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What is insomnia?

Insomnia is a common sleep disorder. If you have it, you may have trouble falling asleep, staying asleep, or both. As a result, you may get too little sleep or have poor-quality sleep. You may not feel refreshed when you wake up.

What are the types of insomnia?

Insomnia can be acute (short-term) or chronic (ongoing). Acute insomnia is common. Common causes include stress at work, family pressures, or a traumatic event. It usually lasts for days or weeks.

Chronic insomnia lasts for a month or longer. Most cases of chronic insomnia are secondary. This means they are the symptom or side effect of some other problem, such as certain medical conditions, medicines, and other sleep disorders. Substances such as caffeine, tobacco, and alcohol can also be a cause.

Sometimes chronic insomnia is the primary problem. This means that it is not caused by something else. Its cause is not well understood, but long-lasting stress, emotional upset, travel and shift work can be factors. Primary insomnia usually lasts more than one month.

Who is at risk for insomnia?

Insomnia is common. It affects women more often than men. You can get it at any age, but older adults are more likely to have it. You are also at higher risk of insomnia if you:

Have a lot of stress
Are depressed or have other emotional distress, such as divorce or death of a spouse
Have a lower income
Work at night or have frequent major shifts in your work hours
Travel long distances with time changes
Have an inactive lifestyle
Are African American; research shows that African Americans take longer to fall asleep, don't sleep as well, and have more sleep-related breathing problems than whites.

What are the symptoms of insomnia?

Symptoms of insomnia include:

Lying awake for a long time before you fall asleep
Sleeping for only short periods
Being awake for much of the night
Feeling as if you haven't slept at all
Waking up too early

What other problems can insomnia cause?

Insomnia can cause daytime sleepiness and a lack of energy. It also can make you feel anxious, depressed, or irritable. You may have trouble focusing on tasks, paying attention, learning, and remembering. Insomnia also can cause other serious problems. For example, it could make you may feel drowsy while driving. This could cause you get into a car accident.

How is insomnia diagnosed?

To diagnose insomnia, your health care provider:

Takes your medical history
Asks for your sleep history. Your provider will ask you for details about your sleep habits.
Does a physical exam, to rule out other medical problems that might cause insomnia
May recommend a sleep study. A sleep study measures how well you sleep and how your body responds to sleep problems.

What are the treatments for insomnia?

Treatments include lifestyle changes, counseling, and medicines:

Lifestyle changes, including good sleep habits, often help relieve acute (short-term) insomnia. These changes might make it easier for you to fall asleep and stay asleep.
A type of counseling called cognitive-behavioral therapy (CBT) can help relieve the anxiety linked to chronic (ongoing) insomnia
Several medicines also can help relieve your insomnia and allow you to re-establish a regular sleep schedule

If your insomnia is the symptom or side effect of another problem, it's important to treat that problem (if possible).

NIH: National Heart, Lung, and Blood Institute

Insomnia (American Academy of Family Physicians) Also in Spanish
Insomnia (Mayo Foundation for Medical Education and Research)
What Is Insomnia? (National Heart, Lung, and Blood Institute) Also in Spanish

Insomnia (Mayo Foundation for Medical Education and Research) Also in Spanish
Insomnia Treatment (Mayo Foundation for Medical Education and Research) Also in Spanish
Sleep Disorders: In Depth (National Center for Complementary and Integrative Health)
Taking Z-drugs for Insomnia? Know the Risks (Food and Drug Administration) Also in Spanish

ClinicalTrials. gov: Sleep Initiation and Maintenance Disorders (National Institutes of Health)
ClinicalTrials.gov: Sleeping Pills (National Institutes of Health)

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American Academy of Sleep Medicine
Find a Sleep Center Near You (American Academy of Sleep Medicine)
National Heart, Lung, and Blood Institute

Insomnia (Department of Health and Human Services, Office on Women's Health) Also in Spanish

Insomnia | NHS inform

Insomnia will often improve by making changes to your bedtime habits. If these don't help, your GP may be able to recommend other treatments.

If you've had insomnia for more than four weeks, your GP may recommend cognitive and behavioural treatments or suggest a short course of prescription sleeping tablets as a temporary measure.

If it's possible to identify an underlying cause of your sleeping difficulties, treating this may be enough to return your sleep to normal.

