Insomnia: Symptoms, Causes, & Treatments

What Is Insomnia?

Insomnia is a sleep disorder resulting in trouble falling or staying asleep. Individuals often frequently wake up throughout the night or early in the morning, leaving them tired, unrested, and drowsy during the day. Everyone occasionally has trouble sleeping, but people with insomnia experience these challenges more regularly.

Insomnia can be acute or chronic. Acute insomnia can occur because of stress, illness, or life transitions and often resolves without treatment. Chronic insomnia is more regular and lasting. People with chronic insomnia experience trouble sleeping several times a week for months, even years.

Insomnia Vs. Sleeplessness

Insomnia is a clinical condition referring to a chronic difficulty with falling, staying asleep, or both. Sleeplessness is a colloquial term describing occasional sleep problems (i.e., a bad night of sleep or tossing and turning). However, individuals can experience both sleeplessness and insomnia.

How Common Is Insomnia?

Determining how many people suffer from insomnia worldwide is impossible. Some research shows anywhere from 10-30% of the global population meets the criteria for chronic insomnia. This condition appears to be more common in older adults and people with mental health issues or medical problems.²

In 2020, the CDC reported that 14.5% of adults had trouble falling asleep most days or every day over one month. Women are more likely to have chronic insomnia than men, and non-Hispanic White adults are more likely to have sleep issues than adults of other races.²

Symptoms of Insomnia

Symptoms and signs of insomnia vary depending on the individual, type of insomnia, and co-occurring sleep or mental health conditions. However, common manifestations include trouble falling asleep and impaired abilities to function. Chronic insomnia symptoms often impact various aspects of life, including work, relationships, and other responsibilities.

Symptoms of insomnia may include:³

• Significant distress because of sleep issues
• Impairments in one or more areas of life
• Difficulties falling or staying asleep
• Frequently waking up during the night
• Feeling tired after sleeping
• Fatigue throughout the day
• Difficulties paying attention or maintaining concentration
• Anxiety about sleep issues

Types of Insomnia

Medical and mental health professionals classify insomnia depending on frequency, duration, and severity. Some individuals may experience episodic insomnia lasting between one and three months. Persistent insomnia occurs for at least three months, whereas recurrent insomnia includes at least two prolonged episodes in a year. Based on symptom assessments, professionals can determine how to target the type of insomnia experienced.

Types of insomnia include:⁴

• Sleep onset insomnia: People who have trouble falling asleep but not staying asleep
• Sleep maintenance insomnia: People fall asleep easily but cannot stay asleep all night
• Early morning awakening: People who wake up too early and can’t go back to sleep
• Mixed insomnia: People who struggle with more than one of the sleep issues above
• Secondary insomnia: People with insomnia related to an underlying medical or mental health problem
• Primary insomnia: People who struggle to fall or stay asleep, which results in not getting enough sleep
• Paradoxical insomnia: People who feel awake or think they cannot fall asleep, even when they sleep soundly

What Causes Insomnia?

There are many reasons for insomnia, and sleep experts are still discerning these various insomnia causes. In many cases, insomnia closely coincides with increased anxiety and stress. Inadequate sleep conditions, such as a hot room or uncomfortable bed, can also exacerbate symptoms. Sometimes, substance use or other co-occurring health issues can cause insomnia.

Dr. Nishi Bhopal, MD, Integrative Psychiatrist and Sleep Specialist at Intrabalance, states, “Looking at it from a high level, insomnia is caused by hyperarousal. Stress is a common cause of insomnia, but there are multiple other causes as well. These include mood anxiety and depression, pain, medical conditions, and medications. Lifestyle factors can cause insomnia, including irregular sleep schedules, sedentary behaviors, excessive consumption of alcohol, or a poor diet. Furthermore, other sleep disorders like circadian rhythm disorders, obstructive sleep apnea, and restless leg syndrome can also cause insomnia.“¹⁰

Here are some of the most common causes of insomnia:^5,6

• Stress: Relaxing and falling asleep when stressed is challenging, and anxious thoughts may keep individuals up at night.
• Neurological differences: Research shows a relationship between specific neurological issues and sleep disturbances. Sleep problems may also stem from certain disorders like Parkinson’s and Alzheimer’s.⁷
• Caffeine or substance use: Any substance use can disrupt sleep quality, sleep latency, and overall duration of sleep.
• Mental health issues: Mental health issues, such as depression, anxiety, or PTSD, may all affect sleep quality.
• Technology use: Using technology near bedtime may impact the ability to disconnect and fall asleep.
• Poor sleep habits: Falling asleep or waking up at different times or sleeping in noisy environments may affect sleep quality.
• Eating too much at night: Overeating can affect digestion and, in turn, result in sleep disturbances.
• Medications: Certain medications may cause insomnia symptoms or also cause daytime fatigue, which can then impact nighttime sleep.
• Sleep-related disorders: Other sleep-related issues, such as narcolepsy, sleep apnea, or restless legs syndrome, may exacerbate insomnia symptoms.
• Changes in activity: Daily routine changes may affect energy and mood levels.

Risk Factors for Insomnia

While anyone can develop insomnia, certain risk factors may increase the chances of experiencing this condition. Insomnia symptoms may fluctuate based on mental and physical health, and periods of remission are also possible.

Below are the risk factors for insomnia:

• Being born female
• Aging individuals
• Medical conditions like diabetes or chronic pain
• Other sleep disorders
• Having a family history of insomnia

Complications of Insomnia

Sleep is essential for your mental, physical, and emotional health. Current research shows that the brain and body conduct essential tasks and reformation during sleep cycles. People experience various adverse side effects of insomnia when these functions are interrupted, such as mood swings, anxiety, and impaired cognition.

