Insomnia: Causes, Symptoms, Treatments
Insomnia is a common sleep disorder marked by difficulty falling or staying asleep. One in seven adults experience symptoms of chronic insomnia. Losing sleep night after night will affect your day-to-day performance; your work quality may suffer, and your likelihood of getting into a car accident increases.
Once you develop insomnia, you may fear you will never get another good night’s sleep. However, with lifestyle changes and consultations with your doctor, you should be able to get your sleep habits back on track.
Types of Insomnia
Insomnia can be short-term, or it can be an on-going, chronic condition.
Short-term insomnia, also known as acute insomnia, is often caused by recent life events, such as work stress, pressure from family or societal expectations, or a traumatic event. Acute insomnia typically lasts a few days or weeks.
Chronic insomnia lasts a month or more, and it is often a symptom of another medical condition or sleep disorder. When your insomnia is a symptom or side effect of something else, it is known as secondary insomnia; most cases of chronic insomnia also qualify as secondary insomnia.
Occasionally chronic insomnia has no clear cause, although it may be rooted in long-term stress, travel, or varying shift work. This is known as primary insomnia.
Risk Factors for Insomnia
A risk factor is a variable that increases your chances of developing insomnia. Risk factors for insomnia include:
- Gender: More women tend to develop insomnia than men. One in four women experiences insomnia symptoms.
- Age: Older adults are more likely to develop insomnia than younger people.
- Race: Research shows African Americans take longer to fall asleep than Caucasian Americans.
- Mental Health: Depression and stress can cause you to develop insomnia.
- Shifting Schedule: If you work at night, have a changing shift schedule, or travel into different time zones, it can affect your sleep schedule.
- Economic Status: Lower-income people are more likely to develop insomnia. One reason might be that lower-income areas may have more noise exposure.
- Medical Conditions: Certain conditions or sleep disorders may have insomnia as a symptom.
- Sedentary lifestyle: Exercise is often suggested as a treatment for insomnia.
Causes of Insomnia
Insomnia may be caused by an emotional disorder, a neurological disease, a sleep disorder, or a medical condition.
Common causes for insomnia include:
- Post-traumatic stress disorder
- Chronic pain conditions, such as arthritis
- Respiratory conditions, such as asthma
- Hyperthyroidism, also known as an overactive thyroid
- Parkinson’s disease
- Gastrointestinal issues, such as GERD (chronic acid reflux)
- Restless legs syndrome
- Sleep apnea
Symptoms of Insomnia
If you have insomnia, you may:
- Lie awake for a long time before falling asleep, or find yourself awake for much of the night
- Sleep for short periods or wake up early
- Feel as if you haven’t slept much at all
Many insomniacs underestimate how much sleep they’re actually getting, but if you feel as if you aren’t sleeping enough, you likely aren’t.
You’re also likely to experience a decreased performance from sleep deprivation. When you’re sleep-deprived, you may have difficulty concentrating and remembering information, crave junk food, and feel anxious, irritable, or depressed.
To diagnose insomnia, your doctor may give you a physical exam and ask about recent changes that might indicate a disorder behind your insomnia. For example, if you’ve recently gained weight and your partner complains that you snore and gasp in the night, your doctor may diagnose you with sleep apnea.
Things your doctor may ask about include:
- Do you worry about falling or staying asleep?
- What is your bedtime routine?
- What do you eat and drink before bed?
- Do you take any medication?
- Do you have distractions in your room, such as a TV, computer, tablet, or smartphone?
You may be asked to fill out an Epworth Sleepiness Scale questionnaire, which will ask you to rate how likely you are to doze off in everyday situations such as driving or watching TV.
Your doctor may ask you to track your sleep patterns in a journal for a couple of weeks. Even if you’re not asked to, keeping a sleep diary can help you track when you wake up on workdays and days off, how long it takes to fall asleep, and what times you wake up in the night.
A blood test may be needed to rule out causes such as thyroid issues.
If it’s unclear what’s causing your insomnia or you show signs of another sleep disorder, your doctor may refer you to a sleep center for a sleep study. The sleep center will be able to measure your brain activity, breathing patterns, heart rate, eye movements, and body movements to better determine a cause.
If you have acute insomnia, simple lifestyle changes may be enough to alleviate it. Therapy and medications can relieve chronic insomnia symptoms.
Try to avoid stimulants such as caffeine, which lingers in your body hours after you ingest it. Schedule your last meal before bed to minimize sleep disruptions. You may also wish to discuss any current over-the-counter and prescription medications you’re taking with your doctor, as side effects may include sleep disruptions.