The various treatments for insomnia are outlined below.

Good sleeping habits

Your GP will be able to advise you about what you can do at home to help you sleep. This is known as "sleep hygiene" and includes:

establishing fixed times for going to bed and waking up
creating a relaxing bedtime routine
only going to bed when you feel tired
maintaining a comfortable sleeping environment that's not too hot, cold, noisy or bright
not napping during the day
avoiding caffeine, nicotine and alcohol late at night
avoiding eating a heavy meal late at night

Read more about self-help tips for insomnia

Cognitive and behavioural treatments

If changing your sleeping habits doesn't help, your GP may be able to refer you for a type of cognitive behavioural therapy (CBT) that's specifically designed for people with insomnia (CBT-I).

The aim of CBT-I is to change unhelpful thoughts and behaviours that may be contributing to your insomnia. It's an effective treatment for many people and can have long-lasting results.

CBT-I may include:

stimulus-control therapy – which aims to help you associate the bedroom with sleep and establish a consistent sleep/wake pattern
sleep restriction therapy – limiting the amount of time spent in bed to the actual amount of time spent asleep, creating mild sleep deprivation; sleep time is then increased as your sleeping improves
relaxation training – aims to reduce tension or minimise intrusive thoughts that may be interfering with sleep
paradoxical intention – you try to stay awake and avoid any intention of falling asleep; it's used if you have trouble getting to sleep, but not maintaining sleep
biofeedback – sensors connected to a machine are placed on your body to measure your body's functions, such as muscle tension and heart rate; the machine produces pictures or sounds to help you recognise when you're not relaxed

CBT-I is sometimes carried out by a specially trained GP. Alternatively, you may be referred to a clinical psychologist.

The therapy may be carried out in a small group with other people who have similar sleep problems, or one-to-one with a therapist. Self-help books and online courses may also be used.

Sleeping tablets

Sleeping tablets (hypnotics) are medications that encourage sleep. In the past, they were frequently used to help with insomnia, but they're used much less often nowadays.

They will generally only be considered:

if your insomnia is severe
as a temporary measure to help ease short-term insomnia
if the good sleep habits and cognitive and behavioural treatments mentioned above don't help

Doctors are usually reluctant to recommend sleeping tablets in the long-term because they just mask the symptoms without treating the underlying cause.

They can also cause potentially dangerous side effects, such as drowsiness the following morning, and some people become dependent on them.

If they are recommended, you should have the smallest effective dose possible for the shortest time (usually no more than two to four weeks).

Over-the-counter sleeping pills

A number of sleeping tablets are available to buy over the counter (OTC) from pharmacies. These are usually a type of antihistamine medicine that causes you to feel drowsy.

Taking OTC sleeping tablets regularly isn't usually recommended if you have insomnia, because it's not clear how effective they are, they don't tackle the underlying cause of your sleeping difficulties and they can cause side effects.

In particular, they can cause you to feel drowsy the next morning, which can make activities such as driving and operating machinery dangerous.

Speak to your GP for advice if you find yourself needing to take OTC sleeping tablets regularly.

Benzodiazepines

Benzodiazepines are prescription medicines that can reduce anxiety and promote calmness, relaxation and sleep. Your GP may prescribe them for a short time if you have severe insomnia or it's causing extreme distress.

Examples of benzodiazepines include temazepam, loprazolam, lormetazepam, diazepam and nitrazepam.

Long-term treatment with benzodiazepines isn't usually recommended because they can become less effective over time and some people become dependent upon them.

They can also cause a number of side effects, including:

drowsiness and dizziness, which can persist into the next day
finding it difficult to concentrate or make decisions

depression
feeling emotionally numb
irritability

You should avoid driving if you feel drowsy, dizzy, or unable to concentrate or make decisions, as you may not be able to do so safely.

Z-drugs

Z–drugs are a newer type of medicine that work in a similar way to benzodiazepines and are similarly effective. They include zaleplon, zolpidem and zopiclone.

As with benzodiazepines, long-term treatment with Z–drugs isn't normally recommended because they can become less effective over time and some people become dependent on them.

They're usually only prescribed for a maximum of two to four weeks.

