Difficulty sleeping or insomnia is a very common complaint. It is estimated that 30-50% of Americans are affected by insomnia. About one-third of these or 10% of the population complain of chronic insomnia. Insomnia can involve difficulty falling asleep or staying asleep or both. Insomnia can be due to inadequate quantity or quality of sleep. Insomnia affects women more than men and it tends to increase with age.

Insomnia is a symptom not a disease and it can be caused by many different things. Common causes of short-term insomnia include stress, illness, pain, poor sleep environment, medications, and changes in normal sleep schedule. Illnesses associated with insomnia include congestive heart failure, restless leg syndrome, acid reflux (GERD), asthma, and obstructive sleep apnea. Common causes of chronic insomnia include depression, anxiety, chronic stress, and pain. Insomnia can have a negative impact on health by increasing the risk of accidents and chronic illnesses such as diabetes and heart disease. Here are some tips to help improve sleep.

• Go to bed and get up at about the same time every day, even on weekends or vacations. A regular schedule helps reinforce your body's sleep-wake cycle.

• Don't eat or drink large amounts before bedtime. Eat a light supper at least two hours or large supper at least four hours before bedtime. This will allow time for food to be digested and reduce waking because of heartburn or indigestion. Also limit fluids before bed to avoid waking to use the bathroom.

• Avoid caffeine, nicotine and alcohol before bed. These have a stimulant effect that can affect sleep. Do not have caffeine after 2 p.m. to give your body time to eliminate it. Alcohol can cause waking and reduces sleep quality.

• Do not watch TV or use a computer for at least an hour before bedtime as they stimulate the brain with light and sound. Start quieting your brain and body before you go to bed.

• Eat a healthy diet. High fat diet has been associated with poor sleep.

• Get regular exercise but do not exercise too close to bedtime as it has a stimulating effect that may make falling asleep more difficult. Exercise at least 3 to 4 hours before bedtime.

• Have a good environment to sleep in. The bedroom should be comfortable, dark, and quiet. A sleeping mask may help if light is a problem and "white noise" such as a fan may help cover up disturbing noises.

• Have a relaxing routine before going to bed such as reading, listening to music or a bath.

• Use your bed only for sleep or sex. Avoid watching television, reading or working while in bed.

• Make a to-do list of things that you need to do the next day before going to bed to avoid worrying about them in bed.

• If you can't sleep get up and do something that is not too stimulating until you get drowsy.

References: http://www.webmd.com/sleep-disorders/insomnia, http://www.mayoclinic.com/health/sleep/HQ01387, http://www.emedicinehealth.com/insomnia/article_em.htm.

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