Insomnia: Symptoms, Causes, & Treatments

If you frequently have trouble falling asleep or staying asleep, you may be struggling with insomnia. This common sleep disorder affects 30-40% of people in any given year, and can have many negative impacts on your physical and mental health and your ability to focus, think clearly, and function your best.¹

What Is Insomnia?

Insomnia is a condition where people have trouble getting to sleep or staying asleep, and often feel tired, unrested, and drowsy during the day. Some people with insomnia wake up throughout the night or early in the morning and have a hard time going back to sleep. While everyone occasionally has trouble falling asleep or waking up, people with insomnia experience this more regularly.

Insomnia can be acute or chronic in nature. Acute insomnia can occur during times of stress or illness or when someone is going through a big life transition or change. Acute insomnia tends to be temporary and often resolves itself without treatment. Chronic insomnia is more regular and lasting. People with chronic insomnia experience trouble sleeping several times a week, and they might have had this problem for several months or even years.

Dr. Nishi Bhopal, MD, Integrative Psychiatrist & Sleep Specialist at Intrabalance states, “Looking at it from a high level, insomnia is caused by hyperarousal. This refers to the body and mind being in a “high-alert” state. This hyperarousal state may be caused by underlying physical or mental health conditions. 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, caffeine, or a poor diet. Furthermore, other sleep disorders like circadian rhythm disorders, obstructive sleep apnea, and restless leg syndrome can also cause insomnia.”⁹

Over time, people with insomnia accumulate sleep debts that take a toll on their physical and mental health.

Some of the common issues reported by people with chronic insomnia include:^2,3,4

• Difficulty waking up in the morning
• Feeling tired, foggy, or unable to think clearly in the day
• Higher levels of stress, frustration and irritability
• More problems with mental health problems like depression or anxiety
• Being dependent on prescribed or non-prescribed drugs to fall asleep
• Being dependent on stimulants or caffeine to wake up or be alert
• Cognitive impairments like poorer memory, trouble learning and problem solving
• Poorer work attendance and impaired work performance

Types of Insomnia

Insomnia includes a range of different sleep problems that can affect people. Some experts classify insomnia into 5 distinct subtypes.⁵ Each type can cause different signs of insomnia, and different sleep patterns.

The 5 types of insomnia are:⁵

1. Sleep onset insomnia: People who have trouble falling asleep but not staying asleep
2. Sleep maintenance insomnia: People fall asleep easily but can’t stay asleep all night
3. Early morning awakening: People who wake up too early and can’t go back to sleep
4. Mixed insomnia: People who struggle with more than one of the sleep issues above
5. Comorbid insomnia: People with insomnia related to an underlying medical or mental health problem

In addition to the different subtypes of insomnia, there are also different ways that medical and mental health professionals classify insomnia. Depending on how often people have insomnia and how long it has been a problem, insomnia may be classified differently.

The different ways that medical and mental health professionals classify insomnia are:⁶

• Episodic insomnia: When the sleep issues have only started recently and been occurring for 1-3 months
• Persistent insomnia: When insomnia has been occurring for more than 3 months
• Recurrent insomnia: When a person struggles with periodic insomnia, with at least two prolonged episodes in the span of a year

When to Seek Professional Help for Insomnia

Insomnia is a sleep disorder that involves experiencing trouble getting to sleep or staying asleep three or more times a week for a period of one month or more. People who only suffer from occasional sleep problems may not need to seek professional help, especially if it isn’t having a negative impact on their ability to function.

Chronic insomnia can have many negative impacts on a person’s life and ability to function. When sleep problems begin to negatively affect your physical health, mental health, relationships, work, or daily functioning, it is important to seek treatment from a medical or mental health professional. There are several effective treatments for insomnia, and these professionals can help you determine which is right for you.

If you suspect that your insomnia is related to an underlying medical problem, chronic pain or illness, it’s best to consult a doctor. Making an appointment with your primary care doctor or specialist is often a good place to start.

If you don’t have underlying health issues or symptoms of another medical problem, you could consider making an appointment with a therapist (for counseling) or psychiatrist (for medication). Making an appointment with a mental health professional is especially important if your insomnia is negatively impacting your mood or an underlying mental health issue.

