Overview

What is insomnia?

Insomnia is a common sleep disorder that can make it hard to fall asleep, hard to stay asleep, or cause you to wake up too early and not be able to get back to sleep. If you have trouble falling and/or staying asleep, you may still feel tired when you wake up. Insomnia can sap not only your energy level and mood but also your health, work performance and quality of life. 

How much sleep do most people need?

Most adults need around seven to nine hours of sleep per night but the amount of sleep needed to function at your best varies between individuals. The quality of your rest matters just as much as the quantity. Tossing and turning and repeatedly awakening is as bad for your health as being unable to fall asleep.

How common is insomnia?

Sleep disorders are very common. They affect up to 70 million Americans every year. Insomnia symptoms occur in approximately 33% to 50% of the adult population while chronic insomnia disorder, which is associated with distress or impairment, is estimated at 10% to 15%.

At some point, many adults experience short-term (acute) insomnia, which lasts for days or weeks. It’s usually the result of stress or a traumatic event. But some people have long-term (chronic) insomnia that lasts for a month or more. Acute insomnia lasts from 1 night to a few weeks. Insomnia is chronic when it happens at least 3 nights a week for 3 months or more. Insomnia may be the primary problem, or it may be associated with other medical conditions or medications. You don’t have to put up with sleepless nights. Simple changes in your daily habits can often help.

Types of Insomnia

There are two types of insomnia: primary and secondary.

Primary insomnia: This means your sleep problems aren’t linked to any other health condition or problem.

Secondary insomnia: This means you have trouble sleeping because of a health condition (like asthma, depression, arthritis, cancer, or heartburn); pain; medication; or substance use (like alcohol).

Most cases of chronic insomnia are secondary. This means they are the symptom or side effect of some other problem, such as certain medical conditions, medicines, and other sleep disorders. Substances such as caffeine, tobacco, and alcohol can also be a cause.

Sometimes chronic insomnia is the primary problem. This means that it is not caused by something else. Its cause is not well understood, but long-lasting stress, emotional upset, travel and shift work can be factors. Primary insomnia usually lasts more than one month.

You might also hear about:

Sleep-onset insomnia: This means you have trouble getting to sleep.

Sleep-maintenance insomnia: This happens when you have trouble staying asleep through the night or wake up too early.

Mixed insomnia: With this type of insomnia, you have trouble both falling asleep and staying asleep through the night.  

Paradoxical insomnia: When you have paradoxical insomnia, you underestimate the time you’re asleep. It feels like you sleep a lot less than you really do.

Symptoms

Insomnia symptoms may include:

Difficulty falling asleep at night

Waking up during the night

Waking up too early

Not feeling well-rested after a night’s sleep

Daytime tiredness or sleepiness

Irritability, depression or anxiety

Difficulty paying attention, focusing on tasks or remembering

Increased errors or accidents

Ongoing worries about sleep

Fatigue

Grumpiness

Lying awake for a long time before you fall asleep

Sleeping for only short periods

Being awake for much of the night

Feeling as if you haven’t slept at all

Difficulty returning to sleep

Causes

Insomnia may be the primary problem, or it may be associated with other conditions.

Chronic insomnia is usually a result of stress, life events or habits that disrupt sleep. Treating the underlying cause can resolve the insomnia, but sometimes it can last for years.

Common causes of chronic insomnia include:

Stress. Concerns about work, school, health, finances or family can keep your mind active at night, making it difficult to sleep. Stressful life events or trauma — such as the death or illness of a loved one, divorce, or a job loss — also may lead to insomnia.

Travel or work schedule. Your circadian rhythms act as an internal clock, guiding such things as your sleep-wake cycle, metabolism and body temperature. Disrupting your body’s circadian rhythms can lead to insomnia. Causes include jet lag from traveling across multiple time zones, working a late or early shift, or frequently changing shifts.

Poor sleep habits. Poor sleep habits include an irregular bedtime schedule, naps, stimulating activities before bed, an uncomfortable sleep environment, and using your bed for work, eating or watching TV. Computers, TVs, video games, smartphones or other screens just before bed can interfere with your sleep cycle. It could also be things around you like noise, light, or temperature.

Eating too much late in the evening. Having a light snack before bedtime is okay, but eating too much may cause you to feel physically uncomfortable while lying down. Many people also experience heartburn, a backflow of acid and food from the stomach into the esophagus after eating, which may keep you awake.

Your genes. Research has found that a tendency for insomnia may run in families.

Chronic insomnia may also be associated with medical conditions or the use of certain drugs. Treating the medical condition may help improve sleep, but the insomnia may persist after the medical condition improves.

