Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

What Causes Insomnia?

Tuesday, 08 June 2010 11:23 AM

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.

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