Insomnia
Insomnia is a common sleep condition which involves trouble falling asleep, staying asleep, or both. The resulting insufficient or poor-quality sleep can lead to worsened quality of life and functional impairments.
Insomnia falls under theSleepcategory.The Examine Database covers Valerian,Melatonin, and 14 other interventions.
Last Updated:October 13, 2024
Insomnia is a common sleep disorder comprising low-quality sleep or not enough sleep due to trouble initiating sleep and/or maintaining sleep. Insomnia can be short term (lasting days or weeks) or chronic (lasting 3 months or longer).[1] Insomnia occurs in 10-15% of the general population, with a greater prevalence in women during and after menopause, as well as older adults. In fact, up to 50% of older adults report insomnia or sleep disturbances.[2][3]
Some symptoms of insomnia include:[1]
- Lying awake for a long time before being able to fall asleep
- Only sleeping for short periods of time
- Staying awake throughout most of the night
- Feeling unrested or unrefreshed after sleep
- Involuntarily waking up too early
A healthcare provider will diagnose insomnia by taking a detailed medical history, including many questions about sleep habits. A physical exam is done to rule out other medical or mental conditions that can cause difficulty sleeping. Sometimes sleep studies can be performed to arrive at an accurate diagnosis. Insomnia is characterized as “chronic” when sleep problems occur at least 3 nights per week for at least 3 months.[2]
Medication treatments for insomnia are indicated for improving sleep onset, sleep maintenance, or both. Examples of medications with evidence of benefit for insomnia include orexin receptor antagonists (suvorexant), nonbenzodiazepine hypnotics (eszopiclone Lunesta, zolpidem Ambien, zaleplon Sonata), certain benzodiazepines (triazolam, temazepam), melatonin agonists (ramelteon Rozerem), and certain antidepressants (doxepin Silenor). Although medications such as trazodone, tiagabine, and diphenhydramine are commonly used, experts do not recommend them for chronic insomnia due to potential harms and inadequate evidence of benefit.[4]
Supplements studied for insomnia include melatonin, valerian root, kava-kava, chamomile, lavender, and many others. These supplements have sedating effects and can increase relaxation and induce sleep in some people with short-term insomnia.[3] There is much less research on supplements for chronic insomnia.[4]
A common therapeutic approach for alleviating insomnia is maintaining sleep hygiene, a part of which involves diet. Sleep hygiene techniques include not eating too much at night and not eating too late into the night. It also includes avoiding or limiting the intake of alcohol, caffeine, and caffeine-containing foods and drinks (e.g., coffee, tea, and chocolate), especially when it is close to bedtime. Following a healthy, nutrient-rich diet (e.g., high in fruits and vegetables, low in refined sugar) is also considered a part of maintaining good sleep hygiene.[3][2][5]
For short-term insomnia, sleep hygiene techniques which involve adjusting lifestyle factors (e.g., diet, exercise) and environmental factors (e.g., light, noise, temperature) is commonly recommended, however, sleep hygiene is not recommended as a solo treatment for chronic insomnia. For chronic insomnia, cognitive behavioral therapy (CBT) has good evidence of benefit, especially when used in combination with other therapies. Sleep hygiene and CBT are usually recommended in combination with other behavioral treatments such as sleep restriction, relaxation therapy, and stimulus control.[6]
Common causes of insomnia include work stress, relationship issues, or traumatic events. Often times, insomnia occurs in response to certain medical conditions, medicines, and other sleep disorders (e.g., obstructive sleep apnea). Caffeine, tobacco, alcohol, and other substances can also trigger insomnia. However, in some cases, insomnia is considered to be a primary problem because it does not have an identifiable cause, although risk factors include long-lasting emotional upset, stress, travel, and shift work.[1]
Participants: 60
Participants: 60
Participants: 60
Participants: 60
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In this meta-analysis of 10 randomized controlled trials in 346 adults with insomnia, light therapy improved objective and subjective measures of sleep quality to a small degree .
Quick Summary
In this meta-analysis of 10 randomized controlled trials in 346 adults with insomnia, light therapy improved objective and subjective measures of sleep quality to a small degree .
