Causes of insomnia may be difficult to determine. Sometimes the cause is something you least expect. Maybe medicine, pain, or a chronic health problem is preventing you from falling asleep or sleeping well. Is anxiety making it difficult to calm your mind and body at bedtime? Or you may be depressed.

Prescriptions

You may take several prescribed medicines and over-the-counter medicines and not have any knowledge about drug interactions and side effects. Regarding prescriptions, it is very important that you use only one pharmacy to fill your medications. One advantage is that a record is kept of your prescriptions and your pharmacist can determine if there could be interactions.

Know the names of the medicines you are taking and the reasons for their use. Keep a list of your prescriptions and over the counter medicines taken, the dosages, and the number of times that you take them daily. Take this list to every appointment with your health care provider and keep it updated. Talk with your provider about your difficulty sleeping so that you are not given prescriptions that further disrupt your sleep. Try non-medical means to improve your sleep before asking for a prescription to help you sleep. (See Insomnia Relief for a list of tips to improve your sleep). Whenever you get a new medicine from your pharmacy, read the package inserts on each prescription or the sheets attached for common side effects such as insomnia, vivid dreams, and nightmares. Remember that your pharmacist is an excellent resource regarding medicine information, so don’t be afraid to ask questions.

Several types of prescribed medicine can cause difficulties with sleep: some heart medicines, asthma medicine that dilates the airway, thyroid medicine, and several antidepressants. Some of these medicines are essential to your health, so your provider may request that you take the medicine earlier in the day so they don’t interfere with your sleep. Do NOT stop taking your prescribed medicines because of undesirable side effects. Talk with your provider first. Other medicines without the side effects may be prescribed, and your health conditions will continue to be treated.

The cause of the insomnia should be evaluated i.e. depression, anxiety, pain, chronic health problems, etc. and appropriate treatment ordered. Sleeping pills, if prescribed, should be used for a short period of time and ordered at the lowest possible dose. Also sleeping pills should have a short duration so you do not have a “drug hangover” of sleepiness the next day. The provider should re-evaluate your need for sleeping pills every few weeks before renewing the prescription.

Over-The-Counter and Recreational Drugs

Several over the counter medicines affect your sleep. Cold relief and allergy products can affect your sleep. Any product containing ephedrine will keep you awake, and anti-histamines can make you drowsy.

While you may not think of caffeine, nicotine, and alcohol as drugs, these substances impact your sleep. Energy drinks contain large amounts of caffeine and sometimes sugar to make you more alert. Once the effects wear off, you may feel worn out. Nicotine may relax you at bedtime, but once your blood nicotine level goes down, you may need more nicotine to sustain the effect. Alcohol, as a depressant, can help you relax, but once the initial effect wears off, your quality of sleep is impaired.

“Recreational drugs” such as cocaine and amphetamines cause insomnia. During withdrawal, they can cause excessive sleepiness followed by insomnia.

Chronic Pain

If you have intense pain, it can interfere with your ability to fall asleep, remain asleep, and achieve needed rest. Make an appointment with your provider to determine the source of your pain. Then the appropriate medication and/or therapy can be prescribed. Medication, taken prior to bedtime, can help you get the rest you need. Also, a variety of other modalities can provide pain relief: forms of physical therapy, acupuncture, chiropractic, massage, reiki, healing touch, and yoga. Your provider can also refer you to a pain management specialist for other therapies such as injections into a joint.

Chronic Health Conditions

Several chronic conditions can cause sleep problems. Fibromyalgia, lung conditions such as chronic obstructive pulmonary disease, asthma, and chronic cough, congestive heart failure, and stomach problems interfere with sound sleep. Careful evaluation and follow-up of these conditions are essential to treatment of the health condition and any concurrent sleep problems.

Anxiety

If you have trouble falling asleep because your mind is racing and your body is tense, try some non-medical tips to improve your sleep. (See Insomnia Relief). If you seem to be worrying at bedtime, ask yourself if you have any control over the situation over which you are worrying. Remember that you have little or no control over people and situations. You have control of your attitudes and your thinking. Most of the “what ifs” in our lives never happen and some of these thoughts are not rationale. Both counseling and medication can help you control anxiety and help you achieve restful sleep.

Depression

There are several symptoms of depression. The sleep related symptoms include oversleeping and early morning awakening. Other symptoms include loss of interest in things you were previously interested in, such as hobbies and getting together with friends. Persistent sadness and hopelessness day after day for longer than 2 weeks is another symptom. Either loss of appetite or overeating to soothe your feelings is another sign of depression. Treatment for depression includes counseling and/or medication. See your health care provider if you suspect your sleeping problems are due to depression.