Exercise, particularly aerobic exercise, increases the amount of deep sleep you get. If you live a sedentary lifestyle, try to work your way up to at least 30 minutes a day. Limit your exercise sessions to at least one to two hours before bed.
Set up your bedroom for better sleep. Have a set of blackout curtains and consider wearing an eye mask to maximize darkness. Keep your bedroom’s temperature between 60 to 75 degrees Fahrenheit.
If a chronic medical condition causes your insomnia, consider an adjustable base to elevate your head and feet. Adjustable beds can alleviate symptoms of sleep apnea, acid reflux, restless legs syndrome, and more.
Messy rooms are often tied to anxiety and depression, so you might need to declutter your bedroom. Moving distractions from sleep out of your bedroom, such as your TV, work desk, and exercise equipment, can help you better focus on thoughts of sleep when it’s time for bed.
Establish a relaxing bedtime routine. You might want to try a warm bath, a massage, gentle stretches, deep-breathing exercises, or reading a good book.
Try to wake up at the same time every day, even on weekends. By waking up at the same time, it will be easier for you to fall asleep at a regular bedtime.
Counseling for insomnia seeks to minimize and eliminate thoughts and actions that keep you from sleeping. In the long run, it often provides better relief than prescribed medication would on its own. Successful cognitive behavioral therapy (CBT) may require you to see a therapist weekly for 2 to 3 months.
A cognitive-behavioral therapist may involve one-on-one or group sessions to discuss your thoughts and feelings about sleep. The idea is to describe the thoughts that race through your head, to better calm your mind at bedtime.
The therapist may instruct you in relaxation techniques and biofeedback to control your breathing, heart rate, and mood. They may also guide you through positive thinking to combat sleep anxiety.
Sleep restriction is another common CBT strategy for insomnia. By decreasing the time you spend in bed and avoiding naps, you experience partial sleep deprivation meant to help you fall asleep the next night.
If the cause behind your insomnia is a mental health condition such as depression or anxiety, cognitive behavioral therapy with prescribed medication is often effective at easing both conditions.
Your doctor may prescribe short-term or long-term medication for your insomnia. These medications may help you fall asleep, but you might feel lingering grogginess in the morning. Discuss this and other possible side effects and risks of your medication with your doctor—rare but potentially serious side effects include sleepwalking and even falling asleep while driving.
If you experience side effects or find the medication ineffective, let your doctor know so they can consider alternatives.
Over-the-counter medications such as melatonin supplements, L-tryptophan supplements, and valerian teas or extracts are often sold as sleep aids. We advise caution with these, as these products are unregulated by the Food and Drug Administration, leaving their safety and effectiveness in question.
Some people take over-the-counter medications with antihistamines to help them sleep; a few are even explicitly sold as sleep aids. However, while taking antihistamines may help you fall asleep, your overall sleep quality may remain poor. Many people quickly develop a tolerance for antihistamines, and some feel more active than sleepy after taking one.
Instead of taking over-the-counter medications, we recommend speaking with your doctor about possible causes for your insomnia and effective treatment plans. To fix your sleep schedule, you first need to establish one—try to wake up at the same time every day, even on your days off. Cut back on caffeine, as it remains in your system hours after you ingest it, and limit how much you eat and drink before bed. If worries keep you up at bedtime, devote time earlier in the day to review the day’s events and write down your anxieties. Try relaxation such as a warm bath, gentle stretches, and deep breathing exercises before bed. If problems persist, get a referral from your doctor to see a sleep specialist or a therapist.
Frequently Asked Questions
To fix your sleep schedule, you first need to establish one—try to wake up at the same time every day, even on your days off. Cut back on caffeine, as it remains in your system hours after you ingest it, and limit how much you eat and drink before bed.
If worries keep you up at bedtime, devote time earlier in the day to review the day’s events and write down your anxieties. Try relaxation such as a warm bath, gentle stretches, and deep breathing exercises before bed.
If problems persist, get a referral from your doctor to see a sleep specialist or a therapist.
Did We Help?
Insomnia is a common sleep disorder many of us experience at some point in our lives. Simple lifestyle changes such as setting up your bedroom for better sleep and exercising more may be enough to alleviate symptoms. However, you may need to see a cognitive behavioral therapist and ask your doctor about possible medications if symptoms persist.
This article is for informational purposes and should not replace advice from your doctor or other medical professional.