All day you‘ve been feeling irritable, fatigued, and had trouble focusing. 

But when it comes time for bed, you feel anxious, and pressured. 

Why?

Because it’s been ages since you had a good night’s sleep.

Trouble sleeping is one of the most common medical complaints in America, with up to a third of Americans suffering from insomnia at some point in their lives. A normal adult generally needs seven to eight hours of sleep a night. When you can’t sleep, you feel like your energy is being sapped. This, in turn, affects nearly every aspect of your life. If you do not get enough sleep, it can affect you physically and mentally. The risks of high blood pressure, diabetes, and heart disease can all increase due to insomnia.

There are many reasons insomnia may occur. Stress is a particular culprit, as a stressed brain has trouble sleeping peacefully. Anxiety and depression can also result in sleeplessness.

Certain medications can cause insomnia including corticosteroids, blood pressure medications, heart medications, and allergy medicine. Caffeine, found in coffee, tea, and some soft drinks, is a stimulant that can keep you awake. Tobacco contains nicotine that causes sleeplessness. Alcohol may initially cause drowsiness but it later prevents deep sleep.

In addition, certain medical conditions may lead to insomnia including diabetes, lung disease, arthritis, cancer, congestive heart failure, overactive thyroid, gastroesophageal reflux disease, Alzheimer’s disease, and Parkinson’s disease.  

To confirm your insomnia, your health care provider may ask questions about your lifestyle, sleeping habits, smoking status, and alcohol and caffeine intake. Providers will also ask for a list of any medications you are taking, ask you if you are facing any stressful life situations, and take a medical history.

Another method of diagnosis may be a blood test to check for thyroid function or other underlying disease. You may have to sleep at a sleep center for a night or two, where a study of sleep known as a “polysomnogram” (PSG) is conducted. The study records various activities of your body during sleep: heartbeat, breathing, body and eye movement, and brain waves.

You may also be asked to maintain a “sleep diary,” in which you will record what time you go to bed, the duration of your sleep, the number of times you wake up during the night, and what time you get up in the morning. These records will help to better understand your sleep patterns.

Insomnia is primarily treated by identifying the underlying source of stress. You may also be told to improve your sleeping habits, like going to bed every night at the same time.

Relaxation techniques are another treatment that may be prescribed such as deep breathing techniques and muscle relaxation exercises to help reduce anxiety at bedtime. You may also try cognitive behavior therapy, in which you learn to replace anxiety about sleeplessness with positive thoughts about sleep.

Some people benefit from a therapy called “stimulus control,” where they are taught to limit their time in bed being awake and to associate the bed and bedroom only with sleep.

Sleep restriction is another treatment. It forces a partial deprivation of sleep in order to make you so tired that you can go to sleep easily the next night. 

Finally, there are many types of medications that are prescribed for insomnia. Over-the-counter medications commonly include diphenhydramine. Forms of antidepressants and anti-anxiety medications are often prescribed to aide sleep, and there are newer sleep-inducing pills including eszopiclone, zolpidem, ramelteon, and zaleplon. All medications should be taken only under your health care provider’s supervision.

To improve your chances of a good night’s sleep, avoid alcohol, tobacco, decongestants, coffee, tea, chocolate, and caffeinated soft drinks. Get aerobic exercise, but not too close to the time that you are going to sleep.

Try to reduce your stress, possibly by practicing stress-relieving techniques like deep breathing, yoga, or meditation. Drinking a glass of warm milk or eating a light snack like cheese crackers before going to bed can help you get to sleep better at night, as can avoiding an afternoon nap.