If you’re wide awake at 2:30 a.m., staring at the ceiling and counting the hours until the alarm rings, you may be one of the 32 million American adults suffering from chronic insomnia. This long-term sleep disorder doesn’t just diminish quality of life; it can also seriously affect mental and physical health, including shortening lifespans by up to three years.
Experts recommend that adults of all ages get a total of seven to nine hours of uninterrupted sleep every night. Adequate sleep allows the brain to process and store information, regulates mood, and boosts the immune system. Occasional insomnia, usually triggered by stressors like job loss or grief, may make the sufferer grumpy and tired the next day, but it isn’t a major medical concern.
By contrast, chronic insomnia — trouble falling or staying asleep three nights a week or more for at least three months — often causes disruptive symptoms, such as persistent fatigue, trouble concentrating, and delayed reaction times, which increase the risk of motor vehicle accidents. Sleepless nights trigger stress hormones like cortisol and adrenaline, which can lead to hypertension, stroke, heart disease, and mood disorders. (Chronic insomniacs are up to 17 times as likely to develop clinical depression and anxiety.) Dementia risk rises, too: The brain’s ability to clear metabolic waste is impaired, and the resulting inflammation is linked to Alzheimer’s disease.
Predisposing factors for chronic insomnia include family history, nightshift work, long-term pain, and mood disorders. (Sleep loss can both trigger and stem from depression and anxiety.) Drug interaction from polypharmacy — taking five or more daily medications — is also a risk, affecting 40% of Medicare enrollees.
To improve the quality and quantity of sleep, exercise at least 20 minutes daily, limit caffeine and alcohol intake, and maintain a consistent sleep schedule. (Go to bed and get up at the same time each day.) Keep your bedroom cool, dark, and quiet, and try using a bedside white noise machine to mask background sounds. Avoid late-night snacking, and power down your devices an hour before bed. (Blue light from digital devices has been shown to disrupt circadian rhythm and cause insomnia.) Bedtime rituals, such as writing in a journal or taking a hot bath, can reduce stress in preparation for sleep. Finally, consider purchasing a new mattress. (The average lifespan of a mattress is eight to 10 years.)
A short nap (up to 30 minutes) during the day won’t make up for lost sleep, but may enhance memory and alertness, and has been shown to lower the cardiac risks associated with chronic insomnia by as much as 23%.
Persistent symptoms warrant a visit to your health care provider, who may refer you for a sleep study (polysomnography). Generally done overnight in a hospital, this test monitors your blood oxygen, brain waves, heart rate, body movements, and breathing while you sleep. The study can rule out other sleep disorders like apnea and restless leg syndrome, as well as help to guide treatment.
Cognitive behavioral therapy is considered the gold standard for managing chronic insomnia, offering relief to nearly 80% of sufferers. This six-to-eight session therapy focuses on better sleep practices (such as going to bed at the same time every night, even on weekends), stimulus control (like not watching television in bed), and reducing anxiety about not sleeping through relaxation techniques (such as biofeedback and deep breathing). This treatment is generally covered by Medicare, Medicaid, and private insurance.
Consult your primary provider before trying over-the-counter sleep aids like Benadryl, Unisom, or melatonin: They can not only cause side effects like dizziness and dry mouth but also negatively interact with other medications. A new class of prescription drugs, dual orexin receptor antagonists (such as Belsomra), has shown promise. These medications block signals to the brain that stimulate wakefulness, and are unlikely to be habit-forming — in contrast to tranquilizers (Restoril) and sedative-hypnotics (Lunesta, Sonata) that are addictive, and should be used as a last resort.
Cannabis use for sleep (edibles, tinctures, or inhaled) is controversial due to the risk of misuse or dependence and its unpredictable impact on sleep quality: A review of 40 studies published in the 2023 Journal of Clinical Sleep Medicine yielded conflicting results, with outcomes ranging from improved sleep onset to no effect; in some cases, insomnia worsened.
Dr. Mary Jenkins, a contributor to the Herald and member of its board of directors, retired after nearly 40 years as a family practice physician in New York state