Sleeping difficulty

Alternative Names

Home Care

Try changing your nighttime sleeping habits and other behavior before taking drugs for insomnia. For example:

• Avoid emotional upset or stressful situations before bedtime.
• Avoid using alcohol in the evening. Avoid caffeine for at least 8 hours before bedtime. Give up smoking, because nicotine is a stimulant.
• Eat a light snack before bedtime. Foods such as warm milk or turkey contain a natural sleep inducer called L-tryptophan.
• Establish a regular bedtime, but don't go to bed if you feel wide awake.
• Exercise regularly, but not in the last 2 hours before going to bed. Exercise, especially aerobic exercise, has been shown to make people fall asleep faster and get deeper and more restful sleep. Sex can be a natural sleep inducer for some people.
• Relax by reading, taking a bath, or listening to soothing music before going to bed.
• Take your TV or computer out of your bedroom. Otherwise, your brain becomes used to the stimulation and starts to expect it when you are there. This makes it harder for you to fall asleep.
• Use the bedroom for bedroom activities only. Once in bed, use creative imagery and relaxation techniques to keep your mind off unrestful thoughts. Avoid staying in bed for long periods of time while awake, or going to bed because of boredom.

IN INFANTS AND CHILDREN

• Avoid going in to your child's room throughout the night. Otherwise, the child may depend on the attention and become sleepless if you don't offer it.
• Avoid sending your child to bed as punishment, which can make the child afraid and lead to poor sleep.
• For children who have trouble falling asleep, try to make sure that the child is not disturbed by noise. Leaving a radio playing soft music may help cover up disturbing noises.
• Never give a child sleeping medicine without asking the doctor first. It's usually not a good idea to treat the problem with drugs.

MEDICATION

• Avoid all sedatives, including benzodiazepines, during pregnancy.
• Over-the-counter sleep medicines can have side effects, including a "hangover" effect the next morning. If these fail, you may want to ask your health care provider to recommend other options.
• Use medication as a last resort.

When to Contact a Medical Professional

Call your health provider if:

• Your sleeping problem becomes persistent and unbearable, despite home treatment
• Your sleeping problem occurs more than 3 nights per week for more than 1 month
• You have other worrisome symptoms, such as chest pain or shortness of breath

Your health care provider will do a physical examination. To help better understand your sleeping problems, he or she may ask the following:

• Do you have difficulty falling asleep or staying asleep (insomnia)?
• Do you wake up not feeling rested?
• How often do you wake up at night?
• How long have you had the problem?
• Have you taken any over-the-counter sleeping products?
• What medications do you take?
• Do you take any herbal supplements or alternative remedies?
• Do you drink much coffee or alcohol? Have you recently cut down on your coffee or alcohol?
• Do you have any excessive stress or anxiety?
• How much do you normally sleep? What hours?
• What do you do during the few hours before you go to bed?
• Do your sleep schedule change often? (shift work)
• Do you fall asleep at the wrong times or places?
• Does your sleep schedule change a lot on weekends?
• Do you worry too much about sleep?
• Do you have breath-holding spells or do you snore?
• Do you have any aches or pains that prevent you from sleeping?

• Psychological tests
• Sleep log record
• Thyroid tests (TSH, T3, T4)

In some rare cases, your health care provider may want you to see a sleep medicine specialist who will perform a sleep study (polysomnography)

MEDICATIONS

Most people don't need medication. Your health care provider can talk to you about using prescribed medications if everything else has failed.

Some antidepressants such as Elavil (amitriptyline) can be used at bedtime because they make you drowsy. They require a prescription. If insomnia is caused by depression, treating the depression with the right medications or therapy should solve the problem.

Benzodiazepines such as Valium (diazepam) or Ativan (lorazepam) are anti-anxiety medications that can also help people sleep. They must be used with caution because they can be addictive. They also require a prescription.

Newer sleep medicines help reduce the time it takes you to fall asleep. They are less likely to be addictive than benzodiazepines. Two examples are the prescription mediciness Ambien (zolpidem) and Sonata (zaleplon).

WARNING: The FDA has asked manufacturers of sedative-hypnotic sleep medicines to put stronger warning labels on their products so that consumers are more aware of the potential risks. Possible risks while taking such medicines include severe allergic reactions and dangerous sleep-related behaviors, including sleep-driving.