Complications associated with insomnia may include:^1,3,4

• Increased irritability and mood swings
• Increased risk for anxiety and depression
• Increased risk for psychosis (with severe sleep deprivation)
• Inability to focus and concentrate
• Impaired decision making
• Poorer work performance
• Trouble thinking clearly
• Short-term memory problems
• Weakened immune system
• Increased risk for chronic diseases like diabetes and heart disease
• Daytime sleepiness and increased risk for injuries and accidents
• Increased weight gain and higher risk for obesity

Obtaining a Diagnosis of Insomnia

A healthcare provider can diagnose insomnia after asking relevant questions about sleep history, medical health, mental health, and current sleep problems. They may also recommend tests, such as a sleep study, to rule out medical issues. A provider may use questionnaires to evaluate sleep issues to establish a working insomnia diagnosis.

Insomnia Treatments

Insomnia is a highly treatable condition. Treatment for insomnia commonly includes psychotherapy, medication, and healthy lifestyle changes. Consulting with a therapist can help when insomnia relates to anxiety, stress, or other mental health problems. While experts have yet to determine a cure for insomnia, support is available to help you cope with symptoms.

Dr. Bhopal notes, “Educating yourself about insomnia is really important, as there are a lot of misconceptions out there about sleep. People are often seeking a “magic bullet” to alleviate the symptoms. However, there is no one singular fix for insomnia and it takes multiple, consistent changes over time. As far as specific treatments for insomnia, it’s best to start by figuring out the root cause and addressing other conditions that are contributing to insomnia. This may include a medical assessment and/or referral to a sleep specialist for further evaluation.”

Therapy

Various therapies can help treat insomnia symptoms. However, one single approach cannot inherently cure sleep problems. In addition, treating severe insomnia may take time and effort, so pay attention to successes and stay consistent with your treatment.

Below are common therapies for insomnia:

• Cognitive behavioral therapy (CBT): Cognitive behavioral therapy for insomnia (CBT-I) focuses on five key components, including sleep hygiene, cognitive restructuring, sleep consolidation, stimulus control, and relaxation techniques. Research has shown this model can be highly effective in treating insomnia.⁸
• Light therapy: Light therapy entails sitting next to a light therapy box to mimic natural sunlight. These techniques can help optimize your overall sleep schedule.
• Hypnosis: Hypnosis for sleep encourages people to enter a highly relaxed state to release anxieties blocking their ability to unwind before bed.
• Stimulus control therapy: Stimulus control therapy focuses on decreasing anxiety or breaking problematic patterns around bedtime, which can help reinforce a better sleep routine.
• Aromatherapy: Some people benefit from experimenting with essential oils, such as lavender, to treat their insomnia.⁹

Medications

Numerous medications can aid in treating insomnia. Antidepressants with sedative effects may treat co-occurring insomnia with depression or anxiety. Benzodiazepines* can also be effective but have a higher risk for addiction and are intended for short-term use. Sleep medications such as Ambien (zolpidem) and Lunesta (eszopiclone) may also be helpful for some. Drinking alcohol with Ambien or other sleep medications is not recommended.

*This medication has black box warnings, the most serious kind of warnings from the FDA for abuse or misuse, risk of physical dependence, and risk of serious side effects, including death, when combined with an opioid.

Over-the-Counter Remedies

Some people use over-the-counter (OTC) sleep aids to treat insomnia, such as melatonin supplements, Benadryl, or Unisom. These drugs can have mild sedative effects. Natural sleep aids are also available without a prescription and also come with risks.  Seek medical advice before taking any OTC or natural sleep aids, especially if you take other medications or regularly drink alcohol.

How to Deal With Insomnia

Lifestyle changes are also important when determining how to stop insomnia. Adopting healthy sleep hygiene and routines is beneficial, even if you receive counseling or medication for insomnia. These techniques help when having trouble sleeping or staying asleep.

Below are tips for coping with insomnia:^2,3,8

• Turn off your devices: Many of your devices emit blue light that has a stimulating effect similar to caffeine. Turning these off before bed can help you fall and stay asleep.
• Block out light: You sleep better in the dark. Consider getting black-out curtains or using black electrical tape to put over any devices that emit light in your bedroom.
• Avoid alcohol, caffeine, and nicotine: Caffeine and nicotine have stimulating effects, so consuming them in the evening could impact your ability to fall asleep. Alcohol can help you fall asleep but reduces the quality of your sleep, so consider limiting your alcohol use at night as well.
• Don’t eat or exercise before bed: Both food and physical activity stimulate chemical responses in your brain that energize you, keeping you awake. Consider setting a cutoff time in the evening and note any improvements.
• Wake up at the same time: While you may be unable to fall asleep at the same time each night, waking up at the same time can help you establish a sleep schedule.
• Make your bedroom a sanctuary: A comfortable bed, perfect pillow, and nice sheets can go a long way toward getting a good night’s sleep. Making your bedroom into a calming, relaxing, and quiet space can also help improve your sleep.
• Write down your thoughts: Try writing your thoughts down if your mind races at night because of a mental to-do list. Doing so tells your mind, “I won’t forget. I wrote it down,” so you can rest easy.
• Use your bed wisely: Avoid working, reading, or doing activities in bed during the day. Instead, reserve your bed for nighttime use to help build an association between your bed and sleep.
• Use mindfulness or meditation techniques: Guided meditations and mindfulness practices can help you relax and feel sleepy, especially if you struggle with racing thoughts at night.
• Don’t lie in bed awake: Staying in bed trying to fall asleep can be frustrating. Get out of bed next time you can’t sleep. Go to the couch or another room and try reading a book, writing, or doing something quiet until you feel tired.

Final Thoughts

Insomnia is a common problem when under stress or experiencing change. However, you can reduce your symptoms by taking small steps toward improving sleep hygiene.