Insomnia occurs when you’re unable to get the sleep you need to feel refreshed. Causes range from stress to jet lag to pregnancy to chronic health conditions. Treatments include therapy, medications, and lifestyle changes.
If you live with insomnia, you may:
- find it difficult to fall asleep, stay asleep, or both
- wake up from several hours of sleep not feeling refreshed
- experience fatigue and difficulty functioning throughout the day
Quality sleep plays an important role in overall well-being. Not getting the sleep you need on a regular basis can have a pretty big impact on mental and physical health, not to mention quality of life.
Among sleep disorders, insomnia is the most common.
According to the American Psychiatric Association (APA):
- about a third of all adults report some insomnia symptoms
- 6 to 10 percent of adults have symptoms severe enough to meet the diagnostic criteria for insomnia disorder
Read on to learn all about the main symptoms and causes of insomnia, plus tips on possible strategies and treatments to help you get back to sleeping soundly.
A note for Veterans
Insomnia is a common and complex obstacle for Veterans. In order to address sleep, it can be helpful for Veterans and their caregivers to explore how other elements of health, such as nutrition, mental wellness, and fitness, play a role in improving rest.
Take a look at our resources.
You can typically recognize insomnia by the following symptoms:
- waking too early and finding yourself unable to fall back asleep
- spending a lot of the night lying awake, worrying you won’t fall asleep
- a consistent pattern of interrupted or broken sleep that doesn’t refresh you
- trouble falling asleep after going to bed
As a result, you might begin to experience other symptoms related to lack of sleep, including:
Experts describe insomnia in a few different ways, depending on its specific characteristics:
- Acute insomnia refers to short-term sleeping difficulties that generally last no more than a few weeks.
- Chronic insomnia refers to insomnia that affects your sleep for 3 or more days each week on a regular basis, typically for a period of 3 months or longer.
- Onset insomnia describes difficulty falling asleep. Trouble getting to sleep might happen as a result of caffeine use, mental health symptoms, or other common insomnia triggers, but it can also develop with other sleep disorders.
- Maintenance insomnia refers to trouble remaining asleep once you get to sleep, or consistently waking up too early. This type of insomnia might relate to underlying health and mental health symptoms — but lying awake and worrying you won’t get enough sleep can make it worse.
- Behavioral insomnia of childhood involves consistent trouble falling asleep, refusing to go to bed, or both. Children with this condition often benefit from learning self-soothing strategies and following a regular sleep routine.
Insomnia can also be primary (idiopathic) or secondary (comorbid).
Primary insomnia doesn’t stem from any clear cause or existing health or mental health condition. Secondary insomnia, in contrast, relates to underlying causes, including:
- chronic pain or illness
- mental health conditions like depression or anxiety
- shift work
- certain medications
Typically, the type of insomnia you experience has a lot to do with the underlying causes of insomnia.
Possible causes of acute insomnia, for example, might include:
- an upsetting or traumatic event
- changes to your sleep habits, like sleeping in a hotel, new home, or with a partner for the first time
- physical pain or illness
- jet lag
- certain medications
Chronic insomnia can occur on its own or as a result of:
- chronic pain conditions, such as arthritis or back pain
- psychological issues, such as anxiety, depression, or substance use disorders
- sleep apnea and other sleep disorders
- health conditions such as diabetes, cancer, gastroesophageal reflux disease (GERD), or cardiovascular disease
Risk factors for insomnia
Insomnia can affect people of any age or sex, though it most commonly develops in:
Risk factors associated with insomnia include:
- high levels of stress, which might relate to life challenges, financial difficulties, or family and relationship concerns
- traveling to different time zones
- a sedentary lifestyle
- varying sleep-wake times or an irregular schedule, which might happen with frequent changes in work hours or shift work
- taking naps
- drinking a lot of caffeine
- alcohol and tobacco use
- difficulty winding down at bedtime
You might have trouble sleeping for a range of reasons, including:
- bodily changes, like fluctuating hormones, nausea, and an increased need to urinate
- increased stress and anxiety about the increasing responsibilities you’ll face as a new parent
- pain, such as cramps and back discomfort
The good news is that pregnancy-related insomnia usually passes and doesn’t affect your baby’s development. All the same, getting the right amount of sleep is important for your overall well-being.
Lifestyle changes that could help with insomnia in pregnancy include:
- getting regular physical activity
- eating a balanced diet
- staying hydrated
- maintaining a consistent sleep schedule
- practicing relaxation techniques during the day to help ease anxiety and promote calm
- taking a warm bath before bed
Children can develop insomnia, too — and often for the same reasons as adults. These reasons might include:
- heavy caffeine intake
- physical or mental health conditions
If your child has trouble falling asleep or staying asleep, or if they frequently wake up too early, they may have insomnia.
