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JAMA Patient Page
May 21, 2003


JAMA. 2003;289(19):2602. doi:10.1001/jama.289.19.2466

Insomnia (trouble falling asleep or staying asleep) is a common problem. It can cause daytime tiredness and sleepiness and difficulty paying attention at school or being alert at work. Insomnia can begin at an early age and affects people of all ages. Insomnia can be transient (short-term) and related to a specific condition like stress or travel, or it can be a chronic (long-term) problem that persists for many months and may be caused by another medical problem. The May 21, 2003, issue of JAMA includes an article about insomnia, its causes, and its treatments.


  • Persistent stress

  • Relationship problems

  • Use of stimulants such as caffeine, cocaine, and some diet drugs

  • Alcohol consumption

  • Shift work or keeping erratic hours

  • Inactive lifestyle

  • Environmental factors like noise and light

  • Depression or anxiety disorders

  • Medical problems including sleep apnea (waking up frequently during the night, severe snoring, and brief periods of not breathing)

  • Restless legs syndrome (uncomfortable leg sensations at night that are relieved by walking, rubbing, or other movements that prevent sleeping)


  • Keep a regular schedule with a consistent bedtime

  • Use your bedroom mainly for sleep

  • Exercise regularly, but try to finish exercise at least 3 to 4 hours before going to bed

  • Avoid caffeine for at least 6 hours before going to bed

  • Avoid large meals close to bedtime

  • If you nap during the day, try to do so at the same time each day, and limit napping to an hour or less


If you experience persistent insomnia, see your doctor. Depending on the cause of the insomnia, your doctor may prescribe various treatments ranging from psychiatric counseling to drug therapy.



To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at Many are available in English and Spanish. A Patient Page on breathing problems during sleep was published in the June 13, 2001, issue.

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. Any other print or online reproduction is subject to AMA approval. To purchase bulk reprints, call 718/946-7424.

Sources: National Sleep Foundation, American Insomnia Association, National Center on Sleep Disorders Research, American Academy of Sleep Medicine