Insomnia is a sleep condition characterized by having difficulty falling or staying asleep throughout the night. There are two types of insomnia — acute and chronic — which can affect your sleep occasionally or three nights per week for up to three months.
About one in three adults deal with insomnia symptoms, while 10 percent deal with chronic insomnia lasting for months.
Poor sleep can harm your mood, energy levels, and overall health long-term. “Epidemiological studies show that lack of sleep is associated with obesity, diabetes, and heart disease, even Alzheimer’s,” says Sara Nowakowski, PhD, a clinical psychologist and associate professor at Baylor College of Medicine in Houston, Texas. But thankfully, it’s treatable with lifestyle changes.
Types of Insomnia
Two types of insomnia — acute and chronic — involve the inability to sleep, says Gerard J. Meskill, MD, a neurologist and sleep disorders specialist with the Tricoastal Narcolepsy and Sleep Disorders Center in Sugar Land, Texas.
Acute insomnia means you have trouble sleeping for a short period of time, even if just for one night. Almost everyone gets this once in a while, says Dr. Meskill. Once the cause disappears, you return to normal sleep patterns.
Chronic insomnia is more severe and involves difficulty sleeping three or more days per week over the course of three months. Individuals with chronic insomnia also report disruptions in their daytime functioning, including sleepiness, irritability, or anxiety, or difficulty paying attention, focusing on tasks, or remembering, Dr. Nowakowski says.
People with chronic insomnia often need to work with a medical professional to help resolve the underlying cause of the sleep condition.
Signs and Symptoms of Insomnia
Taking 30 minutes or longer to fall asleep at night suggests you might have insomnia.
Waking up for more than a few seconds or minutes and being unable to fall back to sleep, or waking up early in the morning before you intend to, is also indicative of insomnia.
Waking up just four or five hours after going to bed can be a problem, as well.
Other symptoms may include the following:
- Fatigue
- Problems with focusing or concentration
- Poor memory
- Mood changes or irritability
- Daytime sleepiness
- Issues doing work, school, or other activities
- Delayed reflexes (which can lead to increased errors or accidents)
If you’re at all concerned about your sleep issues, talk with your doctor. Your doctor can then direct you to a qualified sleep specialist.
Causes and Risk Factors of Insomnia
Insomnia doesn’t just have one cause — it can be caused by several factors, including:
- Medical conditions, such as asthma, chronic pain, sleep apnea, and neurological conditions (including Parkinson’s disease)
- Medications like antidepressants, asthma, blood pressure meds, allergy and cold medications, or other stimulants
- Mental health conditions such as depression and post-traumatic stress disorder
- Dietary habits, such as consuming heavy meals too close to when you go to sleep, or consuming too much caffeine or alcohol
- Nicotine use
- Jet lag
- Unhealthy sleep habits, such as having an inconsistent or irregular sleep schedule
To better understand how insomnia develops and its causes in a specific individual, sleep experts often use what’s called the “Spielman model” or “3P behavioral model” of insomnia. It helps sleep doctors chart factors that may trigger insomnia and account for possible causes.
According to research, here’s what each “P” means, and how each can potentially contribute to insomnia:
- Predisposing Factors This category includes most psychological, biological, and social factors that could make you more prone to insomnia. For example, anxiety, being a woman (because statistics show insomnia is more common in women than in men), and hyperarousal (meaning that you’re at greater risk of anxiety or have a higher wake drive than normal) are all predisposing psychological or biological factors. Predisposing social factors include an unconventional work schedule and a bed partner whose sleep schedule doesn’t align with yours.
- Precipitating Factors These are new and often stress-related events that trigger insomnia. For instance, you might be dealing with stress at work, financial worries, bad news about something important in life, or travel. Pain, depression, illnesses, and medication may also play into this, and all of these factors can lead to chronic insomnia. Note, though, that an ongoing medical issue like chronic pain or untreated obstructive sleep apnea can serve as both precipitating and perpetuating factors, Meskill says.
- Perpetuating Factors These are generally behaviors or beliefs people have adopted that either maintain their sleep difficulties or make them worse, all of which perpetuate chronic insomnia. This could include changes in daytime behaviors — many people take naps or try to sleep in later, which can, in some cases, make insomnia worse — or beliefs about sleep that fuel the insomnia flame. For instance, people with insomnia often develop anxieties connected to their bed, fear about not sleeping, and even worries about how lack of sleep will affect their daytime routines. Medical issues, as Meskill mentioned, can also fall into this category.
Sometimes, a combination of factors from each category can contribute to insomnia.
How Is Insomnia Diagnosed?
In many cases, your doctor will be able to tell whether you have insomnia just by talking with you. Along with discussing your medical and family history, your doctor will ask about your sleep habits and patterns. You must be clear and precise with your doctor when describing your symptoms.
To help with this, many sleep experts recommend that you keep an accurate sleep journal or “sleep history” for two weeks (or more) before visiting a doctor to talk about your insomnia. Write down when you go to bed, approximately how long it takes you to fall asleep, when you wake up, and the frequency and duration of any middle-of-the-night awakenings.
All of this information can help your doctor determine whether you have insomnia and how best to manage it. (Note: Write all of this information down in the morning, after you’ve gotten up for the day. If you’re trying to document middle-of-the-night arousals as they happen, you could be making the awakenings worse.)
Most of the time, your primary care provider can evaluate and diagnose these symptoms of insomnia. Sometimes, they may refer you to a sleep specialist if your symptoms are complex or for certain treatments.
