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If do not get enough sleep or if the quality of your sleep is poor (you wake frequently or too early), you might have insomnia. Insomnia is a symptom that makes it difficult to fall asleep, stay asleep, or both.

Insomnia can be:

  • Transient - sleeping poorly for several nights
  • Short-term - sleeping poorly for 2 or 3 weeks
  • Chronic - sleeping poorly every or most nights

Insomnia Symptoms Include:

  • Problems falling asleep
  • Waking during the night
  • Waking too soon
  • Difficulty maintaining healthy sleep patterns (sleep rhythm disorders)
  • Abnormal behaviors during sleep (sleep-disruptive behaviors)
  • Feeling tired and sleepy during the day
  • Feeling irritable, down, or excessively worried (anxious)
  • Difficulty concentrating
  • Difficulty remembering
  • Having accidents
  • Headaches
  • Stomach and intestinal problems, including upset stomach, diarrhea, and constipation
  • Gaining or losing weight

What Causes Sleep Problems?

Although many people suggest emotional stress can cause their long-term inability to sleep (chronic insomnia), data show that almost half of all chronic insomnia results from emotional problems such as depression and anxiety or physical problems such as breathing problems, involuntary limb movements (PLM and RLS), side effects from certain medications, and disturbances with the body’s internal clock (circadian rhythm). According to the National Sleep Foundation Sleep in American poll, having 1 or more diagnosed medical conditions increases the odds of sleep problems in older adults.

Research Shows That Difficulty Sleeping Can Result From:

  • Aging, including:
    • Changes in health
    • Being less active
    • Taking medication(s)
    • Changes in sleep patterns, including waking early
  • Changes in your schedule at work, home, or school
  • Emotional disorders, including:
    • Anxiety
    • Bipolar disorder
    • Depression
    • Posttraumatic stress disorder (PTSD)
  • Disturbances in the body’s internal clock (abnormal circadian rhythms) from changes in your schedule and activity level, traveling (jet lag), illness, medications, and aging
  • Medical conditions, including:
    • Alzheimer’s disease
    • Arthritis
    • Cancer
    • Diabetes
    • Gastroesophageal reflux disease (GERD)
    • Heart disease, heart failure
    • Breathing and lung problems
    • Heart disease
    • Overactive bladder
    • Overactive thyroid
    • Pain
    • Parkinson’s disease
    • Stroke
  • Medications, including:
    • Prescription drugs such as:
      • Allergy medications
      • Antidepressants
      • Certain heart and blood pressure drugs
      • Corticosteroids
      • Stimulants such as Ritalin
    • Nonprescription or over-the-counter (OTC) drugs such as:
      • Pain medications
      • Decongestants
      • Weight loss drugs
    • Overuse or improper use of prescription and nonprescription sleeping pills
  • Menopause, including hormonal changes and related symptoms such as night sweats
  • Poor sleep habits (poor sleep hygiene), including:
    • An irregular sleep schedule
    • An uncomfortable sleep environment, including one that is too warm, too cold, too noisy, and too bright
    • Activities that stimulate you at bedtime
  • Pregnancy
  • Stimulants such as caffeine, alcohol, and nicotine
  • Stress from family, work, school, or health problems as well as life events such as job loss, divorce, death, and illness
  • Eating a large or heavy meal before going to sleep that can cause discomfort, heart burn, and acid reflux

Other Conditions That Can Disturb Sleep Are: 

  • Jet lag
  • Klein-Levin syndrome
  • Narcolepsy
  • Nightmares
  • Night terrors
  • Obstructive sleep apnea (OSA)
  • Periodic limb movement disorder (PLMD)
  • Restless legs syndrome (RLS)
  • Sleep walking (somniloquy)
  • Snoring
  • Tooth grinding (bruxism)

Insomnia Treatment

Treatment for insomnia depends on what is causing your sleep problems. For example, some people can help restore healthy sleep patterns by practicing good sleep habits (also known as good sleep hygiene). People with medical conditions such as restless legs syndrome (RLS) or sleep apnea are likely to need medical help in combination with good sleep hygiene to better manage or resolve the medical condition. When necessary, doctors may prescribe medication to help restore healthy sleep patterns.

Click here for the Improve your Sleep workbook, a free resource provided by the VA

Behavioral therapy also is an effective way for many people to return to getting a good night’s sleep. Some people also find that other complementary medicine approaches such as acupuncture can help improve sleep. 

Click here to learn about our therapeutic ancillary services, including acupuncture

Behavioral therapy for insomnia includes:

  • Learning about good sleep habits (sleep hygiene)
  • Cognitive behavioral therapy (CBT) to help you manage or eliminate worries
  • Relaxation techniques
  • Managing thoughts and activities (stimuli) that keep you awake
  • Reducing the amount of time you spend in bed when not sleeping
  • Light therapy, including getting more sunshine or using a full-spectrum light box

When necessary, your doctor might prescribe medication for a limited time to help restore your sleep schedule. 

Some prescription medications that can help you sleep are:

  • Ambien® (zolpidem)
  • Lunesta® (eszopiclone)
  • Rozerem® (ramelteon)
  • Sonata® (zaleplon)

Nonprescription medications that some people believe can help with sleep are:

  • Antihistamines such as Benadryl®, which can make you drowsy.
  • Melatonin, an over-the-counter (OTC) drug that can help supplement the body’s natural melatonin supply. There are no data to support melatonin supplements for insomnia
  • Valerian, a dietary supplement with a mild sedative effect. Although valerian has not been thoroughly studied in clinical trials, it has been associated with liver problems when it is used long term and/or in high doses. If you are taking and want to stop taking valerian, you must gradually reduce the dose

Because some over-the-counter drugs are not safe or can interact with other medications, talk with your doctor first before taking a nonprescription medication to help you sleep.

If you have slept poorly for a 3 or fewer nights, you often can take steps to restore a good sleep pattern on your own. But if you continue sleeping poorly and begin experiencing changes in daytime functioning, you should see a sleep expert.

Whether your sleep problems are transient, short-term, or chronic, it is important to practice good sleep habits (also known as good sleep hygiene).

Learn more about good sleep hygiene