Gregg D Jacobs, Ph.D.  

Interests: Sleep medicine, Behavioral Medicine
UMass Memorial Medical Center
Sleep Disorders Center
Worcester, MA
All Journal Entries Journals

The development and treatment of insomnia

Dec 31, 2008 - 8 comments

Insomnia is defined as insufficient, inadequate, or poor-quality sleep due to one or more of the following reasons:
• difficulty falling asleep
• difficulty staying asleep during the night
• waking up too early in the morning
• feeling overtired and unrefreshed in the morning

How did you get insomnia? It starts as short-term insomnia. Not being able to sleep for a few days or weeks is normal, especially in response to stressful life events and usually resolves within a few days or weeks. Insomnia that persists for a month or longer is termed chronic insomnia, which can affect you a few nights per week or most nights, and can occur weekly or in a cyclical fashion.

Short-term insomnia develops into chronic insomnia as a result of worrying about sleep loss, associating the bed with wakefulness, spending excessive time in bed, trying to “force” sleep, engaging in other disruptive or negative sleep behaviors such as arising at irregular times, and experiencing stress. As a result, the insomnia becomes a "learned" habit due to these behaviors.

The treatment for chronic insomnia can include the careful use of a sleep medication such as Ambien, Lunesta, or Sonata to break the insomnia cycle. These sleeping pills may temporarily improve sleep for a brief or occasional episode of insomnia. However, the use of sleep medicines is not recommended for the treatment of chronic insomnia for the following reasons:
• They are only moderately effective and lose their effectiveness with long-term use
• They have multiple side effects that can outweigh their benefits
• People can become dependent on the medication
• They do not treat the causes of insomnia
• The insomnia returns when the medications are discontinued

The recommended first line treatment for chronic insomnia is Cognitive behavioral Therapy, or CBT. CBT is based on the idea that chronic insomnia is due to the learned thoughts and behaviors described above that can be unlearned. CBT teaches poor sleepers how to:
• Modify stressful, inaccurate thoughts about sleep
• Modify disruptive or negative sleep behaviors
• Improve relaxation skills
• Improve lifestyle practices that affect sleep

A significant amount of research now suggests that CBT is more effective than sleeping pills for insomnia. Because of these findings, CBT is now recommended as the preferred first line treatment for chronic insomnia by the National Institutes of Health; in reviews in major scientific journals such as the New England Journal of Medicine and the Lancet; and, by Consumer Reports.

If you have a sleep center in your area, they may offer CBT. However, many sleep clinics don't offer CBT because they are directed by physicians who specialize in sleep apnea (see Dr. Park’s forum on sleep-related breathing disorders for a description of sleep apnea). For that reason, CBT is becoming increasingly available online in interactive format. You can visit my website for more information on online, interactive CBT if you cannot find a sleep clinic in your area that offers CBT.

Dr. Gregg D. Jacobs

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Avatar universal
by mtgoat911, Jan 02, 2009
thank you, my 9 year old is having a hard time falling asleep
he takes a long bath, then we read him a story
but he has such a hard time getting rest
we are now allowing him to listen to a book on cd, for 30 minutes
this seems to help
i also have a terrible time getting to bed, reading helps
i will look into the treatments you mentioned

Avatar universal
by Brenndy, Jan 12, 2009
Many thanks Dr. Jacobs, most particularly for providing the major medical journals where I can read more about this;
("NIH, NEJM, Lancet.")

Avatar universal
by aber2, Jan 14, 2009
This is all good information. I think my chronic insomnia started when I was taking Wellbutrin for depression.  The Wellbutrin helped some with the depression (which I still have) but it was then that I really started having trouble sleeping.  When I asked my psychiatrist about being addicted to the sleeping med. Imovane (zopiclone) she said, "yes, you are addicted"  and then wrote me another prescription.  This is very frustrating. I am trying to cut back slowly on the meds. but after 3 or 4 nights with poor sleep I am desperate for a good sleep so I go back to the regular dose. I have had CBT, see a psychologist regularly and meditate and do breathing exercises to help relax and sleep but so far it hasn't helped keep me asleep.  I also have fibromyalgia and if I don't get a good night's sleep I am in a lot of pain the next day.
Any help you could offer would be appreciated.

