Sleep and Insomnia Insomnia is the inability to fall asleep or stay asleep. According to the National Sleep Foundation, the condition affects more than 70 million Americans. It's more common in women and those over 60. Insomnia can be transient (occasional), acute (lasting one to several nights at a time) or chronic (lasting longer than a month). Chronic insomnia affects 10 to 15 percent of adults.

Insomnia can be caused by many different factors. Caffeine, alcohol, nicotine and some ingredients in medications can interfere with the ability to fall asleep or stay asleep. Shift workers often have a hard time adapting to changing sleep routines. Noise and high levels of light in the bedroom can also interfere with sleep. Insomnia can also be caused by depression, stress, certain medical conditions and pain. Sometimes the cause of insomnia can't be found.

Lack of quality sleep has important consequences for daytime behaviors. Patients may feel excessively tired during the day and have a hard time concentrating or staying focused on a task. They may be irritable or depressed. Daytime sleepiness also increases the risk of accidents.

Treating Insomnia: Sleeping Pills Many people with insomnia turn to sleeping pills to help them get a good night's sleep. In 2004, Americans spent $2.1 billion on sleeping pills. Nalaka Gooneratne, M.D., a Sleep Disorders Specialist at the University of Pennsylvania Hospital, says the armada of sleeping pills today is different from those used in the past. Older medications (like Halcion®) were in a class called benzodiazepines. They switch on a receptor in the brain which eventually triggers the sleep response. Although they were deemed safer than some of the stronger narcotics used long ago, patients still developed a drug dependence. Eventually, higher and higher doses were needed to maintain the effect. The medications also tend to stay in the body for a long time and can cause problems with daytime alertness.

Newer medications, like Ambien®, Sonata®, Lunesta™ and Roserem™, activate a very specific area of the benzodiazepine receptor in the brain. These drugs tend to stay in the body for a much shorter period of time, so they are less likely to cause problems with daytime alertness. The newer medications are also less addictive than some of the older drugs. Studies show Ambien, Sonata and Lunesta are safe for short term use. Long-term use has not been studied.

Some people prefer to use over-the-counter sleep aids. These drugs often contain antihistamines to induce drowsiness. However, the drugs can have side effects, like dry mouth, dry eyes and confusion.

Experts warn sleeping pills are not a panacea for insomnia. They don't cure the causes of insomnia and can be unsafe for some people. Patients who have sleep problems should discuss the symptoms with a healthcare provider. In some cases, a medical examination or sleep study may be necessary to determine the cause of the problem or rule out other medical conditions which may be contributing to insomnia.

Treating Insomnia: Other Therapies Often a combination of treatments is the best therapy for people with insomnia. Behavioral therapy may involve cognitive therapy (learning to develop positive thoughts about sleep), stimulus control therapy (developing a better sleep environment) and sleep restriction (limiting time in bed).

The National Sleep Foundation and Better Sleep Council offers some tips on getting a good night's sleep:

Maintain a consistent schedule for going to bed and waking (including weekends). Avoid napping during the day.

Use the bedroom only for sleeping and sex. Avoid non-sleep activities in the bedroom, like reading, watching television or working.

Create a sleep-friendly bedroom that is dark, quiet and cool. Use a comfortable mattress and pillow.

Limit food and alcohol intake before bedtime. Also avoid nicotine and caffeine.

Exercise regularly. Try to complete workouts three hours before bedtime to give time for the body to unwind.

If you find you can't fall asleep, don't stay in bed. Get up and go to another room for about 20 minutes.

If you have any questions about sleeping pills or sleep problems, talk to your healthcare provider.

For information and tips on dealing with insomnia: American Insomnia Association, http://www.americaninsomniaassociation.org The Better Sleep Council, http://www.bettersleep.org National Heart, Lung and Blood Institute, http://www.nhlbi.nih.gov National Institute of Neurological Disorders and Stroke, http://www.ninds.nih.gov National Sleep Foundation, http://www.sleepfoundation.org