The other, more common type of insomnia is secondary to an underlying medical or psychiatric problem; the side effects of medications; behavioral factors like ill-timed exposure to caffeine, alcohol or nicotine or daytime naps; or environmental disturbances like jet lag or excessive noise or light — especially the blue light from an electronic device — in the bedroom.
Among the many medical conditions that can cause insomnia are heart failure, gastroesophageal reflux (GERD), lung disease, arthritis, Alzheimer’s disease and incontinence. Treating the underlying condition, if possible, often relieves the insomnia.
Regardless of the reason for insomnia, it can become a learned response when people anticipate having difficulty falling asleep or returning to sleep after middle-of-the-night awakenings. They may spend hours lying awake in bed worrying about being unable to sleep, and the anxiety itself impairs their ability to sleep.
The more one frets about a sleep problem, the worse it can get. When on occasion I awaken in the wee hours of the morning and can’t get back to sleep, I usually get up and do something useful, which takes the curse off my insomnia. If I’m worried about forgetting something important, I write it on a pad kept next to the bed, taking care not to turn on a light. (Bright light in the middle of the night can reset your biological clock; if you get up to use the bathroom, use a night light near the floor.)
Nonmedical causes of insomnia are often successfully treated by practicing “good sleep hygiene,” a concept developed by the late Peter J. Hauri, a sleep specialist at the Mayo Clinic. That means limiting naps to less than 30 minutes a day, preferably early in the afternoon; avoiding stimulants and sedatives; avoiding heavy meals and minimizing liquids within two to three hours of bedtime; getting moderate exercise daily, preferably in the morning or early afternoon; maximizing exposure to bright light during the day and minimizing it at night; creating comfortable sleep conditions; and going to bed only when you feel sleepy.
If you still can’t fall asleep within about 20 minutes in bed, experts recommend leaving the bedroom and doing something relaxing, like reading a book (one printed on paper, not on a brightly lit screen), and returning to bed when you feel sleepy.
Many people mistakenly resort to alcohol as a sleep aid. While it may help people fall asleep initially, it produces fragmented sleep and interferes with REM sleep, Dr. Avidan and others report.