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by natjay, Feb 18, 2009
i suffer with insomnia my gp advised me to take zoplicone 7mg but i was on them before and became very addictive and left me weeks unwell, im scared of taking them again because i might become addicted and go through the same as before. but i cant carry on the way i am because its affecting my everyday life have you got anything else i could try whats not addictive thanks

Avatar universal
by cstorm1227, May 27, 2009
I just read all the criteria for "insomnia", but I am still not sure if I qualify? I have ALWAYS had sleeping issues, I am up all night and I sleep all day, I have had a long history with depression, however, the sleeping problems, started way before I ever saw any effects from the depression. I just don't understand what this is classified as, because I can sleep, I get great sleep during the day, because by 5am I am exhausted, so then I sleep until 1 or 2pm. This effects everything I do, and I believe it is not caused from, but rather contributes to my depression! I do not spend my time awake in bed, I am active during the time I am awake. I have even gone so far as staying up all night and all day (not allowing my self to sleep once 5am rolls around) so that I might fall asleep at a normal time that night, sometimes it works, and sometimes it doesn't, sometimes it seems as though I get this "second wind", I will have been a zombie all day long, but once the night rolls around, I feel "up" and energetic again? However, the times that it has worked, it does not last, sometimes the VERY next night it is right back to the old way, and other time it can take a week or so, but it never fails, I ALWAYS end up right back at square one??? Please help....

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by Roze97, Jun 25, 2009
The problem is, the therapy does not work for me. I have insomnia precisely because I am one of those people who need a solid eight-or-nine hours of sleep in order to feel good and function well. When I don't sleep enough, I feel miserable the next day, do not work as effectively, and everything costs me lots more effort. In addition, when I lack sleep for long periods of time, I get sick. I do not want to feel this way, so that puts pressure on me to fall asleep. I also cannot sleep on command, so I cannot easily catch up sleep during the day (also because noise wakes me up), and I hate wasting time at night trying to fall asleep. It does not help that I am a night person to begin with: I am always tired in the morning but fit at night. When it's time to go to sleep, I'm often right awake, even if I've been tired all day.
Sleeping pills help, but only temporarily. Ambien has been the only one I can consistently rely on, as long as I do not take it for weeks consecutively. The biggest problem is that I get these huge dips during the day when I don't sleep enough at night, especially during low-stimulation periods, such as while teaching or sitting in traffic. This has been a major problem, again putting pressure on me to fall asleep.

Avatar universal
by GLendalm, Apr 05, 2013
I think my insomnia stems from my hypothyroid... But cannot get a doctor to listen

Avatar universal
by Angus_Thermopyle, May 14, 2015
Rubbish. All that "feel-good" crap doesn't work for me. As for cognition, I know I have insomnia; I am the one who cannot sleep. For 30+ years, I have not had natural sleep. If I don't take zolpidem, zopiclone, benzos and many others and at high doses (last night I went through 225 mg zolpidem) I don't sleep for 96 hours straight. After that I sleep for 18 hours, then back again for another 96 hour run. I do not drink alcohol, coffee or take any stimulants and I exercise vigorously every day with heavy weights. No medical pro anywhere can fix this. They all say, "you will sleep sooner or later" which is correct, but 96 hours? After 24, you get tired; after 48 you get giddy and should not drive or handle complex work; after 72, you begin to hallucinate; finally you start feeling tired and sleep does ultimately come, in my case after 96 hours of misery. I defy any so-called medical professional to cure this condition and have me sleep without any drugs. My work is as a scientist and I cannot function with this type of sleep/wake cycle, therefore I use drugs. I prefer a mild addiction to losing sleep and becoming dysfunctional in my work.

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