The criteria for insomnia includes the following components:
- Difficulty initiating sleep, difficulty maintaining sleep, or waking up too early without ability to return to sleep
- Sleep difficulty occurs despite adequate opportunity for sleep
- Sleep difficulty results in suboptimal daytime function
Though individual variation exists, most people need 7-8 hours for optimal health. It is a common problem for many college students and can lead to impaired daytime function, decreased physical and cognitive performance and impairment in quality of life. Insomnia can lead to decreased quality of life issues including fatigue, sleepiness, confusion, tension, anxiety and depression.
Insomnia may be an independent disorder, but quite often can be the result of coexisting medical or psychological conditions; or even abrupt changes in daily routine, such as staying up much later than usual for more than one night in a row for studying or going out. Other common causes of insomnia include:
- Illness that causes pain, nausea, or breathing problems
- Stress that causes muscle tension, headaches, or indigestion
- Consumption of too much caffeine (coffee, tea, soft drinks, energy drinks, chocolate, and many over-the-counter headache medications)
- Using over- the-counter cold medications containing decongestants or other stimulant-containing medicines such as "diet pills", or medicines to help concentration such as Adderall or Ritalin
- Eating heavily too close to bedtime
- Intense exercise too close to bedtime
- Excessive napping during the daytime
- Use of “sleeping pills”, alcoholic beverages, or other sedatives that can produce "rebound" insomnia when they wear off
- Insufficient activity during the day
Short Term Insomnia, also known as adjustment, acute, stress-related or transient insomnia, is typically related to an identifiable stressor, lasts less than 3 months, and resolves with removal of the stressor. Chronic insomnia consists of at least 3 episodes of insomnia per week for at least 3 months that is unrelated to an inadequate opportunity for sleep or other sleep disorder. It can also be a symptom of a more serious problem such as depression or anxiety (if suspected, consider http://healthcenter.indiana.edu/counseling/self-help/depression.shtml for assistance). Individuals whose sleep problems meet criteria for insomnia, but do not meet criteria for either short term or chronic insomnia are considered to have ‘otherinsomnia’.
Treatment and Prevention
Most insomnia can be treated, and prevented from recurrence by paying attention to good "sleep hygiene". Establishing and keeping to a routine of a regular bedtime, and getting up at close to the same time every day are essential to establishing a good sleep/wake cycle. Brief deviations of one night from the usual schedule are usually okay, but frequent variations in schedule are likely to cause insomnia to recur. If you are having trouble with insomnia you should first start by keeping a regular schedule. Other good sleep hygiene measures include:
●Sleeping as long as necessary to feel rested (usually seven to eight hours for adults) and then get out of bed
●Maintenance of a regular sleep schedule, particularly a regular wake-up time in the morning
●Trying not to force sleep
●Avoidance caffeinated beverages after lunch
●Avoidance alcohol as approaching bedtime hours (late afternoon and evening)
●Avoidance smoking or other nicotine intake, particularly during the evening
●Adjusting the bedroom environment as needed to decrease stimuli (such as reduction of ambient light, turning off the television or radio, etc.)
●Avoidance prolonged use of light-emitting screens (laptops, tablets, smartphones, and electronic reading devices) before bedtime 
●Resolving concerns or worries before bedtime
●Exercising regularly for at least 20 minutes, preferably more than four to five hours prior to bedtime
●Avoidance daytime naps, especially if they are longer than 20 to 30 minutes or occur late in the day
If stress related issues are a concern visit the following URL: http://healthcenter.indiana.edu/counseling/self-help/relaxation-techniques.shtml
For assistance w/tobacco cessation consider contacting this IUHC site: (http://healthcenter.indiana.edu/wellness/services/smoking-cessation.shtml)
Stimulus Control Therapy may be of additional assistance in the treatment of non-chronic insomnia.
- Go to bed only when sleepy.
- Do not watch television, read, eat, or worry while in bed. Use bed only for sleep and sex.
- Get out of bed if unable to fall asleep within twenty minutes and go to another room. Return to bed only when sleepy. Repeat this step as many times as necessary throughout the night.
- Set an alarm clock to wake up at a fixed time each morning including weekends.
- Do not take a nap during the day.
Additional modalities of insomnia treatment may be found through use of Relaxation Therapy, Cognitive Therapy and Cognitive Behavioral Therapy skill development. Results are best achieved through counseling w/trained therapist.
Medication Use: While a number of both prescription and over the counter medications claim to be useful in treatment of insomnia, the potential benefits of pharmacologic therapy on sleep quality and daytime function are balanced against the risk of side effects as well as physical and psychological dependence with long-term use. If medication is found to be necessary, it is important to appropriately match an appropriate sleep aid drug with particular type of insomnia. Additionally, underlying medical conditions and/or routine prescription and over the counter medications must be taken into consideration. Essentially all sleep aid medications have potential side effects and potential for drug interactions. For these reasons, it is recommended that discussion with a medical professional be done prior to use. If your insomnia continues, or worsens in spite of use of above self-care measures for 5-7 days, consider an appointment with IUHC Counseling and Psychological Services (CAPS 812 855 5711) call or make an appointment with the IU Health Center Medical Clinic for further evaluation and treatment. (http://healthcenter.indiana.edu/services/medical-clinic.shtml)
Additional sleep related information may be found thru the UpToDate link on the IU Health Center website (http://healthcenter.indiana.edu/answers/index.shtml) and at the CDC web page on sleep issues (https://www.cdc.gov/sleep/index.html)