I can't ever sleep.

Yesterday I got up at 9AM and went to bed at 12:30AM last night.

I couldn't fall asleep until around 5AM. I have to leave for work around 6AM.

I wonder if it's mental problems. I always get tired around 5AM-6AM. Around the time I decide I'm not going to work because I haven't slept.

I took some sleeping pills a couple times recently and they don't do anything for me. My dad and a friend of mine both take one and they can't stay awake. I take two and hours later I'm still wide awake.

Anyways... I thought maybe somebody could recommend something that has worked for them.


bro, fark sleeping pills

Melatonin. Above and beyond the BEST for sleeping

I have a big insomnia problem, and melatonin has ALWAYS worked for me. SUPER cheap too. I didn't know it was an antioxidant...


Jacob sorry that you are going through that. It really sucks. Alot of factors can be involved in insomnia. I have a long-ass patient information handout on insomnia with really good information. I can fax it to you, cut and paste it to email to you. I can post it too if it would benefit people. It is pretty long, but not like you are sleeping or anything. Let me know.


Thanks man.

pbolger- if it's not too much trouble, think you could post it?




Insomnia is the sensation of daytime fatigue and impaired performance caused by insufficient sleep. In general, people with insomnia experience one of the following:

  • An inability to sleep despite being tired.
  • A light, fitful sleep that leaves one fatigued upon awakening.
  • Waking up too early.

Under debate is the question of whether insomnia is always a symptom of some other physical or psychological condition or whether in some cases it is a primary disorder of its own.

Duration of Insomnia

Insomnia, usually temporary, is often categorized by how long it lasts:

Transient insomnia lasts for a few days.

Short-term insomnia lasts for no more than three weeks.

Chronic insomnia occurs when the following characteristics are present:

  • When a person has difficulty falling asleep, maintaining sleep, or has nonrestorative sleep for at least three nights a week for one month or longer.
  • In addition, the patient is distressed and believes that normal daily functioning is impaired because of sleep loss.

Chronic insomnia may also be primary or secondary, depending on the cause:

  • Primary chronic insomnia occurs when it is the sole complaint of a patient.
  • Secondary chronic insomnia is caused by medical or psychiatric conditions, drugs, or emotional or psychiatric disorders.

Forms of Insomnia

Insomnia may also be defined in terms of inability to sleep at conventional times. The following are examples and are referred to as circadian rhythm disorders. [For a definition of circadian rhythm, see Box Healthy Sleep.]

Delayed Sleep-Phase Syndrome. Delayed sleep-phase syndrome is the term for a circadian clock that runs late but reliably. People who have this condition (usually adolescents) fall asleep very late at night or in early morning hours, but then they sleep normally.

Advanced Sleep Syndrome. This syndrome tends to develop in older people; it produces excessive sleepiness in the morning and undesired awakening early in the morning.


Healthy Sleep

In sleep studies, subjects spend about one-third of their time asleep, suggesting that most people need about eight hours of sleep each day. Individual adults differ in the amount of sleep they need to feel well rested, however. (Infants may sleep as many as 16 hours a day.)

The daily cycle of life, which includes sleeping and waking, is called a circadian (meaning "about a day") rhythm, commonly referred to as the biologic clock. Hundreds of bodily functions follow biologic clocks, but sleeping and waking comprise the most prominent circadian rhythm. The sleeping and waking cycle is approximately 24 hours. (If confined to windowless apartments, with no clocks or other time cues, sleeping and waking as their bodies dictate, humans typically live on slightly longer than 24-hour cycles.) It usually takes the following daily patterns:

  • Humans are designed for daytime activity and nighttime rest.
  • Additionally, there is a natural peak in sleepiness at mid-day, the traditional siesta time.

In addition, daily rhythms intermesh with other factors that may interfere or change individual patterns:

  • The fraction-of-a-second-firing of nerve cells in the brain may be faster or slower in different individuals.
  • The monthly menstrual cycle in women can shift the pattern.
  • Light signals coming through the eyes reset the circadian cycles each day, so changes in season or various exposures to light and dark can unsettle the pattern. The importance of sunlight as a cue for circadian rhythms is dramatized by the problems experienced by people who are totally blind. They commonly suffer trouble sleeping and other rhythm disruptions.

