Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Insomnia is an inability to get enough sleep. Symptoms can include difficulty falling asleep, difficulty staying asleep, orwaking earlierthan desired. People with insomnia often report chronically poor quality sleep that may be light and unrefreshing. As a result, people with insomnia also have daytime symptoms like poor attention, irritability, and reduced energy.
There are three types of insomnia: transient, short-term, and chronic. Transient insomnia lasts less than a month. Short-term insomnia lasts between one and six months. Chronic insomnia lasts longer than six months.
Fortunately, insomnia can be effectively treated in many different ways, ranging from the temporary use of sleeping pills to cognitive behavioral therapy.
Verywell / JR Bee
Insomnia Symptoms
Insomnia negatively affects daytime functioning, leading to one or more of the following symptoms:
In addition to the above daytime symptoms, mood disorders, like anxiety or depression, are commonly associated with insomnia. Depression may be associated withearly morning awakeningand difficulty returning to sleep. Anxiety may leave your mind buzzing at night, with worries washing over you as you try to get to sleep. When sleep becomes difficult to obtain, this may fuel the fires of anxiety, making matters worse and fueling a vicious cycle.
Moreover, insomnia may affect serotonin levels and the function of thefrontal lobeof the brain. The frontal lobe is responsible for various executive functions, which are key in making rational choices and appropriate social interactions. Impairment can be so significant that the ability to suppress suicidal thoughts, or even the outright impulse to kill oneself, may be lost.
Studies suggest that the risk of suicide may double among those with insomnia. If you or someone you know are having suicidal thoughts, dial988to contact the988 Suicide & Crisis Lifelineand connect with a trained counselor.
Racing Thoughts: Steps to Take in the Moment
Experts' understanding of the cause of insomnia is rooted in three factors: predisposition, provocation, and perpetuation.
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Predisposition
Everyone has the potential to develop thekind of difficulty sleeping that characterizes insomnia. This is referred to as a predisposition or threshold. The threshold for developing insomnia will vary for each person.
Believe it or not, there are people who rarely or never develop trouble sleeping at night. On the other hand, some people may be unlucky and are simply predisposed to have insomnia. This likely relates to genetic factors (insomnia often runs in families), age, sex (insomnia occurs more often in women), substance use, and other medical and psychiatric conditions (e.g., depression, anxiety, or chronic pain disorders, likemigraineorfibromyalgia).
Insomnia may also be attributed to an increased alerting signal. This relates to the sympathetic nervous system, which is responsible for the “fight or flight” response. Some people may have an increased sympathetic drive, meaning they are primed to respond to an external threat. This signal can keep you awake during the day, but it also keeps people with insomnia up at night. Some have described this as being “tired but wired.”
2:02Click Play to Learn All About Insomnia
2:02
Click Play to Learn All About Insomnia
Provocation
Even though you might have a predisposition to insomnia, it has to be triggered. These triggers are called precipitating or provocative factors.
Examples of such factors include:
Perpetuation
In the end, there are a variety of choices that might perpetuate your insomnia. Some people choose to limit their daytime activities because of sleepiness. This avoidance may reduce your physical activity. Since you aren’t exercising, you may be less tired and unable to sleep.
Alternatively, you may start working on your computer in bed to make the most of your time spent awake. Thelight from your computerand the activity may worsen your ability to sleep. You may also start napping during the day to get some rest, which could undermine your sleep drive and ability to sleep at night.
The existence of perpetuating factors prolongs your battle with insomnia.
Insomnia is usually diagnosed based on a careful history alone. In some cases, asleep log, multiple sleep latency test,sleep-wake actigraphy, or asleep study (polysomnogram)may provide corroborative evidence or be used to rule out other sleep conditions such ascircadian rhythm disorderorsleep apnea.
Preparing for a Sleep Study
Insomnia Treatment
If insomnia results in disrupted daytime function, especially if it persists chronically, it may require treatment.
Here are a few key interventions that healthcare providers, especiallysleep specialists, use totreat insomnia.
Addressing Your Triggers
For many people, insomnia goes away on its own. For example, a bad night of sleep before a school exam will go away as soon as the test is over.
Other triggers can be alleviated once they are properly identified and addressed. For instance, afternooncaffeine, avoiding alcohol as a “nightcap,” and removing technological devices or disturbances within your sleep environment may be enough for you to get some quality shuteye.
The Optimal Sleep Environment
If you are suffering from chronic insomnia, you may need to seek professional help. It can be very beneficial to address the beliefs, thoughts, and feelings that surround your insomnia with a treatment calledcognitive behavioral therapy for insomnia (CBTI).
With CBTI, a specially trained psychologist will help you identify your unique triggers and then help you defuse them. For instance:
Lastly, if your insomnia is due to a more long-term trigger (e.g., shift work or jet lag from frequent travel), talk with your healthcare provider about interventions that specifically target that trigger.
Adjusting Your Sleep to Work Night Shifts
Taking Medication
There are many medications that can be effective in the short-term for treating insomnia.Two major classes includebenzodiazepineand nonbenzodiazepine medications.