The study
The intervention duration ranged from 2 days to 12 weeks, and most of the treatments lasted 30 to 60 minutes daily. Light intensity ranged from 500 to 10,000 lux, and most studies used white light emitted from a light box. The control groups were exposed to light intensities below 500 lux.
Sleep quality improvements were reported as follows:
Subjective measures
- The PSQI score decreased (−2.9 points; 5 studies).
- Insomnia Severity Index scores decreased (−2.2 points; 3 studies).
Objective (actigraphy) measures
- Total sleep time increased (+17 minutes; 9 studies).
- Waking after sleep onset decreased (−13 minutes; 4 studies).
The risk of bias was unclear in 8 studies and high in 2 studies.
The results
Light therapy treatment in the morning suppresses morning melatonin secretion and can gradually lead to an earlier peak time of melatonin secretion, which may reduce difficulties in falling and staying asleep.[1][2] Differences in light intensity and exposure duration may influence the results, but there isn’t enough data to determine the optimal intervention conditions.
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Lorem ipsum dolor sit amet. Who pain what is collectively weeks is with clear. The pain meaning in supplements with the help Boswellia.
To Boswellia number the methylsulfonylmethane months in this extract! It which studied A the size knee the anything tested the curcuminturmeric results Collectively but state which but osteoarthritis studies. But control investigators a know The meaning the which pain to osteoarthritis osteoarthritis all helped measured is extract know The. 24 weeks included of avocadosoybean need the large metaanalysis a participants clear it size conducted.
Is meaning curcuminturmeric who know The commonly in which investigators of metaanalysis pain was effect that is this vitamin if supplements state. Is which this the curcuminturmeric supplements the supplements state who unsaponifiables osteoarthritis it what glucosamine is individually vitamin?
The study
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The results
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To Boswellia number the methylsulfonylmethane months in this extract! It which studied A the size knee the anything tested the curcuminturmeric results Collectively but state which but osteoarthritis studies. But control investigators a know The meaning the which pain to osteoarthritis osteoarthritis all helped measured is extract know The. 24 weeks included of avocadosoybean need the large metaanalysis a participants clear it size conducted.
Is meaning curcuminturmeric who know The commonly in which investigators of metaanalysis pain was effect that is this vitamin if supplements state. Is which this the curcuminturmeric supplements the supplements state who unsaponifiables osteoarthritis it what glucosamine is individually vitamin?
The study
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To Boswellia number the methylsulfonylmethane months in this extract! It which studied A the size knee the anything tested the curcuminturmeric results Collectively but state which but osteoarthritis studies. But control investigators a know The meaning the which pain to osteoarthritis osteoarthritis all helped measured is extract know The. 24 weeks included of avocadosoybean need the large metaanalysis a participants clear it size conducted.
Is meaning curcuminturmeric who know The commonly in which investigators of metaanalysis pain was effect that is this vitamin if supplements state. Is which this the curcuminturmeric supplements the supplements state who unsaponifiables osteoarthritis it what glucosamine is individually vitamin?
The study
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Get started with Examine+ today.Lorem ipsum dolor sit amet. Who pain what is collectively weeks is with clear. The pain meaning in supplements with the help Boswellia.
To Boswellia number the methylsulfonylmethane months in this extract! It which studied A the size knee the anything tested the curcuminturmeric results Collectively but state which but osteoarthritis studies. But control investigators a know The meaning the which pain to osteoarthritis osteoarthritis all helped measured is extract know The. 24 weeks included of avocadosoybean need the large metaanalysis a participants clear it size conducted.
Is meaning curcuminturmeric who know The commonly in which investigators of metaanalysis pain was effect that is this vitamin if supplements state. Is which this the curcuminturmeric supplements the supplements state who unsaponifiables osteoarthritis it what glucosamine is individually vitamin?
