Insomnia

Insomnia is a common sleep disorder that makes it hard to fall asleep, stay asleep, or causes you to wake up too early and not be able to get back to sleep. While everyone has occasional sleepless nights, chronic insomnia can significantly impact your health, mood, and quality of life.

Quick Facts

  • Affects 30% of adults
  • More common in women
  • Increases with age
  • Highly treatable
  • Can be chronic

⚠️ Seek Medical Care Immediately If Insomnia Occurs With:

  • Thoughts of self-harm or suicide
  • Severe depression or hopelessness
  • Hallucinations or paranoia
  • Chest pain or heart palpitations
  • Severe shortness of breath at night
  • Confusion or memory problems
  • Falling asleep while driving or operating machinery
  • Substance abuse to cope with sleep problems

Call 988 for mental health crisis support or 911 for medical emergencies.

Understanding Insomnia

Insomnia isn't just about the number of hours you sleep or how long it takes to fall asleep — people vary in their sleep needs and patterns. Instead, insomnia is diagnosed based on how you feel and function after sleep. You may have insomnia if you regularly wake up tired, have difficulty concentrating, or feel irritable despite spending enough time in bed.

The condition affects both sleep quality and quantity. Some people have trouble falling asleep (sleep-onset insomnia), while others wake frequently or too early (sleep-maintenance insomnia). Many experience both patterns. The impact extends beyond nighttime, affecting daytime energy, mood, performance, and overall health.

Insomnia can be primary (occurring on its own) or secondary (resulting from other conditions). Understanding the type and underlying causes helps determine the most effective treatment approach, which may range from simple lifestyle changes to professional therapy.

Types of Insomnia

Acute Insomnia

  • Short-term (days to weeks)
  • Often stress-related
  • Life events trigger
  • Usually resolves itself
  • May not need treatment
  • Very common

Chronic Insomnia

  • 3+ nights per week
  • Lasts 3+ months
  • Multiple causes
  • Affects daily life
  • Needs treatment
  • May require therapy

Sleep-Onset Insomnia

  • Trouble falling asleep
  • Takes 30+ minutes
  • Racing thoughts
  • Can't relax
  • Anxiety common
  • Bedtime dread

Sleep-Maintenance Insomnia

  • Frequent awakenings
  • Early morning waking
  • Can't return to sleep
  • Fragmented sleep
  • May indicate conditions
  • Poor sleep quality

Common Causes

Psychological Factors

  • Anxiety: Racing thoughts, worry about sleep
  • Depression: Early morning awakening common
  • Stress: Work, relationships, finances
  • PTSD: Nightmares, hypervigilance
  • Bipolar disorder: Sleep disruption during episodes

Medical Conditions

  • Chronic pain: Arthritis, fibromyalgia, back pain
  • Asthma: Nighttime symptoms
  • GERD: Acid reflux disrupts sleep
  • Thyroid disorders: Hyperthyroidism
  • Neurological: Parkinson's, Alzheimer's
  • Heart conditions: Heart failure, arrhythmias
  • Hormonal changes: Menopause, pregnancy

Sleep Disorders

  • Sleep apnea: Breathing interruptions
  • Restless leg syndrome: Uncomfortable leg sensations
  • Circadian rhythm disorders: Shift work, jet lag
  • Periodic limb movements: Involuntary leg jerks
  • Narcolepsy: Disrupted sleep-wake cycle

Lifestyle Factors

  • Caffeine: Especially late in day
  • Alcohol: Disrupts sleep stages
  • Nicotine: Stimulant effects
  • Irregular schedule: Shift work, travel
  • Screen time: Blue light exposure
  • Late exercise: Too stimulating
  • Heavy meals: Before bedtime
  • Napping: Especially late afternoon

Medications

  • Stimulants: ADHD medications
  • Antidepressants: Some types
  • Blood pressure meds: Beta blockers
  • Corticosteroids: Prednisone
  • Decongestants: Pseudoephedrine
  • Weight loss pills: Stimulant-based

