Sleep Disorders: What You Need To Know

Chronic, long-term sleep disorders affect millions of Americans each year. These disorders and the sleep deprivation they cause can interfere with work, driving, social activities, and overall quality of life, and can have serious health implications.

To learn more about sleep, sleep deprivation and deficiency, and sleep disorders, visit the National Heart, Lung, and Blood Institute (NHLBI) website.

• There is a small amount of low-quality evidence that relaxation techniques by themselves can help with chronic insomnia. Relaxation techniques may be recommended in certain situations, depending on individual preferences, health provider qualifications, and treatment availability. 
• The treatment most strongly recommended for insomnia remains multicomponent cognitive behavioral therapy for insomnia (CBT-I). CBT-I often includes types of relaxation techniques, such as progressive relaxation, abdominal breathing, and guided imagery training. 
• A small randomized controlled trial of 108 women showed that progressive relaxation may help women with insomnia during menopause. Another small randomized controlled trial of 161 postmenopausal women found that training in both progressive relaxation exercises and good sleep habits helped with insomnia. 
• Using relaxation techniques before bedtime can be part of a strategy to improve sleep habits that also includes other steps, such as (1) maintaining a consistent sleep schedule; (2) avoiding caffeine, nicotine, alcohol, large meals, strenuous exercise, and bright artificial light (such as from a TV, computer, or cell phone) too close to bedtime; (3) spending time outside every day; and (4) sleeping in a quiet, cool, dark room. To learn more, visit NHLBI’s webpage Healthy Sleep Habits.
• Relaxation techniques are generally considered safe for healthy people. However, occasionally, people report negative experiences such as increased anxiety, intrusive thoughts, or fear of losing control. There have been rare reports that certain relaxation techniques might cause or worsen symptoms in people with epilepsy or certain psychiatric conditions. 

• A 2022 review of 13 studies with 1,007 adult participants found that listening to music may lead to improved reports of sleep quality among people with insomnia. (The term sleep quality refers to a collection of measures, including total time asleep, how long it takes to fall asleep, time asleep before waking, time spent awake, and satisfaction of sleep). However, there was not enough good-quality evidence to determine the effect of listening to music on the severity of insomnia or the number of times a person wakes up. The results showed that listening to music may slightly improve sleep-onset latency (how quickly a person falls asleep), sleep duration (length of time a person is asleep), sleep efficiency (amount of time a person is asleep compared to the total time spent in bed), and daytime effects.
• In general, research studies of music-based interventions do not show any negative effects. However, listening to music at too high a volume can contribute to noise-induced hearing loss. You can find out about this type of hearing loss on the National Institute on Deafness and Other Communication Disorders website.
• Because music can be associated with strong memories or emotional reactions, some people may be distressed by exposure to specific pieces or types of music.

• A 2019 clinical practice guideline from the U.S. Department of Veterans Affairs and U.S. Department of Defense said there was not enough evidence to know whether mindfulness meditation is helpful for people with insomnia. 
• A 2021 clinical practice guideline from the American Academy of Sleep Medicine said there was not enough evidence to make recommendations on using mindfulness by itself for insomnia. 
• A 2022 review of 20 studies and 2,890 participants found that mindfulness-based stress reduction might be ineffective for improving sleep quality in people with insomnia, but the authors noted that the studies were small and showed bias.
• Mindfulness practices are usually considered to have few risks. However, few studies have examined mindfulness practices for potentially harmful effects, so it isn’t possible to make definite statements about safety.

• A 2019 clinical practice guideline from the U.S. Department of Veterans Affairs and U.S. Department of Defense said there was insufficient evidence to recommend for or against yoga for treating insomnia.
• A 2020 review of 19 studies and 1,832 participants suggested that yoga may be helpful for improving sleep quality but not necessarily insomnia in women with sleep problems.
• A 2019 review included 4 studies of 353 older adults and found that yoga had a small-to-moderate positive effect on improving sleep quality.
• A 2022 review included 3 studies of 109 participants with rheumatic diseases and found that yoga helped improve sleep quality.
• Yoga is generally considered a safe form of physical activity for healthy people when performed properly, under the guidance of a qualified instructor. However, as with other forms of physical activity, injuries can occur. The most common injuries are sprains and strains, and the parts of the body most commonly injured are the knee or lower leg.  

