Insomnia

What is insomnia

Insomnia is a sleep disorder. Insomnia causes difficulty falling asleep, waking often from sleep or waking up too early from sleep without being able to get back to sleep.

The average amount of sleep adults require is about 7-8 hours, but this is just an average, as everyone is different and some people need more sleep, while others can survive quite well on less.

General hours of sleep required through the ages (these are averages and there will be variations):

Sleep is highly complex. It’s when the brain dreams and produces a number of different brain waves, as well as a number of other changes that are physiological and chemical in nature. Sleep is when the immune system works to repair and recharge the body.

There are five stages of sleep

• Stage 1 & 2 are light sleep/true sleep
• Stage 3 & 4 are deep sleep
• Stage 5 is when REM sleep occurs.

People who miss out on sleep tend to miss out on the transition stages (stages 1 & 2) as the body tends to try to catch up on deep sleep first and then REM sleep.

Insomnia is described as being unable to wake up from sleep feeling refreshed and restored, rather waking up feeling tired and exhausted. Insomnia occurs when the quality of sleep is poor and this leaves the person feeling tired and lethargic upon waking. Insomnia is not about the hours of sleep, but rather the quality of sleep.

Two basic types of insomnia

• Primary insomnia – this type of insomnia is due to some type of severe psychological distress or major life changes and is the less common form. This type of insomnia is not due to any other external or internal factor and is a disorder on its own
• Secondary insomnia – this type of insomnia is due to an underlying health disorder (such as anxiety, depression, Alzheimer’s disease, restless legs syndrome), taking certain medicines, an underlying sleep disorder (such as sleep apnoea) and/or using certain stimulating substances (such as caffeine, smoking cigarettes)

People who experience constant insomnia are not able to function very well and falling asleep while driving is one example of how insomnia can be very dangerous.

There are two main types of insomnia symptoms (and people can experience one or the other or both types):

• Sleep maintenance insomnia – this type of insomnia is characterised by frequent awakenings (throughout the night) or waking too early
• Sleep onset insomnia – this type of insomnia is characterised by an difficulty in falling asleep

Facts about insomnia

• Insomnia literally means “no sleep”, it is derived from Latin
• Insomnia is the most common sleep disorder in Australia (and this is the same in the USA, UK and many other countries)
• Statistics from the Australasian Sleep Association suggest that around 10% of people take medication to help them sleep (but these statistics don’t include all people with insomnia symptoms, only a subset of those who take medication)
• A 2003 survey by the National Sleep Foundation in the United States found that 60% of adults surveyed reported driving while feeling drowsy
• Not everyone needs the same amount of sleep
• Insomnia is all about a lack of quality sleep that leaves a person feeling tired in the morning after waking up
• Eating too late at night can often cause insomnia
• Excessive worry and thinking too much at night can also cause insomnia
• Caffeine late at night over-stimulates the brain and can cause insomnia
• People who have insomnia generally have some form of depression too
• Insomnia causes excessive tiredness throughout the day
• People with any type of anxiety disorder often experience insomnia at a high frequency
• There are a number of medications that can cause insomnia to occur
• There are a number of health conditions that can cause insomnia to occur
• People experiencing any life changing or traumatic/emotional events can experience insomnia

Symptoms of insomnia

Insomnia can cause a number of symptoms:

• Feeling tired after waking
• Inability to fall asleep
• Inability to fall asleep after waking up during the night
• Waking up often during the night
• Waking up too early in the morning

Other symptoms

In addition to these symptoms during the night/morning, insomnia can also cause the following symptoms:

• Decreased alertness
• Excessive daytime sleepiness
• Falling asleep while undertaking any daily activity (work, driving, watching tv)
• Feelings of anxiety and tension
• Inability to concentrate properly during the day
• Irritability
• Memory lapses

Causes of insomnia

Primary insomnia

Primary insomnia has one cause – any type of major life changes:

• Major life changes – any type of stress, either positive, neutral or negative can trigger primary insomnia in people
  • changes to schedule
  • death of loved one
  • different responsibilities at work
  • illness of loved one
  • marriage
  • moving house
  • new job
  • travel for work

Primary insomnia usually occurs for at least one month.

Researchers believe that even if these life changes become resolved, the patterns that occurred with the insomnia and the associated changes to the internal body clock (circadian rhythms) may not go back to normal so easily or so quickly. People with primary insomnia may need to find some strategies to help them sleep once their issue has been resolved.

Secondary insomnia

There are a number of causes of secondary insomnia, which is a symptom of another health condition:

