What is it?

Insomnia is a sleep problem characterized by trouble falling or staying sleep or not feeling rested upon waking.

Risks and symptoms

Symptoms include: trouble falling or staying asleep, feeling tired during the day, forgetting things or having trouble thinking clearly, anxiety, irritability or depression, and lack of interest or energy.


Most patients do not require tests to diagnose insomnia. In some cases, people need special sleep tests, known as a polysomnography [link] or acitgraphy [link]. To improve insomnia, a patient should follow good sleep hygiene.

Good sleep hygiene consists of:

  • Enter bed at a uniform time every night (seven days a week) and keep a standard 
wake time.
  • Do not watch TV in bed.
  • Keep your room dark and quiet.
  • Adjust your thermostat to keep your bedroom cool.
  • Exercise daily to help reduce stress. However, avoid heavy exertion within two hours of bedtime.
  • Restrict caffeine intake after 2 PM each day.
  • Do not smoke after dinner or during the night.

Sleep Restriction

  • Limit the time you spend in bed.
  • Do not enter your bed until you are sleepy.
  • If you cannot fall asleep in 20 minutes or if you wake during the night and cannot fall asleep again within 20 minutes then rise from bed.
  • Leave the bedroom until you are tired enough to fall asleep easily.

Stimulus control

  • Spend enough time before you enter bed to clear your mind, make lists, and address problem issues.
  • Do not enter bed until these issues are resolved.
  • If you are in bed and your mind starts to race or you cannot clear your mind then you should leave the bedroom.
  • Do not re-enter bed until your mind is clear and you are relaxed.

Relaxation exercises

  • Consider using a “sound generator” to provide a low level of relaxing music or background sound.
  • Practice progressive muscle relaxation.
  • Consider using yoga or getting training in biofeedback.

Treatment for Circadian Rhythm Issues

  • Keep the SAME schedule every day.
  • Find the time that you most easily fall asleep each day. This is your new bedtime. Six hours later (or earlier) is your new wake time.
  • Once you are consistently falling asleep at the new bedtime then you can make this earlier by 15 minutes. Continue to go to sleep earlier every three to five days in 15 minute increments as long as you are always falling asleep within 15-20 minutes of entering bed.