If you have trouble falling asleep or sleeping through the night, you may have a common sleep disorder called insomnia. This is likely to cause you to feel groggy or tired as if your sleep was poor quality. So, what is insomnia?
Insomnia is defined as a "persistent difficulty with sleep initiation, duration, consolidation or quality."
There are two different types of insomnia:
Primary – This type of sleeplessness may also be called chronic or ongoing insomnia. It refers to sleep disturbances that last longer than a month. If your doctor rules out other medical conditions, you might be diagnosed with primary insomnia.
Secondary – Sometimes referred to as acute or short-term insomnia, secondary means something is causing the sleep disturbance. There are several physical, mental, chemical, and lifestyle factors that can cause secondary insomnia.
Sleep disorders are common in the United States, affecting 70 million Americans annually. Secondary or short-term insomnia affects between 33% to 50% of adults, while primary insomnia is estimated to affect about 10% to 15%.
The amount of sleep needed at night is different for everyone. That number can also fluctuate depending on certain factors like health, activity level, age, and nutrition.
Whether you need 4-5 hours of sleep a night or 8-9 hours, insomnia means that you are not getting enough good quality sleep for what your system requires. It also means that you're not waking up refreshed and your body does not feel restored.
Over time, the symptoms of this sleep debt grow, and it may cause serious side effects or health problems in the future.
Some symptoms of insomnia are easy to spot, like difficulty falling asleep or staying asleep throughout the night. However, some are a little harder to recognize. The following are some symptoms that patients with insomnia may experience.
Physical symptoms of insomnia:
Unable to sleep even if very tired
Waking up many times at night
Unable to fall back asleep if awakened
Waking unrefreshed every morning
Needing sleep medicine or alcohol to fall asleep
Fatigue and drowsiness during the day
A slower reaction time can be unsafe when driving
Emotional symptoms of insomnia:
Cranky or irritable throughout the day
Feeling indifferent or flat
Depressed or anxious
Unable to concentrate
Loss of memory or feeling forgetful¹
There are also health problems and complications that may occur if insomnia is left untreated. Some preexisting health problems can even get worse over time. Here are some to watch for:
During sleep, your body repairs and restores itself. If you're not getting adequate sleep, it may cause inflammation, making it harder to protect against infections.
If you don't get enough sleep, your hormone levels may change. This increases the risk of weight gain, which can lead to metabolic syndrome, diabetes, and obesity.
Some people who have a history of headaches may notice more of them. Sleep deprivation can lead to more frequent or chronic headaches.
In some cases, especially in people who have a history of chronic pain, sleeplessness can make the problem worse.
You need a lot of rest when you're pregnant. Insomnia is pretty common during pregnancy due to changing body and hormones. If you're struggling to get the necessary sleep you need, talk to your OBGYN. They can discuss the risks and help you get a more restful sleep.
People with asthma, allergies, or emphysema might experience more breathing problems than they are used to.
Too little sleep can affect the heart. Arrhythmias, coronary heart disease and blood pressure can worsen if the body is unable to repair during sleep.
If there is a history of a mental health disorder, insomnia can make the situation worse. Insomnia can also cause the onset of anxiety, depression, or suicidal thoughts.²
The causes of primary insomnia are not fully understood, and more research is needed. However, there are several known and suspected causes of secondary insomnia.
Medical causes of insomnia include:
Restless leg syndrome
Emotional causes of insomnia include:
Anxiety or depression
Loss of a loved one (grief)
Major life changes
Post-traumatic stress disorder (PTSD)
Lifestyle causes of insomnia include:
Caffeine, alcohol, and nicotine use
Uncomfortable place to sleep
New baby keeping you up
Shift-work or inconsistent work schedule
Sedentary or low activity levels
Low or poor nutrition
There has recently been some evidence that our genes may also play a role in how well we sleep. Insomnia might be caused, in some cases, by heredity.¹
Some people may be at higher risk of developing insomnia than others. Women are more likely to experience symptoms of insomnia than men. Research also shows that African Americans are disproportionately affected.²
Insomnia is a sleep disorder that a doctor can diagnose. In order to get an official diagnosis that your sleeplessness is insomnia, your health care provider may need to:
Ask about personal and family medical history
Ask about your sleep history
Ask about different lifestyle factors
Evaluate your stress levels
Ask about daily exercise and activity
Ask about possible substance use or misuse
Do a physical exam
Run some bloodwork
Request a sleep study from a specialist
Have you fill out a sleep log
There are a lot of factors that can cause a person to struggle with sleep. Some of them include food, medication, age, hormones, gender, and mood. Before you can be diagnosed, your doctor will need to know how much sleep you're getting, what your sleep routine used to look like, and if there is something medical causing the problem. They will also need to know how long the issue has been happening.
Insomnia is highly treatable, and there are a lot of options for you and your doctor to discuss. In some cases, lifestyle changes may be the best steps toward a healthy night's sleep. Sometimes, medication is the best choice. There are also natural treatments that might help.
In this section, we'll cover the most common treatment types.
