8 Myths and Facts About Insomnia

Fact: You may have insomnia if you have difficulty falling or staying asleep, including waking up before your alarm.

Insomnia means that you have trouble falling or staying asleep or experience poor sleep quality.

If you experience these sleep difficulties at least 3 nights per week, a doctor may be able to diagnose you with acute insomnia. If the insomnia occurs 3 nights per week or more and lasts for 3 months, you may have chronic insomnia.

Fact: Sleeping later on weekends won’t make up for the sleep you missed during the week.

If you consistently lose sleep each night, you accumulate sleep debt. This is the total amount of lost sleep over time.

While you may feel better if you sleep longer on weekends, this can worsen insomnia. Oversleeping on certain days can disrupt your sleep-wake cycle.

Various factors influence your body’s sleep-wake cycle. These include sleep-wake homeostasis, which keeps track of how much sleep you need, and your body’s circadian rhythm, which sets the times of day you’re most likely to feel sleepy.

A 2019 research study found that weekend sleepers were unable to make up their sleep debt. They also had signs of lower insulin sensitivity than those who got adequate rest daily.

Sticking to a regular sleep schedule may improve insomnia. That means going to bed at the same time each night and waking up at the same time each morning, even on weekends.

Fact: There are a number of ways to treat and manage insomnia.

You can take some steps to manage insomnia at home. If you live with chronic insomnia, you can also talk with a doctor or sleep specialist about cognitive behavioral therapy or medication. If you have other conditions that contribute to insomnia, such as anxiety or sleep apnea, treating those conditions may also improve your insomnia.

Self-care strategies for better sleep

Changes to your lifestyle and sleep environment can help with insomnia. Some strategies include:

• maintaining a regular sleep schedule, even on weekends
• avoiding long naps, especially in the late afternoon and evening
• avoiding stimulants like caffeine, especially after lunch
• avoiding stimulants nicotine, especially before bed
• avoiding alcohol before bedtime
• eating regular meals and avoiding late-night snacking
• getting regular exercise during the day, about 5-6 hours before bedtime
• keeping electronic devices out of the bedroom
• making your bedroom dark and cool

You can also speak with a doctor about medications that may help.

Cognitive behavioral therapy for insomnia (CBT-I)

CBT-I is a form of therapy to help you learn techniques for better sleep. The process takes several weeks, during which you work with a licensed therapist.

Aspects of CBT-I often include:

• learning to have positive feelings about sleep
• learning that staying in bed and not sleeping can worsen insomnia
• reducing nervousness about sleep
• learning good sleep habits
• practicing relaxation therapy
• learning to maintain a regular sleep-wake cycle
• focusing on specific periods of quality sleep (sleep restriction)

CBT-I is often the first-line treatment for insomnia. A 2021 meta-analysis found that CBT-I works at least in part by changing a person’s beliefs about sleep.

Fact: Each class of medications for insomnia works in a different way to help you sleep.

There are several options for insomnia medications. Some help you fall asleep, while others help you stay asleep. Some do both.

Doctors take many things into account when recommending a medication, including your age and sex, safety, side effects, interactions with other drugs, and length of use. Properties of the medications are also considered, such as how quickly they start to work and how long they work.

Food and Drug Administration (FDA)-approved prescription medications for insomnia in current use include:

• Benzodiazepines: These are medications that promote calm, relaxation, and reduced anxiety. This can make it easier for you to sleep. Benzodiazepines are typically only prescribed for short-term use.
• Z–drugs: These medications work in a similar way to benzodiazepines. They make you feel drowsy by slowing brain activity. According to the FDA, they shouldn’t be used by people with complex sleep behaviors like sleepwalking. The medications can cause complex sleep behaviors.
• Melatonin receptor agonists: These prescription medications, such as ramelteon and tasimelteon, affect brain chemicals that regulate the sleep-wake cycle. They help reset your biological clock. Although many people also take melatonin for sleep, this is considered a dietary supplement and isn’t regulated by the FDA.
• Orexin receptor antagonists: These medications block orexin, a chemical in the brain that helps keep you awake.
• Antidepressants: Doxepin at a very low dose has been approved to treat insomnia. Doctors sometimes prescribe antidepressants if you have depression and associated insomnia.

You may also consider an over-the-counter (OTC) sleep aid. Many of these are antihistamines that make you drowsy. Some antihistamines may cause restlessness or restless legs syndrome.

It’s best to talk with a doctor before taking any OTC medications or supplements for insomnia.

Fact: Lying in bed awake can increase anxious feelings about sleep.

It can also train your brain to associate the bedroom with those negative feelings, which may worsen insomnia.

As much as possible, consider reserving your bedroom for sleep and sex. If your bedroom becomes a workspace, your brain can learn to associate the bed with your job. When you want to rest, it may be harder to turn off work-related thoughts.

Experts recommend not getting in bed until you’re ready to fall asleep. If you can’t fall asleep after about 20 minutes, get out of bed. Try doing a relaxing activity like reading something relaxing or boring under a dimly lit light (as long as it’s not on an electronic device), gentle yoga, or listening to music until you feel sleepy.

Fact: Sleep quality is also important for your health.

It’s recommended for adults to get 7 or more hours of sleep per night. But you can still wake up not feeling rested.

Many factors can reduce sleep quality. Health conditions such as sleep apnea can cause changes in breathing and prevent deep sleep.

Practicing good sleep hygiene and paying attention to your overall health can lead to better quality sleep. Your doctor is a good source of information about managing conditions such as sleep apnea or chronic pain that may affect your sleep.

Fact: Drinking alcohol in the evenings can negatively affect your sleep quality.

Drinking alcohol before bed may make you feel sleepy, but it only induces light sleep. You may be more likely to get up during the night and not sleep as efficiently.

To have a fulfilling night of sleep, you need to experience REM and non-REM sleep cycles. Drinking before bed can make it harder to stay in REM sleep and deep sleep for the time your body needs.

Fact: Various health conditions and behaviors can also cause insomnia.

While insomnia may occur due to mental health conditions, such as anxiety and post-traumatic stress disorder, it can also occur due to other health conditions and medications. These can include:

• sleep apnea
• acid reflux
• pregnancy
• caffeine
• stress
• shift work
• getting too little physical activity during the day

A doctor can recommend ways to address these causes and improve your sleep.

Insomnia is a common but treatable condition. By learning more about insomnia, you can better understand the tools at your disposal to get better rest. This may mean practicing good sleep hygiene, participating in CBT-I, or talking with a doctor about medications.