Insomnia refers to a disturbance of sleep initiation or maintenance, despite adequate opportunity and circumstances for sleep, resulting in impaired daytime function. Ten to thirty percent of the general population experiences some form of insomnia. Acute life stressors, suboptimal sleep hygiene, depression/anxiety, excessive caffeine use, smoking, medications, chronic pain, and undiagnosed sleep disorders can all contribute. Insomnia is often a temporary condition. In chronic insomnia, various perpetuating factors can lead to a maladaptive conditioned response to sleep such that going to bed induces a state of hyperarousal.
Although sleep aids (discussed below) certainly have a role in management of insomnia, a comprehensive approach with cognitive/behavioral interventions and sleep hygiene modification is essential. While each individual is different, there are several general considerations to maintain proper sleep hygiene. First, allow sufficient time in your schedule for sleep. Most people seem to need 7-8 hours nightly to feel rested. Next, think about how your daily activities impact sleep at night. It is best to limit caffeine intake to before noon. Nicotine is another stimulating drug, so you should not smoke close to bedtime. Avoid alcohol within several hours of going to sleep because it can disrupt sleep architecture. Regular exercise is beneficial, but try to stay away from strenuous activity in the hours before attempting sleep. Consider establishing a regular bedtime routine preceded by an hour of quiet relaxation. While a light snack prior to bed can be helpful, eating a heavy meal can delay sleep initiation. The sleeping environment should be dark, quiet, and kept at a comfortable temperature. Best practice suggests that the bedroom should be used only for sleep (and sex); avoid studying, using the computer, watching TV, discussing problems, or paying bills. Finally, try to maintain a regular awakening time in the morning, even on weekends and days off – napping should be avoided.
To assist with difficulty falling or staying asleep, your healthcare provider may recommend OTC or prescription sleep aids after careful consideration of such things as your age, current medications, and other medical conditions. A prescription sleep aid (also known as a sedative or hypnotic), like zaleplon (Sonata), zolpidem (Ambien), or eszopiclone (Lunesta), may be selected based on the type of insomnia as each agent has a different timing of medication effect. It is important to be aware of the potential side effects for any sleep aid, and best to start treatment in a supervised familiar setting until you are sure how you will respond. A typical course may be 1-2 weeks while behavioral strategies and lifestyle changes are implemented to address insomnia. In general, these medications are not recommended for long-term use and caution needs to be used because they could mask underlying causes of sleep disturbance. For chronic insomnia, a sleep specialist may recommend longer treatment under careful medical supervision.