Insomnia: Causes, symptoms, and treatment
Date Published
Quick answer: insomnia is the persistent difficulty falling asleep, staying asleep, or waking too early despite adequate opportunity for sleep, with associated daytime impairment. About 10-30 percent of adults experience chronic insomnia at some point (American Academy of Sleep Medicine). First-line treatment for chronic insomnia is Cognitive Behavioral Therapy for Insomnia (CBT-I), which is the only intervention with documented sustained benefit beyond one year (AASM 2021 clinical practice guideline). Medications are second-line and are typically prescribed for short-term use. Common contributing factors include anxiety, depression, chronic pain, untreated sleep apnea, restless legs syndrome, caffeine or alcohol use, irregular schedules including shift work, and side effects from prescribed medications. Insomnia that persists more than three months or causes meaningful daytime impairment should be evaluated by a sleep physician, particularly to rule out underlying conditions such as OSA that may present as insomnia in some patients.
Everyone has had trouble sleeping at some point in their lives. Maybe nerves about an upcoming presentation, a late-afternoon nap, or a hefty before-bed snack kept you up into the wee hours of the night. The next day probably wasn't one of your best--maybe you felt sluggish, exhausted, and irritable.
But for insomniacs, this experience can become a common one. Here are the signs, causes, and potential treatments for insomnia.
What does it mean to be an insomniac?
The gist of insomnia can be summed up in one word:sleeplessness.
According to the National Sleep Foundation,insomnia is the difficulty falling asleep or staying asleep, even when you have the opportunity to do so and need further rest.
Causes of Insomnia
The causes of insomnia are potentially infinite. Acute insomnia--a brief disruption in sleep for a few nights--is common, and there are many factors that impact the quality of your sleep on a daily basis. Everything from stress or anxiety, to spending too much time on your laptop before bed, to taking too many naps, to using cold medicine could lead to a bout of restless nights.
Chronic insomnia, or a frequent sleep deficit, can be caused by a wide variety of issues. Here are some examples:
- Medical conditions. These include nasal alergies, arthritis, asthma, or chronic pain.
- Emotional distress. There is a proven link between depression and insomnia. People with depression are at much higher risk of developing the sleep disorder, and lack of sleep can worsen depression symptoms. Anxiety and stress also lead to sleeplessness.
- Lifestyle/sleep patterns. If you have irregular or untraditional sleep patterns, you might be finding it hard to nod off at night. Naps, an irregular sleep schedule, or shift work can mess up your circadian rhythms.
- Sleep disorders. This is a big one! If you're chronically not getting the sleep you need or feel tired in spite of having a full night's sleep, this could be a sign of a sleep disorder, like Restless Leg Syndrome or sleep apnea, that's disrupting the quality of your rest.
Symptoms
Here are some signs that you might be battling insomnia:
- Having trouble falling asleep
- Waking up at night and not being able to get back to sleep
- Waking up too early in the morning
- Unrefreshing sleep (also called "non-restorative sleep"--a common symptom of sleep apnea)
- Fatigue or daytime sleepiness
- Mood swings, irritability, trouble concentrating, or trouble with memory
- Behavioral problems, such as feeling impulsive or aggressive
- Difficulty at work or school
Part of the trouble with giving a specific diagnosis for insomnia is how common these symptoms are! Everyone has felt sleepy or irratible at some point in their lives. Therefore, doctors provide guidelines for what constitues chronic insomnia:it must occur at least three nights a week for three months or longer.
Treatment
If you have chronic difficulty sleeping, you should talk to your doctor about it. Your doctor might consider prescribing you a medication to assist with sleeping, or, if the problem has roots in anxiety or depression, referring you to a psychotherapist. He might recommend that you undergo one of these treatment options. If you still have trouble sleeping, ask your doctor to refer you to a sleep specialist for testing.
Other posts you may find interesting:
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- Which Sleep Position is Best for You
- Bedroom Colors to Help You Sleep
- How Much Sleep Do You Really Need
- Dangerous Effects of Sleep Deprivation
Photo Credit:Benjamin Watson
Frequently asked questions
Chronic insomnia is defined as difficulty falling asleep, staying asleep, or early-morning awakening occurring at least 3 nights per week for at least 3 months, with associated daytime impairment (DSM-5 and ICSD-3 criteria). Shorter episodes are typically classified as acute or short-term insomnia.
Cognitive Behavioral Therapy for Insomnia (CBT-I) is the recommended first-line treatment per the 2021 AASM clinical practice guideline. It is the only intervention with sustained benefit beyond one year. Sleep medications are second-line and are typically used for short-term symptom relief while CBT-I is being learned.
Sleep medications can help short-term but are not first-line for chronic insomnia. Risks include dependence, tolerance, next-day sedation, and falls in older adults. AASM recommends CBT-I before or alongside medication. Discuss benefits and risks specific to your situation with your physician.
Yes. Sleep-related breathing disorders including OSA can present as insomnia, particularly difficulty maintaining sleep or early-morning awakening. This is sometimes called "comisa" (comorbid insomnia and sleep apnea). A sleep study may be indicated when insomnia does not respond to standard treatment or when OSA risk factors are present.
Consider sleep specialist evaluation if insomnia persists more than 3 months, causes meaningful daytime impairment, does not respond to CBT-I or initial medication, or is accompanied by symptoms suggesting OSA, restless legs, or other primary sleep disorders.
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