Insomnia

Last Updated: May 25, 2023

Insomnia is a common sleep condition which involves trouble falling asleep, staying asleep, or both. The resulting insufficient or poor-quality sleep can lead to worsened quality of life and functional impairments.

Insomnia falls under theSleepcategory.

What is insomnia?

Insomnia is a common sleep disorder comprising low-quality sleep or not enough sleep due to trouble initiating sleep and/or maintaining sleep. Insomnia can be short term (lasting days or weeks) or chronic (lasting 3 months or longer).[1] Insomnia occurs in 10-15% of the general population, with a greater prevalence in women during and after menopause, as well as older adults. In fact, up to 50% of older adults report insomnia or sleep disturbances.[2][3]

What are the main signs and symptoms of insomnia?

Some symptoms of insomnia include:[1]

  • Lying awake for a long time before being able to fall asleep
  • Only sleeping for short periods of time
  • Staying awake throughout most of the night
  • Feeling unrested or unrefreshed after sleep
  • Involuntarily waking up too early
How is insomnia diagnosed?

A healthcare provider will diagnose insomnia by taking a detailed medical history, including many questions about sleep habits. A physical exam is done to rule out other medical or mental conditions that can cause difficulty sleeping. Sometimes sleep studies can be performed to arrive at an accurate diagnosis. Insomnia is characterized as “chronic” when sleep problems occur at least 3 nights per week for at least 3 months.[2]

What are some of the main medical treatments for insomnia?

Medication treatments for insomnia are indicated for improving sleep onset, sleep maintenance, or both. Examples of medications with evidence of benefit for insomnia include orexin receptor antagonists (suvorexant), nonbenzodiazepine hypnotics (eszopiclone Lunesta, zolpidem Ambien, zaleplon Sonata), certain benzodiazepines (triazolam, temazepam), melatonin agonists (ramelteon Rozerem), and certain antidepressants (doxepin Silenor). Although medications such as trazodone, tiagabine, and diphenhydramine are commonly used, experts do not recommend them for chronic insomnia due to potential harms and inadequate evidence of benefit.[4]

Have any supplements been studied for insomnia?

Supplements studied for insomnia include melatonin, valerian root, kava-kava, chamomile, lavender, and many others. These supplements have sedating effects and can increase relaxation and induce sleep in some people with short-term insomnia.[3] There is much less research on supplements for chronic insomnia.[4]

How could diet affect insomnia?

A common therapeutic approach for alleviating insomnia is maintaining sleep hygiene, a part of which involves diet. Sleep hygiene techniques include not eating too much at night and not eating too late into the night. It also includes avoiding or limiting the intake of alcohol, caffeine, and caffeine-containing foods and drinks (e.g., coffee, tea, and chocolate), especially when it is close to bedtime. Following a healthy, nutrient-rich diet (e.g., high in fruits and vegetables, low in refined sugar) is also considered a part of maintaining good sleep hygiene.[3][2][5]

Are there any other treatments for insomnia?

For short-term insomnia, sleep hygiene techniques which involve adjusting lifestyle factors (e.g., diet, exercise) and environmental factors (e.g., light, noise, temperature) is commonly recommended, however, sleep hygiene is not recommended as a solo treatment for chronic insomnia. For chronic insomnia, cognitive behavioral therapy (CBT) has good evidence of benefit, especially when used in combination with other therapies. Sleep hygiene and CBT are usually recommended in combination with other behavioral treatments such as sleep restriction, relaxation therapy, and stimulus control.[6]

What causes insomnia?

Common causes of insomnia include work stress, relationship issues, or traumatic events. Often times, insomnia occurs in response to certain medical conditions, medicines, and other sleep disorders (e.g., obstructive sleep apnea). Caffeine, tobacco, alcohol, and other substances can also trigger insomnia. However, in some cases, insomnia is considered to be a primary problem because it does not have an identifiable cause, although risk factors include long-lasting emotional upset, stress, travel, and shift work.[1]