Side effects of Z-drugs can include:

drowsiness and dizziness, which can persist into the next day
feeling and being sick
diarrhoea
increased snoring and breathing problems during sleep
dry mouth
confusion

Z–drugs can also sometimes cause psychiatric reactions, such as delusions, nightmares and hallucinations. Contact your GP if you experience any of these effects.

Read the National Institute for Health and Care Excellence (NICE) guidance on zaleplon, zolpidem and zopiclone for the short-term management of insomnia for more information.

Melatonin (Circadin)

For adults aged 55 or over, a medication called Circadin is sometimes used to help relieve insomnia for a few weeks. It contains a naturally occurring hormone called melatonin, which helps to regulate the sleep cycle.

Circadin is usually only recommended for three weeks at first, but it can be continued for a total of 13 weeks if it helps.

Common side effects of Circadin include:

headaches
cold-like symptoms
back pain
joint pain

Treatments that aren't recommended

The following treatments aren't normally recommended for insomnia, because it's not clear how effective they are and they can sometimes cause side effects:

antidepressants (unless you also have depression)
chloral hydrate
clomethiazole
barbiturates
herbal remedies, such as valerian extract
complementary and alternative therapies, such as acupuncture, hypnotherapy and reflexology

Insomnia - symptoms, causes, signs, diagnosis and treatment in "SM-Clinic"

This disease is treated by a Neurologist

What is insomnia?
Symptoms of insomnia
Causes of insomnia
Diagnosis of insomnia in "SM-Clinic"
Treatment of insomnia in "SM-Clinic"
Prevention of insomnia
Doctors

Symptoms of insomnia

It happens that the most active day, with many events, brings great fatigue in the evening, and it seems that sleep will overtake as soon as the head touches the pillow. But the long-awaited rest does not bring relief, sleep does not come, nervous and muscular tension does not give rest. Signs of insomnia in addition to the problem of falling asleep are:

superficial sleep
frequent waking up from the slightest irritants
insufficient sleep to feel good
daytime sleepiness
extreme fatigue
heightened emotionality
memory impairment

Sleep disturbances due to insomnia require consultation with a doctor if they last more than a month and occur three or more times a week.

Causes of insomnia

Stress is one of the most common causes of disturbances in the process of falling asleep and the quality of sleep. In addition, among the causes of insomnia, the following are noted:

stress
chronic fatigue syndrome
non-standard work schedule (at night)
jet lag when traveling
excessive consumption of tonic drinks
side effects of certain medications
disorders in the thyroid gland
pain syndrome
mental disorders
organism intoxication
intracranial pressure disorders
individual characteristics of the nervous system
lack of B vitamins

Get advice

If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.

You can find out more about the disease, prices for treatment and sign up for a consultation with a specialist by phone:

+7 (495) 292-39-72

Request a call back Book online

Why SM-Clinic?

Treatment is carried out in accordance with clinical recommendations

A comprehensive assessment of the nature of the disease and treatment forecast

Modern diagnostic equipment and own laboratory

High level of service and balanced pricing policy

Diagnosis of insomnia at the SM-Clinic

Diagnosis of insomnia at the SM-Clinic in Moscow is carried out by neurologists who, over many years of work, have helped hundreds of patients to improve the processes of sleep and wakefulness, and return the joy of an active life. Our doctors participate in specialized seminars and conferences and constantly improve their knowledge and skills, master new methods of therapy.

The SM-Clinic neurologist will begin diagnosing insomnia with a detailed survey of the patient about complaints, time and duration of sleep disturbances, body characteristics, temperament, work environment and anamnesis. Then the doctor will conduct a neurological examination and prescribe laboratory tests (blood test, hormone test and ultrasound of the thyroid gland).

In order to determine how to cure insomnia, the neurologists of our clinic prescribe the following diagnostic tests:

polysomnography
electroencephalography
electromyography
electrocardiography

Treatment of insomnia in the SM-Clinic

The main thing for the doctors of the SM-Clinic is to help their patients get rid of the unpleasant symptoms of insomnia in a short time and restore good health and vigor throughout the day. For this, concomitant disorders or diseases of the body are treated, if they are its cause.

In order for the treatment of insomnia to be effective, neurologists at SM-Clinic use an integrated approach and involve colleagues from other specialties (endocrinologists, psychologists, therapists, etc. ) in choosing a method of treatment.

