. I was wondering, is this a type of insomnia? And if it is, should I see a doctor about it?

A. Your biological clock is upside down. Congratulations. You are not sick or anything you live in a different time zone than others. You can go to a sleep lab and they may find a reason for this. Or you can stop fighting it. Cause if you’ll do you’ll start sleeping only 3-4 hours a night and than it’ll affect your body- the hormone balance will change, and you’ll gain weight and things like that.

Q. Any other treatment for sleeplessness problem than Melatonin??? 33 years male having acute sleeping problem awake until 08:00-09:00am. Taking Melatonin failed.

A. Belladonna. [Bell]
The sleepless conditions calling for Belladonna are due to congestion; sleep is extremely restless, as a rule it is interrupted by talking, startings, muscular jerkings and spasmodic motions; frightful images appear on closing the eyes and the patient therefore dreads sleep. Children awake from sleep frightened. The dreams found under Belladonna are frightful ones, and they constantly awaken the patient. It is probably our best remedy for insomnia due to cerebral hyperaemia; that is, it will be most often indicated, also after morphine which produces cerebral hyperaemia of a passive variety. Aconite comes in here, too, but with Aconite there is intense anxiety and restlessness, fear of disaster or death. Cuprum, Stramonium and Zincum have the symptom that the patient is aroused from sleep frightened. For the complete list: Hope this helps.

Q. On stopping the medicines his insomnia like condition starts hi all………………my dad is bipolar II and he was on lithium and clonazepam which had put his mania under control, but he sleeps a lot, as he finds his sleep refreshing him; which is due to medicine. On stopping the medicines his insomnia like condition starts and so now he takes his doses in excess to sleep…..we were told not to stop on these medicines……is it all right?

A. I agree with the others it is very dangerous to start and stop medications. One has to be weined off Lithium slowly. If your dad is finding that his current doses are not working properly he should be discussing it with his doctor whom will tweak his dosages or change his medications. It is so important to take medications as perscribed. Clonezepam can be addictive so it should be taken exactly as perscribed and monitored. There are other medications in the "pam" family that he can be changed to if the Clonezepam is no longer effective, rather than taking more.
The insomnia syptoms are signs of mania which will happen when he stops taking his medications. If you stop taking medications that are controlling bipolar symptoms the only logical outcome is the return of the bipolar symptoms. I would have him visit his doctor and discuss changing or increasing his doseages if he is finding they are not working effectivly anymore.

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