• A 2019 clinical practice guideline from the U.S. Department of Veterans Affairs and U.S. Department of Defense said there was insufficient evidence to recommend for or against using tai chi to treat insomnia.
• The authors of a 2022 review said several studies suggested that tai chi could help improve sleep quality, particularly among older adults. They said that the impact of tai chi on insomnia, however, needs to be studied more. The review included 5 studies on tai chi (742 participants).
• Tai chi appears to be safe. A 2019 review of 24 studies (1,794 participants) found that the frequency of adverse events was similar for people doing tai chi, another active intervention, or no intervention. The adverse events that were reported as related to tai chi or other active interventions were minor, such as musculoskeletal aches and pains.

• A 2023 review evaluated the effects of hypnotherapy on sleep for 2,551 participants in 44 studies. Some of the participants were healthy and others had different health conditions, including insomnia, pain, cancer, sickle cell disease, and various psychiatric conditions. The review found that 47.7 percent of the studies showed hypnotherapy had beneficial effects on sleep, 22.7 percent showed mixed results, and 29.5 percent showed no impact. A separate evaluation of the 11 studies (546 participants) that used hypnotic suggestions to improve sleep and included only participants with sleep disturbances saw greater beneficial effects from hypnotherapy, with 54.5 percent of the studies showing positive results, 36.4 percent showing mixed results, and 9.1 percent showing no impact.
• Hypnotherapy is generally considered safe when led by licensed hypnotherapists with special training in this technique.

• A 2021 review of 11 studies and 775 participants suggested that acupuncture may help improve insomnia, but the studies were small, differed from each other in many ways (e.g., treatment dosage, acupoint selection), and judged to be low quality. 
• A 2019 clinical practice guideline from the U.S. Department of Veterans Affairs and U.S. Department of Defense said there was not enough evidence to recommend for or against using acupuncture for insomnia, except for a weak recommendation for auricular acupuncture, which involves specific points on the outer ear.
• A 2020 evaluation of 7 systematic reviews (10,001 participants) on auricular acupuncture for insomnia found that the reviews suggested auricular acupuncture may be beneficial, but the quality of most of the reviews was low or critically low and the quality of the studies within the reviews was poor.
• Relatively few complications from using acupuncture have been reported. However, complications have resulted from use of nonsterile needles and improper delivery of treatments. When not delivered properly, acupuncture can cause serious adverse effects, including infections, punctured organs, and injury to the central nervous system. 

• There is very little research on magnesium for insomnia. A 2021 review of 3 studies (151 participants) suggested that magnesium may help with sleep-onset latency (how quickly a person falls asleep) in older adults with insomnia. But the reviewers said the studies were of low quality and inadequate for making well-informed decisions on using magnesium. 
• A 2022 review of 9 studies (7,582 participants) showed conflicting findings for magnesium’s effect on sleep quality and sleep disorders, and the reviewers said that large, well-designed studies lasting more than 12 weeks are needed.
• Magnesium in dietary supplements and medications should not be consumed in amounts above the upper limit (e.g., 110 mg for children 4 to 8 years old; 350 mg for adults and children 9 to 18 years old), unless recommended by a health care provider. High intakes of magnesium from dietary supplements and medications can cause diarrhea, nausea, and abdominal cramping. Extremely high intakes of magnesium can lead to irregular heartbeat and cardiac arrest (when the heart stops beating).

• A 2022 review of 19 studies with over 18,000 participants suggested that vitamin D may help improve sleep quality, but the reviewers said its effect on sleep quantity and sleep disorders is not clear.
• Getting too much vitamin D can be harmful. Very high levels of vitamin D in your blood (greater than 375 nmol/L or 150 ng/mL) can cause nausea, vomiting, muscle weakness, confusion, pain, loss of appetite, dehydration, excessive urination and thirst, and kidney stones. Extremely high levels of vitamin D can cause kidney failure, irregular heartbeat, and even death. (High levels of vitamin D are almost always caused by consuming excessive amounts of vitamin D from dietary supplements.)

