The Centers for Disease Control (CDC) recommends all adults receive at least seven hours of sleep per night. Insomnia is a common sleep disorder with difficulty either falling or maintaining sleep. It is estimated nearly 30% of all adults have insomnia. There are two types of insomnia, short- term insomnia and more long-term insomnia. Having a few sleepless nights may be due to life stressors, but longer-term problems may indicate that something else is going on. Long-term insomnia is usually classified as three months or longer with problems occurring three times a week. Insomnia has many causes including medications such as steroids and stimulants and also age because as we age our sleep cycles tend to become shorter. Some common insomnia symptoms are daytime sleepiness, significant fatigue at bedtime, and inconsistent bedtimes.  Insomnia can be treated through following proper sleep hygiene, and also with medications and behavioral therapy. Sleep hygiene is the term used to describe a set of behaviors that improve and maintain sleep.

There are quite a few actions that can be taken to improve sleep. First, it is important to keep a regular sleep schedule to prevent changes in circadian rhythm. A key factor we also tend to forget is artificial light from smartphones, which should be avoided at least two hours before bedtime. Caffeinated beverages should be avoided after lunch. In addition, stimulants such as exercising, nicotine, and alcohol should be avoided at least four hours before sleep. Another important step is to make your sleeping environment more conducive to sleep with less distractions, more dim lights and reduced background noise. Also, keeping a sleep diary to document when you try to sleep, and how long you sleep can be helpful.

In addition to proper sleep hygiene, insomnia can also be treated with medications and behavioral therapy. Medications for insomnia are often targeted towards either assisting with falling asleep or maintaining asleep. Medications to help fall asleep include short-acting medications while medications for staying asleep tend to be long-acting. Some of the popular choices are often melatonin and non-benzodiazepines including zaleplon and zolpidem (Ambien).  Benzodiazepines are not preferred due to serious side effects and increased risk of sedation. Although not indicated initially, anti-depressants and anti-histamines can also be beneficial.

However, medications may have potential side effects, so risks and benefits must always be considered. Behavioral therapy, on the other hand, tends to pose less side effects. There are many types of behavioral therapies including relaxation techniques and stimulus control. Relaxation techniques often include learning how to relax different sets of muscles progressively in a head-to-toe sequence. Stimulus control is based on the concept of going to bed only when you are ready to sleep and to avoid other activities like reading or television while in bed. 

Many of the tips outlined above are places to start helping with sleepless nights. If this sounds like something happening to you, hopefully the steps outlined above may be able to help you. If you are still having problems with sleeping despite these interventions, please see your medical doctor as there may be other underlying problems contributing.   

Dr. Philip T. Sobash (left) is a second-year resident physician at the White River Medical Center. He completed his medical training at the Medical University of South Carolina in Charleston, SC. When not working he enjoys spending time with his black lab Dakota. 

Dr. Krishna Vedala is a third-year resident physician at the White River Medical Center, specializing in Internal Medicine. He is from Oklahoma and received his MD and Masters in Public Health from the University of Oklahoma.