Symptoms of insomnia in children often include:
- daytime sleepiness or restlessness
- irritability and mood changes
- repeated disciplinary issues
- problems with memory and focus
The first step to treating insomnia in children generally involves setting a firm bedtime and sticking to it. Other helpful tips include:
- creating a soothing bedtime routine
- following good sleep hygiene practices, like avoiding screen time near bedtime
- reducing sources of stress in your child’s life
A therapist or pediatrician can offer more guidance on treating insomnia in children.
According to 2019 research,
A few different factors contribute to insomnia in older adulthood, and these can have something of a domino effect:
- Age-related changes in the circadian rhythms responsible for your sleep-wake cycle can make it harder to fall asleep or stay asleep.
- If you’re retired, you may no longer have a consistent daytime schedule or get regular social interaction, both of which can contribute to insomnia.
- Social isolation can contribute to loneliness and increase your chances of experiencing depression, which can also raise your risk of sleep problems.
- Health concerns related to aging, including chronic pain conditions, can also affect your sleep.
- If you’re not getting enough sleep at night, you might feel drowsy and fatigued during the day. You might be more inclined to nap as a result. Napping, of course, can leave you less tired at bedtime, fueling a cycle of sleeplessness.
If you experience insomnia, a therapist or clinician can offer more support with finding helpful treatment options.
Ever spent a night lying awake worrying about something you couldn’t control?
Insomnia commonly happens with anxiety, and the link can go both ways.
You might find it tough to fall asleep when you can’t soothe persistent feelings of worry and fear, for one. But chronic insomnia can leave you anxious about all the sleep you’re not getting, not to mention make it more difficult to manage difficult and unwanted emotions during the day.
Whether you’re dealing with an anxiety disorder or short-term anxiety related to a specific stressor, like a challenging work situation or conflict in your relationship, support from a mental health professional can help you begin to address all of your symptoms.
If your insomnia is related to anxiety, cognitive behavioral therapy (CBT) may be an effective way to manage both conditions (more on this later).
You can also take steps to manage milder anxiety on your own by:
- adding foods that help reduce anxiety to your diet
- getting some physical activity each day
- adding relaxation strategies to your self-care routine
- making time for hobbies and enjoyable activities
Evidence suggests a close link between insomnia and depression:
2016 meta-analysis of 34 studiesconcluded that poor sleep, especially during times of stress, appeared to significantly increase the risk of depression.
- In a
2018 studyinvolving 1,126 adults who didn’t have a diagnosis of either insomnia or depression when the study began, the risk of depression increased as persistent insomnia symptoms worsened over time.
What’s more, sleeping difficulties — including insomnia — are among the main symptoms of depression.
But here’s the good news: The same treatments often help both depression and insomnia, no matter which condition comes first.
The most common treatments are:
- therapy, including CBT
- lifestyle changes, including improved sleep habits, regular exercise, and meditation
When considering a diagnosis of insomnia, a healthcare professional will generally ask questions about:
- any existing medical conditions
- physical and mental health symptoms you’ve noticed
- stressors in your personal or professional life
- sleep history, including how long you’ve had insomnia symptoms and how they affect your daily life
This information can help them determine the underlying causes of your sleep problems. They may also ask you to keep a sleep log for 2 to 4 weeks, tracking:
- what time you go to bed
- the approximate time it takes you to fall asleep
- any instances of repeated waking in the night
- what time you wake up each day
A written or app-based sleep log will give your healthcare team a clearer picture of your sleep patterns.
They can also order medical tests or blood work to help rule out medical conditions that can interfere with your sleep. If they suspect you could have an underlying sleep disorder, such as obstructive sleep apnea, they may recommend participating in a sleep study.
What does a sleep study involve?
There are two ways to participate in a sleep study:
- an overnight stay at a sleep center
- at home, in your own bed
Both sleep study options involve having electrodes placed on your body in various places, including your head. The electrodes record your brain waves to help categorize the states of sleep and detect body movements while you’re asleep.
The results of your sleep study will provide your doctor with important neuroelectrical and physiological information they can use to better diagnose sleep disorders.
You’ll likely receive a clinical diagnosis of insomnia if you’ve experienced both of the following:
- sleep difficulties occurring at least 3 nights a week for a minimum of 3 months
- sleep difficulties creating major distress or difficulties in daily life
You have a number of options for treating insomnia, including therapy, medication and supplements, and natural remedies.