• Certain medications – a number of medications can increase feelings of anxiety and unease, which can increase likelihood of insomnia. The medications mostly responsible for this effect are: anti-depressants, anti-convulsants, cold and flu medicines, corticosteroids, HRT, ritalin, thyroxine. These medications treat a number of health disorders, so if you are unsure about your medication, ask your doctor or pharmacist about side effects
• Menopause – women who are in menopause often find it difficult getting to sleep or to sleep properly partly because of the hot flushes and partly because of the fluctuating hormones
• Mental health conditions – health conditions that are emotional/psychological in nature can cause insomnia as part of the symptoms of the disorder. Examples are: anxiety disorders, depression, post-traumatic stress disorder
• Neurological health conditions – health conditions that are neurological in nature can cause insomnia as part of the symptoms of the disorder. Examples are: Alzheimer’s disease, Parkinson’s disease
• Other health conditions – a number of health conditions can cause pain at night, which disturbs ability to get to sleep, such as arthritis, gastroeosophageal reflex (GERD), headaches and migraines. A number of other health disorders impair with breathing, such as allergic rhinitis (hay fever), asthma, sinusitis. An overactive thyroid, which is producing too much thyroxin can also keep a person alert and unable to sleep. Stroke and heart failure can cause insomnia symptoms
• Sleep disorders – people with other sleep disorders, such as snoring, sleep apnoea and restless legs syndrome find it very difficult to have refreshing sleep, either due to an inability to sleep properly or pain that prevents getting to sleep in the first place
• Stimulants – a number of substances have a very stimulatory effect on the body (and brain) and make insomnia more likely. Known stimulants are: caffeine (found in coffee, tea, chocolate, energy drinks and soft drinks like cola), nicotine (cigarettes), some recreative drugs (speed, cocaine), alcohol

Prevention of insomnia

Non-preventable risk factors

Insomnia may be unpreventable in certain circumstances:

• Anxiety disorders – people with any type of anxiety disorders have a higher incidence of insomnia as part of the symptoms of this disorder and it is very difficult for people with high anxiety to be able to fall asleep very well
• Certain medical conditions – there are a number of health conditions which can cause insomnia as a symptom of the disorder. Insomnia from this cause is difficult to prevent. Conditions known to cause insomnia are: anxiety, depression, sleep disorders, neurological disorders, thyroid disorders, respiratory disorders, pain disorders
• Certain medications – there are a number of medications which can cause insomnia as a side effect of the medication. It is difficult to prevent the insomnia from this cause. The medications that can most commonly cause insomnia are:
  • Anti-depressants – used for depression
  • Anti-convulsants – used for epilepsy
  • Bronchodilators – used for asthma and other lung conditions
  • Cold and flu medicines – especially if they contain the stimulant pseudoephedrine
  • Corticosteroids – used for asthma, arthritis and other inflammatory conditions
  • Hormone replacement therapy – oestrogen and progresterone replacement
  • Levodopa – used for Parkinson’s disease
  • MAOIs – used for depression and anxiety
  • Ritalin – used for ADHD
  • Sympathomimetics – found in cold/flu medicines
  • Theophylline – for asthma
  • Thyroid hormone – thyroxine, used for underactive thyroid hormone disorders
• Dementia – people with all forms of dementia (including Alzheimer’s disease) experience a higher rate of insomnia and this so far is proving difficult to prevent
• Depression – people with any type of depression have a higher incidence of insomnia as part of the symptoms of this disorder and it is very difficult for people with depression to be able to fall asleep very well
• Hypoglycaemia – people who experience hypoglycaemia quite often experience insomnia due to much lowered blood glucose levels, especially at night, when the reserves are very low, so this can keep them up, awake and alert
• Fibromyalgia – the inflammatory arthritis conditions fibromyalgia is often associated with insomnia because it causes a lot of pain and difficulty getting to sleep and difficulty having restful sleep
• Menopause – many women who are going through menopause (which is a completely normal part of all women’s lives) will also experience insomnia, either due to the hot flushes that make it difficult to sleep at night, or from the fluctuating hormones
• Thyroid disorders – people with thyroid disorders that increase the release of the thyroid hormone thyroxin find it very difficult to sleep because of the stimulating effect this hormone has on the body and it keeps them awake unable to get to sleep

Preventable risk factors

There may be ways to prevent insomnia from occurring or at least reduce severity and duration of symptoms:

• Counselling – people experiencing a stressful situation which is the underlying cause of the primary insomnia, may need to get a referral to a counsellor or psychologist who can help to work through the issues
• Keep blood glucose levels steady – lower than normal blood glucose levels can make a person feel very anxious and unable to get to sleep or even stay asleep. Ensure to eat enough food during the day and if necessary, have a small snack an hour or two before bed, to keep blood glucose levels maintained throughout sleep
• Reduce intake of stimulants – there are many well-known stimulants which increase risk of insomnia (caffeine, nicotine, alcohol, recreational drugs). In order to prevent secondary insomnia from these causes, it is vital to reduce intake or completely avoid them
• Regular exercise – it is important to engage in regular exercise every day, as it helps to improve mood, releases the “feel good” endorphins, exhausts energy and this may reduce incidence of insomnia symptoms from any type of insomnia
• Regulate sleep patterns – while it can be difficult, it is important to try to regulate sleep patters, to reset the internal body clock (and circadian rhythms) back to normal by going to bed and waking up at the same time each day. This can greatly help to improve insomnia, but only if done on a regular basis

Complications of insomnia

There are a number of complications of insomnia, some of which can be really serious:

Accidents and injuries

Insomnia causes people to experience daytime sleepiness and excessive tiredness. In some people, this excessive tiredness can be lethal if they are driving and fall asleep and hit another car or some other object. Other people who operate machinery are also at great risk if they experience a lot of insomnia and daytime sleepiness that causes a loss of concentration when operating the machinery. At a more basic level, being excessively tired and cooking or participating in any activity can easily cause an accident or injury if concentration lapses too much.