Additional common causes of insomnia include:

Mental health disorders. Anxiety disorders, such as post-traumatic stress disorder, may disrupt your sleep. Awakening too early can be a sign of depression. Insomnia often occurs with other mental health disorders as well.

Medications. Many prescription drugs can interfere with sleep, such as certain antidepressants and medications for asthma or blood pressure. Many over-the-counter medications — such as some pain medications, allergy and cold medications, and weight-loss products — contain caffeine and other stimulants that can disrupt sleep.

Medical conditions. Examples of conditions linked with insomnia include chronic pain, cancer, diabetes, heart disease, pregnancy, ADHD, asthma, PMS and menopause, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson’s disease and Alzheimer’s disease.

Sleep-related disorders. Sleep apnea causes you to stop breathing periodically throughout the night, interrupting your sleep. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.

Caffeine, nicotine and alcohol. Coffee, tea, cola and other caffeinated drinks are stimulants. Drinking them in the late afternoon or evening can keep you from falling asleep at night. Nicotine in tobacco products is another stimulant that can interfere with sleep. Alcohol may help you fall asleep, but it prevents deeper stages of sleep and often causes awakening in the middle of the night.

Insomnia and aging

Insomnia becomes more common with age. As you get older, you may experience:

Changes in sleep patterns. Sleep often becomes less restful as you age, so noise or other changes in your environment are more likely to wake you. With age, your internal clock often advances, so you get tired earlier in the evening and wake up earlier in the morning. But older people generally still need the same amount of sleep as younger people do.

Changes in activity. You may be less physically or socially active. A lack of activity can interfere with a good night’s sleep. Also, the less active you are, the more likely you may be to take a daily nap, which can interfere with sleep at night.

Changes in health. Chronic pain from conditions such as arthritis or back problems as well as depression or anxiety can interfere with sleep. Issues that increase the need to urinate during the night ―such as prostate or bladder problems ― can disrupt sleep. Sleep apnea and restless legs syndrome become more common with age.

More medications. Older people typically use more prescription drugs than younger people do, which increases the chance of insomnia associated with medications.

Insomnia in children and teens

Sleep problems may be a concern for children and teenagers as well. However, some children and teens simply have trouble getting to sleep or resist a regular bedtime because their internal clocks are more delayed. They want to go to bed later and sleep later in the morning.

Risk Factors

Nearly everyone has an occasional sleepless night. But your risk of insomnia is greater if:

You’re a woman. Hormonal shifts during the menstrual cycle and in menopause may play a role. During menopause, night sweats and hot flashes often disrupt sleep. Insomnia is also common with pregnancy.

You’re over age 60. Because of changes in sleep patterns and health, insomnia increases with age. Older people may also be less likely to sleep soundly because they may have medical conditions or take medications that disturb sleep.

Young and middle-age African Americans also have a higher risk. Research shows that African Americans take longer to fall asleep, don’t sleep as well, and have more sleep-related breathing problems than whites.

You have a mental health disorder or physical health condition. Many issues that impact your mental or physical health can disrupt sleep.

You’re under a lot of stress. Stressful times and events can cause temporary insomnia. And major or long-lasting stress can lead to chronic insomnia.

You don’t have a regular schedule. For example, changing shifts at work or traveling can disrupt your sleep-wake cycle.

You have a lower income.

You have an inactive lifestyle.

Insomnia Complications

Sleep is as important to your health as a healthy diet and regular physical activity. Whatever your reason for sleep loss, insomnia can affect you both mentally and physically. People with insomnia report a lower quality of life compared with people who are sleeping well.

Complications of insomnia may include:

Lower performance on the job or at school due to trouble focusing, a lack of energy, and memory problems

Slowed reaction time while driving and a higher risk of accidents

Mental health disorders, such as depression, an anxiety disorder or substance abuse

Increased risk and severity of long-term diseases or conditions, such as high blood pressure, obesity, diabetes, and heart disease

A higher risk of falling, if you’re an older woman

Grumpiness and irritability

Insomnia Diagnosis

Your doctor will do a physical exam and ask about your medical history and sleep history. The physical exam is needed to rule out other medical problems that might cause insomnia. Your doctor may want you to do a blood test to rule out certain medical conditions such as thyroid problems or low iron levels that can negatively impact sleep. Your provider will also ask you for details about your sleep habits.

They might tell you to keep a sleep diary for a week or two, keeping track of your sleep patterns and how you feel during the day. They may talk to your bed partner about how much and how well you’re sleeping. You might also have special tests at a sleep center. This is called a sleep study. A sleep study measures how well you sleep and how your body responds to sleep problems.