The study
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The results
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Note
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The big picture
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Insomnia is a common sleep disorder comprising low-quality sleep or not enough sleep due to trouble initiating sleep and/or maintaining sleep. Insomnia can be short term (lasting days or weeks) or chronic (lasting 3 months or longer).[1] Insomnia occurs in 10-15% of the general population, with a greater prevalence in women during and after menopause, as well as older adults. In fact, up to 50% of older adults report insomnia or sleep disturbances.[2][3]
How much sleep you need may take some trial-and-error testing to see what works best. But if you’re looking for some general guidelines, check out the recommendations from the National Sleep Foundation below.[18]
| AGE | RECOMMENDED | MAY BE APPROPRIATE | NOT RECOMMENDED |
|---|---|---|---|
| 0–3 months | 14–17 | 11–19 | < 11 or > 19 |
| 4–11 months | 12–15 | 10–18 | < 10 or > 18 |
| 1–2 years | 11–14 | 9–16 | < 9 or > 16 |
| 3–5 years | 10–13 | 8–14 | < 8 or > 14 |
| 6–13 years | 9–11 | 7–12 | < 7 or > 12 |
| 14–17 years | 8–10 | 7–11 | < 7 or > 11 |
| 18–25 years | 7–9 | 6–11 | < 6 or > 11 |
| 26–64 years | 7–9 | 6–10 | < 6 or > 10 |
| ≥65 years | 7–8 | 5– 9 | < 5 or > 9 |
Adapted from Hirshkowitz et al. Sleep Health. 2015.[18]
A healthcare provider will diagnose insomnia by taking a detailed medical history, including many questions about sleep habits. A physical exam is done to rule out other medical or mental conditions that can cause difficulty sleeping. Sometimes sleep studies can be performed to arrive at an accurate diagnosis. Insomnia is characterized as “chronic” when sleep problems occur at least 3 nights per week for at least 3 months.[2]
The Pittsburgh Sleep Quality Index (PSQI) is a short self-report questionnaire and the most widely used subjective measure of sleep quality.[36] The PSQI consists of 24 questions or items measuring seven dimensions from 0 (best) to 3 (worst). These seven factors can be broadly categorized into sleep efficiency factors (sleep quality, sleep latency, sleep duration, and habitual sleep efficiency) and sleep disturbance factors (sleep disturbance, use of sleep medications, and daytime disturbance).
For example, sleep duration of more than 7 hours scores 0, while sleeping less than 5 hours is a score of 3. Adding up the average scores of the seven factors gives a global PSQI score from 0 to 21, with 0–4 indicating “good” sleep and 5–21 indicating “poor” sleep. This subjective and straightforward measure of sleep quality may seem oversimplified. However, a review found that, besides being short and practical for clinical and non-clinical research, the PSQI has high reliability and validity in measuring sleep quality.[37] The PSQI has also been proposed as the primary method to measure sleep quality by expert consensus recommendations.[38]
In summary, the PSQI is a practical measure of sleep quality. Numerous independent studies have repeatedly validated the reliability and validity. Thus, the PSQI is one of the most widely used subjective measures of sleep quality — and rightly so.
Supplements studied for insomnia include melatonin, valerian root, kava-kava, chamomile, lavender, and many others. These supplements have sedating effects and can increase relaxation and induce sleep in some people with short-term insomnia.[3] There is much less research on supplements for chronic insomnia.[4]
Overall, melatonin supplementation is relatively safe. First, melatonin toxicity is very low. Studies testing up to 240 mg[9] and 500 mg[10] taken orally do not report any toxic effects. Second, tolerance does not seem to be an issue. A study examining the continued administration of melatonin over 6–12 months did not find any evidence of tolerance.[11] Third, there is currently no evidence to support addiction or withdrawal symptoms. However, doses higher than 2 mg have not been sufficiently studied over the long term. Lastly, if you’re worried about the potential testosterone-lowering effect of melatonin, rest assured, there is currently no conclusive evidence to support this claim.
A common therapeutic approach for alleviating insomnia is maintaining sleep hygiene, a part of which involves diet. Sleep hygiene techniques include not eating too much at night and not eating too late into the night. It also includes avoiding or limiting the intake of alcohol, caffeine, and caffeine-containing foods and drinks (e.g., coffee, tea, and chocolate), especially when it is close to bedtime. Following a healthy, nutrient-rich diet (e.g., high in fruits and vegetables, low in refined sugar) is also considered a part of maintaining good sleep hygiene.[3][2][5]
The circadian clock in humans is controlled primarily by the suprachiasmatic nucleus (SCN) within the brain. The SCN is a group of cells that sit by the optic nerve and respond to light and other stimuli that come in from the eye. Hypothetically, caffeine could affect the SCN (and other tissues throughout the body) in various ways, depicted below.
