Arthur J. Spielman, PhD

How do you know if you have insomnia?

If you feel that your sleep is inadequate in some way, then you may have insomnia. There are also daytime consequences of insomnia such as fatigue and irritability. If on the occasions that you do sleep well your energy and mood improve and problems concentrating subside then this also suggests you have insomnia. Daytime sleepiness is sometimes a result of insomnia, but not a reliable indicator of insomnia.

If you think you have insomnia, what should you do about it?

If you think you have insomnia, try practicing good sleep hygiene. For example, wake up every day at the same time and don’t nap during the day. Avoid stimulants that may cause insomnia like coffee or tea. Prepare yourself for bed with a relaxing bedtime routine. Prevent insomnia by creating a safe, comfortable sleeping environment.

Behavioral sleep medicine experts, or insomnia experts, pay attention to the details of the problem which will suggest different causes and different treatments. You may only have trouble falling asleep, or you may have the kind of insomnia that’s related to stress, stimulating medications or some other kind of sleep problem (such as limb movements during sleep). The specifics of your sleep disturbance will suggest different approaches to the problem.

The underlying causes of insomnia can include sleep hygiene problems (varying the sleep schedule, for example), stress, psychological problems (such as depression or anxiety), circadian rhythm disturbances (such as an evening type person trying to adapt to an early morning work schedule), pain and discomfort, and ingestion of activating substances (such as certain medications and stimulants like coffee or tea).

If you have symptoms of insomnia, when should you talk to your physician about it?

The question answers itself. When you think the problem is serious enough, you should see your doctor. When sleep problems are impairing your mood or ability to function in any way, you should seek expert advice. You may not need help if these problems occur occasionally, or if you’re anticipating a major event in your life. But if these problems persist for a month or more, see your physician or behavioral sleep medicine expert.

What are the generally recommended methods of treatment?

Cognitive behavioral therapy techniques are usually the first ones recommended because they are effective for a wide variety of causes of insomnia. This approach involves a combination of techniques such as stimulus control instructions, sleep restriction therapy, and addressing the cognitive aspects of sleep problems such as the tendency to worry about insomnia and misconceptions about sleep.

Medications can be effective in many cases. There are many on the market that are safe and effective. Sleeping pills or sedating antidepressant medications vary in how fast they act and the duration of their action. Therefore, choosing the right medication, the dose and timing its administration will depend on the characteristics of the sleep problem.

There are circadian rhythm treatments such as exposure to bright light or the ingestion of melatonin, which reset the body clock to allow you to sleep better at night and function during the day.

For some people, the cause of insomnia is a mood disorder or problems in living, and they may find it helpful to seek psychotherapy where they can talk about these issues. There are psychiatric drugs that are effective in treating mood disorders and anxiety disorders.

The important thing to realize is that you don’t need to suffer from insomnia. There are effective treatments available. Addressing insomnia may take some effort, but it’s well worth it.

--Dr. Spielman is a professor in the Department of Psychology at The City College at the City University of New York. He is also author of "A Conceptual Framework of Insomnia for Primary Care Practitioners," which appears in NSF’s Sleep Medicine Alert Insomnia Series. To receive Sleep Medicine Alert, sign up as a Professional Member of the National Sleep Foundation by going to https://www.websciences.org/NSF/orderform_professionals.html

This article originally appeared in the Fall 2004 issue of sleepmatters.