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Insomnia

Intro

When to call the doctor

Your insomnia needs a doctor's attention if it lasts longer than 4 weeks or interferes with your daytime activities and ability to function. Insomnia may be a symptom of another medical or psychological problem, which you may need to address first or at the same time.

When to go to the hospital

Generally, you will not be hospitalized for insomnia. However, accidents may result from poor coordination and attention lapse seen with sleep deprivation. Worsening pain or increased difficulty breathing at night also may indicate your need to seek emergency medical care.

Self-Care at Home

You can do several things to prepare yourself for sleep.

Exercise regularly.
  • Aerobic exercise and general fitness are important to maintaining good health.
  • You should exercise in the early part of the day and avoid strenuous activity before bedtime.
  • Avoid large meals and excessive fluids before bedtime.
Control your environment.
  • Light, noise, and elevated room temperature can disrupt sleep. Shift workers and night workers especially must address these factors.
  • Your body's circadian rhythm  (biological clock) is particularly sensitive to light. Parents who need to sleep during the day may have to make child care arrangements to allow them to sleep.

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Follow-up

Follow your doctor's recommendations for your medical and psychological conditions. You will be asked to give your doctor feedback after you have followed a treatment plan.

Often you will have more than 1 option and more than 1 medication available to help you. Do not lose hope if the first  medication does not give you the results you want or if you experience side effects or concerns. Report back to your doctor for advice.

Prevention

The following are suggestions to help anticipate and modify situations likely to be associated with insomnia. They are not foolproof, nor will they safeguard you from the consequences of sleep deprivation once it has occurred.

Insomnia from jet lag
  • Behavioral and short-term drug therapy has been used.
  • If you can anticipate your trip, begin to shift your bedtime to coincide with the time schedule in your destination.
  • Short-acting tranquilizers (benzodiazepines) have been shown to be useful. Melatonin, a hormone secreted by the pineal gland that regulates our sleep-wake cycles, is currently being studied.

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Insomnia from shift changes
  • Behavioral therapy has been useful in modifying the insomnia and symptoms of sleep deprivation in shift workers.
  • You should shift your schedules forward in a clockwise direction—from days to evening to night shift—and allow sufficient time to adapt (at least 1 week) between shift changes.
  • Bright light is a potent stimulus to circadian rhythm. Bright light is being examined as a rhythm synchronizer.
  • Shift workers should stress the importance of good sleep habits with regular bedtime and awakening.
  • Supplemental naps may be necessary to ensure work time alertness.
  • Discuss the use of naps with your doctor.
  • Some people promote using short-acting sedatives in the first few days following a shift change, but not everyone agrees.
  • Insomnia from acute stresses
  • Stress may be positive or negative, and concerns about sleep may vary. Many stressors will go away with support and reassurance.
  • Education about the importance of good sleep habits is also helpful.
  • Some people may need short-term medication treatment. Your doctor will often work toward the lowest effective dose with a short-acting sedative to achieve proper sleep.

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General recommendations include the following:
  • Work to improve your sleep habits.
  • Learn to relax. Self-hypnosis, biofeedback, relaxation breathing are often helpful.
  • Control your environment. Avoid light, noise, and excessive temperatures.
  • Use the bed only to sleep and avoid using it for reading and watching TV. Sexual activity is an exception.
  • Establish a bedtime routine. Fix wake time.
  • Avoid large meals, excessive fluid intake, and strenuous exercise before bedtime and reduce the use of stimulants including caffeine and nicotine.
  • If you do not fall asleep within 30 minutes, try a relaxing activity such as listening to soothing music or reading.
  • Limit naps to less than 15 minutes unless directed by your doctor.
  • It is generally preferable to avoid naps whenever possible to help consolidate your night's sleep.
  • There are certain sleep disorders, however, that will benefit from naps. Discuss this is with your doctor.
Outlook

Recovery from insomnia can vary.

  • If you have insomnia caused by jet lag, your symptoms will generally clear up within a few days.
  • If you are depressed and have had insomnia for many months, it is unlikely that your symptoms will go away on their own. You will need further evaluation and treatment.
  • Your outcome will also depend on coexisting medical conditions, which may include congestive heart failure, chronic obstructive pulmonary disease, and chronic pain syndromes.

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