Table of ContentsView AllTable of ContentsSigns and SymptomsDiagnosisCausesRisk FactorsTypesTreatmentCoping
Table of ContentsView All
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Table of Contents
Signs and Symptoms
Diagnosis
Causes
Risk Factors
Types
Treatment
Coping
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Insomnia is a commonsleep disorderthat 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 asdepression,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 oncognitive 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 inaggression, anger,hopelessness, and in extreme cases,suicidal ideation.
If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see ourNational Helpline Database.
If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.
For more mental health resources, see ourNational Helpline Database.
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 andmental health conditionsthat 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:
It’s important to note that insomnia can impair one’s ability to drive or safely operate machinery. Driving while tired has been shown to be similar todriving while drunk, reducing alertness, vigilance, and reaction time.
‘I Want to Sleep But My Body Won’t Let Me’: Why Does This Happen?
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.
As the experience of insomnia is subjective and self-reported, it relies on your likely groggy recollections of fractured sleep—unless you go to a sleep clinic to be observed. Evaluation at a sleep clinic is an option for those that may have more complex sleep issues at play and would benefit from diagnostic assessment in a sleep lab.
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, andstress.
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 thestress surrounding worryingabout getting enough sleep creates an unwelcome self-fulfilling prophecy that erodes sleep quality.
Often Undiagnosed
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 takemay be impacting your sleep and vice versa.
Sometimes, adjusting a prescription or treating a coexisting condition can drastically improve your sleep—but your doctor needs to know that you are having trouble sleeping in order to suggest these changes. This is why talking to your doctor and getting diagnosed with insomnia is so important.
Insomnia is a good example of the chicken and the egg principle, as worrying about lack of sleep is known to exacerbate lack of sleep and lack of sleep is known to exacerbate worry about sleeplessness. Which came first might not really matter—either way, this negative self-affirming cycle can keep people locked in a vicious cycle of destructive sleep patterns.
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:
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
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
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.
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 associal 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 healthystress reduction techniques, re-sync your circadian sleep rhythms, and replace worrisome, fitful sleep with the restorative kind.
Your doctor will work with you to tailor a treatment plan to your specific needs.
Often, you will be advised tomake a variety of general lifestyle changesas 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 ortraumatic 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, helpimprove self-regulationand reduce the stress that can exacerbate insomnia. Relaxation activities to try include:
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.
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. Anyactivities that you find calming, centering, and/or restorative will work.
The key is to do the same sequence of relaxing activities before bed consistently—that pattern can help set the stage for an easier time falling (and staying) asleep.
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:
Pharmaceutical Treatments
Insomnia is also often managed with medications, including prescription drugs, OTC products such as melatonin, orherbal 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.
What Is Cognitive-Behavioral Therapy for Insomnia (CBT-i)?
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.
Learning to comfort yourself and relax when you begin to worry about not being able to fall asleep or not getting enough sleep can be very challenging—but is also key to overcoming insomnia.
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 thenumerous sleep apps(such asCalm) 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 helpfrom your doctor and/orcounselor. 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.
8 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bhaskar S, Hemavathy D, Prasad S.Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities.J Family Med Prim Care. 2016;5(4):780-784. doi:10.4103/2249-4863.201153Mitchell MD, Gehrman P, Perlis M, Umscheid CA.Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review.BMC Fam Pract. 2012;13:40. doi:10.1186/1471-2296-13-40Krause AJ, Simon EB, Mander BA, et al.The sleep-deprived human brain.Nat Rev Neurosci. 2017;18(7):404-418. doi:10.1038/nrn.2017.55Rizzo D, Baltzan M.An objective measure of drowsy driving: are we there yet?J Clin Sleep Med. 2019;15(9):1191-1192. doi:10.5664/jcsm.7954Arroll B, Fernando A 3rd, Falloon K, Goodyear-Smith F, Samaranayake C, Warman G.Prevalence of causes of insomnia in primary care: a cross-sectional study.Br J Gen Pract. 2012;62(595):e99-e103. doi:10.3399/bjgp12X625157Worley SL.The extraordinary importance of sleep: the detrimental effects of inadequate sleep on health and public safety drive an explosion of sleep research.P T. 2018;43(12):758-763.Vriend J, Corkum P.Clinical management of behavioral insomnia of childhood.Psychol Res Behav Manag. 2011;4:69-79. doi:10.2147/PRBM.S14057National Heart, Lung, and Blood Institute.Insomnia.