The Response in the Brain to Light Signals

The response to light signals in the brain is an important key factor in sleep:

  • Light signals travel to a tiny cluster of nerves in the hypothalamus in the center of the brain, the body's master clock, which is called the supra chiasmatic nucleus or SCN.
  • This nerve cluster takes its name from its location, which is just above (supra) the optic chiasm, which is a major junction for nerves transmitting information about light from the eyes.
  • The approach of dusk each day prompts the SCN to signal the nearby pineal gland (named so because it resembles a pine-cone) to produce the hormone melatonin.
  • Melatonin is thought to act as the body's time-setting hormone. The longer a person is in darkness the longer the duration of melatonin secretion. Secretion can be diminished by staying in bright light. Melatonin also appears to trigger the need to sleep.

Sleep Cycles

Sleep consists of two distinct states that alternate in cycles and reflect differing levels of brain nerve cell activity:

Non-Rapid Eye Movement Sleep (NonREM). NonREM sleep is also termed quiet sleep. NonREM is further subdivided into three stages of progression:

  • Stage 1 (light sleep).
  • Stage 2 (so-called true sleep).
  • Stage 3 to 4 (deep "slow-wave" or delta sleep).

With each descending stage, awakening becomes more difficult. It is not known what governs NonREM sleep in the brain. A balance between certain hormones, particularly growth and stress hormones, may be important for deep sleep.

Rapid Eye-Movement Sleep (REM). REM sleep is termed active sleep. Most vivid dreams occur in REM sleep. REM-sleep brain activity is comparable to that in waking, but the muscles are virtually paralyzed, possibly preventing people from acting out their dreams. In fact, except for vital organs like lungs and heart, the only muscles not paralyzed during REM are the eye muscles. REM sleep may be critical for learning and for day-to-day mood regulation. When people are sleep-deprived, their brains must work harder than when they are well rested.

The REM/NREM Cycle. The cycle between quiet (NonREM) and active (REM) sleep generally follows this pattern:

  • After about 90 minutes of NonREM sleep, eyes move rapidly behind closed lids, giving rise to REM sleep.
  • As sleep progresses the NonREM/REM cycle repeats.
  • With each cycle, NonREM sleep becomes progressively lighter, and REM sleep becomes progressively longer, lasting from a few minutes early in sleep to perhaps an hour at the end of the sleep episode.


Response to Change or Stress

A reaction to change or stress is one of the most common causes of short-term and transient insomnia. This condition is sometimes referred to as adjustment sleep disorder.

The precipitating factor could be a major or traumatic event such as the following:

  • An acute illness.
  • Injury or surgery.
  • The loss of a loved one.
  • Job loss.

Temporary insomnia could also develop after a relatively minor event, including the following:

  • Extremes in weather.
  • An exam.
  • Traveling.
  • Trouble at work.

In most cases, normal sleep almost always returns when the condition resolves, the individual recovers from the event, or the person becomes acclimated to the new situation. Treatment is needed if sleepiness interferes with functioning or if it continues for more than a few weeks. It should be noted that individual responses to stress vary and some people may not experience insomnia at all, even during very stressful situations while others may suffer from insomnia in response to very mild stressors.

Female Hormonal Fluctuations

Fluctuations in female hormones play a major role in insomnia in women over their lifetimes. Such insomnia is most often temporary.

  • During Menstruation. Progesterone promotes sleep, and levels of this hormone plunge during menstruation, causing insomnia. (When they rise during ovulation, women may become sleepier than usual.)
  • During Pregnancy. The effects of changes in progesterone levels in the first and last trimester can disrupt normal sleep patterns.
  • Menopause. Insomnia can be a major problem in the first phases of menopause, when hormones are fluctuating intensely. Insomnia during this period may be due to different factors that occur. In some women, hot flashes, sweating, and a sense of anxiety can awaken women suddenly and frequently at night during the first months of menopause. Insomnia may also be perpetuated by psychologic distress provoked by this life passage. In most cases, insomnia is temporary. Cases of chronic insomnia in women after 50 are more likely to be due to causes unrelated to gender.

