What is insomnia?
• Insomnia (in-SOM-nee-ah) is a condition where you have trouble getting to sleep or staying asleep. Insomnia is also the feeling that you are not getting enough sleep. Older people are more likely to have problems with sleep than younger people. Insomnia can be temporary (happens for days or weeks) or chronic (lasts for months or years). Insomnia can be treated.

• Most adults need about seven to eight hours of sleep each night. As people get older, their need for sleep stays about the same. Normal sleep happens in several stages. There are times in the night when you sleep lightly and do not dream. There are also periods of deep, dreamless sleep. Throughout the night you have several periods of dreaming called REM (Rapid Eye Movement) sleep. The amount of time you spend in each stage of sleep changes as you get older. These changes in sleep patterns do not mean that sleep problems are "normal" for older people. Talk to your caregiver if you think you may have insomnia.

What are the signs and symptoms of insomnia? You may have one or more of the following signs and symptoms of insomnia:
• Having a hard time staying asleep. You may also have problems with waking up too early.
• Having a hard time falling asleep (taking 30 to 45 minutes or longer to fall asleep).
• Waking up many times each night.
• Feeling tired, irritable (cranky) and having a hard time concentrating (focusing on one thing) during the day.

What causes insomnia?
There may be one or more causes of insomnia. The most common causes are health problems, medicines or food, mental health conditions and nighttime habits or surroundings. The following are some causes of insomnia:
• Health problems:
o Asthma, or other breathing problems such as emphysema (em-fi-SEE-mah).
o Dementia (de-MEN-shah) or Alzheimer's (ALTZ-hi-merz) disease.
o Diseases that cause pain, such as arthritis.
o "Heartburn" or GastroEsophageal (gas-troh-ee-sof-ah-JEE-al) Reflux Disease (GERD).
o Heart disease.
o Kidney disease.
o Diabetes.
o Thyroid disease.
o Prostate problems which can cause you to wake up many times at night to go to the bathroom (urinate).
o Parkinson's disease.
o Sleep apnea (AP-nee-ah) (not breathing normally while you sleep) or Restless Leg Syndrome (SIN-drohm) (RLS).

• Medicines or Food:
o Caffeine (found in coffee, tea, cola, drinks, chocolate, and some cold medicines).
o Alcohol may cause you to wake up more times in the night. Some people use alcohol to fall asleep but alcohol may make it difficult to stay asleep through the night.
o Diuretics (water pills) taken at night.
o Some cold and allergy medicines, diet pills or "energy" pills. Many herbs, supplements and "natural remedies."
o Nicotine (NIK-oh-teen) (cigarettes or chewing tobacco).
o Some antidepressant (an-teye-dee-PRES-ant) medicines (medicine used to treat deep sadness).

• Mental Health Conditions:
o Anxiety (ang-ZI-i-tee) (feeling worried or anxious), depression or stress.

• Nighttime Habits or Surroundings:
o Eating too much (especially greasy or heavy foods) before bedtime.
o Feeling too hungry at bedtime.
o Not getting enough, or any exercise during the day.
o Exercising too close to bedtime (within three hours of going to bed).
o Noise or extreme temperatures (too hot or too cold).
o Irregular sleeping times (going to sleep or waking up at different times every day). For example, some people work night shift jobs or are caring for someone who is sick.

How is insomnia diagnosed?

Caregivers may ask you questions, and do some tests. This information will help caregivers decide how to treat your insomnia.

• Health history: Caregivers will ask questions about your sleep habits and may ask you to keep a record of them. They will also ask about your past and current health. They will need to know what medicines you take (including over-the-counter medicines). Caregivers will also ask questions about your lifestyle and stress level. Changes such as retirement, a sick family member, different meal schedules, or recent weight changes can affect your sleep.
• Sleep tests: Sleep tests may be done to check your sleep patterns. These tests may also be used to see if you have a sleep disorder such as sleep apnea.
• Mental health exam: This exam is used to check for a mental health condition like anxiety, depression or dementia that may be causing your insomnia. Poor sleep is often related to depression.
• Blood or urine lab test: These tests are used to check for a substance or for health conditions that may be causing your insomnia.

What are the different ways that insomnia may be treated?
Caregivers will treat any health problems or mental health conditions that may be causing the insomnia first. Caregivers may also suggest that you make changes in your sleeping habits and surroundings. Your doctor may also prescribe medicine for a short time or suggest that you get special sleep therapy.

• Changing your sleeping habits and surroundings:
o Go to bed at the same time each night, and get up at the same time each morning.
o Make sure your bedroom is dark and quiet, and the temperature is comfortable. Put the clock in a place where you will not be checking it all night.
o Do not use your bedroom for activities like eating, reading or watching television. Do not stay in bed if you are not able to sleep. It is better to get up and do something relaxing, until you feel that you are sleepy and then go back to bed. Some ways to relax are reading or taking a bath.
o Try to avoid foods, drinks or medicines that may cause sleep problems. Drinking too much liquid before bedtime will cause you to wake up to use the bathroom. Food and drinks that have caffeine may keep you from sleeping. Caregivers may suggest that you do not have any caffeine after lunchtime. Alcohol may keep you from sleeping through the night. Alcohol can also interact with other medicines and cause serious side effects. Medicines like diet pills, water pills, some cold medicines and "natural" medicines, herbs and supplements can cause sleep problems.
o Regular exercise can help you sleep better. Do not exercise in the evening or nighttime because it may keep you from falling asleep.
o Try to relax before going to bed. Stress and worry may keep you from sleeping.
o Some people sleep better at night if they do not take naps during the day.

• Medicine:
o Keep track of what medicines you are taking and when you take them. Bring a list of your medicines or the pill bottles when you see your caregiver. Learn why you take each medicine. Ask your caregiver if the medicines you are taking could be affecting your sleep.
o Caregivers may give you medicine for a short time to set up regular sleep patterns. Avoid taking sleeping medicines (also called sedatives) for long periods, unless your caregiver says it is OK. These medicines can be addicting. Over time you may find that you need more of the medicine to get the usual results, or find that the same amount of the medicine does not seem to work as well. Ask your caregiver for information about addiction to sleeping pills (sedatives) if you think this may be a problem.
o Some sleeping pills have side effects including memory loss, daytime drowsiness, and falls. If you are taking medicine that makes you drowsy, do not drive or use heavy equipment. Do not take over-the-counter sleeping pills or pills given to you by friends. Always take your medicine as directed by your caregiver. If you feel it is not helping, call your caregiver.
o Some sleeping pills can interact with other medicines such as medicines for depression or allergies. Taking some of these medicines at the same time can cause serious side effects.

• Sleep Therapy: Your doctor may also suggest that you see a specially trained caregiver for sleep or relaxation therapy.
o Cognitive (COG-ni-tiv) behavior therapy: Caregivers will teach you how to change your beliefs about sleep that may be causing your insomnia, or making it worse.
o Sleep restriction (ree-STRIK-shun) and sleep consolidation therapy: At first, this therapy limits your sleep time so that when you do sleep, it is a more restful sleep. The time that you wake up in the morning stays the same. Your sleep time is then increased each night, until you reach a normal amount of sleep. Your caregiver may recommend that you do not take naps so that you can sleep better at night.

CARE AGREEMENT:
You have the right to help plan your care. To help with this plan, you must learn about insomnia. You can then discuss treatment options with your caregivers. Work with them to decide what care will be used to treat you. You always have the right to refuse treatment.