What Is Insomnia?

Insomnia is a common sleep disorder that affects millions of Americans. This often unrelenting condition can impact sleep in multiple ways, including causing difficulty falling asleep, difficulty staying asleep, waking up too early (and not being able to fall back asleep), and poor sleep quality. Studies estimate that between 10% to 30% or more of the worldwide population experiences insomnia.

Additionally, research indicates that among people seeking primary care treatment, the prevalence of insomnia is as high as 69%. Lack of sleep and tiredness is known to contribute to many serious health concerns, such as depression, anxiety, stress, high blood pressure, diabetes, obesity, stroke, and cardiovascular disease. Plus, the effects of chronic sleep loss are accumulative.

Insomnia also takes a significant toll on cognitive ability, executive function, working memory, the ability to focus and pay attention, emotional self-regulation, mood, and decision-making (as in avoiding risk-taking and impulsivity). Research also shows that chronic sleep loss promotes negative emotional processing, which can result in aggression, anger, hopelessness, and in extreme cases, suicidal ideation.

Signs and Symptoms

The lived experience of having insomnia tends to vary widely among those who have it and may change over time in tandem with the person's life and any other physical and mental health conditions that may coexist with sleep issues. Teasing out the signs, symptoms, and causes of insomnia from those of other related health issues can be a challenge, as many may overlap and/or exacerbate each other.

That said, generally, a person with insomnia may have any of these signs and symptoms:

• Daytime drowsiness
• Difficulty focusing during the day
• Feeling frustrated or anxious by a perceived difficulty or inability to fall or stay asleep
• Feeling that they are not getting enough sleep (despite trying to do so)
• Fitful, nonrestorative sleep
• Frequent waking during the night and/or inability to fall back asleep
• Not feeling rested upon waking
• Only being able to stay asleep for short periods
• Poor executive function
• Trying to fall asleep (sometimes for hours) without success
• Waking up too early (and not being able to get back to sleep)

Diagnosis

Insomnia is diagnosed by your doctor using your feedback as well as a variety of tests, including completing checklists that evaluate your self-reported sleep experience. As this sleep condition happens while drowsy and trying to fall asleep, often in the dark, tired, anxious, and alone, it can be challenging to precisely ascertain and relay exact signs and symptoms to your doctor.

Sleep logs are often a helpful tool in both diagnosis and treatment. Usually, doctors will advise people to track all of their sleep, including sleep habits, time trying to fall asleep, and when they wake up, over the course of a week or two. This data can help create a more complete picture of your sleep issues and which management options may be most effective for you.

Self-Reported Criteria

Essentially, the criteria for insomnia is perceived impairment during the day due to an inability to get enough good quality sleep at night. It's important to note that lack of sleep due to work schedule, studying, staying up late, or other reasons one might not have enough time for rest do not constitute insomnia. Insomnia means not getting sleep despite having the time and intention to do so.

Functional Impact

A key component of the diagnosis of insomnia is how a person's problems with sleep impact their daily life. Functional impairment related to insomnia may include difficulty focusing on daily tasks, inability to get work done, irritability, anxiety, poor work performance, impaired executive function, daytime sleepiness, restlessness, and stress.

Interestingly, research also shows that people with insomnia often get more sleep than they think they do. However, for those with insomnia, the sleep they are getting may be less restorative than needed and/or the stress surrounding worrying about getting enough sleep creates an unwelcome self-fulfilling prophecy that erodes sleep quality.

Often Undiagnosed

The main outward sign of insomnia is looking tired, which is not always noticeable and can be caused by many issues. Research indicates insomnia is often suffered in silence. In fact, researchers estimate that up to 80% of cases are undiagnosed. Primary care doctors do not always ask about a patient's sleep quality either, despite the big impact lack of sleep can have on a person's overall health.

So, bring up any sleep concerns you have with your physician so that you get can help with your insomnia. Additionally, keeping your doctor in the loop about any sleep difficulties you have is especially important because other physical and/or mental health conditions you may have or medications you take may be impacting your sleep and vice versa.