Symptoms and Daytime Effects

Nighttime Symptoms

  • Difficulty falling asleep
  • Waking up during the night
  • Waking up too early
  • Not feeling rested after sleep
  • Tossing and turning
  • Clock watching
  • Anxiety about sleep

Daytime Consequences

  • Fatigue: Persistent tiredness
  • Mood changes: Irritability, depression
  • Cognitive problems: Poor concentration, memory
  • Performance issues: Work or school difficulties
  • Physical symptoms: Headaches, GI problems
  • Accidents: Increased risk while driving
  • Social problems: Relationship strain

Diagnosis and Evaluation

Medical Assessment

  • Sleep history and patterns
  • Medical conditions review
  • Medication evaluation
  • Mental health screening
  • Physical examination
  • Family sleep history

Sleep Tracking Tools

  • Sleep diary: 1-2 week record
  • Actigraphy: Wrist device monitoring
  • Sleep apps: Track patterns
  • Questionnaires: Insomnia Severity Index

Sleep Studies

  • Polysomnography: Overnight sleep study
  • Home sleep test: For sleep apnea
  • Multiple sleep latency test: Daytime sleepiness
  • Blood tests: Thyroid, iron levels

Treatment Options

Sleep Hygiene

  • Regular sleep schedule
  • Cool, dark, quiet room
  • Comfortable mattress
  • No screens before bed
  • Relaxing bedtime routine
  • Limit bedroom activities

Behavioral Therapy

  • CBT-I (gold standard)
  • Sleep restriction therapy
  • Stimulus control
  • Relaxation techniques
  • Biofeedback
  • Mindfulness meditation

Medications

  • Sleep aids (short-term)
  • Melatonin
  • Antidepressants
  • Antihistamines
  • Prescription hypnotics
  • Natural supplements

Lifestyle Changes

  • Regular exercise
  • Limit caffeine
  • Avoid alcohol
  • Quit smoking
  • Manage stress
  • Light therapy

Natural Sleep Aids

  • Melatonin: Natural sleep hormone supplement
  • Valerian root: Traditional sleep aid
  • Chamomile: Calming tea before bed
  • Magnesium: Muscle relaxation
  • L-theanine: Promotes relaxation
  • Passionflower: Anxiety reduction
  • Lavender: Aromatherapy or tea
  • Glycine: Improves sleep quality
  • Tart cherry juice: Natural melatonin
  • CBD: May improve sleep

Better Sleep Strategies

Daytime Habits

  • Get morning sunlight exposure
  • Exercise regularly (not late)
  • Limit naps to 20 minutes
  • No naps after 3 PM
  • Manage stress throughout day

Evening Routine

  • Dim lights 2 hours before bed
  • Avoid large meals
  • Limit fluids before bed
  • Wind-down activities
  • Warm bath or shower
  • Practice relaxation

Bedroom Environment

  • Temperature 60-67°F
  • Blackout curtains
  • White noise if needed
  • Remove clocks from view
  • Comfortable bedding
  • No work materials

When to See a Doctor

Schedule an Appointment If:

  • Insomnia lasts more than a month
  • Sleep problems affect daily functioning
  • You rely on sleep medications
  • Loud snoring or gasping during sleep
  • Legs feel restless at night
  • Falling asleep during daytime activities
  • Morning headaches
  • Mood changes or depression
  • Memory or concentration problems
  • Other concerning symptoms

Living with Chronic Insomnia

Managing chronic insomnia requires patience and persistence:

  • Set realistic goals: Improvement takes time
  • Track progress: Keep sleep diary
  • Be consistent: Maintain sleep schedule
  • Address underlying issues: Treat conditions
  • Join support groups: Share experiences
  • Work with specialists: Sleep medicine experts
  • Avoid sleep anxiety: Don't obsess over sleep
  • Celebrate small wins: Any improvement matters

Related Conditions

Depression

Often co-occurs with insomnia, creating a difficult cycle to break.

Anxiety

Racing thoughts and worry are common causes of sleep difficulties.

Sleep Apnea

Breathing interruptions cause frequent awakenings and poor sleep.

Fatigue

The primary daytime consequence of poor nighttime sleep.