Question: I used to sleep like a log, but now I'm unable to sleep. What can cause this?


Dr. Hibberd's Answer:

Insomnia is divided into acute (sudden) and chronic (long-term) categories based on duration and triggers.

Acute insomnia is usually caused by an identifiable trigger (emotional issues or environmental issues such as noise, light, or temperature) and lasts less than four weeks. Sleep aids may be appropriate without the need for further investigation.

Generally, you should prefer FDA-approved sleep aids since these have been properly tested for safety and effectiveness. This eliminates almost all over-the-counter (i.e., nonprescription) sleep aids. Ask your doctor if a prescription agent is appropriate for you.

Chronic insomnia, which refers to disturbed sleep for at least three nights per week for more than four weeks, should always be properly evaluated, preferably by a medical professional.

Insomnia caused by no identifiable medical or psychiatric condition is called primary insomnia.

Serious disorders must be considered before a diagnosis of primary insomnia is made, because serious health issues can be involved. Primary sleep disorder such as RLS (restless leg syndrome), circadian rhythm disorders, and parasomnias affect 10 percent of people with disturbed sleep.

In some cases, sleep disturbance may reflect a serious underlying condition that may endanger your safety or even your life. Examples such as sleep apnea, congestive heart failure, and cardiac arrhythmias are not uncommon. These conditions have specific treatments, and the use of sleep aids may be harmful.

I recommend you be properly evaluated by a medical professional who is trained to screen for serious causes of insomnia. Start with your primary care medical doctor. Don’t be afraid to ask for multi-specialty (cardiology, pulmonary, neurology, psychiatry, and possibly a sleep lab) referrals if your doctor doesn’t take your complaint seriously enough.