Causes

The causes of insomnia are many, but are somewhat elusive and hard to precisely distill as the condition involves a complex interplay of mind-body connection, medical history, environmental factors, and outside influence. This sleep condition is impacted by (and impacts) a large number of other conditions as well. However, there are some common causes and contributing factors that many people with insomnia share.

• Chronic pain, which can make settling down at night uncomfortable
• Depression, anxiety, post-traumatic stress disorder (PTSD), and other mental health conditions
• Dementia
• Emotional issues, such as grief, anger, loneliness, and worry
• Excess use of electronic devices
• Irregular sleep habits and/or schedule
• Medications, including prescription and recreational drugs
• Neurological disorders
• Ongoing health problems, including obesity, diabetes, breathing issues (such as allergies and asthma), and cardiovascular disease
• Other sleep conditions, such as sleep apnea
• Poor sleep habits, such as using screens right before bed
• Stress, in general and also in response to specific life events
• Use of alcohol, caffeine, and/or nicotine

Risk Factors

While the exact causes of insomnia can be a bit murky, there are clear risk factors that contribute to this dogged sleep condition. The most common of these risk factors include the following:

• Age: This condition can happen at any time of life but is more common the older you get
• Being female: Women are more likely to have insomnia than men, particularly during pregnancy, while caring for a newborn, and in menopause
• Comorbid conditions: These include as obesity, diabetes, lung problems, and heart disease
• Family history: Researchers believe there may be a genetic component to insomnia as it tends to run in families
• Frequent environmental disturbances: These include light, temperature (too cold or too hot), or noise disrupting sleep
• Frequent travel to different time zones: While jet lag is not insomnia, frequent jet lag can develop into prolonged sleep issues such as insomnia
• Lack of regular exercise or physical activity
• Shift or night work schedules
• Use of electronics at bedtime: These include TV, cell phones, gaming devices, and/or computers, as the artificial light inhibits sleep and promotes a restless mind
• Use of stimulating drugs: These include coffee, alcohol, some prescription medications (such as those for attention-deficit/hyperactivity disorder), or illegal drugs
• Waking frequently to care for a child, ill loved one, or pet

Types

As noted above, insomnia is not the same as not having time to get enough sleep due to your schedule. Insomnia means having the time and intent for sleep that doesn't come. There are multiple subtypes of insomnia relating to the specifics of an individual's sleep condition, age, coexisting medical conditions, and other factors. Plus, different experts may use different terms to define these types of insomnia.

However, while there are important distinguishing factors to each person's insomnia experience, generally, the sleep condition is classified into two main types, acute and chronic insomnia.

Acute Insomnia

Acute insomnia (also called adjustment or short-term insomnia) is short-term, lasting anywhere from a night or two to a few weeks or months—but less than three months in duration. This type of insomnia is usually brought on by stressful life events, such as job loss, the death of a loved one, health problems, or other traumatic or worrisome events.

Short-term Insomnia may come and go as people deal with the ups and downs of life. Usually, this type of insomnia will resolve when the stressor that triggered it is relieved and/or the person adjusts to this stressor. For example, when someone is first diagnosed with a serious illness, they may have trouble sleeping for a few weeks until they come to grips with their new reality.

Chronic Insomnia

Chronic insomnia (also called long-term insomnia) is long-term difficulty with sleep. Chronic insomnia is defined as having trouble falling or staying asleep for three or more nights per week for three months or more. Chronic insomnia may come and go in a person's life and/or worsen or improve in severity over time but is characterized by a more persistent, longer-lasting duration than acute insomnia.

Other Types

Some other common sub-types of insomnia include behavioral insomnia, which is very prevalent in children, occurring in 25% or more of young people, particularly in the first years of life but also affecting kids of all ages up through adolescence. Behavioral insomnia involves the difficulty (or refusal) to fall asleep, particularly in one's own bed, avoiding bedtime, and frequent night waking.

Another common type of insomnia is persistently waking up with nightmares. In children, this is frequently called night terrors, which are estimated to impact between 5% to 35% of kids. Sleep related movement disorder is another disorder linked to insomnia, which results in frequent movements that inhibit sleep. These include bruxism (teeth grinding), restless leg syndrome, and leg cramps or jolts.

