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Do I have insomnia?

January 08, 2019 | UCI Health
woman frustrated by insomnia

It’s a complaint primary care physicians hear from up to 70 percent of their adult patients: “Doc, I can’t sleep.”

Indeed, most of us have experienced lying awake at night contemplating the ceiling, willing sleep to come.

But it’s not considered insomnia, says UCI Health clinical psychologist Ariel B. Neikrug, PhD, unless we are having trouble:

  • Falling asleep
  • Staying asleep
  • Getting restorative sleep
  • Or being able to go back to sleep at least three times a week for three months

About 40 percent of people will experience occasional difficulty sleeping, says Neikrug, director of UCI Health Sleep Medicine Services.

But it’s a chronic problem for about 10 percent to 15 percent of the population. Insomnia also can affect a person’s ability to function during the daytime.

What causes insomnia?

What Neikrug calls the 3-P model explains the vexing problem of insomnia:

  • Insomniacs have predisposing genetic, physiological and psychological susceptibilities.
  • They then experience precipitating physiological, environment or psychological stressors that lead to trouble sleeping.
  • Next, perpetuating behavioral, psychological, environmental and physiological factors ultimately reinforce poor sleep patterns, which then results in chronic insomnia.

How to get back to sleep

“People who want to maintain healthy sleep patterns should practice good sleep hygiene,” Neikrug says. “Eat healthily, exercise, use alcohol in moderation, get good morning light and establish a regular sleep schedule.”

If possible, make the bedroom a place for sleep and sex only.

Once you are in bed, don’t:

  • Eat
  • Read
  • Watch TV
  • Use a computer or phone
  • Worry

When you still can't sleep

Unfortunately, sometimes those behaviors aren’t sufficient for people who suffer from insomnia disorder, Neikrug says.

“Some things patients do to try to get sleep actually work to push it further away. Chasing sleep can be like quicksand — the more you work at it, the deeper you sink into sleeplessness.”

After a sleepless night, he advises against spending more time in bed trying to fall asleep, or trying to catch up on sleep later in the day.

Therapy vs. sleep-inducing drugs

When sleeplessness persists, people often want to go straight to sleep-inducing drugs. But Neikrug says the No. 1 treatment for insomnia disorder is cognitive behavioral therapy.

Research shows that such therapy is unquestionably more effective and longer lasting than pharmacological treatments.

With these treatments, sleep experts help insomnia patients retrain the brain to associate the bed with sleep as well as, stabilize the sleep drive and circadian rhythms.

They also help reshape behavioral patterns of exercise, sleep and wake-up times and relate them to how a person goes about getting to sleep in order to achieve the desired outcome.

Sleep experts also conduct a benefit analysis to see what, if any, medicines or supplements may be helpful to the patient.

Getting help for insomnia

“If you have insomnia, we have very good treatments that can help you,” Neikrug says. “There are also online tools that some people find extremely beneficial.”

He cites two for cognitive behavioral therapy for insomnia that have demonstrated success in clinical trials: Sleepio and SHUTi. A free app from the U.S. Veteran’s Affairs Office can be found at CBT-iCoach.

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