Your doctor or sleep specialist will also likely perform a medical exam, listen to your heart and lungs, and perform other routine screening measures for health problems that may cause insomnia. Follow-up tests can help determine the cause, like bloodwork or an actigraphy test — a small device you wear in your sleep to measure sleeping patterns.
Treatment and Medication Options for Insomnia
People with insomnia might feel there’s no hope for relief, but it can be overcome, and current treatment therapies are highly effective.
Tried-and-true sleep hygiene strategies, like keeping consistent sleep and wake times, avoiding stimulating activities before bed, and shutting down electronic devices 30 to 60 minutes before bed, usually help sleep problems and often alleviate them completely. These strategies are recommended for insomnia prevention, too.
Once sleep problems become chronic, these strategies aren’t as effective in reversing sleep difficulties — though they’re often still recommended to keep insomnia from becoming worse and help make other treatments more effective, Meskill says.
Cognitive Behavioral Therapy
Although prescription medication may be used in some cases, cognitive behavioral therapy for insomnia (CBTi) — a type of psychotherapy or talk therapy — is now considered the gold standard for chronic insomnia treatment. “CBTi is generally recommended as first-line therapy for chronic insomnia,” says
Sheila Tsai, MD, pulmonologist and section head of sleep medicine at National Jewish Health in Denver.
With CBTi, you’re essentially retraining your brain and body on how to sleep. “People with chronic insomnia develop an aversion to their bed and bedroom and the act of sleeping,” Meskill says. CBTi works to erase that aversion by training people to use techniques specifically targeting the psychological factors associated with insomnia, such as having negative emotions and worries about not being able to sleep.
CBTi can involve breathing techniques, muscle relaxation practices, and other complementary therapies that can help you get to sleep. It can also involve changing your sleep routines or bedroom environment in ways that promote sound sleep.
Although doing CBTi with a trained specialist in person is the best option, online programs can also be effective, especially with people who are self-motivated and highly disciplined, or who live somewhere where there is no CBTi specialist, Meskill says.
How long it will take to overcome chronic insomnia depends on each individual. For some, the therapy may reverse sleep problems in just a few weeks, while others need several months. Just like other health conditions, though, there is a chance of relapse, which is why it’s important to remember the behavioral skills you learn in CBTi and practice them if and when your sleep starts to get disrupted again, Nowakowski says.
Medication Options
Prescription
sleeping pills do play a role in insomnia management, but they should be used with caution and only for a short period of time. They can come with serious side effects, and they can be habit-forming if relied on for too long. Taking these frequently can lead to physical dependency, meaning you might need more to go to sleep or not be able to sleep without them, Dr. Tsai says.
Still, medicine may help prevent a bout of short-term insomnia from turning into a chronic problem, or help jump-start a healthier sleep pattern for someone with chronic insomnia. The idea is that you use the medication for a few nights to get back to a healthy sleep schedule, then stop the pill after you’ve fallen back into that good routine.
Many people also reach for over-the-counter sleep aids, such as
melatonin. Our bodies naturally produce melatonin, a hormone that triggers a series of reactions that help our brains and bodies fall asleep. It’s available as a supplement and, according to research, does not carry the same risk as other prescription sleep aids of becoming addictive.
Lifestyle Changes and Prevention of Insomnia
Stress and anxiety can play a role in insomnia. If you engage in stressful activities before bed — like watching the news, sending work emails, or scrolling social media — you’ll want to avoid these things so they don’t interfere with your sleep.
Apart from avoiding anxiety triggers, these habits or behaviors can also help keep your sleep on track:
- Get up and go to sleep at the same time every day, even on weekends
- Get regular physical activity, which includes walking and other low-impact exercises (but avoid vigorous exercise too close to bedtime, which tends to wake up and energize your body)
- Avoid taking long or frequent naps
- Limit your caffeine and alcohol intake
- Don’t eat heavy meals before bed
- Avoid nicotine
Finally, it can be helpful to create a consistent bedtime ritual, which helps signal to your brain and body that it’s time to sleep. Yours could be taking a shower and then reading a book or listening to some soft music.
Complications of Insomnia
Mental health issues, such as depression or anxiety, can exacerbate insomnia and vice versa. Sleep also plays a key role in maintaining brain health — research suggests sleep helps clear out toxins and replenish energy stores in the brain each night.
Disrupted sleep can therefore wreak havoc on everyday processes in the brain, like thinking and regulating your emotions, which can contribute to psychological problems.
The effects of poor sleep aren’t relegated to the brain. Studies show that insomnia may disrupt appetite and hormones in ways that increase the risk of obesity and high blood pressure.
Chronic insomnia has also been linked to increased risk of the following:
- Asthma
- Heart disease
- Pregnancy complications
- Worsened chronic pain
- A weakened immune system
Conditions Related to Insomnia
Sleep is so important to overall health that a lack of it is linked, directly or indirectly, to almost every health condition. In some cases, insomnia is thought to be a cause or contributing factor to a condition or makes other symptoms worse. And for many conditions, other symptoms (like pain, anxiety, itching, and heartburn, among many others) make it more difficult to sleep and contribute to insomnia.
Some of the conditions that insomnia is most closely associated with include:
- Mental health disorders, including depression and anxiety
- High blood pressure and heart disease
- Cancer
- Chronic pain
- Parkinson’s disease
- Alzheimer’s disease
- Thyroid disorders
- Obesity