Anxiety

While a lot of people who have insomnia already have some type of anxiety disorder, excessive insomnia and the irritability and lack of sleep can induce anxiety symptoms too, when cortisol level remain too high, the body is never able to relax and this can result in a great deal of anxiety due to the insomnia. This anxiety then fuels the insomnia and it just becomes a vicious circle which is hard to break from from.

Depression

While a lot of people who have insomnia already have some type of depressive illness, excessive insomnia and the irritability and lack of sleep can induce symptoms of depression too. This is due to the higher than normal cortisol levels, lowered tryptophan and serotonin levels (both of which are associated with normal mood) which are all associated with the risk of development of depression.

Lowered immunity

Sleep is the time for the body to repair itself and recharge energy. It is thought to be the time (especially during REM, deep sleep) when the immune system goes to work to repair any part of the body that is damaged or injuried or just not functioning properly. If the immune system does not have this opportunity, it means that the body cannot repair and recharge itself. Another factor in this is higher cortisol levels, which if they occur over a long period, can cause lowered immunity. This means that not only do you feel excessively tired and irritable from the lack of sleep, the immune system also fails to function properly and it means you are more vulnerable to illness.

When to see a doctor about insomnia

People who have any of the symptoms associated with insomnia should see a doctor for proper diagnosis to confirm this condition (or to rule it out and confirm another diagnosis). In this way the doctor can try to work out a treatment plan to help reduce symptoms and help improve sleep patterns, or refer you to a counsellor/psychologist (if there any underlying psychological issues that are causing the insomnia) who may be able to help further.

People with existing insomnia need to see their doctor (or counsellor/psychologist) on a regular basis, to monitor their condition, to ensure they are not suffering from complications and to help with medication and lifestyle management.

People who experience worsening of symptoms, or experience new and different symptoms associated with the insomnia need to visit their doctor so that these symptoms can be investigated.

Diagnosis of insomnia

Initial diagnosis of insomnia includes:

• Medical history of symptoms – the doctor will ask a series of questions about your symptoms (especially the duration and severity), whether there have been any impacts on your daily activities and if you fall asleep during the day. The doctor may ask you if you drink a lot of coffee, smoke cigarette, drink alcohol or engage in other activities which may predispose you to insomnia. You will also be asked if you are particularly worried about anything, if you feel stressed and under pressure at home or work, to try to get to the root of the insomnia
• Physical examination – the doctor will examine your heart, lungs (breathing) and may do a general physical examination to check out your general lung and heart health to determine if there are any obvious signs of ill health

Further tests

If it is warranted, further tests can be requested:

• Blood test – if it suspected that you may have a thyroid disorder (overactive thyroid) or vitamin B deficiency, this can be confirmed through a blood test
• Monitoring device – such as an actigraph, which is a device that is worn on the wrist and measures activities of daily life (including daytime napping) and it also helps to detect any unusual circadian rhythms
• Overnight sleep study – if it is suspected that you have sleep apnoea or are snoring at night and this could be the cause of the sleep apnoea, you will be requested to undergo a sleep study, which involves sleeping overnight in a special sleep laboratory, where you will be hooked up to a monitor with electrodes to your head and other parts of your body, in order to monitor your breathing, heart rate and oxygen levels while you sleep. If you snore or have sleep apnoea this test should reveal it (but only if you snore or have the sleep apnoea during the overnight test)

Conventional treatment of insomnia

Conventional treatment of insomnia (unless it is persistent and pervasive) usually consists of lifestyle advice on avoiding certain stimulants and trying to relax more. Medication are normally prescribed if the insomnia is very severe and other more conservative strategies have not succeeded.

Medication

There are a number of medications that can be prescribed by a docotr (or purchased over-the-counter without prescription) for insomnia:

• Anti-anxiety medications – these medications are prescribed to help reduce any anxiety symptoms (or anxiety disorders) that are the underlying cause of the insomnia. These medications help to reduce levels of anxiety and this is thought to help people relax and get to sleep more easily. There are a number of side effects associated with these types of medications and they do not suit everyone. Common examples are: Alprazolam (Xanax^®), Diazepam (Valium^®), Oxazepam (Serax^®)
• Anti-depressant medications – there are a number of different types of anti-depressant medications that can be prescribed for reducing depression that has either been caused by the insomnia or was there before the insomnia and is the cause of the insomnia. These medications help to improve mood and is this is thought to help people calm down and get to sleep more easily. There are a number of side effects associated with these medications and new research suggests that they may not be effective for depression anyway, that it is more effective to use other methods for depression instead. Common examples are: MAOIs: Phenelzine (Nardil^®), Tranylcypromine (Parnate^®), Isocarboxazid (Marplan^®), SSRIs: Citalopram (Cipramil^®), Paroxetine (Seroxat^®), Fluoxetine (Prozac^®), Tricyclics: Amitriptyline (Triptafen^®), Clomipramine (Anafranil^®), Imipramine (Tofranil^®)
• Anti-histamine medications – the sedating type of these medications can be purchased without a prescription at the chemist. There are a number of side effects associated with these medications (arrhythmia in particular) and they should not be taken by people with heart rhythm disorders (unless specified and monitored by a doctor) or people with depression or other mental health disorder (as these medications can make these disorders much worse). Common examples are: xxxxxx
• Barbituate medications – these are an older type of sedative, which are highly addictive, both physically and mentally and which act on the central nervous system to produce mild sedation to anaesthesia effects. Barbituates have a high potential for lethal overdose and are not prescribed as much today as a sedative, except in special cases. Common examples are: Amobarbital (Amytal^®), Pentobarbital (Nembutal^®), Phenobarbitol (Luminal^®), Secobarbital (Seconal^®)
• Benzodiazepine medications – these sedatives are also muscle relaxants commonly prescribed in people with insomnia for short term use. High dosage, combined with long term use can result in addiction. Even short term use in some people can result in rebound wakefulness (more insomnia than you started with). Discuss any side effects with your doctor and do not suddenly stop taking any medication you have been. Common examples are: Alprazolam (Xanax^®), Chlordiazepoxide (Librium^®), Diazepam (Valium^®), Estazolam (Prosom^®), Lorazepam (Ativan^®), Nitrazepam (Mogadon^®), Oxazepam (Serax^®)
• Non-benzodiazepine medications – these sedatives are a new class of drugs, which are similar to the benzodiazepines, but are not in the same class of drugs. The non-benzodiazepines tend to have less problems with addiction, but long term use of these drugs is still not recommended. Common examples are: Eszopiclone (Lunesta^®), Zaleplon (Sonata^®), Zolpidem (Ambien^®), Zopiclone (Imovane^®, Zimovane^®)