• Melatonin may help with jet lag after eastbound and westbound flights, according to a 2021 review of 10 studies and 994 participants. Melatonin may also help with sleep problems related to shift work, according to a 2022 review of 10 studies of 318 participants. 
• A 2022 review of 12 studies and 2,666 participants suggested that melatonin helped improve sleep-onset latency (how quickly a person falls asleep) and daytime sleepiness in people with insomnia, but the use of melatonin did not improve sleep quality or the time awake during the night.
• A 2017 clinical practice guideline from the American Academy of Sleep Medicine and a 2019 clinical practice guideline from the U.S. Department of Veterans Affairs and U.S. Department of Defense recommended against using melatonin for treating chronic insomnia. Both said there was not enough evidence for recommending its use.
• Dietary supplements containing substances that can be changed into melatonin in the body—L-tryptophan and 5-hydroxytryptophan (5-HTP)—have sedative effects, but it is unclear how they work and there is very limited data on their effects on insomnia. The 2017 clinical practice guideline from the American Academy of Sleep Medicine recommended against using tryptophan for treating chronic insomnia.
• Melatonin appears to be relatively safe for short-term use, but its long-term safety has not been established. Use of over-the-counter melatonin might place children and teenagers at risk for accidental or intentional overdose. A 2022 study showed that from 2012 to 2021, hospitalization and serious outcomes from melatonin ingestion by people 19 years and younger increased.
• The use of L-tryptophan as a dietary supplement was discontinued in 1989 because of an outbreak of eosinophilia-myalgia syndrome (EMS) that was traced to contaminated synthetic L-tryptophan from a single manufacturer. EMS is a rare disorder that can potentially cause severe, disabling complications and even death. Because of its chemical and biochemical relationship to L-tryptophan, 5-HTP has been under close watch for its safety. Extensive analyses of several sources of 5-HTP have shown no toxic contaminants similar to those associated with L-tryptophan, nor the presence of any other significant impurities.

• Although chamomile has traditionally been used for insomnia, often in the form of a tea, there is no conclusive evidence from clinical trials showing whether it is helpful. Some people, especially those who are allergic to ragweed or related plants, may have allergic reactions to chamomile.
• Although kava is said to have sedative properties, very little research has been conducted on whether this herb is helpful for insomnia. More importantly, the use of kava has been linked to liver injury that is sometimes serious or even fatal. The exact cause and frequency of the liver damage are unclear.
• Clinical trials of valerian (another herb said to have sedative properties) have had inconsistent results, and its value for insomnia has not been demonstrated. Although few people have reported negative side effects from valerian, it is uncertain whether this herb is safe for long-term use. A 2017 clinical practice guideline from the American Academy of Sleep Medicine recommended against using valerian for treating chronic insomnia.

Visit this page for more information on dietary supplements.

• Aromatherapy is the therapeutic use of essential oils from plants. A 2021 review of 16 studies (1,346 participants) suggested that aromatherapy helped improve sleep quality and reduce symptoms in people with insomnia, but the researchers said that larger and more rigorous studies are needed.
• Safety testing on essential oils shows very few side effects or risks when they are used as directed. Allergic reactions and skin irritation may occur when essential oils are in contact with the skin for long periods of time. Sun sensitivity may occur when citrus or other essential oils are applied to the skin before going out in the sun.
• A few cases of breast tissue swelling have been reported in children who used topical products containing lavender essential oil. However, it’s unclear whether the essential oil was responsible for the breast swelling, a condition that can have many causes.

• A 2020 review that included 12 studies with 250 participants indicated that there was insufficient evidence to support the use of cannabinoid therapies for treating any sleep disorder. The cannabinoid therapies that were evaluated included cannabidiol (CBD). The authors of the review said there was not much published research and that most of the studies had a moderate-to-high risk of bias.
• CBD may have side effects, including decreases in alertness, changes in mood, decreased appetite, and gastrointestinal symptoms such as diarrhea. In addition, CBD use has been associated with liver injury, male reproductive harm, and interactions with other drugs.

Recent projects include studies on:

• How a mindfulness-based intervention may improve poor sleep quality during pregnancy.
• The potential of the plant Centella asiatica (also called gotu kola) in promoting functional resilience to some of the challenges of growing older, including sleep deprivation.
• The effects of CBD on sleep in people with multiple sclerosis and chronic pain.
• The feasibility of using acupuncture to help manage multiple symptoms, including sleep disturbances, of breast cancer survivors who are receiving endocrine therapy at Federally Qualified Health Centers.

A 2020 review of 9 studies and 584 participants suggested that acupuncture might help improve breathing in obstructive sleep apnea, but the researchers said the quality of evidence was low to very low. Three studies looked at safety, and none of them had reports of side effects from the acupuncture treatment. There is very limited, if any, research on other complementary approaches for obstructive sleep apnea.

A 2019 review of 13 randomized controlled trials and 22 uncontrolled before-and-after studies (1,420 participants) suggested that conventional lifestyle interventions (diet, exercise, good sleep habits, and tobacco and alcohol cessation) may help improve sleep apnea. Weight loss through diet and exercise was found to be most effective for male patients with moderate-to-severe obstructive sleep apnea.

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