Insomnia is a common sleep disorder. About one-third of Americans live with the condition during the course of a year. About 1 in 7 have chronic insomnia.
Insomnia means that you have trouble falling or staying asleep. Your waking life may also be disrupted by symptoms such as daytime sleepiness and irritability. Over time, insomnia can contribute to a number of health conditions that can also make it harder for you to fall asleep.
There are a lot of myths about insomnia, but learning more about the facts can help you understand your sleep cycles. It may also give you the tools you need to deal with the condition and get better sleep.
fact: Sleeping later on weekends won’t make up for the sleep you missed during the week.
If you consistently lose sleep each night, you accumulate sleep debt. This is the total amount of lost sleep over time.
While you may feel better if you sleep longer on weekends, this can make insomnia worse. Oversleeping on certain days can disrupt your normal sleep-wake cycle. This makes it harder for you to get the regular rest you need.
Your body’s sleep-wake cycle is based on a number of factors. These include sleep-wake homeostasis, which keeps track of how much sleep you need, and your body’s circadian rhythm, which sets the times of day you’re most likely to feel sleepy.
A 2019 research study found that weekend sleepers were unable to make up their sleep debt. They also had signs of lower insulin sensitivity than those who got adequate rest daily.
Instead of skimping on sleep during the week and oversleeping on weekends, try sticking to a regular sleep schedule. That means going to bed at the same time each night and waking up at the same time each morning, even on weekends.
fact: There are a number of ways to treat and manage insomnia.
You can take some steps to manage insomnia at home. If you live with chronic insomnia, you can also talk with a doctor or sleep specialist about cognitive behavioral therapy or medication.
Self-care strategies for better sleep
Changes to your lifestyle and sleep environment can help with insomnia. Some strategies include:
- maintaining a regular sleep schedule, even on weekends
- avoiding long naps
- avoiding stimulants like caffeine and nicotine before bed
- avoiding alcohol in the 3 to 4 hours before bedtime
- eating regular meals and avoiding late-night snacking
- getting regular exercise during the day
- keeping electronic devices out of the bedroom
- making your bedroom dark and cool to facilitate better sleep
You can also speak to your doctor about medications that may help.
Cognitive behavioral therapy for insomnia (CBT-I)
CBT-I is a form of therapy to help you learn techniques for better sleep. The process takes several weeks, during which you work with a licensed therapist.
Aspects of CBT-I often include:
- learning to have positive feelings about sleep
- learning that staying in bed not sleeping can worsen insomnia
- reducing nervousness about sleep
- learning good sleep habits
- practicing relaxation therapy
- learning to maintain a regular sleep-wake cycle
- focusing on specific periods of quality sleep (sleep restriction)
CBT-I is often the first-line treatment for insomnia. A 2021 meta-analysis found that CBT-I works at least in part by changing a person’s beliefs about sleep.
Fact: Each class of medications for insomnia works in a different way to help you sleep.
Doctors take a number of things into account when recommending a medication, including age and sex of the patient, safety, side effects, interactions with other drugs, and length of use. Properties of the medications are also considered, such as how quickly they start to work and how long they work.
Prescription Food and Drug Administration (FDA)-approved medications for insomnia in current use include:
- Benzodiazepines: These are medications that promote calm, relaxation, and reduced anxiety. This can make it easier for you to sleep. Benzodiazepines are typically only prescribed for short-term use.
- Z-drugs: These medications work in a similar way to benzodiazepines. They make you feel drowsy by slowing brain activity. They include drugs like eszopiclone (Lunesta) and zolpidem (Ambien). According to the FDA, they shouldn’t be used by people with complex sleep behaviors like sleepwalking. The medications can cause complex sleep behaviors.
- Melatonin receptor agonists: These prescription medications, such as ramelteon and tasimelteon, affect brain chemicals that regulate the sleep-wake cycle. They help reset your biological clock. Although many people also take melatonin for sleep, this is considered a dietary supplement and isn’t regulated by the FDA.
- Orexin receptor antagonists: These medications block orexin, a chemical in the brain that help keeps you awake.
- Antidepressants: Doxepin at a very low dose has been approved to treat insomnia. Doctors sometimes prescribe antidepressants if you have depression and associated insomnia.
You may also consider an over-the-counter (OTC) sleep aid. Many of these are antihistamines that make you drowsy. Some antihistamines may cause restlessness or restless legs syndrome.
Talk with your doctor before taking any OTC medications or supplements for insomnia.
fact: Lying in bed awake can increase anxious feelings about sleep.
It can also train your brain to associate the bedroom with those negative feelings, which may make your insomnia worse.
As much as possible, your bedroom should be reserved for sleep and sex. If your bedroom becomes a workspace, your brain can learn to associate the bed with your job. When you want to get some rest, it may be harder to turn off those work-related thoughts.
You shouldn’t get into bed until you’re ready to fall asleep. If you can’t fall asleep after about 20 minutes, get out of bed. Try doing a relaxing activity like reading (as long as it’s not on an electronic device) or listening to music until you feel sleepy.
Fact: Sleep quality is also important for your health.
It’s recommended for adults to get 7 or more hours of sleep per night. But you can still wake up not feeling rested.
Many factors can reduce sleep quality. Health conditions such as sleep apnea can cause changes in breathing and prevent deep sleep. Drinking alcohol before bed may make you feel sleepy, but it only induces light sleep. You may be more likely to get up during the night.
Practicing good sleep hygiene and paying attention to your overall health can lead to better quality sleep. Your doctor is a good source of information about how to manage conditions such as sleep apnea or chronic pain that may affect your sleep.
Insomnia is a common but treatable condition. By learning more about insomnia you can have a greater understanding of the tools at your disposal to get better rest. This may mean practicing good sleep hygiene, participating in CBT-I, or talking with your doctor about medications.