Treatment

Finding the right treatment protocol for insomnia can be complicated by multiple factors, but there are many effective and accessible treatments available to manage this sleep disorder. However, as noted above, many people with this condition continue to struggle with it untreated for years and often have co-existing medical conditions (treated or not) that contribute to their difficulties with sleep.

Effective management is especially challenging as not only will the issues causing the sleep disorder need to be addressed but any contributing factors, such as stress, maladaptive coping strategies, drug or alcohol use, and work schedule, as well as relevant comorbid conditions, such as social anxiety, obsessive compulsive disorder (OCD), chronic pain, or lung issues, need to be treated as well.

Treatment may involve a bit of trial and error as well as patience, as it will likely take time to resolve all of the various physical and mental health issues at play and reestablish healthy sleep habits, instill healthy stress reduction techniques, re-sync your circadian sleep rhythms, and replace worrisome, fitful sleep with the restorative kind.

Often, you will be advised to make a variety of general lifestyle changes as well as specific adjustments to your sleep timing and habits. You also will likely have other individualized recommendations or treatments based on your specific diagnosis, medical history, and personal situation.

However, common treatment approaches usually start with building or adjusting healthy sleep habits, and include one of more of the following:

Address Underlying Conditions and Concerns

As mentioned above, any underlying or contributing conditions will need to be simultaneously treated. These may include mental and physical health concerns as well as emotional issues and/or the fallout of stressful or traumatic life events. Medications you are taking to treat another illness may also be causing trouble with sleep and may need to be altered.

As a part of your treatment, you'll want to learn stress management techniques to help you deal with any worries you have—those relating specifically to falling asleep and getting enough sleep as well as any general stressors you may be experiencing.

Pregnancy is another common condition that can contribute to insomnia, so be sure to get specific advice from your doctor at your prenatal visits. Sometimes, adjustments to sleep position or using extra pillows for support can help. Addressing any pregnancy-related anxiety or complications can also improve your ability to get a good night's rest.

Calming Techniques

A calm mind and body begets restful sleep. There are a variety of relaxation strategies that can help you develop a more balanced state of mind, which in turn encourages sleep. These calming techniques, which can be used singly or in concert with each other, help improve self-regulation and reduce the stress that can exacerbate insomnia. Relaxation activities to try include:

• Acupuncture
• Aromatherapy
• Gentle physical activity, such as yoga, walking, and stretching
• Listening to music
• Massage
• Meditation
• Mindfulness
• Reading (not on an electronic device)
• Sexual activity, such as physical touch and orgasm
• Taking a warm bath or shower

Consistent Bedtimes

Getting into bed at night and getting up in the morning at the same times each night and day have been shown to help establish healthy sleep. Even if you have trouble falling asleep, following the same schedule cues you that it is time to sleep and helps to sync your body up with its natural circadian rhythm. It's also important to avoid daytime napping, as naps can interfere with nighttime sleep.

A Healthy Sleep Space

Make sure your bedroom is conducive to sleep. Ideally, you will want to create a clutter-free, dark, quiet, slightly cool space to sleep. As mentioned above, research also shows that reserving your bed just for sleep can also help bring on slumber. In contrast, a too warm room, the light of electronic devices, and a messy space can all inhibit sleep.

Additionally, if possible, keep the TV, computer, and work desk out of your room. Ideally, your bedroom is just for sleep, so that when you enter the room, your mind and body associate it with rest, rather than work, entertainment, socializing, and/or chores, any of which can bring unwelcome worries at bedtime.

Establish a Set Routine

Sticking to a reliable sleep routine helps encourage sleep as well. A healthy bedtime routine includes following the same pattern prior to going to bed each night. This might entail taking a shower or a bath, getting in pajamas, having a cup of tea, doing some stretches, reading a book, and/or lighting a candle. Any activities that you find calming, centering, and/or restorative will work.

Monitor Your Meals and Drinks

Eating regular, healthy meals can facilitate healthy sleep. Avoid heavy or spicy foods right before bedtime as well as anything that might cause an upset stomach or make you to feel overly full. Limit caffeine, alcohol, and smoking. Additionally, if waking up to go to the bathroom is an issue for you, aim to limit drinking beverages close to bedtime.