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Examine Database References
  1. Insomnia Signs and Symptoms - Taavoni S, Ekbatani N, Kashaniyan M, Haghani HEffect of valerian on sleep quality in postmenopausal women: a randomized placebo-controlled clinical trialMenopause.(2011 Sep)
  2. Sleep Quality - Fernández-San-Martín MI, Masa-Font R, Palacios-Soler L, Sancho-Gómez P, Calbó-Caldentey C, Flores-Mateo GEffectiveness of Valerian on insomnia: a meta-analysis of randomized placebo-controlled trialsSleep Med.(2010 Jun)
  3. Sleep Quality - Leathwood PD, Chauffard FAqueous extract of valerian reduces latency to fall asleep in manPlanta Med.(1985 Apr)
  4. Sleep Quality - Shinjyo N, Waddell G, Green JValerian Root in Treating Sleep Problems and Associated Disorders-A Systematic Review and Meta-Analysis.J Evid Based Integr Med.(2020)
  5. Sleep Quality - Bent S, Padula A, Moore D, Patterson M, Mehling WValerian for sleep: a systematic review and meta-analysis.Am J Med.(2006-Dec)
  6. Insomnia Signs and Symptoms - Lemoine P, Nir T, Laudon M, Zisapel NProlonged-release melatonin improves sleep quality and morning alertness in insomnia patients aged 55 years and older and has no withdrawal effectsJ Sleep Res.(2007 Dec)
  7. Insomnia Signs and Symptoms - Luthringer R, Muzet M, Zisapel N, Staner LThe effect of prolonged-release melatonin on sleep measures and psychomotor performance in elderly patients with insomniaInt Clin Psychopharmacol.(2009 Sep)
  8. Insomnia Signs and Symptoms - van Geijlswijk IM, Mol RH, Egberts TC, Smits MGEvaluation of sleep, puberty and mental health in children with long-term melatonin treatment for chronic idiopathic childhood sleep onset insomniaPsychopharmacology (Berl).(2011 Jul)
  9. Insomnia Signs and Symptoms - George T Lewith, Anthony Dean Godfrey, Philip PrescottA single-blinded, randomized pilot study evaluating the aroma of Lavandula augustifolia as a treatment for mild insomniaJ Altern Complement Med.(2005 Aug)
  10. Sleep Quality - Inn-Sook Lee, Gyung-Joo Lee[Effects of lavender aromatherapy on insomnia and depression in women college students]Taehan Kanho Hakhoe Chi.(2006 Feb)
  11. Sleep Quality - Li-Wei Chien, Su Li Cheng, and Chi Feng LiuThe Effect of Lavender Aromatherapy on Autonomic Nervous System in Midlife Women with InsomniaEvidence-Based Complementary and Alternative Medicine.()
  12. Insomnia Signs and Symptoms - Jasmine Mah, Tyler PitreOral magnesium supplementation for insomnia in older adults: a Systematic Review & Meta-AnalysisBMC Complement Med Ther.(2021 Apr 17)
  13. Insomnia Signs and Symptoms - Behnood Abbasi, Masud Kimiagar, Khosro Sadeghniiat, Minoo M Shirazi, Mehdi Hedayati, Bahram RashidkhaniThe effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trialJ Res Med Sci.(2012 Dec)
  14. Insomnia Signs and Symptoms - Hornyak M, Voderholzer U, Hohagen F, Berger M, Riemann DMagnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study.Sleep.(1998-Aug-01)
  15. Sleep Quality - Langade D, Kanchi S, Salve J, Debnath K, Ambegaokar DEfficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Insomnia and Anxiety: A Double-blind, Randomized, Placebo-controlled StudyCureus.(2019 Sep 28)
  16. Sleep Quality - Hemmeter U, Annen B, Bischof R, Brüderlin U, Hatzinger M, Rose U, Holsboer-Trachsler EPolysomnographic effects of adjuvant ginkgo biloba therapy in patients with major depression medicated with trimipraminePharmacopsychiatry.(2001 Mar)
  17. Sleep Quality - D E Shumov, I A Yakovenko, N N Alipov, Z V Bakaeva, E B Yakunina, A N Minyuk, A V Vinokurov, V B Dorokhov[The effect of music containing binaural beats on daytime fall-asleep dynamics]Zh Nevrol Psikhiatr Im S S Korsakova.(2020)
  18. Sleep Quality - David J Rog, Turo J Nurmikko, Tim Friede, Carolyn A YoungRandomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosisNeurology.(2005 Sep 27)
  19. Sleep Quality - Mark A Ware, Tongtong Wang, Stan Shapiro, Ann Robinson, Thierry Ducruet, Thao Huynh, Ann Gamsa, Gary J Bennett, Jean-Paul ColletSmoked cannabis for chronic neuropathic pain: a randomized controlled trialCMAJ.(2010 Oct 5)
  20. Anxiety Symptoms - Lee J, Jung HY, Lee SI, Choi JH, Kim SGEffects of Passiflora incarnata Linnaeus on polysomnographic sleep parameters in subjects with insomnia disorder: a double-blind randomized placebo-controlled study.Int Clin Psychopharmacol.(2020-Jan)