Do You Have Trouble Sleeping?

If you or someone you love has trouble falling asleep and/or staying asleep, you are not alone. On any given night, 40% of Americans experience sleeping difficulties, and for 10-15% of adults, these difficulties develop into a chronic problem called insomnia. The good news is there is a highly effective, scientifically proven, and user-tested solution for insomnia, which we’ll review below.

What is insomnia?

Insomnia simply means difficulty falling asleep and/or difficulty staying asleep, with a daytime consequence (see below for a sample list). Just because you have a bad night of sleep doesn’t mean that you have insomnia. But at the same time, trouble sleeping can quickly take on a life of its own and warrant medical attention.

How do I know if I have insomnia?

If it takes you 30 or more minutes to fall asleep, or if you’re awake 30 or more minutes in the middle of the night, and these problems take place 3 or more nights per week for 1-3 months or longer, then you might have insomnia.

  • Do you have trouble falling asleep?
  • Do you have trouble staying asleep?
  • Do you wake up too early (without trying to?)

What are the consequences of insomnia?

Although scientists can’t say that insomnia causes all of these problems, we do know that insomnia is more common among medical patients (eg, heart disease, lung disease, diabetes, and cancer) and those suffering pain, depression, or anxiety.

To be classified as insomnia, a patient must experience a waking consequence. One of the most frustrating of these symptoms is reduced quality of life. Trouble sleeping can make each day seem like a chore. Common daytime symptoms of insomnia include:

  • Tiredness

  • Fatigue

  • Irritability

  • Difficulty paying attention

  • Poor concentration

  • Memory troubles

  • Mood disturbance

  • Daytime sleepiness

  • Low motivation

  • Lack of energy

  • Risk for accidents and errors

  • Headaches

  • Upset stomach

  • Difficulties at work, school, or with family

  • Concerns or worries about sleep

Who gets insomnia?

More than half a billion people worldwide suffer chronic insomnia. Women are roughly twice as likely to experience insomnia as are men, and insomnia is more common as we get older. In fact, over half of so-called “older adults” complain of sleep difficulties. As stated above, insomnia is also more common among medical patients and those experiencing pain, depression, anxiety, or other problems.

What causes insomnia?

Trouble sleeping can be caused or made worse by a large number of factors. Medications, illness, sleeping environment, poor sleeping habits, and stress can all lead to trouble sleeping. Even the ways that you think about sleep can cause insomnia. And the truth is that most cases of insomnia have multiple causes, so comprehensive evaluation is essential.

How is insomnia treated?

Unfortunately, most insomnia goes untreated. In fact, in the US, the most common approach to trouble sleeping is to self-medicate with alcohol, which has disastrous negative impact on sleep! And although many people also purchase over-the-counter agents in the hope of a good night’s slumber, the Food and Drug Administration has specifically advised against these non-prescription medications due to lack of effectiveness and risk of side effects.

The truth is that chronic insomnia is unlikely to go away on its own. In fact, because “practice makes permanent,” insomnia is likely to get worse over time, as the habit or poor sleep becomes more and more ingrained.

There are a range of prescription medications available to treat insomnia, each with its own cost-benefit ratio and risk profile. But, once medications are stopped, insomnia often returns. Further, all medications have side effects, and many patients are concerned about the infrequent but serious side effects of hypnotic sleep medication, including cognitive problems, increased risk for falls and accidents, infection, and even death.

The “gold standard” treatment for chronic insomnia is cognitive-behavioral treatment or cognitive-behavioral training, or CBT for short. To provide context, CBT is recommended as the first-line intervention for chronic insomnia by virtually every leading medical authority on the planet:

  • US National Institutes of Health
  • American Academy of Sleep Medicine
  • British Pharmacological Society
  • Journal of the American Medical 
  • New England Journal of Medicine
  • and many more expert sources

CBT is so strongly recommended for three simple reasons that CBT:

  1. No pill can teach your body how to sleep
  2. CBT has virtually no risks of side effects
  3. Unlike sleeping pills, the gains are maintained long after treatment concludes

Five studies have compared CBT to sleeping pills (including benzodiazepines, Ambien, Lunesta, and Sonata), and every single study found CBT to be equally effective to sleeping pills in the short-term, with gains significantly better maintained over time.

What is the Insomnia Program at the University of Maryland Medical Center?

The Insomnia Program at the University of Maryland employs the most effective treatments available to help patients fall asleep faster, stay asleep longer, get the rest they deserve… and feel better all day long. Our integrated care model is CBT-based but flexible to include medications when necessary. We also help patients discontinue sleep medications in a safe, structured way.

Insomnia treatment begins with a comprehensive evaluation to understand your personal sleep history and problems, and what is causing your trouble sleeping. Most insomnia treatment is delivered over 4-6 visits, jointly managed by MD and PhD sleep specialists, in our lovely Sleep Disorders Center space on the Midtown campus. Most insurances are accepted.