Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

What causes insomnia?

Many people have insomnia, or trouble sleeping. People who have insomnia may not be able to fall asleep, may wake up during the night and not be able to fall back asleep or may wake up early in the morning.

Insomnia isn't a disease. It's the body's way of saying that something isn't right. Many things can cause insomnia - stress, too much caffeine, depression, changes in work shifts and pain from certain medical problems, such as from arthritis.

Is insomnia a serious problem?

30 - 40% of adults have some amount of insomnia in any given year. The rate of insomnia increases with age and is more common in women. Insomnia can become serious. It can make you feel less able to do your work and can make you feel tense and anxious. People who have insomnia may feel tired, depressed and irritable. They may also have trouble concentrating. Insomnia causing drowsiness may lead to motor vehicle accidents and other health risks or problems.

How much sleep do I need?

Most adults need about eight hours of sleep each night. You know you're getting enough sleep if you don't feel sleepy during the day. Some people may need only six hours of sleep a night. Others may need 10 hours.
Sleep patterns change with age. For example, older people may take naps during the day and sleep less at night. In general, how much sleep you need as an adult will probably stay about the same.

What can my doctor do to find out why I'm not sleeping?

Your family doctor may ask you and your bed partner (if possible) some questions to find out why you aren't sleeping. These questions may concern your sleep habits (such as when you go to bed and when you get up), the medicine you take, the amount of caffeine and alcohol you drink, and if you smoke or chew tobacco.

Your doctor may also ask about events in your life that may be upsetting you and making it hard for you to sleep. These questions may involve your work or your personal relationships.

Other questions may include how long you've been having insomnia, if you have any pain, such as from arthritis, and if you snore or jerk your legs while you sleep. If the cause of your insomnia is still not clear, your doctor may suggest that you fill out a sleep diary. The diary will help you keep track of when you go to bed, how long you lie in bed before falling asleep, how often you wake during the night, when you get up in the morning and how well you slept.

How is insomnia treated?

The treatment of insomnia can be simple. Often, once the problem that's causing the insomnia is found and taken care of, the insomnia goes away on its own. The key is to find out what's causing the insomnia so that it can be dealt with directly.
If your insomnia is related to stress, you may need to reduce your stress or learn how to manage it. If you're depressed, your family doctor may suggest counseling or give you medicine to treat the depression.

Will sleeping pills help?

Sleeping pills can help in some cases but can also make insomnia worse. They're only a temporary form of relief, not a cure. They're best used for only up to a few weeks. Regular use can lead to rebound insomnia. This occurs when a person quits taking sleeping pills and the insomnia comes back. So instead of being a cure, sleeping pills can become a cause of insomnia.

Drugs you buy without a prescription often don't work very well, and prescription drugs may change normal sleep patterns and may make you groggy the next day. Because sleeping pills don't work as well over time, higher and higher doses are needed. For these reasons, you shouldn't use sleeping pills for long periods.

Sleeping pills can also be unsafe if your insomnia is caused by certain health problems. Your doctor can tell you if sleeping pills would be helpful and safe for you.

What can I do to improve my sleep habits?

Here are some things you can do to help you sleep better:

	Go to bed and wake up at the same time every day, even if you didn't sleep enough during the night. This will help train your body to sleep at night.
	Do the same thing every night before going to bed to help your body get ready for sleep. You might try taking a warm bath, reading or doing some other relaxing activity every night before going to bed. Soon you'll connect these activities with sleeping, and they'll help make you sleepy.
	Use the bedroom for sleeping. Don't eat, talk on the phone or watch TV while you're in bed.
	Make sure your bedroom is quiet and dark. If noise is a problem, use a fan to mask the noise or use ear plugs. You may hang dark blinds over the windows or wear an eye mask if needed.
	Avoid trying to fall asleep. The more you try to fall asleep, the more trouble you may have. Don't watch the clock. Turn it away so you can't see the time.
	Lying in bed and not being able to fall asleep can be frustrating. If you're still awake after 30 minutes, get up and go to another room. Sit quietly for about 20 minutes before going back to bed. Do this as many times as you need to until you can fall asleep.

Tips to help you sleep

	Avoid or limit your use of caffeine (coffee, tea, colas, chocolate), decongestants, alcohol and tobacco.
	Exercise more often, but don't exercise within a few hours before going to bed.
	Don't start worrying about things when you go to bed. Set another time aside just for worrying. For example, you could spend 30 minutes after dinner writing down what's worrying you and what you can do about it.
	Try eating a light snack before going to bed, but don't eat too much right before bedtime. A glass of warm milk or cheese and crackers may be all you need.
	Don't nap during the day if naps seem to make your insomnia worse.

What is sleep apnea?

Some people feel tired not because they can't fall asleep but due to the way they sleep. Snoring and pauses in your breathing during your sleep with daytime tiredness can be caused by sleep apnea. Talk to your doctor if you think this might be a problem for you.

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Revised 2007 The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor. This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada: Dr Cathy MacLean, Halifax, NS (Scientific Editor) Dr C. Richard Fischer, Pickering, ON Dr Patrice Laplante, Fleurimont, QC Dr Richard Moffatt, Red Deer, AB Dr David Nunn, Kentville, NS Dr Cornelius Woelk, Winkler, MB The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages. This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.