Sleep studies (polysomnograms) are not necessary for diagnosing insomnia. If your doctor has concerns that your insomnia may be caused by sleep apnea or another sleep disorder, you may be referred. You may go to a sleep disorders center or do the study at home.

Insomnia Treatment

Lifestyle changes, including good sleep habits, often help relieve acute (short-term) insomnia. These changes might make it easier for you to fall asleep and stay asleep. Other treatments include counseling and medicines.

If it’s hard for you to do everyday activities because you’re tired, your doctor may prescribe sleeping pills for a short time. Medicines that work quickly but briefly can help you avoid problems like drowsiness the next day.

Don’t use over-the-counter sleeping pills for insomnia. They might have side effects, and they tend to work less well over time.

For chronic insomnia, you’ll need treatment for the conditions or health problems that are keeping you awake. Your doctor might also suggest behavioral therapy. This can help you change the things you do that make insomnia worse and learn what you can do to promote sleep. A type of counseling called cognitive-behavioral therapy (CBT) can help relieve the anxiety linked to chronic (ongoing) insomnia.

The therapy is referred to as Cognitive Behavioral Therapy for Insomnia or CBT-I. CBT-I is a brief, structured intervention for insomnia that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Unlike sleeping pills, CBT-I helps you overcome the underlying causes of your sleep problems.

If your insomnia is the symptom or side effect of another problem, it’s important to treat that problem (if possible).

Can melatonin help me sleep?

Your body produces a hormone called melatonin that promotes sleep. Some people take melatonin supplements as an effective sleep aid. But there’s no proof that these supplements work. Because the U.S. Food and Drug Administration (FDA) doesn’t regulate supplements the same as medications, you should talk to your healthcare provider before taking one.

What is the prognosis (outlook) for people who have insomnia?

Some people with insomnia sleep better after changing daytime and nighttime behaviors. When these changes don’t help, therapy or medications can improve slumber.

Insomnia Prevention

Good sleep habits, also called sleep hygiene, can help prevent insomnia and promote sound sleep:

Keep your bedtime and wake time consistent from day to day, including weekends. This includes going to sleep at the same time each night, and get up at the same time each morning.

Stay active — regular activity helps promote a good night’s sleep. Try not to work out close to bedtime, because it may make it hard to fall asleep. Experts suggest exercising at least 3 to 4 hours before bed.

Check your medications to see if they may contribute to insomnia.

Avoid or limit naps. Try not to take naps during the day, because they may make you less sleepy at night.

Avoid or limit caffeine (including coffee, sodas and chocolate) and alcohol, and don’t use nicotine. Caffeine and nicotine are stimulants and can keep you from falling asleep. Alcohol can make you wake up in the middle of the night and hurt your sleep quality.

Avoid large meals and beverages before bedtime. But a light snack before bedtime may help you sleep.

Make your bedroom comfortable for sleep and only use it for sex or sleep. Don’t use phones or e-books before bed. Their light can make it harder to fall asleep. Make your bedroom dark, quiet, and not too warm or too cold. If light is a problem, use a sleeping mask. To cover up sounds, try earplugs, a fan, or a white noise machine.

Create a relaxing bedtime ritual, such as taking a warm bath, reading or listening to soft music. If you can’t fall asleep and aren’t drowsy, get up and do something calming, like reading until you feel sleepy. If you tend to lie awake and worry about things, make a to-do list before you go to bed. This may help you put your concerns aside for the night.

When to See a Doctor

If insomnia makes it hard for you to function during the day, see your doctor to identify the cause of your sleep problem and how it can be treated. If your doctor thinks you could have a sleep disorder, you might be referred to a sleep center for special testing.

You should call your healthcare provider if you experience:

Difficulty concentrating or memory problems.

Extreme fatigue.

Mood problems, such as anxiety, depression or irritability.

More than three months of sleep problems.

What should I ask my healthcare provider about insomnia?

If you have insomnia, you may want to ask your healthcare provider:

Am I taking any medications keeping me awake?

What changes can I make to sleep better?

How does cognitive behavioral therapy improve sleep?

How do I find a therapist?

Could I have other sleep disorders like sleep apnea?

If you’re suffering from insomnia, don’t hesitate to reach out to your healthcare provider for help. They may offer tips for managing issues that interfere with your sleep. Many people with insomnia rest better after changing their diet, lifestyle and nighttime routines. Or they may also recommend medications or cognitive behavioral therapy.