8 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bhaskar S, Hemavathy D, Prasad S.Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities.J Family Med Prim Care. 2016;5(4):780-784. doi:10.4103/2249-4863.201153Mitchell MD, Gehrman P, Perlis M, Umscheid CA.Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review.BMC Fam Pract. 2012;13:40. doi:10.1186/1471-2296-13-40Krause AJ, Simon EB, Mander BA, et al.The sleep-deprived human brain.Nat Rev Neurosci. 2017;18(7):404-418. doi:10.1038/nrn.2017.55Rizzo D, Baltzan M.An objective measure of drowsy driving: are we there yet?J Clin Sleep Med. 2019;15(9):1191-1192. doi:10.5664/jcsm.7954Arroll B, Fernando A 3rd, Falloon K, Goodyear-Smith F, Samaranayake C, Warman G.Prevalence of causes of insomnia in primary care: a cross-sectional study.Br J Gen Pract. 2012;62(595):e99-e103. doi:10.3399/bjgp12X625157Worley SL.The extraordinary importance of sleep: the detrimental effects of inadequate sleep on health and public safety drive an explosion of sleep research.P T. 2018;43(12):758-763.Vriend J, Corkum P.Clinical management of behavioral insomnia of childhood.Psychol Res Behav Manag. 2011;4:69-79. doi:10.2147/PRBM.S14057National Heart, Lung, and Blood Institute.Insomnia.
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Bhaskar S, Hemavathy D, Prasad S.Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities.J Family Med Prim Care. 2016;5(4):780-784. doi:10.4103/2249-4863.201153Mitchell MD, Gehrman P, Perlis M, Umscheid CA.Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review.BMC Fam Pract. 2012;13:40. doi:10.1186/1471-2296-13-40Krause AJ, Simon EB, Mander BA, et al.The sleep-deprived human brain.Nat Rev Neurosci. 2017;18(7):404-418. doi:10.1038/nrn.2017.55Rizzo D, Baltzan M.An objective measure of drowsy driving: are we there yet?J Clin Sleep Med. 2019;15(9):1191-1192. doi:10.5664/jcsm.7954Arroll B, Fernando A 3rd, Falloon K, Goodyear-Smith F, Samaranayake C, Warman G.Prevalence of causes of insomnia in primary care: a cross-sectional study.Br J Gen Pract. 2012;62(595):e99-e103. doi:10.3399/bjgp12X625157Worley SL.The extraordinary importance of sleep: the detrimental effects of inadequate sleep on health and public safety drive an explosion of sleep research.P T. 2018;43(12):758-763.Vriend J, Corkum P.Clinical management of behavioral insomnia of childhood.Psychol Res Behav Manag. 2011;4:69-79. doi:10.2147/PRBM.S14057National Heart, Lung, and Blood Institute.Insomnia.
Bhaskar S, Hemavathy D, Prasad S.Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities.J Family Med Prim Care. 2016;5(4):780-784. doi:10.4103/2249-4863.201153
Mitchell MD, Gehrman P, Perlis M, Umscheid CA.Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review.BMC Fam Pract. 2012;13:40. doi:10.1186/1471-2296-13-40
Krause AJ, Simon EB, Mander BA, et al.The sleep-deprived human brain.Nat Rev Neurosci. 2017;18(7):404-418. doi:10.1038/nrn.2017.55
Rizzo D, Baltzan M.An objective measure of drowsy driving: are we there yet?J Clin Sleep Med. 2019;15(9):1191-1192. doi:10.5664/jcsm.7954
Arroll B, Fernando A 3rd, Falloon K, Goodyear-Smith F, Samaranayake C, Warman G.Prevalence of causes of insomnia in primary care: a cross-sectional study.Br J Gen Pract. 2012;62(595):e99-e103. doi:10.3399/bjgp12X625157
Worley SL.The extraordinary importance of sleep: the detrimental effects of inadequate sleep on health and public safety drive an explosion of sleep research.P T. 2018;43(12):758-763.
Vriend J, Corkum P.Clinical management of behavioral insomnia of childhood.Psychol Res Behav Manag. 2011;4:69-79. doi:10.2147/PRBM.S14057
National Heart, Lung, and Blood Institute.Insomnia.
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