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HEALTH CONDITION

Insomnia

Insomnia is the medical term for having trouble sleeping. Most healthy adults need 7-8 hours of sleep each night to function properly. Insomnia can be a symptom of an underlying health condition or caused by stress, medications, poor sleep habits, or other factors. Insomnia can be short-term (acute insomnia) or long-lasting (chronic insomnia). Chronic insomnia is when sleep difficulties occur at least three nights a week for three months or longer.

A healthcare provider can diagnose insomnia. To learn more about insomnia and mental health services, you can visit One Medical's Mindset program.
Symptoms
The symptoms of insomnia include:
• Trouble falling asleep
• Waking up frequently during the night
• Waking up too early and being unable to fall back asleep
• Feeling tired and unrested even after a full night's sleep
Causes
There are many potential causes of insomnia, including:
• Stress, anxiety, depression or other mental health issues
• Medications or substances like caffeine, nicotine, alcohol
• Medical conditions like chronic pain, asthma, heartburn
• Poor sleep habits or an irregular sleep schedule
• Environmental factors like noise, light, or uncomfortable temperatures
• Insomnia during pregnancy is a common issue that many expectant mothers face
Treatment
Here are some tips and treatments for insomnia that can help you get better sleep:

Lifestyle Changes
• Use your bed only for sleeping and sex. Avoid eating, reading, or watching TV in bed.
• Establish a regular sleep schedule by going to bed and waking up at the same time each day, even on weekends. This helps regulate your body's sleep-wake cycle.
• Create a relaxing bedtime routine like taking a warm bath, reading a book, or practicing gentle stretches. Avoid screens for 2-3 hours before bedtime.
• Get regular exercise, but not too close to bedtime as it can be stimulating. Aim for morning sunlight exposure to help set your body's circadian rhythms.
• Aim for morning sunlight exposure to help set your body's circadian rhythms.
• Avoid caffeine, nicotine, and alcohol close to bedtime as they can interfere with sleep quality.
• Create a comfortable sleep environment. Keep your bedroom cool, dark, and quiet. Use comfortable bedding. Use blackout curtains or an eye mask to block out light, and consider using earplugs or a white noise machine to minimize disruptive sounds.
• Manage stress through relaxation techniques like meditation or deep breathing exercises.
• Don't use your bed for worrying. Get up and write down your thoughts, then revisit them in the morning.
• If you can't fall back asleep within 20-30 minutes, get out of bed and do a relaxing activity until you feel sleepy again.
Cognitive Behavioral Therapy for Insomnia (CBT-I):
CBT-I is a highly effective treatment that helps change thoughts and behaviors that perpetuate insomnia. It teaches strategies like sleep restriction, stimulus control, and relaxation techniques.

Medications:
If lifestyle changes and CBT-I are not effective, your doctor may recommend prescription sleep medications like zolpidem (Ambien), eszopiclone (Lunesta), or ramelteon (Rozerem) for short-term use. However, these carry risks of side effects and dependence, so they should be used cautiously and only as a temporary solution.

Natural Remedies:
Some people find relief with natural supplements like melatonin, valerian root, or chamomile tea. However, check with your doctor first, as supplements can interact with medications.
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Frequently asked questions