Many people are able to improve their insomnia by making lifestyle changes alone. We often have habits that negatively impact our ability to get restful sleep, but the good news is they are able to be modified by creating a good “sleep hygiene” plan. Here are some suggestions that may help:
Make your bedroom more comfortable and inviting
Create a sleep-wake schedule you stick to and do so even on days off
Avoid nicotine, caffeine, and alcohol before bedtime
Exercise regularly and do it early in the day, not before sleep
Eliminate naps throughout the day
Drink plenty of fluids during the day, rather than in the lead-up to bedtime
Don't eat right before bed unless it's to manage glucose levels
Try techniques such as meditation or mindfulness to manage stress levels
Most importantly, turn off all screens and unnecessary lights¹; you need a minimum of one hour without screens (phone, tablet, TV, etc.) for your sleep signals to respond appropriately
Prescription sleep aids can help many people get back to a healthy sleep routine. However, they are not intended for long-term use and should only be used temporarily due to their side effects. They may make insomnia worse if not used correctly¹. Here are some commonly prescribed sleep medications:
Other medications that your doctor might prescribe will depend on what is causing the sleeplessness. For example, if the exam and bloodwork indicate diabetes, you may be prescribed medication to manage your blood sugar. If anxiety or depression is the culprit, you may be given a prescription for antidepressants.²
Sometimes natural treatments may be all you need, or they are used before moving on to prescriptions. Here are some natural remedies that may improve sleep:
This is a hormone produced in the body to help regulate the sleep cycle. A synthetic form can be bought as a supplement over the counter as well. This is not meant to be used long-term as this may cause your body to produce less of it over time. Instead, it should be used as directed until a sleep routine is established.
This is an herb that is available as an over-the-counter treatment that may help with insomnia. It has mild to moderate sedative effects.
This is a great option if insomnia is caused by any kind of stress. It can also be used in combination with other treatments and medications.
Like mediation, yoga can help relieve stress. It can also get your blood flowing and make your muscles tired, which may help improve your sleep quality.
If you are dealing with long-term or chronic insomnia, cognitive behavioral therapy for insomnia is a common treatment option. It is typically 6-8 weeks of treatment designed to help the patient learn how to fall and stay asleep. The steps in CBT-I include:
Sleep education to learn healthy sleep habits
Meditation to help with relaxation
Cognitive therapy to help with negative feelings about sleep
Stimulus control therapy to improve your sleep-wake cycle
Sleep restriction therapy to train your body to sleep while in bed
If your doctor recommends CBT-I as a treatment option, it can be done in multiple settings, including in-person, online, or by phone.²
Can insomnia be prevented? In some cases, insomnia can be prevented through lifestyle choices. In other cases, the cause of your sleeplessness may be unavoidable.
For example, if stressors cause your insomnia, learning to better recognize and cope with the stress may help you avoid sleep disturbances.
If the cause of insomnia is due to stimulation before bed, you can prevent it by avoiding the source of the stimulation altogether. Here are the most common stimulants affecting sleep:
Electronic devices (phones, tablets)
Watching TV before bed
Late-night eating or snacking
Exercising before bed
Drinking caffeinated beverages too late in the day
Drinking alcohol or smoking
Another common cause of insomnia is too much light. This can be a problem for people who work at night and sleep during the day. It can also occur if you live in large cities where there are a lot of streetlights.
In this situation, the light is confusing your sleep-wake cycle. One possible solution is to buy black-out curtains.
Making sleep a priority can also help prevent insomnia. You can do this by creating a healthy sleep routine.
Most people need their bedroom to be quiet, dark, and cool. When your body begins the process of falling asleep, your body temperature drops a few degrees. When the room is a little cooler, it is easier to fall asleep.¹
The types of doctors and specialists you may receive treatment from will partly depend on what may be causing insomnia. Here are some of the most common healthcare practitioners who might be a part of your care team:
Your PCP may be the first person you talk to about your insomnia. They may be able to help you directly, or they might refer you to a specialist.
An ENT specializes in the structures of the ears, nose, and throat. If insomnia is due to sleep apnea or other obstructive breathing problems, they may be able to address them.
If allergies are causing you to be congested or have asthma symptoms during sleep, they might be able to help with antihistamines, inhalers, or injections.
Sometimes insomnia is related to mental health, like depression or anxiety. If this is the case, they can help with CBT-I or counseling.
This type of doctor specializes in the lungs and breathing. If sleeplessness is due to breathing difficulties, you may be referred to a pulmonologist.
A sleep disorder specialist is responsible for monitoring you during a sleep study. They can evaluate what your brain and body are doing while asleep.
If the insomnia is caused by a chronic condition like diabetes or a thyroid disorder, you may need to see an endocrinologist.
This type of doctor specializes in the brain and nervous system. Nerve damage, brain injuries, and stroke are just a few conditions they treat.
Insomnia, whether short-term or long-term, is not likely to kill you directly. It can, however, shorten your lifespan if it starts to affect your health. If, for example, chronic sleep deprivation causes type 2 diabetes, you will be at higher mortality risk.
Not getting enough sleep can also lower your cognitive function and make driving and other daily tasks more dangerous.
Once the cause is discovered, insomnia can be treated and, in some cases, cured. However, if it's a case of primary insomnia with no known cause, it may be better to focus on a treatment plan that improves your symptoms rather than a cure.
In some cases, there is some evidence to suggest that insomnia might be genetic. Therefore, people with a family history of insomnia should speak to their doctor about it if they start showing symptoms.
Physically, insomnia comes with a groggy, tired feeling that is hard to shake without getting more sleep. On an emotional level, it can cause irritability. Some people may feel indifferent or depressed.
In most cases, you should start out by seeing your primary care physician. They may need to do an exam, order some bloodwork, and ask questions to help determine which type of specialist is the best fit. This can save you time and money in the long run.
Pregnancy can be physically and mentally exhausting for many women. It can also be challenging to find the right sleeping position. About 50% of pregnant women are affected by insomnia-related symptoms.¹
Acute or temporary insomnia is common during menstruation. This can occur before, during, or after a woman has her period. There are several main reasons for this, including:
Hormones – During menstruation, hormones fluctuate, which can cause sleeplessness.
Pain – PMS can cause painful cramping, headaches, and discomfort, all of which can keep you up at night.
Mood changes – Some women experience added stress and anxiety that can affect their sleeping habits.
Like pregnancy and menstruation, menopause can affect sleep patterns. Hormones can change quickly, causing hot flashes, mood swings, and sleepless nights.