Other strategies and therapies

There are a number of other strategies that some doctors will recommend first, before prescribing medications, as many of those medications can be habit-forming and do not treat the underlying issues:

• Avoid stimulation before bed – caffeine, exercising late at night, watching too much television, using computers late at night all have a stimulanting effect and should be avoided for a few hours before you go to sleep. In addition to this, some doctors will recommend you avoid having a television in the bedroom because this provides more stimulation too close to sleep and can disturb sleep by causing strange dreams and nightmares
• Counselling – if you cannot go to sleep because there is a stressful situation in your life which is making you worry too much, your doctor can recommend some counselling to help you deal with it and in this way, you can reduce the worry, be advised on some strategies to help your situation and this will alll help you get some more restful sleep. If you have been diagnosed with an anxiety disorder, depression or some other mental health disorder, your doctor will recommend you undertake some sort of psychotherapy to help you manage your condition. Psychologists today usually recommend CBT, cognitive behavioural therapy and mindfulness, both of which have a great deal of success in helping people with any type of stress/worry to anxiety and depressive illness. In Australia, a certain number of your sessions with a psychologist are covered under Medicare
• Hot and cold packs on the legs – to reduce the pain symptoms of restless legs syndrome that some people experience, a general recommendation (other than pain medication) is to use alternating hot and cold packs on the legs which can help reduce the pain and inflammation symptoms and if pain is reduced, this can help induce sleep more easily
• Regular sleep routine – your doctor will recommend you try to get your sleep routine more regulated as this will help to reset your body clock (circadian rhythm) back to a more normal level and this should help you sleep better. It will take a lot of hard work and effort to achieve this and it needs to be done on a regular basis to make it work
• Relaxation – some doctors will recommend you engage in some type of relaxation therapy, as this is known to help people relax, reduce anxiety and tension and ultimately help you sleep better. Some good forms of relaxation are: meditation, tai chi and yoga. Your doctor will suggest that you can try a CD/DVD or join a class, but ensure you find a reputable one
• Supplements for restless legs syndrome – if you have the neurological disorder restless legs syndrome, your doctor may recommend you take certain supplements, especially if you have been confirmed to have lower than normal blood levels of these nutrients. Most commonly, iron, folic acid, magnesium and vitamin B12 (cyanocobalamin) will be prescribed as they are known to reduce the symptoms of restless legs syndrome either from primary or secondary causes

Alternative / complementary treatment of insomnia

There are a number of alternative / complementary treatment for insomnia (that are not habit-forming), which should be tried first before trying any conventional treatments.

Herbs

There are a number of herbs that can be used to reduce symptoms:

• Chamomile – the tea of chamomile flowers is one of the most gentle and non-habit forming ways to relax the body and help you get to sleep. Try to have at least one cup of chamomile about an hour before sleep and if that does not work, try another cup. The most effective way to have chamomile is to use the loose flowers and boil them in water for a few minutes, strain and then drink with a little honey to sweeten
• Lemon balm (Melissa officinalis) – the herb lemon balm is used in herbal preparations to reduce insomnia and induce sleep. Studies show lemon balm is effective in helping to reduce stress and anxiety to then promote sleep. It is often combined with other herbs (scullcap, passionflower and valerian) to increase the relaxation effect and induce sleep more quickly
• Passionflower (Passiflora incarnata) – the herb passionflower is used in herbal preparations to reduce insomnia and induce sleep. Studies have shown that passionflower has significant anxiety-reducing properties, which may assist with increased relaxation and help with sleep. Passionflower if often combined with lemon balm, scullcap and sometimes valerian to increase efficacy in reducing insomnia
• Scullcap (Scutellaria lateriflora) – the herb scullcap is used in herbal preparations to reduce insomnia and induce sleep. Scullcap is often combined with other herbs (passionflower, lemon balm and valerian) to reduce anxiety and nervous tension and help induce sleep
• St John’s Wort (Hypericum perforatum) – the herb St John’s Wort is often used to help reduce anxiety, depression and stress. Studies show that St John’s Wort may be a beneficial and effective treatment for mild to moderate depression without any of the side effects of prescription anti-depressant medications. St John’s Wort works by increasing the levels of the neurotransmitter serotonin, which regulates mood and decreases insomnia. If you are taking any type of anti-depressant you must not take St John’s Wort and you must also wait a few weeks after stopping the anti-depressants before trying it. If you are taking any other medications, talk to your doctor about St John’s Wort before trying it, as it could cause some serious problems if you take certain medications together with this herb
• Valerian (Valeriana officinalis) – the herb valerian is used to treat anxiety and nervous restlessness which may lead to insomnia. Research shows that valerian increases the amount the amino acid gamma amino-butyric acid (GABA), which also functions as a neurotransmitter in the brain. GABA helps regulate nerve cells so that they function properly and it also has a calming effect on anxiety by producing a much more relaxed mood. Valerian has sedative effects, but it is not habit forming (so you cannot get addicted to it), which is why many people use it instead of pharmaceutical sedative medications. Despite these beneficial effects, there is a very small percentage (about 5%) of people who are over-stimulated by valerian, instead of being relaxed, so try a lower dose to gauge your reaction. You can build up the dosage if it does not stimulate you