Some of these prescription and over-the-counter medications include:
The reason why the above medications should only be used short-term and not long-term is that sleeping pills may cause something called tachyphylaxis. With this phenomenon, the medication becomes less effective, so higher doses are needed for the same effect. Ultimately, the medication stops working, and when discontinued, rebound insomnia occurs.
OTC and Prescription Sleeping Pills
Managing Coexisting Conditions
It is also very important to address any chronic issues that might be contributing to or associated with your insomnia, such as an underlying mood disorder (e.g., depression, anxiety, or post-traumatic stress disorder) or another sleep disorder (e.g., sleep apnea orrestless legs syndrome).
Stress, Anxiety, and Insomnia
Trying Complementary Therapy
Some people also find various complementary therapies helpful for treating their insomnia, such as:
10 Foods That May Contribute to Your Insomnia
A Word From Verywell
Insomnia is a common condition that can lead to significant impairment in one’s quality of life and daily functioning. It may also increase your risk of early death since it can lead to inattention and increase the risk of accidents. Long-term insomnia also increases your risk of chronic conditions like diabetes and heart disease.
The good news is that there are numerous therapy options available, although your individual treatment plan will require a close look at your unique triggers and health profile. In the end, if you are struggling with insomnia, please speak with your healthcare provider. Our Healthcare Provider Discussion Guide below can help you start the conversation to find the best treatment options for you.
Insomnia Healthcare Provider Discussion GuideGet our printable guide for your next healthcare provider’s appointment to help you ask the right questions.Download PDFEmail AddressSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.
Get our printable guide for your next healthcare provider’s appointment to help you ask the right questions.
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3 SourcesVerywell Health 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.Markwald RR, Iftikhar I, Youngstedt SD.Behavioral strategies, including exercise, for addressing insomnia.ACSMs Health Fit J. 2018;22(2):23–29. doi:10.1249/FIT.0000000000000375Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL.Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline.J Clin Sleep Med. 2017;13(2):307–349. doi:10.5664/jcsm.6470McCall WV.The link between suicide and insomnia: theoretical mechanisms.Curr Psychiatry Rep.2013;15(9):389. doi:10.1007/s11920-013-0389-9Additional ReadingAmerican Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine, 2014.Kryger, MHet al. “Principles and Practice of Sleep Medicine.“ExpertConsult, 6th edition, 2016.Spielman AJ, Caruso LS, Glovinsky PB.A behavioral perspective on insomnia treatment.Psychiatr Clin North Am. 1987;10(4):541-553.
3 Sources
Verywell Health 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.Markwald RR, Iftikhar I, Youngstedt SD.Behavioral strategies, including exercise, for addressing insomnia.ACSMs Health Fit J. 2018;22(2):23–29. doi:10.1249/FIT.0000000000000375Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL.Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline.J Clin Sleep Med. 2017;13(2):307–349. doi:10.5664/jcsm.6470McCall WV.The link between suicide and insomnia: theoretical mechanisms.Curr Psychiatry Rep.2013;15(9):389. doi:10.1007/s11920-013-0389-9Additional ReadingAmerican Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine, 2014.Kryger, MHet al. “Principles and Practice of Sleep Medicine.“ExpertConsult, 6th edition, 2016.Spielman AJ, Caruso LS, Glovinsky PB.A behavioral perspective on insomnia treatment.Psychiatr Clin North Am. 1987;10(4):541-553.
Verywell Health 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.
Markwald RR, Iftikhar I, Youngstedt SD.Behavioral strategies, including exercise, for addressing insomnia.ACSMs Health Fit J. 2018;22(2):23–29. doi:10.1249/FIT.0000000000000375Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL.Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline.J Clin Sleep Med. 2017;13(2):307–349. doi:10.5664/jcsm.6470McCall WV.The link between suicide and insomnia: theoretical mechanisms.Curr Psychiatry Rep.2013;15(9):389. doi:10.1007/s11920-013-0389-9
Markwald RR, Iftikhar I, Youngstedt SD.Behavioral strategies, including exercise, for addressing insomnia.ACSMs Health Fit J. 2018;22(2):23–29. doi:10.1249/FIT.0000000000000375
Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL.Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline.J Clin Sleep Med. 2017;13(2):307–349. doi:10.5664/jcsm.6470
McCall WV.The link between suicide and insomnia: theoretical mechanisms.Curr Psychiatry Rep.2013;15(9):389. doi:10.1007/s11920-013-0389-9
American Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine, 2014.Kryger, MHet al. “Principles and Practice of Sleep Medicine.“ExpertConsult, 6th edition, 2016.Spielman AJ, Caruso LS, Glovinsky PB.A behavioral perspective on insomnia treatment.Psychiatr Clin North Am. 1987;10(4):541-553.
American Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine, 2014.
Kryger, MHet al. “Principles and Practice of Sleep Medicine.“ExpertConsult, 6th edition, 2016.
Spielman AJ, Caruso LS, Glovinsky PB.A behavioral perspective on insomnia treatment.Psychiatr Clin North Am. 1987;10(4):541-553.
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