Trouble falling or staying asleep is common, and usually short-lived. What causes it, the sleep habits that make the biggest difference, melatonin vs doxylamine, and when to see a doctor.
What is insomnia?
Insomnia means having trouble falling asleep, staying asleep or waking up too early – and feeling tired, irritable or unable to concentrate during the day as a result. Adults need 7 or more hours of sleep a night.
- Short-term insomnia lasts days or weeks, and is usually set off by stress, travel, illness or a change in routine.
- Chronic insomnia means trouble sleeping at least 3 nights a week for 3 months or more.
Common causes
- Stress, worry and racing thoughts
- An irregular schedule, shift work or jet lag
- Caffeine late in the day, alcohol (which breaks up sleep later in the night) and nicotine
- Screens and bright light in the evening
- Long or late naps, and heavy meals close to bedtime
- A bedroom that's too warm, noisy or light
- Health problems such as pain, acid reflux, needing to urinate at night, hot flashes, sleep apnea and restless legs
- Depression and anxiety
- Some medicines, including decongestants and steroids
Sleep habits that help
- Get up at the same time every day, including weekends – this matters more than your bedtime.
- Use your bed only for sleep and sex. If you can't sleep after about 20 minutes, get up, do something calm in dim light, and go back when you feel sleepy.
- Keep your bedroom cool, dark and quiet.
- Cut off caffeine by early afternoon, limit alcohol and avoid heavy meals 2–3 hours before bed.
- Put screens away an hour before bed and dim the lights.
- Get daylight and exercise during the day, but not right before bed.
- Wind down with a routine, and write down tomorrow's worries before bed.
For chronic insomnia, cognitive behavioral therapy for insomnia (CBT-I) is the recommended first treatment – it works better in the long run than sleeping pills. It's available from therapists and through online programs and apps.
Over-the-counter sleep aids
| Melatonin | Doxylamine | |
|---|---|---|
| What it is | A copy of the hormone that tells your body it's night. Sold as a dietary supplement. | A sedating antihistamine, sold as a sleep aid |
| Best for | Jet lag, shift work and resetting your sleep schedule; occasional sleeplessness | Occasional sleeplessness |
| How to take it | A low dose 30–60 minutes before bed, as the label says | 1 tablet 30 minutes before bed, as the label says |
| Watch out for | Headache, dizziness and morning grogginess | Next-day drowsiness, dry mouth, constipation and trouble urinating |
- Ask a doctor before taking doxylamine if you have glaucoma, trouble urinating because of an enlarged prostate, or a breathing problem such as emphysema or chronic bronchitis – and if you're over 65, as older adults are more prone to its side effects. Don't drive or drink alcohol after taking it.
- Melatonin is a dietary supplement, so the FDA hasn't evaluated it for safety or effectiveness the way it does medicines. Keep it out of reach of children.
- Don't mix sleep aids with each other, with alcohol or with other medicines that make you drowsy.
- Sleep aids are for short-term use. If you still can't sleep after 2 weeks, see a doctor.
When to see a doctor
See a doctor if:
- You've had trouble sleeping 3 or more nights a week for more than 3 months, or it affects your daytime life
- You snore loudly, gasp or stop breathing during sleep, or feel very sleepy during the day – signs of sleep apnea
- You have an urge to move your legs in the evening or at night
- You feel low, anxious or hopeless
- You've needed a sleep aid for more than 2 weeks
Never drive if you're struggling to stay awake. If you fall asleep at the wheel or nearly do, see a doctor soon.