Jet Lag

Air travel across time zones often causes insomnia. After long plane trips, one day of adjustment is usually needed for each time zone crossed. Traveling west to earlier times seems to be less traumatic than going east to a later time because it is easier to lengthen a circadian phase than to shorten it.

Effect of Light and Other Environmental Disruptions

In one study, 20% of adults reported that light, noise, and uncomfortable temperatures caused their sleeplessness. Depending on the time of day too much or too little light can disrupt sleep.

  • Excessive Light at Night. It is well known that a person's biologic circadian clock is triggered by sunlight and very bright artificial light to maintain wakefulness. One study indicated that even dim artificial light might disrupt sleep.
  • Insufficient Light During the Day. Insufficient exposure to light during the day, as occurs in some disabled elderly patients who rarely venture outside, may also be linked with sleep disturbances. One study suggests that when a person is exposed to bright daylight, melatonin levels increase in response to darkness at night, which aids sleep.

Other Causes of Short-Term or Transient Insomnia

Caffeine and Nicotine. Caffeine most commonly disrupts sleep. Nicotine can cause wakefulness. Quitting smoking can also cause transient insomnia. In fact, it has been suggested that if sleeping could be improved during withdrawal from smoking, then perhaps it would be easier to quit smoking.

Partner's Sleep Habits. In one 1999 survey, 17% of women and 5% of men reported that their partner's sleep habits impaired their own sleep. Snoring can certainly be a factor in a partner's insomnia. In fact, in the same survey 44% of men and 36% of women reported snoring a few nights a week and of those who snored, 19% could be heard through a closed door.

Medications.Insomnia is a side effect of many common medications, including over-the-counter preparations that contain caffeine. People who suspect their medications are causing them to lose sleep should check with a physician or pharmacist.


In many cases, it is unclear if chronic insomnia is a symptom of some physical or psychological condition or if it is a primary disorder of its own. In most instances, a collaboration of psychological and physical conditions causes the failure to sleep.

Psychophysiologic Insomnia After Short-Term Insomnia

Psychophysiologic insomnia is the revolving door of sleeplessness:

  • An episode of transient insomnia disrupts the person's circadian rhythm.
  • The patient begins to associate the bed not with rest and relaxation but with a struggle to sleep. A pattern of sleep failure emerges.
  • Overtime, this event repeats, and bedtime becomes a source of anxiety. Once in bed, the patient broods over the inability to sleep, the consequences of sleep loss, and the lack of mental control. All attempts to sleep fail.
  • Eventually excessive worry about sleep loss becomes persistent and provides an automatic nightly trigger for anxiety and arousal. Unsuccessful attempts to control thoughts, images, and emotions only worsen the situation. After such a cycle is established, insomnia becomes a self-fulfilling prophecy that can persist indefinitely.

Sometimes anxiety and the inability to sleep dates back to childhood when parents used various threats to force their children into sleep for which they may not have been ready.

Medical Conditions and Treatments

In a 1999 survey, 22% of adults reported that health conditions, pain or discomfort impaired their sleep.

Nightly Leg Problems. Leg disorders that occur at night, such as restless legs syndrome or leg cramps, are of special note. They are very common and an important cause of insomnia, particularly in older people. [For more information, see, Leg Disorders (Sleep-Related): Restless Legs Syndrome and Others.]

Medical Problems. Among the many medical problems (and some of the drugs that treat them) that can cause chronic insomnia are allergies, arthritis, cancer, fibromyalgia, heart disease, gastroesophageal reflux disease (GERD), hypertension, asthma, emphysema, rheumatologic conditions, Alzheimer's disease, Parkinson's disease, hyperthyroidism, and attention deficit hyperactivity disorder.

