Insomnia by Nathan Kiskila, M.D.

Board Certification: Family Practice

Insomnia is the difficulty in falling asleep or staying asleep, which may result in daytime sleepiness, mood disturbance, irritability, or may cause difficulty with memory, attention, and concentration.  Sleep is cyclical, and our brains are used to a certain cycle of going to bed at the same time and waking up at the same time.  That’s why we experience jet lag or difficulty adjusting to a new sleep pattern when we travel outside our time zone or interrupt our normal sleep routine. Insomnia is treated by cognitive therapy and focuses on changing beliefs about sleep, sleep hygiene, sleep restriction, and stimulus control.

Cognitive therapy may help dismiss misconceptions about sleep such as the amount of sleep needed (8 hours for good health), causes of insomnia (chemical imbalance), or consequences from lack of sleep (having a bad day).

Sleep hygiene means keeping the bedroom cool and conductive to sleep. No TV, pets, or watching clocks in the bedroom. Don’t do the things that will impede slumber late in the day, such as consuming caffeine, using nicotine, or exercising later than 2-3 hours before bedtime.

Sleep restriction therapy is based upon the concept that more time you spend in bed, the less concentrated sleep you have.  In contrast, the less time in bed, the more consolidated sleep becomes.  Sleep restriction therapy decreases the amount of time spent in bed to increase the quality of sleep.

Stimulus control may help with insomnia by going to bed only when sleepy, going to another room if you cannot fall asleep within a 15-20 minute span, or reading quietly until you feel sleepy.

Some medicines may help with insomnia. Diphenhydramine (Benadryl) induces sleepiness, but will often causes drowsiness the next day.  Additionally, the effectiveness may ware off with prolonged use. Melatonin is a hormone that helps with sleep and is available over-the-counter.

Prescription strength medicines for insomnia should be discussed with your doctor to evaluate the risks and benefits before beginning treatment.

Although alcohol may help induce sleep, it shortens stages 3 and 4 of REM sleep (the restful part of sleep), and therefore causes insomnia in the long run, so it should be avoided.