Why can't I sleep at night despite feeling tired?
There could be several reasons why you can't sleep at night despite feeling tired. Insomnia, or the inability to fall asleep or stay asleep, can be caused by various lifestyle factors, medical conditions, and environmental factors. Here are some common causes of insomnia that may be preventing you from getting a good night's sleep:
• Stress, anxiety, or worrying too much at bedtime can keep your mind racing and make it difficult to relax and fall asleep.
• Consuming caffeine (coffee, tea, sodas) too close to bedtime can act as a stimulant and disrupt your sleep.
• Alcohol consumption, while it may help you fall asleep initially, can lead to fragmented sleep and frequent awakenings later in the night.
• Certain medications, both prescription and over-the-counter, can interfere with sleep.
• Irregular sleep schedules or jet lag can disrupt your body's natural sleep-wake cycle.
• Uncomfortable sleeping environment, such as a room that is too hot, cold, bright, or noisy, can make it challenging to fall and stay asleep.
• Medical conditions like chronic pain, respiratory problems, or sleep disorders like sleep apnea can significantly impact your ability to sleep well.
Who is at risk for insomnia?
Certain groups pf people are more likely to experience insomnia. These include:
• Middle-aged and older adults. The amount of sleep you need does not change with age but physical problems can interfere with your sleep.
• Women are more likely than men to have insomnia.
• People with medical or psychiatric illnesses, including depression and anxiety.
• People who use certain medications , or who use tobacco products, alcohol, or caffeine.
How can insomnia affect me?
Lack of quality sleep can cause:
• Lack of energy or fatigue
• Lack of motivation or energy
• Moodiness, irritability, or anger
• Daytime sleepiness
• Anxiety, especially related to sleep
• Poor memory and concentration, which affects school or work performance
• Physical symptoms like headaches or upset stomach
How does pregnancy affect sleep patterns, and what can be done to manage pregnancy-related insomnia?
Pregnancy can significantly impact sleep patterns and lead to insomnia for many women. Here are some key points about pregnancy insomnia and tips to help manage it:

Causes of Pregnancy Insomnia:
• Hormonal changes
• Nausea and vomiting
• Frequent urination
• Discomfort from the growing belly
• Restless leg syndrome
• Anxiety or stress about the pregnancy.
Tips to Help Manage Insomnia During Pregnancy:
• Eat small, frequent meals to avoid discomfort from an empty or full stomach
• Avoid caffeine, spicy foods, and large meals close to bedtime
• Stay hydrated but limit fluids before bed to reduce bathroom trips
• Try relaxation techniques like prenatal yoga, meditation, or deep breathing
• Establish a calming bedtime routine
• Use extra pillows to get comfortable
• Avoid screen time before bed
• Get regular, gentle exercise like walking
• Consider safe herbal remedies like chamomile tea
• Ask your doctor about medication options if insomnia persists.
Insomnia is very common during pregnancy but can be managed through lifestyle adjustments and relaxation practices. Don't hesitate to discuss persistent sleep issues with your healthcare provider. Prioritizing rest is important for your health and your baby's development.
What are the potential side effects of insomnia medications?
Insomnia medications can have potential side effects that you should be aware of. These include:
• Confusion
• Dizziness
• Flushing of the skin
• Headache
• Irregular heartbeat
• Muscle spasms
• Nausea, vomiting, or diarrhea
• Rashes
• Shortness of breath
• Tremors.
If you experience any adverse reaction or medical emergency after taking an insomnia medication, it's crucial to call 911 or contact your prescriber immediately. Once your safety is assured, you can also report the adverse event to the FDA MedWatch by calling 1-800-FDA-1088 or visiting their website.

It's essential to be cautious and follow your healthcare provider's instructions when taking any medication, including those for insomnia. If you have concerns or experience side effects, don't hesitate to seek medical advice promptly.
How is insomnia diagnosed, and what tests or evaluations are involved?
Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or waking up too early and not being able to go back to sleep. The symptoms of insomnia include trouble sleeping, fatigue, difficulty concentrating, and irritability.

To diagnose insomnia, a doctor will typically do the following:
• Review your medical history and ask about your sleep patterns, behaviors, and any potential underlying conditions that may be causing the insomnia.
• Perform a physical exam to rule out any medical conditions that could be contributing to the sleep problems.
• Recommend keeping a sleep diary for 1-2 weeks to track your sleep patterns and habits.
• Order tests like a polysomnogram (sleep study) or actigraphy (wrist monitor that tracks movements) to evaluate your sleep cycles and patterns.
• Rule out other sleep disorders like sleep apnea, restless leg syndrome, or circadian rhythm disorders.
The diagnosis is usually based on the duration, severity, and impact of the insomnia symptoms on your daily functioning. Chronic insomnia is typically defined as having symptoms at least 3 nights per week for 3 months or longer.