Vitamins

There are a number of vitamins that can be used to reduce symptoms:

• Folic acid – folic acid is vital for people with restless legs syndrome, as it can help to reduce their symptoms
• Inositol – the B vitamin co-factor inositol helps to enhance REM sleep, which is when the immune system goes to work to repair the body
• Vitamin B complex – these vitamins are important to help normalise nervous tissue function and reduce overall tension, anxiety and stress. A B vitamin complex containing all the B vitamins (thiamin, riboflavin, niacin, pantothenic acid, pyridoxine, cyanocobalamin) and also the B vitamin co-factors (choline, folic acid, inositol, PABA) should only be taken 1-2 times a day, in the morning and just after lunch, but not at night as the B vitamins may stimulate you too much and make you less likely to sleep
• Vitamin B3 (niacin) – vitamin B3 (niacin) is especially useful for reducing the restless sleep patterns in people who toss and turn all night without respite
• Vitamin B6 (pyridoxine) – vitamin B6 (pyridoxine) is the precursor to tryptophan and may be especially useful in reducing the stress and anxiety symptoms that may be causing the insomnia and it also may help reduce incidence of nightmares. Just make sure to take it in the morning and/or just after lunch, but not in the evening as it can over-stimulate the mind and make you less likely to be able to sleep
• Vitamin E – the antioxidant vitamin E can help improve circulation and helps to reduce jerking of the legs, which may assist people with restless legs syndrome to find relief from their symptoms

Minerals

There are a number of minerals that can be used to reduce symptoms:

• Iron – people with restless legs syndrome may have a deficiency of iron (only after diagnosed with a blood test) and supplementation may be required to help reduce symptoms and reduce incidence of insomnia
• Magnesium – the mineral magnesium is essential for relaxing all the muscles in the body (both the muscles we can move and those we cant move, that surround our internal organs), which may relax your whole body enough to reduce insomnia symptoms and help you sleep

Other nutrients

There are a number of other nutrients that can be used to reduce symptoms:

• Essential fatty acids (EFA) – the essential fatty acids (omega-3 from a variety of sources as well as gamma-linoleic acid from evening primrose oil) are essential in the proper function of the brain and of the neurotransmitters and nerve cells and helps to reduce incidence of insomnia
• GABA – the amino acid and neurotransmitter, GABA helps regulate nerve cells so that they function properly and it also has a calming effect on anxiety by producing a much more relaxed mood, which can help to reduce incidence of insomnia. Due to this, GABA is also known as the “great relaxer”
• Tryptophan – the amino acid tryptophan is the precursor to the neurotransmitter serotonin as well as the hormone melatonin, both of which are required to help initiate normal, restful sleep. Serotonin is the neurotransmitter which helps to relax the body, reducing any anxiety or stress by managing mood and melatonin regulates the circadian sleep cycles (body clock)

Dietary modifications

There are a number of dietary modifications that can be used to reduce symptoms:

• Avoid caffeine after dinner – limit any caffeine intake for at least 6 hours before going to bed. Caffeine is a stimulant and can make insomnia symptoms worse if you drink it too close to bed time. Sources of caffeine are: coffee, tea, cola, chocolate, some soft drinks, energy drinks
• Eat more magnesium rich foods – try to eat more foods that are rich in magnesium, as this mineral helps to relax smooth muscles in the body and relaxes the whole body
• Maintain stable blood sugar levels – ensure you have enough food throughout the day to keep your blood sugar levels stable. This can be achieved by eating 5-6 smaller meals and have a small snack about an hour before bedtime. Low blood sugar levels can have the effect of making you feel tense and unable to sleep
• Reduce alcohol intake – while alcohol has a sedative effect, it is actually not beneficial for helping to induce sleep as it does not provide a restful sleep and excessive alcohol intake is associated with a number of adverse health effects

Lifestyle modifications

There are a number of lifestyle modifications that can be used to reduce symptoms:

• Avoid exercise just before bed – this is because exercise stimulates the whole body, increases circulation, increases heartbeat and all of this can keep you more alert instead of helping you to wind down to sleep. Try to complete exercise at least 6 hours before going to bed
• Regular exercise – it is beneficial to engage in regular exercise every day for anywhere between 30-60 minutes. Alternate your workouts between cardiovascular exercises that elevates heart rate to 80% of maximum rate and resistance training (such as pilates, yoga, weight training) to help condition every part of the body, increase circulation, use up your energy and help you sleep better
• Regular sleep routine – to help reset your body clock (and circadian rhythms) to more normal levels, try to go to bed and wake up at the same time every day, even if this means you cannot get to sleep until very late and feel more tired the next day. Persevering with this strategy on a very strict and regular basis can help reset the body clock back to normal
• Relaxation techniques – it would be beneficial for you to try to use some form of relaxation technique to help you wind down and relax a little before going to bed (as well as any time you feel stressed or tense). Some examples of relaxation techniques are: meditation, tai chi, yoga and you can either buy a CD/DVD or join a class, but ensure you find a reputable one
• Sleep diary – use a sleep diary to help monitor your sleep patters to see where you need the most assistance and to use this information to help you improve your sleep

Alternative treatments

• Bright light therapy – this helps to overcome any type of circadian rhythm sleep disorders (such as insomnia) as the bright light therapy helps to reset the circadian rhythm control centre back to normal. A new type of bright light therapy involves using a Rio Lightmask™, which shines pulsed light (at a specific rate) onto the closed eyes at night. It is used at night before falling asleep, to help sleep come more quickly
• Certified Organic lavender essential oil – lavender is very beneficial as it has calmative properties. Add 3-5 drops into a warm bath and soak in it for about 20 minutes, or add a few drops of the lavender to an aromatherapy vaporiser for a few hours in the evening before you go to sleep, or you can even use a purchased room spritzer with certified organic lavender oil (usually mixed with water)

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with insomnia

Self care strategies

There are a number of strategies which are recommended to help you more effectively deal with insomnia:

• Avoid alcohol – alcohol may help to numb you for a short while, but it has no long term effect other than damaging your health. It is a quick fix and has no real benefit other than in the very short term. Avoid it. You need to find other strategies to get to sleep instead of using alcohol (if you do drink it to try to induce sleep). In addition to this, excessive alcohol intake in general is not good as it has a stimulating effect on the whole body and can keep you unable to sleep properly, which only compounds the symptoms of insomnia
• Chamomile tea – chamomile has relaxing properties. Try some chamomile tea before bed. Use the real flowers and add them to water and let them boil for about 5-10 minutes. Strain and drink with some honey added. Try 1-2 cups about half an hour before bed to help relax your mind and release some tension to help you sleep a little better
• Don’t smoke – smoking cigarettes has a stimulating effect on the body, mainly due to the effect of the nicotine on the brain so if you smoke, you really need to try to give up. In addition to this, do not be exposed to other people’s second hand smoke as that is just as detrimental
• Eat more magnesium rich foods – try to eat more foods which are rich in magnesium up to the recommended daily intake, as this mineral helps to relax smooth muscles in the whole body and relaxes the whole body. Some examples of foods rich in magnesium are: almonds, chickpeas, pumpkin seeds, any type of dried beans, spinach, salmon
• Lavender oil – a very helpful way to help you wind down and relax is to use certified organic lavender oil (that way you know it’s the real thing and it will be more potent in its effect). You can add 3-5 drops into a warm bath and soak in it for about 20 minutes, or add a few drops of the lavender to an aromatherapy vaporiser for a few hours in the evening before you go to sleep, or you can even use a room spritzer with certified organic lavender oil (usually mixed with water)
• Less caffeine – any caffeine you drink/eat will stimulate your brain and may impact on your ability to sleep properly. The more caffeine the less sleep is the general rule. Even if you think you are immune to the effects of caffeine, you are not. Don’t drink any coffee or strong tea after dinner and limit your caffeine intake during the day. Other sources of caffeine are: cola, energy drinks, some soft drinks and chocolate
• Maintain stable blood sugar levels – ensure you have enough food throughout the day to keep your blood sugar levels stable. This can be achieved by eating 5-6 smaller meals and have a small snack about an hour before bedtime (fruit and/or nuts or some yoghurt). This will help ensure your blood glucose levels are maintained while you sleep
• Psychological counselling – if there is a stressful situation which is the underlying cause of the insomnia, you may need to get a referral to a counsellor or psychologist who can help you work through the issues that are causing your symptoms
• Regular exercise – it is really beneficial for you to engage in regular exercise every day between 30-60 minutes. Alternate your workouts between cardiovascular exercises that elevates heart rate to 80% of maximum rate and resistance training (such as pilates, yoga, weight training) to help condition every part of the body, increase circulation, use up your energy, tire you out and help you sleep better. Just don’t exercise near your bedtime. Try to complete all your exercise before dinner
• Relaxation – it would be very beneficial if you use some form of relaxation therapy every day, to help train your mind to relax and be able to go to sleep. It may be useful to try meditation, yoga or tai chi. There are a number of relaxation CD’s that you purchase or you can join a class with other people and have the social interaction too, just ensure you find a reputable one
• Vitamin B complex – the B vitamins are all essential for a healthy nervous system and three of the B vitamins are especially needed to help reduce the effects of insomnia: folic acid and vitamin B3 (niacin) are both needed to help reduce symptoms of insomnia associated with restless legs syndrome and vitamin B3 (pyridoxine) is needed as it is the precursor to tryptophan, the amino acid needed to make serotonin and melatonin.