Review Your Medications

As noted above, certain medications may interfere with sleep. These include over-the-counter (such as some allergy and cold medications), prescription, and recreational drugs as well as herbal medicines, so be sure to discuss any and all medications (and if applicable, illegal drugs) you are taking with your doctor in order to correctly suss out what is causing your insomnia.

Cognitive Behavior Therapy

In addition to incorporating healthy sleep habits and relaxation techniques into your daily life using the above strategies, many people benefit from counseling to help them get to the root of the mental health components of their issues with sleep. Cognitive behavior therapy (CBT) has been shown to be an effective treatment option and is often recommended as a first-line management approach.

When this type of counseling is done specifically to treat insomnia it is called cognitive behavior therapy for insomnia (CBT-I) and usually entails a six- to eight-week program centered on teaching healthy sleep habits, including the skills involved in falling asleep and staying asleep. CBT-I is often used for those with long-term, untreated insomnia and can have excellent results.

CBT-I is done under the supervision of a doctor, nurse, or therapist and seeks to change for the better a person's sleep-related behavior and thoughts. Treatment may include the following components:

• Cognitive therapy (resetting your thoughts to be more conducive to sleep)
• Relaxation therapy
• Sleep restriction therapy (adhering to a strict time schedule for sleep, whether or not it occurs)
• Stimulus control therapy (only sleeping in bed and leaving the bed if sleep does not occur)

Pharmaceutical Treatments

Insomnia is also often managed with medications, including prescription drugs, OTC products such as melatonin, or herbal remedies. There are many effective sleeping pills that your doctor can prescribe, which often result in quick improvement in sleep. Prescription medications (such as Ambien, Restoril, Halcion, and Sonata) may help you fall asleep, stay asleep, or both.

The drawbacks of using medications include possible side effects, dependence, and eventual tolerance. Additionally, sleep drugs do not treat the underlying causes of insomnia, so many people end up needing to use these medications long term in order to be able to sleep—and when the drugs are stopped, the conditions that caused the insomnia will likely still be present.

Coping

A big part of finding your own personal "cure" for insomnia is learning how to cope with the anxiety that having trouble sleeping can feed. (See calming techniques above.) Finding effective ways to live with the uncertainty, anxiety, and stress that having insomnia can cause can result in fewer symptoms.

Your Personal Sleep Needs

It's important to tune into your own sleep needs. Each person has different sleep rhythms, timing, and preferences, such as the type of blankets and sheets they like best, habits that they find relaxing, and smells that may promote or inhibit sleep (like lavender, perfumes, or laundry detergent). Explore the numerous sleep apps (such as Calm) or podcasts out there, which may help you fall asleep.

How Many Hours Are Best?

Some people do fine with six to seven hours per night, while others need nine, 10, or more hours a night to feel refreshed. Around seven to eight hours is optimal. There are also people who only need five or fewer hours of sleep to function at full speed. Some people need quiet and darkness to doze off, while others prefer white noise or the sound of a city humming in the background while they dream.

Try Multiple Approaches

Experiment with the approaches and coping strategies that appeal the most to you—and that your doctor or therapist think will be most effective—until you find the right balance that gets you to sleep. Stay flexible and keep on the lookout for when to make adjustments to your routine if you notice sleep issues cropping up again.

Seek Help as Needed

If you are experiencing something particularly challenging that is impacting your sleep and general wellbeing, seek help from your doctor and/or counselor. There are always more ways to address your insomnia and help you get the rest you need. Be kind and patient with yourself. Insomnia is not your fault and cannot simply be willed away.

Additionally, remember that some life events (such as death, job loss, traumatic events, and divorce) are inherently stressful and challenging to sleep through, regardless of your adherence to optimal sleep practices.

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A Word From Verywell

While there may not be a magical, one-size-fits-all cure for insomnia, there are effective ways to treat this pervasive sleep disorder—and it's never too late to seek help. The key is finding the right approaches that will work for you and to stick with the needed changes and treatments long enough for new, healthier patterns of restive sleep to take hold.