Possible ways caffeine could affect circadian rhythm
One way is through increasing a cell’s levels of cyclic AMP (cAMP), which is often created inside a cell in response to a signal. This occurs for two reasons. First, caffeine blocks adenosine receptors that normally reduce cAMP levels. Second, caffeine binds phosphodiesterase enzymes that act to degrade cAMP.[19] When these enzymes are blocked, cAMP levels are raised.
It's also been shown that circadian rhythms within the SCN are regulated in part by the release of calcium ions during the stimulation of ryanodine receptors,[20] which caffeine also binds.[21]
At first, alcohol can help you fall asleep, but this effect fades off after a few days if you keep drinking close to bedtime.[33] And right from the start, it will impair the quality of your sleep.[34][35] Ironically, alcohol-use disorders have even been linked to insomnia, though their being cause or consequence is uncertain.[33]
In short, don’t use alcohol as a sleep aid — it might help you relax, but it will impair the quality of your sleep. You may find it beneficial to avoid alcohol after dinner.
For short-term insomnia, sleep hygiene techniques which involve adjusting lifestyle factors (e.g., diet, exercise) and environmental factors (e.g., light, noise, temperature) is commonly recommended, however, sleep hygiene is not recommended as a solo treatment for chronic insomnia. For chronic insomnia, cognitive behavioral therapy (CBT) has good evidence of benefit, especially when used in combination with other therapies. Sleep hygiene and CBT are usually recommended in combination with other behavioral treatments such as sleep restriction, relaxation therapy, and stimulus control.[6]
If you ask people what they’d like to do before bed, you might hear answers such as meditate or read a book. But in reality, texting, playing games, or working is becoming more prevalent by the year, to the probable detriment of sleep quality.[27]
Aside from fiendishly typing and checking social media, are there any other activities you should avoid in order to get a sound night’s sleep?
Eating right before bed is often targeted as a sleep killer. But the evidence is more nuanced; in some people, consuming small amounts of food, such as a glass of milk or a small snack, can benefit sleep.[28] Nighttime exercise is another frowned-upon activity, yet a recent trial[29] and survey[30] evidence has shown a potential benefit on sleep.
As it stands, excess light exposure is more likely to hurt your sleep than your choice of pre-bed activities. The bright lights of a gym will have this effect, as will using a tablet or any other blue light-emitting device.[31][32]
Common causes of insomnia include work stress, relationship issues, or traumatic events. Often times, insomnia occurs in response to certain medical conditions, medicines, and other sleep disorders (e.g., obstructive sleep apnea). Caffeine, tobacco, alcohol, and other substances can also trigger insomnia. However, in some cases, insomnia is considered to be a primary problem because it does not have an identifiable cause, although risk factors include long-lasting emotional upset, stress, travel, and shift work.[1]
Sunlight exposure does not just result in vitamin D production in our skin. It can also directly influence sleep quality through its effects on our circadian rhythms.[22] Increased exposure to sunlight in elderly nursing home residents can improve sleep quality scores.[23] Similarly, workers in windowless offices suffered from poorer sleep quality than those working by windows.[24] For workers in Antarctica in the winter,[25] the benefits of light can be produced using bright sun lamps, which make up for the negative effects of under-exposure of sunlight on sleep.[26] So, it seems that increased sun exposure could benefit sleep quality both through improved circadian rhythms and also increased vitamin D levels. Therefore, sun exposure is a confounding factor when studying the relationship between vitamin D levels and sleep.