Therapy of sleep disorders consists of developing an individual regimen, physical activity, nutrition plan and prescribing pharmacological drugs (sleeping pills, antidepressants, tranquilizers, hypnotics, circadian rhythm regulators, etc.).

SM-Clinic doctors get excellent results when using the following methods to treat insomnia:

phototherapy
acupuncture
hirudotherapy
physiotherapy
psychotherapy

Prevention of insomnia

To avoid sleep disorders:

maintain circadian rhythms
do not take tonic drinks before going to bed
maintain moderate physical activity
create conditions suitable for a good sleep and observe sleep hygiene

Diseases referred to Neurologist

Pituitary adenoma Amnesia Cerebral aneurysm Atherosclerosis of cerebral vessels Aphasia Alzheimer's disease Parkinson's disease Backache brachycephaly Vegetovascular dystonia (VVD) Epstein-Barr virus Hemianopia Hydrocephalus Eye migraine Schmorl's hernia dysarthria Dorsopathies Stroke brain cyst Intervertebral hernia Intercostal neuralgia Meningitis myasthenia gravis Myofascial Syndrome Narcolepsy Neuralgia trigeminal neuralgia Neurasthenia Cardiopsychoneurosis Nervous tic Spinal instability Nightmares fainting Osteochondrosis Osteochondrosis of the thoracic region Osteochondrosis lumbar Osteochondrosis of the cervical spine Polyneuropathy Polio Protrusions of the intervertebral discs Radiculitis Tourette syndrome Chronic pelvic pain syndrome Spinal stenosis Enuresis Encephalopathy

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What is insomnia, causes and treatment

Insomnia (insomnia) is a sleep disorder in which a person cannot fall asleep, fully relax and recuperate. According to world medical statistics, more than 35% of women and almost 30% of men suffer from this disease. In children, insomnia is diagnosed less often - about one in four.

Many patients do not pay attention to the disease or try to cope with it on their own. As a result, a persistent sleep disorder develops - chronic insomnia, which is difficult to treat and causes many health problems. In the presence of such a disease, the patient should seek an initial consultation with a general practitioner.

What is considered insomnia

A healthy person needs at least 6-10 hours of sleep per day for a good rest. During this time, the body recovers, the brain processes the information received during the day. The period of immersion in sleep takes no more than 15 minutes.

It is impossible to do without rest for more than 200 hours. If sleep is insufficient, a person feels a breakdown, irritability. With chronic lack of sleep, a decrease in immunity, lethargy, and the development of mental disorders are possible.

Insomnia is a violation not only of the quantity but also of the quality of sleep. Even with severe fatigue in the evening, a person goes to bed and tries for a very long time to find a comfortable position, to relax. Sleep becomes interrupted. In the morning the patient with insomnia still feels tired. Insomnia is diagnosed when there are three or more episodes every week for a month.

Causes of pathology

There are many factors that can affect sleep.

Among the main causes of insomnia:

genetic predisposition;
taking certain medicines;
alcohol abuse;
overeating at bedtime;
thyroid dysfunction;
depressions, neuroses;
increased emotional excitability;
adverse environmental conditions during falling asleep: cold, heat, hard mattress, etc.;
parkinsonism, other neurological disorders;
arthritis, arthrosis, pathology with severe pain syndrome;
diseases of the kidneys and bladder, causing frequent urge to urinate;
restless leg syndrome.

Occasional insomnia may occur due to flights between time zones or work schedule changes (eg night work). After the elimination of the provoking factor, rest is restored.

Insomnia in a woman is often caused by menstrual irregularities, pregnancy or the onset of menopause.

Elderly patients and people in difficult life situations are also at risk.

Types of insomnia

According to the type of provoking factors, insomnia happens:

Adaptive. Symptoms of insomnia appear on the background of severe stress, for example, moving to a different climate zone. Adaptive insomnia does not require serious treatment and can go away on its own within a few weeks.
Psychophysiological. The patient is afraid in advance that he will not be able to sleep. By evening, the tension intensifies, the fear grows.
Idiopathic. Insomnia develops from childhood. Often it is not possible to establish the exact cause of the violation.
Behavioral. This type of insomnia usually affects young children who are accustomed to certain rituals. For example, if a child who has always been rocked is simply put in a crib, he will be capricious and spin for a very long time. Behavioral insomnia can occur while weaning a baby from the breast or pacifier.
On the basis of mental disorders. More than 70% of cases of insomnia are diagnosed in patients with neuropsychiatric diseases.
On the basis of a violation of sleep hygiene. The cause of insomnia is a person's inattention to his daily routine, work and rest schedule. Coffee before bedtime, bright noise and light are also provoking factors.
Caused by somatic disease. Any health problem can be the cause: abdominal pain due to gastritis, sleep apnea, cough due to bronchitis, etc.
Pseudoinsomnia. Human sleep remains normal both in quality and duration, but the patient feels sleep deprivation. It seems to him that he rested less time than actually elapsed.