Talk to your doctor before trying any vitamins, minerals or herbs to make sure it is safe for you to do so.

Caring for someone with insomnia

Partner

If you have a partner with insomnia, there are some useful strategies that you can use to assist them:

• Avoid alcohol after dinner – it will be really beneficial for your partner’s ability to sleep (and not keep you awake too) to not have any alcohol after dinner, as this is not recommended. In addition to this, it is preferable for your partner to keep alcohol consumption to a minimum and your support in this would be helpful
• Don’t smoke inside – you need to make sure you do not smoke inside the house as your second-hand smoke can stimulate your partner’s brain to prevent them falling asleep even more. You also need to encourage your partner not to smoke if they do so
• Encourage exercise – encourage your partner to engage in more exercise, every day, as this is a very helpful strategy for using up energy and will help your partner feel more tired and less likely to have insomnia symptoms. Just make sure your partner takes it slowly at first
• Support – it is really important that your partner has your care, understanding and support as it is really difficult for anyone to exist without adequate sleep, day after day. It is totally exhausting. Ask your partner what you can do to make their life easier and less stressful (if possible)

Friends

If you have a friend with insomnia, there are some useful strategies that you can use to assist them:

• Avoid alcohol – try to ensure your social interactions with your friend are in venues which alcohol is not the focus, because excessive alcohol intake can worsen your friend’s symptoms of insomnia
• Don’t smoke near your friend – you need to make sure you do not smoke near your friend, as your second-hand smoke can stimulate your friend’s brain to prevent them falling asleep even more
• Support – it is really important tat your friend has your support and understanding, as it is really difficult for anyone to exist without adequate sleep, day after day. When you can (and if you can), ask your friend what you can do to help. Even just being there, being supportive and listening to your friend is helpful

Parents

If you have a child with insomnia, there are some useful strategies that you can use to assist them:

• Chamomile tea – a really simple and effective way you can help to relax your child is to provide them a cup of diluted (1/2 cup of the chamomile tea with water added). Use the real flowers and make a proper tea as this has more potent effects. A cup about an hour before your child’s bedtime will be beneficial. Chamomile has a relaxing, soothing effect on the whole body. Just make sure your child is not allergic to ragweed, because they will also be allergic to chamomile too
• Don’t smoke inside – you need to make sure you do not smoke inside the house as your second-hand smoke can over-stimulate your child’s brain to prevent them falling asleep even more. As of 1 January 2010, there are laws in certain parts of Australia which prevent anyone from smoking inside a car if there are any children present because it is so detrimental to the child’s health on so many levels
• Encourage exercise – make sure your child is engaging in adequate forms and amounts of exercise for their age, as this helps them burn off excess energy which will make them tired and more likely to sleep properly
• Limit sugar and processed foods – try to ensure your child eats limited amounts of sugar and processed foods as these foods over-stimulate a child and cause spikes in their blood glucose levels, which means they are not stabilised
• Limit television/computers before bed – try to ensure your child is engaged in non-television and non-computer or computer game activities before bed as these activities can over-stimulate the child’s mind and make it difficult to relax and sleep properly
• No artificial additives – keep your child’s food as additive free as possible to prevent over-stimulation of their mind and an inability to relax, calm down and sleep. Do not buy anything with artificial colours, preservatives or flavours as studies show they can be responsible for ADHD-like effects
• Unprocessed foods – make sure (unless you are otherwise advised by your doctor) to provide lots of fresh, unprocessed foods in their natural form to your child for every meal and snack. You need to ensure your child is getting an adequate supply of leafy green vegetables, fruit, nuts, seeds, legumes, wholegrains and good quality protein, such as eggs, milk, yoghurt, cheese, lean chicken and fish (as long as your child is not allergic or intolerant to any of these foods). These foods are rich in nutrients and will provide the nutrients necessary to help your child function better