Medications. Among the many medications that can cause insomnia are nicotine, certain antidepressants (e.g., fluoxetine, bupropion), theophylline, lamotrigine, felbamate, beta-blockers, and beta-agonists.

Emotional Disorders

A large percentage of chronic insomnia cases prove to have a psychologic or even psychiatric basis. The disorders that most often cause insomnia are the following:

  • Anxiety.
  • Depression. Sleep abnormalities are an integral part of depressive disorders, with more than 90% of depressed patients experiencing insomnia.
  • Bipolar disorder.

It should be noted that insomnia may cause emotional problems, and it is often unclear which condition has triggered the other, or if the two conditions, in fact, have a common source. [ See Effects on Emotions under How Serious is Insomnia?]

Alcohol Overuse

An estimated 10% to 15% of chronic insomnia cases result from substance abuse, especially alcohol, cocaine, and sedatives. One or two alcoholic drinks at dinner, for most people, poses little danger of alcoholism and may help reduce stress and initiate sleep. Excess alcohol or alcohol used to promote sleep, however, tends to fragment sleep and cause wakefulness a few hours later. It also increases the risk for other sleep disorders, including sleep apnea and restless legs. Alcoholics often suffer insomnia during withdrawal and, in some cases, for several years during recovery.

Shift Work

A number of studies have reported that shift work throws off the body's circadian rhythm and have suggested that such changes could lead to chronic insomnia. One study found that 53% of night-shift workers fall asleep on the job at least once a week, implying that their internal clocks do not adjust to unusual work times. (They are also at much higher risk than other workers for automobile accidents due to their drowsiness and may also have a higher risk for health problems in general.) A Japanese study reporting on different aspects of insomnia found that excessive computer work was associated with all forms of insomnia. People who were over-involved with their work tended to have trouble falling asleep and they tended to awaken earlier than average.

Brain Chemicals and Other Biologic Factors Affecting Chronic Insomnia

Changes in Brain Chemicals. Abnormal levels of certain brain chemicals have been observed in some people with chronic insomnia.

  • Melatonin. Low levels of melatonin, the hormone secreted by the pineal gland, are lower, have sometimes been observed in chronic insomnia. Studies are not consistent, however, so the significance of such findings is not clear.
  • Stress Hormones. Some studies have reported persistently high levels of stress hormones, particularly cortisol, in people with chronic insomnia, particularly insomnia related to aging and psychiatric disorders. High levels of cortisol reduce REM sleep. Of note, however, one 2003 study of people with chronic insomnia reported that cortisol levels were high only when their sleep was of poor quality. When they slept well, levels were lower. This study and other research suggests that high levels of stress hormones are caused by poor sleep, rather than being the cause.
  • Growth Hormone. Normal aging is associated with a blunting of regular, cyclical surges of growth hormone, which may affect sleep as one gets older. This hormone, which is normally secreted in the late night, is associated not only with growth but with deep, slow-wave sleep. (Older people generally have less slow-wave sleep.)

Changes in Immune Factors. Chronic insomnia may be perpetuated in some people by a combination of persistently high levels of stress hormones with a shift in the levels of certain immune factors. Studies are reporting that people with chronic insomnia have higher levels of certain immune factors called cytokines, notably interleukin-6 and tumor necrosis factor, during the day, but lower levels at night. These immune factors cause symptoms of fatigue and are typically higher at night and lower during the day in people with healthy sleep. The implications of these immune changes in people with insomnia are not known, however.

Genetic Factors

Sleep problems seem to run in families; approximately 35% of people with insomnia have a positive family history, with the mother being the most commonly affected family member. Still, because so many factors are involved in insomnia, a genetic component is difficult to define.


Studies estimate that between a quarter and one-third of American and European adults experience some insomnia each year, with between 10% and 20% of them suffering severe sleeplessness. In spite of this widespread problem, however, studies suggest that only about 30% of American adults who visit their doctor ever discuss sleep problems. Conversely, physicians seem rarely to ask patients about their sleep habits or problems.