According to the duration of manifestations, insomnia is:

Transient. Sleep disturbances are of short duration, lasting several days. Transient insomnia is caused by changes in the environment, such as moving or depression.
Sharp. Sleep disturbances are regular, but last no more than a month. Acute insomnia is more often associated with stress. Patients have difficulty falling asleep, sleep becomes short, intermittent.
Chronic. Insomnia lasts for several months and is triggered by various factors. Patients note periods of deterioration and improvement in their condition.

Symptoms of insomnia

Sleep disorders cannot be confused with another disease. At night, a person cannot rest, and during the day he becomes distracted and irritable. I want to sleep all the time. Insomnia does not allow you to focus on the performance of job duties, causes a decline in motivation. Additionally, it is possible to develop headaches, indigestion.

Insomnia in children

The timing of sleep varies widely among children. One child needs a long rest, another 6 hours is enough to feel full of energy. If at the same time the children are active, cheerful, then doctors recommend not to worry. Both options can be considered the norm - both long and short sleep.

As the child grows older, they may sleep less and less. The reason for concern should be the capriciousness, irritability of the child, his active unwillingness to go to bed in the evening. Nervousness makes sleep "torn". The child does not sleep well on his own and does not allow his parents to rest.

It is important not to miss the first manifestations of insomnia, when children's sleep is still quite easy to correct. To do this, the process of preparing for the rest must be made pleasant and relaxing. You can bathe the child, give him warm milk, allow him to take his favorite toy to bed. Do not insist on daytime sleep if the baby does not want to, and do not let him fall asleep early in the evening: distract him with a book, cartoons, a walk.

You should not go to bed with your child and wait for him to fall asleep. If joint rest becomes a habit, it will be difficult to get rid of it. Ignore whims, gently but persistently put the child alone, and over time he will learn to fall asleep on his own.

Diagnosis of insomnia

When the first problems with a night's rest appear, it is necessary to make an appointment with a doctor. To diagnose insomnia, a special assessment technique has been developed - the Epworth scale. With its help, the severity of symptoms is assessed and treatment is prescribed. It is also important to establish the cause of insomnia in a man or woman and eliminate the factor.

At the first consultation, the doctor takes an anamnesis. Finds out how long ago the problems with sleep began, what factors could provoke them. The patient is advised to keep a special diary. Every day, the time of falling asleep and waking up, the number of sleep interruptions during the night are entered into the notebook. The patient should describe his feelings in the morning. Based on the diary information, the doctor evaluates the quality and duration of sleep. Data are also needed to select the appropriate treatment.

An alternative to the diary is the actigraphy procedure. The patient is given a special measuring device that must be worn on the wrist for a week. Actigraphy is performed on an outpatient basis.

If insomnia is caused by a medical condition, a diagnosis is made to determine the underlying cause. Treatment of the underlying pathology eliminates sleep problems.

Treatment of insomnia

It is important not to self-medicate. Uncontrolled intake of sleeping pills and any other drugs, at best, will not bring the expected result, and at worst, it will provoke side effects. Insomnia will progress, and medications will negatively affect your overall health. Be sure to see a doctor.

The treatment of insomnia is complex, including consultations of related specialists, taking medications and other auxiliary methods.

Psychotherapy

The doctor helps to overcome crisis situations, cope with neurosis, stress, apathy. The course of psychotherapy includes several sessions at the discretion of the specialist.

One of the methods of treatment is hypnosis. The technology is used for severe violations.

Paradoxical intention technique

A special treatment method aimed at changing perception (cognitive reframing technique). The patient is advised not to think about a night's sleep, but, on the contrary, to make every effort to stay awake. The method is effective in most applications.

