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JAMA Patient Page
February 20, 2013


JAMA. 2013;309(7):733. doi:10.1001/jama.2013.524

Insomnia is a sleep disorder experienced by 12% to 20% of the general adult population. Insomnia is an inability to fall asleep and/or frequent awakenings with an inability to return to sleep. It is associated with daytime symptoms such as irritability and fatigue. The February 20, 2013, issue of JAMA includes an article about insomnia.

Risk factors

Anyone can have an occasional sleepless night, but the following factors can increase your risk of developing ongoing insomnia:

  • Female sex

  • Age older than 60 years

  • Mental and medical disorders

  • Stress

  • Night shift work or rotating shifts

  • Changes in evening and day shifts at work

  • Traveling across multiple time zones


Insomnia commonly interferes with personal relationships, job performance, and daily functions and is associated with the following symptoms:

  • Difficulty falling or staying asleep

  • Nonrestorative sleep—individuals feel that sleep is unrefreshing or of poor quality

  • Daytime fatigue and/or sleepiness

  • Difficulty concentrating and remembering

  • Changes in mood—irritability, anxiety, depression

  • Reduced motivation and energy


The diagnosis of insomnia is based on a careful history taking and physical examination. Your doctor may also recommend 1 or more of the following procedures to more accurately diagnose the sleep problem:

  • Blood or urine tests

  • Sleep log (sleep diary)—a record of your actual sleep habits and patterns over 7 to 14 days

  • Sleep study (polysomnography)—an overnight test to diagnose problems such as sleep apnea


Insomnia can be treated with behavioral and medication strategies. Behavioral therapy can assist a patient in developing new sleep behaviors to improve sleep quality and consolidation. Behavioral therapy may include

  • Learning healthy sleep habits to promote sleep

  • Relaxation and worry-reduction strategies

  • Restricting time spent in bed

  • Establishing a regular wake-up time

  • Light therapy to adjust and regularize the biological clock

Several different types of medications are also effective for treating insomnia. However, many doctors do not recommend relying on prescription sleeping pills for long-term use. It is also important to identify and treat other medical conditions that may be contributing to insomnia, such as depression, breathing problems, and chronic pain.

For more information

Inform yourself

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Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

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. To purchase bulk reprints, call 312/464-0776.