When to Call the Doctor

An occasional night of poor sleep isn’t uncommon for most of us. But if a lack of sleep is interfering with your ability to function during the day, it’s time to seek help, Dr. Wytrzes says.

“The most common complaint I hear from insomniacs is ‘I’m tired, but not sleepy,’ and that’s very different from people who have primary sleep disorders like sleep apnea,” Dr. Wytrzes says. “It’s not just a nighttime problem. It’s a 24/7 problem. Insomniacs are often no more able to sleep during the day than at night. As a result of sleep deprivation, life begins to fall apart.”

The first step in getting help is meeting with your doctor to discuss the potential causes of your insomnia. Are you nervous about a project at work? Do you scroll through your social media accounts on your cell phone before bed? Your doctor will work with you to determine the source of your sleep problem and help you develop a treatment plan. Using a sleep log to record your sleeping habits and patterns can help. Also try following this checklist for a better night’s sleep.

What's Keeping You Awake?

Insomnia can be caused by a wide range of factors. Lifestyle choices, including the use of some over-the-counter substances, may play a role. Some weight loss medications, antihistamine medications, asthma medications, and cold remedies have stimulants in them that can keep you awake.

“By far the most common reasons for acute insomnia are situational stress, anxiety or depression,” Dr. Wytrzes says. “These are things all of us experience at one time or another. How we handle these life challenges says a lot about whether insomnia starts or persists.”  

Irregular sleep and wake-up times, including abnormal work hours, may play a role in your inability to sleep. Shift workers, especially those with rotating shifts, often have difficulty settling into a regular sleep pattern.

Some physical and psychiatric illnesses may contribute to insomnia. Depression in particular may lead to early morning awakening. Menopause can cause insomnia, as can restless leg syndrome, gastroesophageal reflux and chronic pain.

Patients with sleep-related breathing abnormalities, particularly obstructive sleep apnea, may complain of difficulty staying asleep due to frequent nighttime awakenings from snoring or gasping.

While most people with acute insomnia are able to get help from their primary care doctor, those with chronic insomnia may need more extensive intervention. This might include referral to a sleep doctor, a psychiatrist or an internist.

How to Get Sleep

Some cases of insomnia can be corrected by changing your sleep habits. For example, going to bed at a consistent time every night and avoiding screens an hour before bedtime can help. (Learn more about good sleep habits.)

“My experience has been many insomniacs are aware of sleep hygiene and even tried a few things, but they only do so for a short time. They just don’t stick with it,” Dr. Wytrzes says. “If you haven’t slept well for months or years, changing things over a couple of nights won’t make a difference.”

In addition to extra clinical support, chronic insomniacs are encouraged to improve sleep hygiene, and not give up after a couple of nights if they don’t see instant improvement. It takes time to create new sleep habits, Dr. Wytrzes says.

Many of Dr. Wytrzes’s patients ask her about sleeping pills, hoping for a quick fix. Taking an occasional sleeping pill can be helpful for jet lag, shift work or times of acute stress, she says. However, for those who suffer from chronic insomnia, behavioral techniques and treatment of any underlying problems are much more likely to be successful long term.

What about melatonin supplements, which are designed to mimic the body’s natural sleep hormone? Dr. Wytrzes says over-the-counter melatonin supplements may be ineffective for many chronic insomniacs, but it can be helpful for some people if used properly.

“People expect melatonin to work the same way as a sleeping pill,” Dr. Wytrzes says. “But they take it wrong, right before bedtime. Melatonin works at the level of the ‘sleep clock’ so it typically it has to be taken two to three hours before going to sleep.”

The quality of the melatonin you buy is also an issue. Many supplements are unregulated by the U.S. Food and Drug Administration and may contain a lot of fillers and very little of the advertised supplement. So your 3 mg melatonin tablet could have trace amounts of melatonin, or no melatonin in it at all.

“The bottom line is that insomnia is the most common sleeping complaint, but also highly treatable,” Dr. Wytrzes says. “Sorting out the various factors at its root can be challenging, but there is almost always something that can be done to improve the quality and quantity of sleep.”