Insomnia: Symptoms, Causes, and Treatments

Do you ever have trouble sleeping? At one time or another, most of us have experienced bothersome symptoms of insomnia: difficulty falling asleep, staying asleep, or both. We may have lived through bouts of insomnia that last a few days, or much longer. Though the symptoms may seem simple enough, insomnia is a complex condition with a wide variety of causes. (4)

If you have insomnia, you’re in good company – about 10 percent of adults have an insomnia disorder, and an additional 20 percent experience the occasional insomnia symptoms. (5) Below, we’ll let you know all about typical insomnia symptoms, what causes insomnia, and what kinds of insomnia treatments you can expect.

Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t taken as medical advice, and it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately.

What Is Insomnia?

Insomnia is a sleep disorder that makes it hard to fall asleep, stay asleep, and get good quality sleep overall. (4) Your body and brain rely on solid slumber to function at their peak, so insomnia can quickly throw a wrench in your health. (6) (7) Anyone can experience insomnia, but women and older adults tend to deal with it the most, says Dr. Chester Wu, sleep medicine physician in Houston, TX. (8)

Types of Insomnia

Insomnia used to break down into a ton of categories, like primary and secondary insomnia, paradoxical insomnia, and idiopathic insomnia. (9) But now, many experts have simplified insomnia types into these three:

• Short-term insomnia: This temporary type of insomnia can steal your sleep for a few days or a few weeks. (4) (9)
• Chronic insomnia: This longer-term insomnia is characterized by at least three nights per week of poor sleep for three or more months. (4)
• Other insomnia: This insomnia type gets assigned for any other type that doesn’t quite fit into the other two categories. (10)

Symptoms of Insomnia

Other than lying awake in your bed, how can you recognize insomnia symptoms? When you have insomnia, you may notice difficulty either falling or staying asleep, or waking up early and being unable to return to sleep, says Wu, who adds insomnia symptoms can also rear up during the day, which may look like: (11)

• Feeling fatigued and sleepy
• Trouble focusing
• Irritability
• Heightened anxiety or depression

If you have insomnia, you may only be able to sleep in short bursts. When you wake, it might be hard to fall back asleep, leaving you awake (and frustrated) for most of the night. (11) Let’s look at insomnia’s causes and then we can get into some solutions.

Causes of Insomnia

No one can say what causes insomnia with 100 percent certainty, says Wu, but experts have some theories. (9) For example, hormonal changes in women during menstrual cycles, pregnancy, and menopause may lead to insomnia symptoms, says Wu. (8) (12)

Some other short- and long-term insomnia causes may include: (5) (8) 

• Stress: When life stresses you out, your body can keep your mind amped up well past bedtime and even wake you through the night.
• Travel: When you travel over time zones, your circadian rhythm (internal clock) can get confused and make you wakeful or sleepy at odd hours.
• Work schedule: The demands of work can push you to ignore your natural sleep needs by waking up too early or going to bed too late. Shift workers in particular can feel the sleep effects of an irregular schedule.
• Unhealthy sleep habits: Unhealthy habits like eating a large meal or drinking alcohol or caffeine too close to bed can disrupt your night’s sleep.
• Mental health disorders: Mental health disorders like anxiety, depression, and post-traumatic stress disorder often include insomnia in their symptom lists. 
• Certain medications: Some medications can cause sleep disturbances, like antidepressants, asthma medications, and over-the-counter cold medications that include stimulants.
• Other sleep disorders: Other sleep disorder symptoms can easily cause insomnia, such as the breath pausing from sleep apnea, or compulsive leg movements to ease restless leg syndrome.

Risk Factors For Insomnia

Research shows certain factors can make you more prone to insomnia throughout your life: (8) (10) (13)

• Age: With aging can come the build up of stressors, increasing medical issues and any corresponding medications, and decreased natural melatonin production, all of which can steal your sleep, says Wu. As you age, you also may experience less restful sleep and easier nighttime waking.
• Sex: Women experience insomnia more than men, especially during times of hormonal imbalance. In fact, up to 60 percent of women report insomnia during menopause. (14)
• Genetics: Insomnia can run in families, so if your parents and grandparents all lived with this disorder, you may be at higher risk of developing it, too.
• Comorbidities: Other medical conditions may up your risk for insomnia, such as those that cause chronic pain, like arthritis, or prostate issues that keep you running to the bathroom all night. 
• Personality traits: If you are a perfectionist, ambitious, introverted, and a natural compulsive worrier, you may be more prone to chronic insomnia.

If some of these risk factors describe you, don’t fret yet! Everyone has trouble sleeping now and then. To know if you truly have insomnia, you must be diagnosed by a healthcare provider.