Cognitive behavioral therapy (CBT) for insomnia
With support from an online or in-person therapist, you can learn specific techniques to address insomnia, including:
- Stimulus control. This technique teaches you to get out of bed and find a quiet and relaxing activity until you feel sleepy, limiting the time you spend lying awake and worrying about falling asleep.
- Sleep restriction. This technique first restricts and then gradually increases the amount of time you spend in bed, which can help improve sleep efficiency and sleep quality.
- Bright light therapy. This technique involves exposure to bright light in the morning or evening, depending on whether you have more trouble falling asleep or staying asleep.
Your therapist may also offer guidance on relaxation techniques, along with sleep hygiene practices that help you address behaviors preventing you from getting enough quality sleep.
They might, for example, recommend you avoid:
- drinking caffeinated beverages near bedtime
- eating large or heavy meals or spicy foods close to bedtime
- getting intense exercise near bedtime
- using your bed for anything other than sleep or sex
A therapist can also help identify underlying mental health symptoms contributing to insomnia or making your symptoms worse. Addressing these triggers and contributing factors can go a long way toward helping relieve insomnia.
Medications and supplements
Your clinician might also prescribe medication to treat insomnia, such as:
Over-the-counter (OTC) sleep aids and supplements like melatonin can also offer some relief from insomnia.
Your body naturally produces the hormone melatonin during the sleep cycle, and it’s thought that melatonin supplements may slightly decrease the time it takes you to fall asleep.
That said, support for melatonin as an insomnia treatment remains inconclusive. What’s more, experts have yet to confirm whether it’s safe to use melatonin long term, though it’s generally considered safe for short-term use.
Check in with a healthcare professional before trying supplements like melatonin or OTC medications to help ease insomnia. These medications may interact with other prescription and OTC medications or cause side effects.
If you’re pregnant, always ask your healthcare team before you take any medications or supplements.
Lifestyle changes and home remedies can often help manage insomnia symptoms.
Ideas to try include:
- Natural sleep aids. You might try, for example, warm milk, herbal tea, and valerian before bed. Relaxing fragrances like lavender may also offer some benefits.
- Meditation. This technique helps promote present-moment awareness and relaxation. It doesn’t just help improve sleep quality and make it easier to fall asleep. It can also help relieve stress, anxiety, and pain — any of which might factor into insomnia. Many apps can help you get started with meditation.
- Acupuncture. Many people find this traditional Chinese medicine technique, which involves thin needles inserted at pressure points across the body, helpful for easing insomnia symptoms.
Essential oils are strong aromatic liquids made from herbs, flowers, and trees.
People often inhale these oils or massage them into their skin to help ease symptoms of various conditions. This practice is called aromatherapy.
A 2015 review of 12 studies found evidence to suggest aromatherapy could potentially improve sleep quality.
Choosing the right essential oil can improve your chances of success with aromatherapy. Essential oils believed to promote restful sleep include:
Essential oils generally don’t cause side effects when used as directed. The
When you don’t get the sleep you need, your brain doesn’t have the chance it needs to carry out important functions that keep it running smoothly. That’s part of why you feel foggy and have trouble focusing when you get poor sleep.
Insomnia can have more serious health effects over time. Only getting a few hours of sleep each night can increase your chances of developing a number of conditions, including:
- asthma attacks
- weakened immune system function
- high blood pressure
- heart disease
Insomnia can also:
- increase risk of errors on the job or accidents while driving and operating tools or machinery
- affect your performance at school or work
- lower your sex drive
- affect your memory
- make it more difficult to regulate emotions
It’s not always possible to prevent insomnia, but these tips may help you get the sleep you need:
- Try to maintain roughly the same schedule for sleeping and waking, even on weekends.
- Create a bedtime routine that helps you relax and get in the mood for sleep.
- Limit afternoon caffeine.
- Dim the lights and put down electronic devices an hour or so before bedtime.
- Get some sunlight and physical activity most days or every day, if possible.
- Avoid napping, especially if you know sleeping during the day keeps you awake at night.
- Work with a therapist to address mental health symptoms like anxiety and depression as soon as you notice them.
Insomnia isn’t just a nuisance or small inconvenience. It’s a sleep disorder that can affect mental and emotional health along with physical well-being.
If you think you have insomnia, connect with a healthcare professional as soon as possible. They can help you explore possible causes and offer support with finding the best insomnia treatment for your needs.