They may have trouble falling asleep, staying asleep, or both. Insomnia can start with the challenge of trying to sleep in a loud hotel room, struggling with arthritis or dealing with a death in the family. And the current culture is contributing to the problem with people always tethered to work, tapping into computers, cellphones and social media late into the day, plus there's the economic stress from worries about raising families and affording retirement, sleep experts say.
An estimated 70 million Americans suffer from sleep problems, such as insomnia, sleep apnea, restless leg syndrome, shift-work sleep disorder or narcolepsy, as well as sleep disturbances associated with many diseases, mental illnesses and addictions, according to the National Center on Sleep Disorders Research, part of the National Heart, Lung and Blood Institute.
"Insomnia is among the most common problems encountered in medicine," says David Neubauer, associate director of the Sleep Disorders Center at Johns Hopkins Medical School in Baltimore. "Sleeplessness at nighttime and poor concentration and fatigue during the daytime are terribly frustrating."
Among the most common causes of insomnia:
• Anxiety. Half of all those who have experienced insomnia blame the problem on stress and worry, according to the National Sleep Foundation. People often wake up feeling anxious. Sometimes they experience powerful anxiety attacks. These may be people who are hyper alert and hyper vigilant all of the time, Badr says.
Or people may have a bout of insomnia the night before you have a job interview or court date, he says.
• Conditioned mental arousal. When some people wake up, instead of going right back to sleep, they may quickly become anxious because they're not sleeping and worry that they'll feel terrible the following day, Neubauer says. "It becomes a self-fulfilling prophecy."
• Medications. Some drugs prescribed for depression, anxiety, hypertension, pain, asthma, and even colds and allergies can cause sleep problems for some individuals, Neubauer says. "When people come in complaining of poor sleep we always review their prescribed and over-the-counter medications."
• Depression. When people are experiencing a major episode of depression, it's common for them to have lighter sleep and to experience the early-morning awakenings and lots of difficulty falling asleep. "Patients with depression often have sleep-maintenance insomnia and may wake up at 3 in the morning, and can't get back to sleep," Badr says.
• Alcohol consumption. Alcohol may have a sedative effect for the first few hours of sleep, but it metabolizes quickly, causing a rebound effect that contributes to lighter, fragmented sleep or total wakefulness in the second part of the night. "Some people may drink two glasses of wine at night, fall asleep OK and then wake up three hours later," Badr says. "They start watching TV and it creates a vicious circle."
• Medical problems. These include arthritis, asthma, hot flashes and sleep disorders such as sleep apnea — frequent pauses in breathing that reduce the quality of sleep — and restless legs syndrome, an uncomfortable sensation in the legs that causes people to want to move them to get relief. Some describe it as a creepy, crawling feeling or like they have ants under their legs. These sleep disorders should be treated aggressively, sleep experts say.
Sleep doctors offer different suggestions to patients with insomnia, often specific to the cause of the problem. "We use sleeping pills and hypnotics strategically for a short period of time," Badr says.
He says the first thing he advises patients with insomnia is to make sure they are practicing good sleep hygiene. Among his suggestions:
• Keep a consistent wake-up time and bedtime.
• Don't watch TV in bed.
• Don't take naps during the day — that's stealing from that night's sleep.
• If you are unable to fall asleep or get back to sleep within 20 to 30 minutes, leave your bedroom to go to another room.
• Do low-key activities if you change rooms. Don't turn on the TV, do work, balance your checkbook or call your friends in Australia, Badr says. Instead, listen to quiet music, pray or meditate.