Medical treatment

There are many drugs available to improve the quality of sleep. The medicine is selected individually, taking into account the state of health, the severity of symptoms, the patient's lifestyle. Proper treatment should help in the normalization of sleep, but at the same time not create serious side effects and not interfere with daily activities.

More often doctors opt for herbal preparations. Medicines have a cumulative effect and are not addictive. Synthetic sleeping pills are taken in a strictly calculated dosage and for a limited period. In most cases, depressants are prescribed (Doxepin, Amitriptyline and others). Means have a quick sedative effect, help regulate sleep, exhibit antiadrenergic, antihistamine, anticholinergic properties. Antidepressants promote falling asleep, increase the total duration of rest.

It is possible to prescribe drugs based on melatonin, the sleep hormone. The drug is effective against chronic insomnia, especially in the elderly. The remedy is prescribed for 3 weeks, after which it is necessary to take a break.

Important: hormonal preparations have many contraindications. For example, Melatonin should not be given to pregnant women and adolescent girls. In each case, the medication must be agreed with the gynecologist.

Massage

Reflex massage has no contraindications, and you can do it yourself. Just 15-20 minutes before bed will help improve the patient's condition. There are various massage techniques that are aimed at stimulating biologically active points on the ears, neck, abdomen, and feet.

Breathing exercises

Rhythmic inhalations and exhalations stimulate blood circulation in the tissues of the brain, improve the functioning of internal organs. Breathing exercises help elderly people cope well with insomnia, but even children can easily master simple exercises. It is important that classes bring pleasure and do not create additional stress. A set of exercises will be selected by the doctor.

The patient must remember that breathing should be through the nose with a short and strong inhalation and a long exhalation. You can mentally keep score so that the exercises are rhythmic.

Spa treatment

Regular courses have a beneficial effect not only on sleep, but also on the general state of human health. It is recommended to relax in sanatoriums at least once a year. In the institution, patients observe a sleep schedule, receive a set of therapeutic and restorative procedures, undergo massage courses, herbal medicine, mud baths, etc.

Prevention of insomnia

In most cases, insomnia can be corrected at the first manifestation and prevent its recurrence. It is necessary to think over the daily routine, in which at least 8 hours are allotted for sleep.

To reduce the symptoms of insomnia, the following actions will help:

1. Go to bed at the same time every day. Warm tea, a herbal bath, favorite pajamas help many people relax - do not break the usual rituals.

2. Give up alcohol, smoking. Alcohol can have a short-term sedative effect and speed up falling asleep, but it negatively affects the deep sleep phase. A person can suddenly get up at night and can no longer sleep.

3. Give up coffee or keep it to a minimum. Caffeine is able to linger in the cells during the day. Undesirable substances are also found in chocolate, strong tea. You can eat such foods only in the morning.

4. Read medication instructions carefully and consult your doctor. Many over-the-counter medications that are taken for colds or headaches contain ephedrine. The substance has a stimulating effect on the body. If the medication affects sleep, ask your doctor to change the dosage or change the medication.

5. Do not overeat before bed. A full stomach will work all night and send signals to the brain - in the morning there will be a feeling of fatigue. To satisfy your hunger, you can drink a glass of kefir, milk or a cup of herbal tea.

6. Take a warm bath. Some are helped by water procedures 2 hours before bedtime, some just before going to bed. Time is determined individually. Flavored foams, herbal decoctions can be added to the bath.

7. Exercise in the morning. A few simple exercises will help you tone up and create moderate physical activity. Regular exercise contributes to better falling asleep in the evening.

8. Practice good sleep hygiene. The room should be dark, quiet and cool enough - + 15 ... + 18 ° С. It is better to choose a mattress that is dense, but not hard, on which the body feels comfortable. Some people find it difficult to fall asleep in silence, they use "background" noises, such as turning on the air conditioner or soft instrumental music.

9. Avoid long naps. Short rest periods of 20 minutes will have an invigorating effect on the body, but longer daytime sleep contributes to insomnia.

10. Contrary to the stereotype, counting sheep is not worth it. When a person is focused on any action, active processes take place in the brain that interfere with sleep.

Diagnosis and treatment of insomnia in Moscow

MedEx Personal Medicine Clinic invites you to a consultation on the causes and treatment of insomnia.

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