How Is Insomnia Diagnosed?

Insomnia has no blood test or sleep study to give your provider irrefutable proof that you have it. Instead, to diagnose insomnia, your provider will ask you a whole heap of questions. They will use your answers to rule out other factors that can cause sleep issues, like medications, says Wu. (4)

You may also be asked to keep a sleep diary for a time to record your sleep habits or complete a sleep questionnaire like the Insomnia Severity Index or the Functional Outcomes of Sleep Questionnaire. (4) (15)

“See a doctor if [your sleep loss] begins to affect daily functioning with work, school, personal life, or just [your] mental state…becoming a significant source of anxiety,” says Wu, who adds that sleep loss gets problematic if it happens more than three times a week on average, and chronic if it lasts over three months.

Health Consequences of Insomnia

Insomnia’s short-term effects can include fatigue, sleepiness, impaired concentration, and irritability, says Wu. While the occasional bout with insomnia symptoms may be difficult to avoid, insomnia that lasts more than a few weeks or becomes chronic may have serious health effects. 

Long-term insomnia can lead to: (1) (8) (9) (11)

• Impaired immune function (16)
• Chronic daytime sleepiness
• Increased risk of chronic disease like diabetes, heart disease, and hypertension
• Increased risk of mood disorders such as anxiety and depression
• Difficulty concentrating
• Trouble retaining new information
• Impaired judgment, reasoning, and problem-solving abilities
• Impaired performance at work or school
• Increased risk of errors and accidents, due partly to impaired reaction times
• Diminished sex drive and increased sexual dysfunction (17) (18)
• Difficulty maintaining healthy weight (19)

Your body fights back against your daytime sleepiness by revving up your nervous system to make you feel more awake, but it can’t keep that up without some consequences like those above. (20)
Insomnia can affect your quality of life through any of the symptoms and complications we’ve talked about. (1) Now, if you’re ready for some good news, insomnia is treatable.

Insomnia Treatment

Your provider may first try to treat insomnia without medication, but they may also recommend temporary medications if needed. More on your options below. (1)

Cognitive Behavioral Therapy For Insomnia (CBT-I)

“Cognitive behavioral therapy for insomnia (CBT-I) is considered the gold standard treatment,” says Wu. CBT-I is a version of talk therapy (psychotherapy) that, directed by a mental health professional, helps you change negative thought patterns and behavior to improve sleep. (1) (21)

One aspect of CBT-I, called stimulus control therapy, trains your brain to associate your bed with sleep by only lying in bed while sleepy. Some key components include: (22)

• Avoid using your bed for anything other than sleep or sex.
• If you don’t fall asleep within 15 to 20 minutes in bed, then get up and do something calming in another room until you feel sleepy again.
• Get up at the same time every day.
• Avoid daytime napping.

Relaxation Therapy

Relaxation therapy also plays an important role in CBT-I, which uses pre-bed relaxation exercises, deep breathing, progressive muscle relaxation, mindfulness techniques, and meditation to help prepare your body and mind for sleep. (22)

Sleep Restriction Therapy 

Part of the pattern changes in CBT-I can involve a technique called sleep restriction therapy (SRT). If we feel our lack of sleep, we may try to sleep in longer or nap during the day. When you use SRT, you only let yourself stay in bed for the amount of time you expect to sleep. This therapy can make your sleeping time more efficient and help you fall asleep faster. (22) But this part can be tricky — we certainly don’t want to prompt you to sleep less! Talk SRT over with your healthcare provider and come up with a plan together before you try it to make sure it’s right for you.

Cognitive Therapy

The cognitive therapy in CBT-I helps you create realistic expectations around sleep by digging into your thoughts about sleep itself that may be fueling your insomnia. Our thoughts can affect our emotions and behavior, both of which may affect our sleep. 
It’s also easy to feel intense emotions when thinking about certain scenarios in bed, and — as you can imagine — this keeps you from falling asleep or staying asleep. Once you know these thoughts, you can evaluate and modify them to prep your brain for better sleep. (22)

Good Sleep Hygiene

Good sleep hygiene makes up a vital part of anyone’s sleep health. The more you can build positive sleep habits, the better you’ll sleep. While sleep hygiene alone may not cure your insomnia, it certainly can’t hurt, and may help your other therapies work better. (23) Try out these sleep hygiene habits to set yourself up for snoozing success: (24)

