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JAMA Internal Medicine Patient Page
November 2018

I Have Insomnia—What Should I Do?

JAMA Intern Med. 2018;178(11):1572. doi:10.1001/jamainternmed.2018.2626

Insomnia is the inability to sleep.

What Is Insomnia?

  • Some people with insomnia cannot fall asleep to begin with. Others wake up during the night and have trouble falling back asleep.

  • Insomnia causes people to be tired during the day, leading to slowed thinking, mood swings, and poor personal functioning.

  • Insomnia is common and can affect anyone. About 1 in every 10 people have insomnia.

Why Do I Have Insomnia?

  • Health conditions such as stress, anxiety, and certain breathing or neurologic conditions can lead to insomnia.

  • Erratic work hours, shift-work, switching between time zones, excessive alcohol or caffeine intake, stimulant drug use (eg, some diet medications), and excessive screen time at night can also lead to insomnia.

  • Different people need different amounts of sleep. The average is 6 to 8 hours of sleep per night.

How Is Insomnia Diagnosed?

  • Your doctor can typically diagnose insomnia by speaking with you. Recording your nightly bedtime routine in a sleep diary can be helpful.

  • Rarely, your doctor may order a sleep study. This is an overnight test where you are monitored during sleep to look for certain medical conditions.

How Is Insomnia Treated?

Create a Peaceful Environment for Sleep (Sleep Hygiene)

  • Go to bed at the same time every night, and get up at the same time every morning.

  • If you can’t sleep, don’t stay in bed. Get up and do something relaxing until you feel tired enough to fall asleep.

  • Avoid alcohol and caffeine in the evening. Both of these can interrupt sleep.

  • Create a dark and quiet environment for sleeping with minimal distractions.

There Are Special Types of Therapy That Can Help

  • Cognitive behavioral therapy (CBT) is recommended by many experts as the first thing to try for treatment of insomnia. The focus of CBT is to find out why someone is experiencing poor sleep by identifying patterns of thinking and behavior that prevent good sleep. Treatment involves relaxation therapy, talk therapy, and other approaches such as biofeedback.

  • If you are unable to schedule an appointment with a therapist, ask your physician about computer or smartphone-based programs that can help teach you CBT techniques to treat insomnia.

What About Medications Like Sleeping Pills?

  • Sleeping medicines can be useful to help someone sleep for a short period of time only, for example if someone is traveling to a new time zone or switching from night shifts to day shifts at work. Their use should be limited to less than 4 weeks. Shorter is better.

  • Many sleeping medications can have serious side effects, including increased risk of falls, addiction, and death.

  • The side effects of prescription sleeping medications can be particularly strong in the elderly. These medications should generally be avoided in older age groups.

  • Taking both prescription sleeping medications and opioid pain medications can seriously increase your risk of dangerous side effects including death and should be avoided. Alcohol combined with sleeping pills can lead to death.

  • Before taking any pill for sleep (even over-the-counter medications), talk with your doctor.

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Section Editor: Michael Incze, MD, MSEd.
The JAMA Internal Medicine Patient Page is a public service of JAMA Internal Medicine. 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 Internal Medicine 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.
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Article Information

Published Online: September 10, 2018. doi:10.1001/jamainternmed.2018.2626

Conflict of Interest Disclosures: None reported.

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