Symptoms of Insomnia

The particular symptoms of insomnia can vary depending on the type of insomnia you have. Most of the time, insomnia is only diagnosed as a sleep disorder when a person has sleep problems three times a week, and when these issues have been going on for 1-3 months or longer.^2,6

The symptoms of insomnia include being dissatisfied with your quality of sleep because of one of the following problems:⁶

• You can’t fall asleep
• You wake up a lot throughout the night
• You wake up too early and can’t get back to sleep

In addition to having one or more of these issues, insomnia is only diagnosed when you also have:⁶

• Significant distress because of sleep issues
• Impairments in one or more area of life (i.e. work, physical or mental health, etc) because of your sleep issues
• No reason to suspect that your sleep problems are the result of a prescribed medication, recreational drug or alcohol
• No reason to suspect your sleep problems can be fully explained by another medical or mental health problem

Causes of Insomnia

A malfunction in your circadian rhythm is what causes insomnia. Your circadian rhythm is like your internal body clock that tells you when to sleep and when to be awake. When this body clock is working normally, you will naturally feel sleepy at night, stay asleep and not struggle with daytime sleepiness.⁴

Your body clock can malfunction for several reasons. Some of these are related to other underlying cognitive, mental or physical health issues and require professional treatment. Others are related to bad habits or environmental causes that can be addressed by making simple lifestyle changes.

Here are some of the most common causes of insomnia:^2,4

Harmful Consequences of Insomnia

Sleep is essential for the health of your body, your brain, and your mental health. Scientists are still working on solving the puzzle of why sleep is so essential, but even current research reflects that there are many essential tasks within your brain and body that only occur when you sleep.

When you sleep, these actions are occurring within your body and brain:⁴

• Your brain sorts and stores information into your memory banks
• Your cells, tissue, and neurons repair themselves
• Your body and brain get rid of built-up toxins
• Area of the brain related to emotion regulation becomes active
• Your metabolism regulates itself, helping to maintain a healthy weight
• Your immune system strengthens itself

Because there are so many important functions and repairs your brain and body make while you sleep, insomnia causes some of the following issues:^1,2,4

• 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

Common Co-occurring Disorders

Many people with insomnia also struggle with underlying medical or mental health conditions. These conditions are often related in some way to the sleep problems people have. If you have an underlying condition, you might notice that your symptoms can cause or worsen your insomnia and that your insomnia can make your symptoms worse.

Dr. Bhopal comments on the high comorbidity between insomnia and other disorders: “There’s a bidirectional relationship between mental health concerns and insomnia, meaning that mental health conditions can cause insomnia, and insomnia can cause mental health issues. About 40% of people with chronic insomnia have a mental health disorder and 80-90% of people with depression and anxiety have sleep issues. Research shows that having insomnia can actually predispose people to depression and anxiety over time. ”

Here are some of the disorders that are common in people who struggle with insomnia:^1,2,3

• Mental health issues like depression, PTSD, and anxiety can cause or worsen insomnia. 40% of people with insomnia struggle with a mental health condition.
• Chronic pain can also contribute to sleep problems and worsen insomnia.
• Sleep apnea causes people to stop breathing or breathe irregularly during sleep, and can cause people to sleep more lightly or wake up throughout the night
• Restless leg syndrome (RLS) is another condition linked to sleep problems, and is a disorder where people have trouble keeping their legs still when trying to sleep
• Chronic health conditions like diabetes can contribute to insomnia, as well as less serious issues like acid reflux or IBS
• Cognitive or neurological disorders like alzheimers often co-occur with insomnia
• Pregnancy isn’t a disorder, but it is something that increases the risk of insomnia. During pregnancy, hormone changes, physical discomfort, nausea, and the need to urinate more often can all interrupt sleep.

Insomnia vs. Sleeplessness & Sleep Deprivation

Insomnia is a sleep disorder, and is different from sleeplessness and sleep deprivation. While people with insomnia struggle with both of these issues, these problems are also experienced by people who don’t have insomnia. Having some sleepless nights is relatively normal, and can be the result of many factors like stress, abnormal work hours, jet lag, or feeling ill. When people have many sleepless nights or when they don’t get the recommended 7-8 hours of sleep per night, they can become sleep deprived.

Sleep is essential for the brain and body. Over time, sleep deprivation can have serious negative effects on a person’s physical and mental health, and can impair their ability to focus and function. Untreated insomnia can lead to sleep deprivation, putting people at much higher risk for a range of psychological and medical problems, and even taking years off of their life.^1,2

Treatment of Insomnia

Insomnia is a highly treatable condition. Both medical and mental health professionals can treat insomnia, although the treatment provided by each will be different. Because insomnia is such a common problem, a lot of research exists on what treatments are most effective.

