Can't Fall Asleep: Can't Stay Asleep

Most people experience short-term insomnia at some time. Insomnia includes having trouble falling asleep, having trouble getting back to sleep, and waking up too early. Insomnia is more common in females, people with a history of depression, and in people older than 60.

Certain medications could keep you awake, particularly those that treat colds and allergies, heart disease, high blood pressure, and pain. And some of us practice bad habits that sabotage our sleep. This includes drinking alcohol and eating too close to bedtime, says James Walsh, Ph.D., president of the National Sleep Foundation and executive director of the Sleep Medicine and Research Center in Chesterfield, Mo.

"Alcohol works as a sedative, but it's also metabolized quickly--within two to three hours for moderate doses," Walsh says. "So you'll have a rebound effect. You may sleep soundly for the first couple of hours but then toss and turn later." And large meals in the two hours before bedtime could cause indigestion.

Short-term insomnia lasts only a few days and is usually not a cause for concern. For example, with jet lag, your internal body clock will readjust itself within several days. It's wise to read labels carefully and check with your doctor before using over-the-counter (OTC) sleep medicines for short-term insomnia. These drugs use sedating antihistamines to make you drowsy. Examples include Nytol (diphenhydramine) and Unisom Nighttime (doxylamine).

Insomnia is considered chronic when it lasts most nights for a few weeks or more. This longer-term condition deserves professional attention, says Tom Roth, Ph.D., head of the Sleep Disorders and Research Center at Henry Ford Hospital in Detroit. If you're unsure about whether you have chronic insomnia, Roth suggests looking at it like a headache. "If it goes on day after day and nothing you do makes it go away, then you should see a doctor," he says. "Ask yourself: Do you know the cause?"

Sometimes insomnia is caused by an underlying illness that needs treatment, such as a thyroid disorder, anxiety, depression, arthritis, or asthma. Georgi Moyer, 60, of Gaithersburg, Md., has had problems with insomnia for 38 years because of restless leg syndrome, a condition that causes tingling and crawling sensations in the legs. "It feels like ants crawling around inside your legs," says Moyer. "The only thing that helps is moving your legs. So I end up pacing the floor or kicking my husband in bed."

Moyer, who is a nurse, chooses to work nights because her problem is at its worst from about 8 p.m. until 3 or 4 in the morning. There are no drugs approved by the FDA for restless leg syndrome. Moyer says she has found some relief with drugs that treat symptoms of anxiety.

For others, the cause of insomnia may be a combination of factors and hard to pinpoint. Mike Shockey, Ph.D., 52, of Stafford, Va., has had a severe case of insomnia for 30 years. There have been times when he's slept only 15-20 hours during a week. A sleep test indicated that he hasn't been reaching the deepest--and most restorative--stages of sleep for years (see "The Stages of Sleep").

As a result, Shockey has felt both the mental fog and a physical slowdown from sleep deprivation. "Sometimes, my legs have felt like stone," says Shockey, who is a college professor and novelist. "I've had to hold onto the podium to stay up. Or I might drive somewhere and sit in my car for awhile because it's a huge effort to get across the parking lot." He says he's often jealous of his wife. "She falls asleep soon after she hits the pillow and I look over and think--it sure must be nice."

About 85 percent of people who have insomnia can be helped with a combination of behavioral therapy and medicine, says Marc Raphaelson, M.D., a neurologist with the Greater Washington Sleep Disorders Center in Rockville, Md.

Insomnia has traditionally been viewed as a symptom of an underlying medical or psychiatric illness, and drugs to treat insomnia are approved for short-term use only, until the primary condition can be treated.

Raphaelson says there is a gap in approved treatments because some people with this chronic condition may need long-term treatment. About 20 percent of people with chronic insomnia have a primary form of it, which means it's not associated with another medical condition.

"Most people I've seen are frightened of the medications for fear of addiction," Raphaelson says. "But there is little indication that people with insomnia abuse these medications."

As with any prescription medication, it's important to not increase doses or stop taking hypnotic drugs without consulting a doctor. No drugs that promote sleep should be taken with alcohol. And because of the sedating effects, caution must be used when getting out of bed, driving, or operating other machinery.