• Create a comfortable sleeping space: If your bed is lumpy and your room is bright and loud, your brain may learn to dread bedtime. Invest in a great mattress and comfy bedding, and you can look forward to drifting off every night.
• Skip the screens: Light from your various electronics can trick your brain into thinking it’s time to stay awake and party. This may sound fun, but it’s not so great for sleep. (25)
• Keep your sleep and wake times regular: Your brain loves a schedule, and the more you can keep to the same wake-up time and bedtime, the more your circadian rhythm can keep your sleep schedule on track. (26)
• Cut off your stimulants: If you consume caffeine or nicotine regularly, you know they can give you a little boost just when you need it. But when you have them too close to bedtime, that boost can keep you up and lower the quality of your sleep through the night. (27) (28) Everyone reacts to these substances differently, so you may have to experiment with your daily cut-off time to find your sweet spot.
• Avoid alcohol: Your favorite alcoholic beverage may help you feel sleepy and even fall asleep, but alcohol can disrupt your sleep through the night, making it feel like you didn’t get much at all. (29) The earlier you can take your last sip, the better you’ll sleep. (30)
• Add physical activity to your routine: Daily exercise can help you sleep better at night, and it works best if you get your heart pumping in the morning or afternoon, compared to evening, when it might keep you amped up and make falling asleep harder. (31) (32)
• Try not to nap: While the odd nap may help you catch up on some sleep debt, for insomnia, naps are generally discouraged. If you can avoid napping, you may have an easier time falling asleep that night. (8) (33)
• Eat your last meal early: Late-night dinners can shoulder you with indigestion through the night, so try to wrap up heavy meals two or three hours before bedtime and keep pre-bed snacking light. (30)
• De-stress before bed: A pleasant and regular wind-down routine can help you relax before your bed and prepare your mind for blissful slumber. Try a soothing bedtime activity or two like taking a hot bath, reading a book, or meditating. (8)

Sleep Medications

Sometimes the therapies above can’t get you over the initial insomnia hump. “Medications can often be helpful particularly for immediate relief or more acute insomnia,” says Wu. Your provider may recommend natural supplements like melatonin or an over-the-counter sleep aid like diphenhydramine (Benadryl). (34) (35)

If these are ineffective, they may offer a prescription sleeping pill like zolpidem (Ambien) or suvorexant (Belsomra). In the past, benzodiazepines like alprazolam (Xanax) were a sleep aid go-to, but now we know these types of medications can be habit-forming and need higher and higher dosages to keep working. (1) (36) (37)

Insomnia Myths Vs. Reality

There’s plenty of myths about insomnia out there, and many of them are not based in reality. Below, we dispel some of the most common insomnia myths we’ve heard.  

Myth: Insomnia only happens to anxious people

Reality: Insomnia symptoms can happen for a vast number of reasons. While anxiety is a common cause, it’s only one of many factors that can provoke this sleep disorder. (9)

Myth: Insomnia is just the inability to fall asleep

Reality: Insomnia might involve difficulty falling asleep or may manifest as frequently waking during the night, waking early, or feeling sleepy during the day. Someone who can fall asleep quickly may still be diagnosed with insomnia if they can’t remain asleep, wake too early, or suffer from low-quality sleep. (4)

Myth: If you can’t fall asleep, you should lie in bed until you do

Reality: Remaining in bed when you can’t sleep may signal to your brain that your sleeping environment is where you lie awake. It may also heighten anxiety, making it harder to doze off again. Most experts agree that if you don’t fall back to sleep within 15 or 20 minutes of waking up, it’s best to get out of bed and participate in a relaxing activity such as listening to soothing music or reading. (22)

Myth: Alcohol and television can help combat insomnia symptoms

Reality: Alcohol has been proven to impair sleep quality and increase the risk of waking during the night. (29) Watching television — the news in particular — can be stressful, making relaxation more difficult. Additionally, TVs, smartphones, and computers emit the blue light that is well-known for interfering with sleep-wake cycles. (25)

Myth: If you awaken for only short periods during the night, it won’t affect the quality of your sleep
Reality: A brief slumber disruption may not seem particularly important, but waking up for any amount of time during the night can cause more than a few lost minutes of rest. In fact, studies suggest interrupted sleep is just as bad for you as insufficient sleep. (38)

FAQs

The Last Word From Sleepopolis

Insomnia can feel distressing — everyone needs sleep to feel and function their best. But you have options! With provider-directed therapy, better sleep habits, or temporary sleep medications, you can banish insomnia and reclaim excellent sleep.

Sources

Abby McCoy

Abby McCoy is an RN of 16 years who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She has practiced nursing all over the world from San Fransisco, CA to Tharaka, Kenya. Abby loves spending time with her husband, four kids, and their cat named Cat.