Significant Risk Factors for Stress

A 2003 study suggested that there were seven significant factors that predicted who would be at high risk for insomnia:

  • Being older.
  • Having conflicts with relatives.
  • Being overworked on the job.
  • Being overworked at home.
  • Having a sick relative.
  • Having low social status.
  • Having a psychiatric or psychologic problem.

Negative Thinking

It should be noted that stressful events do not cause insomnia in everyone. Negative thoughts and attitudes toward events can be significant factors in insomnia. In one 2003 study, for example, the number of stressful events did not differ between good and poor sleepers. Those with insomnia, however, tended to experience these stressful events more intensively than the healthy sleepers.

In another interesting study, patients with insomnia and good sleepers were asked to record their pre-sleep images using a handheld counter. People with insomnia not only reported fewer images, but their images also tended to be more unpleasant than those of good sleepers. More of the images in people with insomnia were related to intimate relationships and to sleep itself. The images of sleepers were more likely to be random and disconnected.

Having Depression, Chronic Pain, or Both

Studies report that the strongest risk factors for insomnia are psychiatric problems, particularly depression, and physical complaints, such as headaches and chronic pain, that have no identifiable cause (called somatic symptoms). About 90% of people with depression have insomnia. In addition, insomnia and depression often coincide with somatic symptoms, particularly chronic pain. In fact, insomnia worsens chronic pain even in people who are not depressed. Headaches that occur during the night or early in the morning may actually be caused by sleep disorders. In one study, patients who had these complaints were treated for the sleep disorder only, and over 65% reported that their headaches were cured.

Gender Factors

Overall, insomnia is more common in women than men, although men are not immune from insomnia. Sleep efficiency deteriorates equally in men and women as they get older.

Men. One major study suggested that as men go from age 16 to 50, they lose about 80% of their deep sleep. During that period, light sleep increases and REM sleep remains unchanged. (The study did not use women as subjects, and there is some evidence to suggest they are not as affected.) After age 44 REM and total sleep diminish and awakenings increase.

Women. It is not clear why young adult women suffer more from insomnia than young adult men. Some theories are as follows:

  • In women, a number of hormonal events can disturb sleep, including premenstrual syndrome, menstruation, pregnancy, and menopause. All these conditions are short term, however, and in most cases the wakefulness associated with them is temporary and can be ameliorated with sleep hygiene and time.
  • After childbirth, most women develop a high sensitivity to the sounds of their children, which causes them to wake easily. Women who have had children sleep less efficiently than women who have not had children. It is possible that many women never unlearn this sensitivity and continue to wake easily long after the children have grown.
  • Women are at higher risk than men are for depression and anxiety, which are known risk factors for insomnia. In fact, some researchers believe that this is predominant reason for the gender differences in insomnia.

It should be noted that after menopause women are susceptible to the same environmental and biologic causes of insomnia as men. In fact, older women who are not bothered by sleeplessness tend to have longer and better sleep than noninsomniac men their own age.

Risk Factors in Elderly Adults

As people grow older, sleep changes in most older people, and about 15% of their sleeping time is in stage 1, light sleep. (In infancy, only 5% is spent in light sleep.). In a major 2003 survey, 18% of older adults (55 to 94 years old) had trouble falling asleep. A third of them woke up frequently during the night and about a quarter of them woke up too early and couldn't go back to sleep. In the same study, 33% of adults between 55 and 64 reported waking up feeling unrefreshed, which was actually greater than the percentage reported by older people (22%).

Nevertheless, age itself does not appear to be a risk factor for insomnia. A number of factors increase sleeplessness as one gets older:

  • Elderly people are more likely to be sedentary than younger adults.
  • Medical conditions that cause pain or nighttime distress are common in the elderly and pose a high risk for insomnia. They include arthritis, gastrointestinal distress, frequent urination, lung disease, and heart conditions.
  • Neurologic diseases in the elderly, such as Parkinson's, Alzheimer's, and other forms of dementia, can cause nighttime disorientation, confused wandering, and delirium.
  • Older people often take a number of prescription drugs whose side effects include insomnia.
  • The elderly are also prone to grief, depression, and anxiety, the handmaidens of sleeplessness. One study found, in fact, that in healthy older adults, psychologic factors, such as anxiety and depression, were more likely to be the cause of insomnia than illness, medications, or living conditions.
  • Melatonin levels are lower in general in older people. Some research suggests, however, that elderly people may have lower levels simply because many stay mostly indoors and out of normal sunlight.