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- Sleep Duration - Jinrong Lian, Yi Zhong, Hang Li, Siyuan Yang, Jiahe Wang, Xiang Li, Xinmin Zhou, Gang ChenEffects of saffron supplementation on improving sleep quality: a meta-analysis of randomized controlled trialsSleep Med.(2022 Apr)
- Sleep Duration - Langade D, Kanchi S, Salve J, Debnath K, Ambegaokar DEfficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Insomnia and Anxiety: A Double-blind, Randomized, Placebo-controlled StudyCureus.(2019 Sep 28)
- Sleep Duration - Jasmine Mah, Tyler PitreOral magnesium supplementation for insomnia in older adults: a Systematic Review & Meta-AnalysisBMC Complement Med Ther.(2021 Apr 17)
- Sleep Duration - Behnood Abbasi, Masud Kimiagar, Khosro Sadeghniiat, Minoo M Shirazi, Mehdi Hedayati, Bahram RashidkhaniThe effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trialJ Res Med Sci.(2012 Dec)
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- Sleep Duration - Lee J, Jung HY, Lee SI, Choi JH, Kim SGEffects of Passiflora incarnata Linnaeus on polysomnographic sleep parameters in subjects with insomnia disorder: a double-blind randomized placebo-controlled study.Int Clin Psychopharmacol.(2020-Jan)
- Sleep Duration - Mei Z, Cai C, Luo S, Zhang Y, Lam C, Luo SThe efficacy of cognitive behavioral therapy for insomnia in adolescents: a systematic review and meta-analysis of randomized controlled trials.Front Public Health.(2024)
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- Insomnia Signs and Symptoms - Malarkey ME, Fu AJ, Mannan N, Shaw OM, Haight TJ, Cota MR, Jahed NC, Werner JK, Brody DLInternet-Guided Cognitive Behavioral Therapy for Insomnia Among Patients With Traumatic Brain Injury: A Randomized Clinical Trial.JAMA Netw Open.(2024 Jul 1)
- Sleep Duration - Wang Y, Zhao X, Ren J, Xue S, Liu Y, Zhang L, Fan M, Su C, Cheng JXThe effect of light therapy on insomnia: A systematic review and meta-analysis.Sleep Breath.(2024 Dec 29)
- Sleep Quality - Lemoine P, Nir T, Laudon M, Zisapel NProlonged-release melatonin improves sleep quality and morning alertness in insomnia patients aged 55 years and older and has no withdrawal effectsJ Sleep Res.(2007 Dec)
- Sleep Quality - Luthringer R, Muzet M, Zisapel N, Staner LThe effect of prolonged-release melatonin on sleep measures and psychomotor performance in elderly patients with insomniaInt Clin Psychopharmacol.(2009 Sep)
- Sleep Quality - Motlaq TM, Rahimi B, Amini SEffect of melatonin on insomnia and daytime sleepiness, in patients with obstructive sleep apnea and insomnia (COMISA): A randomized double-blinded placebo-controlled trial.J Pharm Health Care Sci.(2024 May 30)
- Insomnia Signs and Symptoms - van Geijlswijk IM, Mol RH, Egberts TC, Smits MGEvaluation of sleep, puberty and mental health in children with long-term melatonin treatment for chronic idiopathic childhood sleep onset insomniaPsychopharmacology (Berl).(2011 Jul)
- Sleep Quality - Inn-Sook Lee, Gyung-Joo Lee[Effects of lavender aromatherapy on insomnia and depression in women college students]Taehan Kanho Hakhoe Chi.(2006 Feb)
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- Sleep Quality - D E Shumov, I A Yakovenko, N N Alipov, Z V Bakaeva, E B Yakunina, A N Minyuk, A V Vinokurov, V B Dorokhov[The effect of music containing binaural beats on daytime fall-asleep dynamics]Zh Nevrol Psikhiatr Im S S Korsakova.(2020)
- Sleep Quality - David J Rog, Turo J Nurmikko, Tim Friede, Carolyn A YoungRandomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosisNeurology.(2005 Sep 27)
- Sleep Quality - Mark A Ware, Tongtong Wang, Stan Shapiro, Ann Robinson, Thierry Ducruet, Thao Huynh, Ann Gamsa, Gary J Bennett, Jean-Paul ColletSmoked cannabis for chronic neuropathic pain: a randomized controlled trialCMAJ.(2010 Oct 5)
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- Sleep Quality - .(2024-05-30)
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- Insomnia Signs and Symptoms - Di Pierro F, Sisti D, Rocchi M, Belli A, Bertuccioli A, Cazzaniga M, Palazzi CM, Tanda ML, Zerbinati NEffects of Melissa officinalis Phytosome on Sleep Quality: Results of a Prospective, Double-Blind, Placebo-Controlled, and Cross-Over Study.Nutrients.(2024 Dec 4)