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Informed Health Online [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-.

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Insomnia: Overview

Created: ; Last Update: March 9, 2017; Next update: 2020.

Introduction

We all know what it’s like to toss and turn at night, wondering how you’re going to manage the next day. But if sleeping poorly has become a normal occurrence, it might be due to bad sleeping habits or worries that are keeping you awake.

There are a number of different things you can try in order to get a better night's sleep. These include relaxation techniques and changing your sleeping habits. Sleeping pills are usually not a good idea – they are only considered for people with severe insomnia, and are then only used temporarily.

If you have more than three bad night’s sleep per week and this goes on for more than one month, you could have chronic insomnia. A doctor can help you find out if the problem is being caused by a medical condition, and let you know what the treatment options are.

Symptoms

Having insomnia means not getting enough rest when you sleep, so you feel tired and run-down the next day. Reasons for not getting enough good sleep include the following:

  • Needing a very long time to fall asleep
  • Not sleeping soundly, and frequently waking up at night
  • Waking up at night and not being able to fall back to sleep for a long time
  • Getting up much too early and then not being able to fall asleep again

It's not normal for healthy people of any age to regularly have a lot of trouble getting to sleep and staying asleep.

Different people need different amounts of sleep. Various factors play a role here, including age:

  • Children over the age of six years usually sleep about nine hours each night.
  • Adults need around seven hours.
  • Healthy 80-year-olds only sleep about six hours.

These are only averages, though, so some people will need a little more or less sleep to feel rested.

The sleep times given here refer to what is known as the "total sleep time." This starts when you fall asleep and ends when you are truly awake the next morning and get up. Any periods of being awake during the night are subtracted to arrive at the total sleep time. It’s perfectly normal to need about half an hour to fall asleep once you've turned off the lights, so there's no reason to worry if it takes that long.

Causes

Things that can make it difficult to sleep include:

  • Anxiety and stress
  • Alcohol and drugs
  • Pain, needing to urinate at night, or hot flashes
  • Sleepwalking
  • Pauses in breathing at night (sleep apnea)
  • Restless legs syndrome
  • Grinding your teeth (bruxism)
  • Certain medications such as SSRIs (used to treat depression) or dopamine agonists (used to treat Parkinson's)
  • Shift work
  • Noise

Some of these causes can be avoided. That is especially true for alcohol. Although some people can fall asleep more quickly after drinking alcohol, it also makes their sleep less restful.

Prevalence

If you sleep poorly, you’re not alone: as many as 20 out of 100 people have trouble either falling asleep or sleeping soundly through the night. Insomnia and chronic sleep problems are most common in women and older people, but can affect anyone – even young children.

Diagnosis

Talking with your doctor may help you find out what is causing your insomnia. He or she can rule out any medical causes and, for instance, tell you about the different treatment options.

If you have severe insomnia that's robbing you of sleep, it may be a good idea to get tested at a sleep laboratory. These laboratories have rooms in which your sleep can be monitored for one or more nights. Instruments record various measurements which are used to monitor the different stages of sleep. This provides information about how long and how well you sleep, whether you get enough deep sleep and REM sleep, and whether you have a sleep disorder.

Treatment

There is currently not much research on what can help against insomnia. Common approaches and treatments include:

  • Home remedies: For instance, a glass of warm milk or valerian tea in the evening, or a hot bath.
  • Relaxation techniques like progressive muscle relaxation or autogenic training.
  • Physical exercise: Evening walks, meditative forms of exercise like yoga or tai chi.
  • Improved sleep habits (sleep hygiene): Doing things like not eating large meals a few hours before going to bed, not drinking alcohol or coffee in the evening, not watching television in bed, and only going to bed when you feel tired.
  • Cognitive behavioral therapy: Cognitive behavioral therapy (CBT) aims to change thought patterns and behaviors that may be keeping you from sleeping. It is often combined with relaxation techniques.
  • Herbal sleeping pills and sedatives like valerian.
  • Prescription-only sleeping pills such as benzodiazepines: These can only be used for a limited period of time because they have numerous side effects and can quickly lead to dependency. Many people are still sleepy and unfocused the day after taking them, and their reaction time is slower. Sleeping pills can also increase the risk of falling in older people.

The hormone melatonin plays an important role in regulating the sleep-wake cycle. Medications containing melatonin are sometimes used to treat problems affecting the sleep-wake cycle, for example caused by working night shifts or jet lag. Light therapy can also help to improve the body's sleep-wake cycle.

Sources

  • Alessi C, Vitiello MV. Insomnia (primary) in older people: non-drug treatment. Clin Evid 2015. [PMC free article: PMC4429264] [PubMed: 25968443]
  • Bruni O, Novelli L. Sleep disorders in children. Clin Evid 2010. [PMC free article: PMC3217667] [PubMed: 21418676]
  • Galland BC, Taylor BJ, Elder DE, Herbison P. Normal sleep patterns in infants and children: a systematic review of observational studies. Sleep Med Rev 2012; 16(3): 213-222. [PubMed: 21784676]
  • Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep 2004; 27(7): 1255-1273. [PubMed: 15586779]
  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

© IQWiG (Institute for Quality and Efficiency in Health Care)
Bookshelf ID: NBK279321

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