Sleep loss among the elderly is not inevitable, however. While older people are more susceptible to many conditions that can cause insomnia, treatments and a healthy lifestyle, particularly regular exercises, are as useful in providing relief to the elderly as to the young. And a number of studies have found no significant increase in insomnia in older healthy adults.


Shift workers are at considerable risk for insomnia. In one major 1999 survey, 65% of shift workers reported one or more symptoms of insomnia at least a few nights a week. Workers over 50 and those whose shifts are always changing are particularly susceptible to insomnia, although night-shift workers also have a high rate of sleeplessness.

Other Risk Factors

Among the many conditions that pose a high risk for insomnia are the following:

  • Frequent travel, particularly crossing time lines.
  • Post-traumatic stress syndrome.
  • Brain injuries.
  • Many chronic medical conditions ranging from seemingly minor ones, such as tinnitus (ringing in the ears) to major medication conditions, such as respiratory problems, heart disease, or being on dialysis.


Insomnia and Mortality Rates

A 2002 study of sleeping habits in over one million people reported that people who slept seven hours a night enjoyed the longest lifespan. Those who slept 8 hours or more or 6 hours or less had higher mortality rates. People with insomnia did not have elevated mortality rates, which supported earlier evidence. People who took sleeping pills, however, did have lower survival rates.

Insomnia is virtually never lethal except in rare cases, such the genetic disorder called fatal familial insomnia. This rare degenerative brain disease develops in late adulthood. It is progressive and the individual develops intractable insomnia, which eventually becomes fatal.

Increased Risk for Accidents

As many as 200,000 automobile accidents in the US and 1,500 deaths from such accidents are caused by sleepiness. Studies continue to report that drowsy driving is as risky as drunk driving. In a major 2003 survey, 60% of young adults reported driving while drowsy and 20% dosed off while driving. In the study, 1% of adults who dozed off reported having an accident because of it. (One study strongly suggested that it was habitual sleepiness, however, and not just being sleepy at the time of an accident that places people at higher risk.)

Effect on Mood and Quality of Life

Surveys in 2001 and 2002 reported that people with severe insomnia had a quality of life that was almost as poor as in people with chronic conditions such as heart failure. In these studies, people with known depression or anxiety were not included. In addition to more daytime sleepiness, people with insomnia complained of more attention and memory problems compared to good sleepers. Insomniacs also experience more irritability, mistakes at work, and poorer relationships with their family than people who sleep well.

Effect on Thinking and Performance. Studies suggest that insomnia worsens many waking behaviors including the following:

  • Reduced concentration. Some experts report that deep sleep deprivation impairs the brain's ability to process information.
  • Impaired task performance. One study reported that missing only two to three hours of sleep every night for a week significantly impaired performance and mood. An Australian study reported that 17 hours of sleep deprivation causes impaired performance levels comparable to those found in people who have blood alcohol levels of 0.10%, a level that defines intoxication in many US states.
  • Effect on learning. Whether insomnia significantly impairs learning is unclear. Some studies have reported problems in memorization, although others have found no differences in test scores between people with temporary sleep loss and those with full sleep.

Insomnia and Depression. Although stress and depression are major causes of insomnia, insomnia may also increase the activity of the hormones and pathways in the brain that can produce emotional problems. Even modest alterations in waking and sleeping patterns can have significant effects on a person's mood. Persistent insomnia may even predict the future development of emotional disorders in some cases. Some investigators, in fact, are exploring the possibility of preventing psychiatric disorders by early recognition and treatment of insomnia.