It's important to get an evaluation to identify and treat any underlying causes of the insomnia. Making lifestyle changes, cognitive behavioral therapy, and sometimes medication can help manage insomnia symptoms.
How can COVID-19 or other illnesses contribute to sleep disturbances and insomnia?
COVID-19 and other illnesses can contribute to sleep disturbances and insomnia in several ways. Symptoms such as fever, cough, and body aches can make it difficult to sleep comfortably. Additionally, the stress and anxiety associated with being ill can lead to insomnia and trouble sleeping. Some medications used to treat COVID-19 or other illnesses may also cause insomnia as a side effect.

COVID-19 can have long-term effects on sleep even after recovery. Some people experience what is known as "COVID insomnia" or "long COVID insomnia," where they continue to have difficulty sleeping, fatigue, and other sleep disturbances for weeks or months after their initial illness. This may be due to the lingering effects of the virus on the body or the psychological impact of the illness.

It's important to prioritize good sleep habits and seek medical advice if you're experiencing persistent insomnia or sleep problems related to COVID-19 or other illnesses. Proper sleep is crucial for recovery and overall health.

If you or a loved one are at higher risk for severe COVID-19 illness and meet the eligibility criteria, you may want to consider Paxlovid, an antiviral medication authorized for emergency use by the FDA. You can learn more about Paxlovid and check your eligibility at this link.
What is the difference between insomnia and other sleep disorders, such as sleep apnea or restless leg syndrome?
Insomnia is the medical term for having trouble falling asleep, staying asleep (waking up a lot) or waking up too early.

Restless legs syndrome means a person has the urge to move his or her legs. This urge is hard to control or resist. Some people with this problem also have pain and tingling or itching in the legs. This problem can be very bothersome and can make it hard to sleep.

Sleep apnea is another distinct sleep disorder where breathing repeatedly stops and starts during sleep.
What non-pharmacological treatments or therapies can be used to manage insomnia?
Here are some non-pharmacological treatments and therapies that can help manage insomnia:
• Practice good sleep hygiene habits:
• Use your bed only for sleeping or sex, not for other activities like eating, reading or watching TV.
• Wake up and go to bed at the same time every day, even on weekends. Setting an alarm to go to bed can help.
• Avoid naps during the day.
• Get regular exercise, but avoid it 2-3 hours before bedtime.
• Limit exposure to screens from electronic devices for 2-3 hours before bed.
• Keep the bedroom cool, quiet, and dark.
• Establish a relaxing bedtime routine like taking a warm bath, gentle stretching, or listening to calming music.
• Try cognitive behavioral therapy for insomnia (CBT-I), which can help change thoughts and behaviors that interfere with sleep.
• Practice relaxation techniques like deep breathing, meditation, or progressive muscle relaxation before bed.
• If you can't fall asleep after 30 minutes, get out of bed and do a relaxing activity until you feel sleepy again.
• Avoid caffeine, nicotine, alcohol, and large meals close to bedtime as they can disrupt sleep.
• Manage stress and anxiety through exercise, mindfulness, or talking to a therapist, as these can contribute to insomnia.
What are the potential consequences or risks associated with chronic or untreated insomnia?
Chronic or untreated insomnia can have several negative consequences and risks. Some potential issues include:
• Fatigue and daytime sleepiness, which can impact work performance, productivity, and quality of life.
• Difficulty concentrating, focusing, and remembering things.
• Increased risk of accidents, especially for those operating vehicles or machinery when sleep deprived.
• Weakened immune system, making you more susceptible to illnesses.
• Increased risk of developing mental health issues like depression, anxiety, and substance abuse.
• Increased inflammation in the body, which is linked to chronic diseases like heart disease, diabetes, and stroke.
• Weight gain due to hormonal imbalances and increased appetite from lack of sleep.
It's important to address insomnia symptoms and identify the underlying cause, whether it's a mental health condition like anxiety or depression, a medical issue, or poor sleep habits. Seeking treatment from a healthcare provider can help manage insomnia and reduce these associated risks. Some treatment options may include cognitive behavioral therapy, medications, or lifestyle changes.

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