Dr. Bhopal notes, “Educating yourself about insomnia is really important, as there are a lot of misconceptions out there about sleep. Oftentimes, people are 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.”

For people who suspect an underlying medical condition may be causing or contributing to their insomnia, it is best to consult first with a medical doctor. For those without medical issues or who suspect their insomnia is related to stress, anxiety, or another mental health problem, it may be best to consult with a therapist.

Therapy

A specific type of cognitive behavioral therapy for insomnia (CBT-I)  is highly effective at treating insomnia. CBT-I is considered a frontline treatment for insomnia, and research shows that 80% of people who receive this treatment report improvements in their sleep.^1,3

In this treatment, a trained therapist helps to address a person’s sleep difficulties by addressing each of the following issues:^1,3

• Improving sleep hygiene (i.e. developing a better sleep schedule/routine)
• Cognitive restructuring (changing unhelpful/worried thoughts about sleep)
• Stimulus control (turning off devices at night)
• Sleep restriction (i.e. less daytime naps, restricting time spent in bed awake)
• Relaxation techniques (i.e. nightly guided meditation routine, muscle relaxation)

Less commonly, hypnosis is also used to address sleep disorders like insomnia. Some therapists help clients struggling with insomnia by teaching them mindfulness or relaxation skills, which can help to reduce anxiety and stress.

Medications

In some cases, medications are prescribed to people who suffer from insomnia. These medications can be helpful to people who struggle with occasional or short-term insomnia, but are not recommended for people to take for more than 4 weeks.^2,3 When used long-term, some sleep medications can cause people to become dependent on them, and also can have adverse effects like oversleeping, daytime drowsiness and sleep-walking.

Lifestyle Changes

Lifestyle changes are also important to consider, even if you are also receiving counseling or medication for insomnia. Lifestyle changes that are aimed at improving sleep are often called “sleep hygiene” techniques. These techniques help to reduce some of the common barriers to sleep, while also promoting feelings of relaxation.

Some ways to improve your sleep hygiene include:^2,3,8

• Turn off your devices 1-2 hours before bed: Many of your devices emit blue light, a specific kind of light that has a stimulating effect similar to caffeine. Turning them off before bed can make it easier to fall asleep.
• Silence your devices at night: Notifications on your phone or tablet can also interrupt your sleep. Try to silence these at night. If you rely on your phone for your alarm, you can usually still silence other notifications in your settings.
• Block out light: You sleep better in the dark, so consider getting black-out curtains if you get a lot of light in your room. You could also consider using black electrical tape to put over any devices that emit light in your bedroom.
• Avoid alcohol, caffeine, and nicotine: Caffeine and nicotine both have stimulating effects, so using them in the evening could be making it hard for you to fall asleep. Also, 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 can energize you, keeping you awake. Consider having a cutoff time in the evening for food and exercise, and see if it improves your sleep.
• Wake up at the same time: While you might not be able to fall asleep at the same time each night, waking up at the same time can help you establish a sleep schedule. This can help you establish a schedule and even if it means a few nights of 5 hours of sleep, it can help you get tired earlier, making it easier to fall asleep.
• Make your bedroom a sanctuary: A comfortable bed, perfect pillow, and nice sheets can go a long way towards getting a good night’s sleep. Also, making your bedroom into a space that feels calming, relaxing and quiet can also help improve your sleep.
• Write down your thoughts: If you get in bed and find your mind racing or can’t fall asleep because you’re making a mental to-do list, try writing it down in a notebook. That way, you can tell your mind, “I won’t forget, I wrote it down”, making it easier to quiet your mind and go to sleep.
• Use your bed wisely: If you struggle with insomnia, you should try to stay out of bed during the day. Avoid working, reading, or doing activities in bed during the day. Instead, reserve your bed for nighttime use only. This will help you 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, so next time you can’t sleep, get out of bed. Go to the couch or another room and try reading a book, writing, or doing something quiet until you feel tired and then go back to bed.

Final Thoughts on Insomnia

Insomnia is a common problem, and something most people have struggled with on occasion. It might happen more when you are under a lot of stress or change happening in your life, and may improve by taking some small steps towards improving your sleep hygiene.

If insomnia becomes more regular or starts affecting your mood or ability to think or function, it might mean you need to reach out to a professional. Finding a therapist or consulting with your primary care doctor could help you improve your sleep, protecting you from the many negative impacts that sleep deprivation can have on your body, brain, and mental health.