September 2020 | Reviewed by: Andrea Matsumura, MD and Virginia Skiba, MD
What is insomnia?
Insomnia is the most common sleep complaint. It occurs when you have trouble falling asleep or staying asleep even though you had the opportunity to get a full night of sleep. The causes, symptoms and severity of insomnia vary from person to person. Insomnia may include:
- Difficulty falling asleep
- Difficulty staying asleep throughout the night
- Waking up too early in the morning
Insomnia involves both a sleep disturbance and daytime symptoms. The effects of insomnia can impact nearly every aspect of your life. Studies show that insomnia negatively affects work performance, impairs decision making and can damage relationships. Insomnia can affect your mood and make other medical conditions more difficult to manage. In most cases, people with insomnia report a worse overall quality of life.
Everyone has the occasional night of poor sleep. This does not mean you have insomnia. In many cases it means you may have stayed up too late, gotten up too early or woken up in the middle of the night. Stress is a common cause of a night of poor sleep.
As many as 35 percent of adults complain of insomnia. It is more common in groups such as older adults, women, people under stress and people with certain medical and mental health problems such as depression.
Types of insomnia
There are two types of insomnia based on the regularity and duration of the sleep disturbance and daytime symptoms:
- Short-term insomnia: This type of insomnia lasts for up to three months. At any given time, it occurs in 15 to 20 percent of people.
- Chronic insomnia: This type of insomnia occurs at least three times per week and lasts for at least three months. About 10 percent of people have chronic insomnia.
A sleep doctor diagnoses chronic insomnia. A sleep doctor helps to make sure there is nothing else in your sleep causing chronic insomnia. Options for treatment of chronic insomnia are best discussed with a sleep doctor. The sleep team at an accredited sleep center can provide ongoing care.
What are symptoms of insomnia?
Symptoms and causes of insomnia can vary. Insomnia symptoms may include:
- Fatigue
- Problems with attention, concentration or memory
- Poor performance at school or work
- Moodiness or irritability
- Daytime sleepiness
- Rash actions or aggression
- Lack of energy or motivation
- Errors or accidents
- Concern or frustration about your sleep
What causes insomnia?
Insomnia is most often associated with another problem that drives the insomnia. These causes may include:
Stress
Many things can cause stress, like work, death, divorce, job loss or change, and relationships.
Other sleep disorders
Some sleep disorders can cause insomnia or make it worse. For instance, people with restless legs syndrome may have a hard time falling asleep.
Medical conditions
Many illnesses can cause insomnia. People with pain, discomfort or limited mobility from medical problems may have difficulty falling asleep or staying asleep. Insomnia due to medical conditions is most common in older adults because people tend to have more chronic health problems as they age. Conditions such as pregnancy, particularly the third trimester, and menopause can cause sleep problems. The severity and duration of insomnia often varies with the related health condition.
Mental disorders
The relationship between sleep and mental health is complex. Insomnia is sometimes caused by a mental health disorder. Often a mental health disorder will be found after a complaint of insomnia. Depression is a frequent cause of insomnia. People with depression often have trouble falling asleep or staying asleep. Difficulty falling asleep is also common in people with anxiety disorders. Other mood disorders such as bipolar disorder may also cause sleep problems.
Medication or substance use or abuse
Insomnia can be an unwanted side effect of many prescription or over-the-counter medications. Common cold and allergy medicines contain pseudoephedrine, which can make it difficult for you to fall asleep. Antidepressants and medications to treat ADHD, high blood pressure or Parkinson’s disease can also cause insomnia.
Using some drugs or drinking alcohol close to bedtime can make it difficult to fall asleep or cause you to wake up during the night. Caffeine and other stimulants can prevent you from falling or staying asleep. When you stop taking some drugs or stop drinking alcohol there may be withdrawal symptoms that can include insomnia.
Tell your medical provider about all prescription and over-the-counter medications that you take. Tell her about your use of certain substances, like caffeine and alcohol. She will need to know if you use illicit drugs to ensure that you receive the appropriate treatment.
Environmental factors
Where you sleep can cause insomnia. Factors like noise, light or temperature can affect sleep. Sleeping with a bed partner who snores also can cause sleep disruption. Extended exposure to environmental toxins and chemicals may prevent you from being able to fall asleep or stay asleep.
Habits or lifestyles
Irregular sleep schedules (see shift work disorder) can cause insomnia in workers who try to sleep during the day. Pushing your bedtime too late, working night shift, being a night owl can or having wide variance in your bedtime can cause insomnia.
How to diagnose insomnia?
If you think you may have insomnia, ask yourself the following questions:
- Does it take you more than 30 minutes to fall asleep, or do you wake up during the night and have trouble returning to sleep, or do you wake up earlier than desired?
- Do you have daytime symptoms such as fatigue, moodiness, sleepiness or reduced energy?
- Do you give yourself enough time in bed to get at least 7 hours of sleep each night?
- Do you go to bed in a safe, dark and quiet environment that should allow you to sleep well?
If you answered yes to all these questions, then you may have insomnia.
If you’ve had insomnia for at least three months (chronic insomnia), consider booking an appointment with a sleep doctor at an accredited sleep center. If you have had insomnia for fewer than three months, you may have short-term insomnia. Try to follow good sleep hygiene, and if the problem does not go away in three months, talk to your medical provider.
A sleep doctor can diagnose insomnia and work with you to help identify its causes. She will work with the sleep team at an accredited sleep center to treat your insomnia.
Consider keeping a sleep diary for two weeks. By recording when you go to sleep and when you wake up, along with how long you were awake during the night, a sleep diary will help your doctor see your habits. This may give your doctor clues about what is causing your insomnia and what course of treatment to take.
Your medical provider will need to know your medical history and whether you are taking any medications, including over-the-counter drugs. She will also want to know about major life events, especially those causing stress or trauma. You may take a test to analyze your mental and emotional wellbeing or have your blood tested if the doctor suspects a related medical problem is causing insomnia.
You will not need a sleep study unless the doctor suspects you have sleep apnea or another sleep disorder.
How to treat insomnia?
When insomnia is caused by a medical condition, your medical provider may refer you to a specialist who can treat the underlying condition. The course of insomnia is likely to change as your medical condition improves.
Although insomnia is common, it can be treated effectively with the help of a sleep doctor who can help identify the cause of your insomnia and recommend treatment options. Use the sleep center directory to find an accredited sleep center near you.
The treatment for insomnia depends on its underlying cause. For chronic insomnia, your medical provider may recommend any combination of the following treatments:
Cognitive behavioral therapy for insomnia
Cognitive behavioral therapy for insomnia, or CBT-I, is recommended for the treatment of chronic insomnia disorder in adults. It is a specific type of cognitive behavioral therapy. It addresses the thoughts and behaviors that keep you from sleeping well. It also helps you learn new strategies to sleep better. CBT-I components can include stress reduction, relaxation, sleep hygiene education, and sleep schedule management. The Society of Behavioral Sleep Medicine has a directory of behavioral sleep medicine providers who offer CBT-I. These visits can be performed in person, using video/telemedicine, and even using programs available online.
Medications
Your medical provider may prescribe a medication to treat your insomnia. Sleeping pills that are approved to treat insomnia are called hypnotics. You may build a tolerance to these medications over time. Some medications that treat other problems also may help you sleep. Your provider can decide which medication is best for you. You should only take a medication when supervised by a medical provider.
WARNING: Complex sleep behaviors such as sleepwalking or sleep driving can occur when you take a sleeping pill. Sleeping medications can also increase your risk of falling and affect your memory. Read this Consumer Update from the FDA to learn about these safety risks.