References

• Altena E, Van Der Werf YD, Sanz-Arigita EJ, Voorn TA, Rombouts SA, Kuijer JP, Van Someren EJ. Prefrontal hypoactivation and recovery in insomnia. Sleep. 2008 Sep 1;31(9):1271-6
• Altena E, Van Der Werf YD, Strijers RL, Van Someren EJ. Sleep loss affects vigilance: effects of chronic insomnia and sleep therapy. J Sleep Res. 2008 Sep;17(3):335-43
• Basta M, Chrousos GP, Vela-Bueno A, Vgontzas AN. Chronic Insomnia and Stress System. Sleep Med Clin. 2007 Jun;2(2):279-291. Accessed 19 January 2010
• Brown L. The Insomniac’s Best Friend: How to Ge a Better Night’s Sleep. Thorsons, 2004
• Deschenes CL, McCurry SM. Current treatments for sleep disturbances in individuals with dementia. Curr Psychiatry Rep. 2009 Feb;11(1):20-6
• Doghramji K. Melatonin and its receptors: a new class of sleep-promoting agents. J Clin Sleep Med. 2007 Aug 15;3(5 Suppl):S17-23
• Gooneratne NS. Complementary and alternative medicine for sleep disturbances in older adults
• . Clin Geriatr Med. 2008 Feb;24(1):121-38, viii
• Hilty D, Young JS, Bourgeois JA, Klein S, Hardin KA. Algorithms for the assessment and management of insomnia in primary care. Patient Prefer Adherence. 2009 Nov 3;3:9-20
• Irwin MR, Olmstead R, Motivala SJ. Improving sleep quality in older adults with moderate sleep complaints: A randomized controlled trial of Tai Chi Chih. Sleep. 2008 Jul 1;31(7):1001-8
• Kalman DS, Feldman S, Feldman R, Schwartz HI, Krieger DR, Garrison R. Effect of a proprietary Magnolia and Phellodendron extract on stress levels in healthy women: a pilot, double-blind, placebo-controlled clinical trial. Nutr J. 2008 Apr 21;7:11
• Koetter U, Schrader E, Käufeler R, Brattström A. A randomized, double blind, placebo-controlled, prospective clinical study to demonstrate clinical efficacy of a fixed valerian hops extract combination (Ze 91019) in patients suffering from non-organic sleep disorder. Phytother Res. 2007 Sep;21(9):847-51
• Krystal AD, Erman M, Zammit GK, Soubrane C, Roth T; ZOLONG Study Group. Long-term efficacy and safety of zolpidem extended-release 12.5 mg, administered 3 to 7 nights per week for 24 weeks, in patients with chronic primary insomnia: a 6-month, randomized, double-blind, placebo-controlled, parallel-group, multicenter study. Sleep. 2008 Jan 1;31(1):79-90
• Manber R, Edinger JD, Gress JL, San Pedro-Salcedo MG, Kuo TF, Kalista T. Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep. 2008 Apr 1;31(4):489-95
• McKinstry B, Wilson P, Espie C. Non-pharmacological management of chronic insomnia in primary care. Br J Gen Pract. 2008 Feb;58(547):79-80. Accessed 19 January 2010
• Meolie AL, Rosen C, Kristo D, Kohrman M, Gooneratne N, Aguillard RN, Fayle R, Troell R, Townsend D, Claman D, Hoban T, Mahowald M; Clinical Practice Review Committee; American Academy of Sleep Medicine. Oral nonprescription treatment for insomnia: an evaluation of products with limited evidence. J Clin Sleep Med. 2005 Apr 15;1(2):173-87
• Morin CM, Koetter U, Bastien C, Ware JC, Wooten V. Valerian-hops combination and diphenhydramine for treating insomnia: a randomized placebo-controlled clinical trial. Sleep. 2005 Nov 1;28(11):1465-71
• Murray M, Pizzorno J. Encyclopedia of Natural Medicine, 2nd Edition. Prima Publishing USA, 2000
• Osiecki H. The Physicans Handbook of Clininical Nutrition, 6th Edition. Bioconcepts Publishing QLD, 2001
• Richardson GS, Zammit G, Wang-Weigand S, Zhang J. Safety and subjective sleep effects of ramelteon administration in adults and older adults with chronic primary insomnia: a 1-year, open-label study. J Clin Psychiatry. 2009 Mar 10. pii: ej07m03834
• Roth T, Hull SG, Lankford DA, Rosenberg R, Scharf MB; Intermezzo Study Group. Low-dose sublingual zolpidem tartrate is associated with dose-related improvement in sleep onset and duration in insomnia characterized by middle-of-the-night (MOTN) awakenings. Sleep. 2008 Sep 1;31(9):1277-84
• Roth T, Zammit GK, Scharf MB, Farber R. Efficacy and safety of as-needed, post bedtime dosing with indiplon in insomnia patients with chronic difficulty maintaining sleep. Sleep. 2007 Dec 1;30(12):1731-8
• Sadeghniiat-Haghighi K, Aminian O, Pouryaghoub G, Yazdi Z. Efficacy and hypnotic effects of melatonin in shift-work nurses: double-blind, placebo-controlled crossover trial. J Circadian Rhythms. 2008 Oct 29;6:10
• Sarris J. Herbal medicines in the treatment of psychiatric disorders: a systematic review. Phytother Res. 2007 Aug;21(8):703-16
• Sobanski E, Schredl M, Kettler N, Alm B. Sleep in adults with attention deficit hyperactivity disorder (ADHD) before and during treatment with methylphenidate: a controlled polysomnographic study. Sleep. 2008 Mar 1;31(3):375-81
• Tratter R, Jones A. Better Health Through Natural Healing: How to Get Well Without Drugs or Surgery, 2nd Edition. McGraw Hill, 2001
• Wilens TE, Klint T, Adler L, West S, Wesnes K, Graff O, Mikkelsen B. A randomized controlled trial of a novel mixed monoamine reuptake inhibitor in adults with ADHD. Behav Brain Funct. 2008 Jun 13;4:24
• Zammit G, Erman M, Wang-Weigand S, Sainati S, Zhang J, Roth T. Evaluation of the efficacy and safety of ramelteon in subjects with chronic insomnia. J Clin Sleep Med. 2007 Aug 15;3(5):495-504
• Zavesicka L, Brunovsky M, Matousek M, Sos P. Discontinuation of hypnotics during cognitive behavioural therapy for insomnia. BMC Psychiatry. 2008 Sep 18;8:80

Last reviewed and updated: 8 May 2025