Insomnia is a common sleep disorder that can make it hard to fall asleep, hard to stay asleep, or cause you to wake up too early and not be able to get back to sleep. You may still feel tired when you wake up. Insomnia can sap not only your energy level and mood but also your health, work performance and quality of life.
How much sleep is enough varies from person to person, but most adults need seven to eight hours a night.
At some point, many adults experience short-term (acute) insomnia, which lasts for days or weeks. It’s usually the result of stress or a traumatic event. But some people have long-term (chronic) insomnia that lasts for a month or more. Insomnia may be the primary problem, or it may be associated with other medical conditions or medications.
You don’t have to put up with sleepless nights. Simple changes in your daily habits can often help.
Insomnia symptoms may include:
- Difficulty falling asleep at night
- Waking up during the night
- Waking up too early
- Not feeling well-rested after a night’s sleep
- Daytime tiredness or sleepiness
- Irritability, depression or anxiety
- Difficulty paying attention, focusing on tasks or remembering
- Increased errors or accidents
- Ongoing worries about sleep
When to see a doctor
If insomnia makes it hard for you to function during the day, see your doctor to identify the cause of your sleep problem and how it can be treated. If your doctor thinks you could have a sleep disorder, you might be referred to a sleep center for special testing.
Insomnia may be the primary problem, or it may be associated with other conditions.
Chronic insomnia is usually a result of stress, life events or habits that disrupt sleep. Treating the underlying cause can resolve the insomnia, but sometimes it can last for years.
Common causes of chronic insomnia include:
- Stress. Concerns about work, school, health, finances or family can keep your mind active at night, making it difficult to sleep. Stressful life events or trauma — such as the death or illness of a loved one, divorce, or a job loss — also may lead to insomnia.
- Travel or work schedule. Your circadian rhythms act as an internal clock, guiding such things as your sleep-wake cycle, metabolism and body temperature. Disrupting your body’s circadian rhythms can lead to insomnia. Causes include jet lag from traveling across multiple time zones, working a late or early shift, or frequently changing shifts.
- Poor sleep habits. Poor sleep habits include an irregular bedtime schedule, naps, stimulating activities before bed, an uncomfortable sleep environment, and using your bed for work, eating or watching TV. Computers, TVs, video games, smartphones or other screens just before bed can interfere with your sleep cycle.
- Eating too much late in the evening. Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable while lying down. Many people also experience heartburn, a backflow of acid and food from the stomach into the esophagus after eating, which may keep you awake.
Chronic insomnia may also be associated with medical conditions or the use of certain drugs. Treating the medical condition may help improve sleep, but the insomnia may persist after the medical condition improves.
Additional common causes of insomnia include:
- Mental health disorders. Anxiety disorders, such as post-traumatic stress disorder, may disrupt your sleep. Awakening too early can be a sign of depression. Insomnia often occurs with other mental health disorders as well.
- Medications. Many prescription drugs can interfere with sleep, such as certain antidepressants and medications for asthma or blood pressure. Many over-the-counter medications — such as some pain medications, allergy and cold medications, and weight-loss products — contain caffeine and other stimulants that can disrupt sleep.
- Medical conditions. Examples of conditions linked with insomnia include chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson’s disease and Alzheimer’s disease.
- Sleep-related disorders. Sleep apnea causes you to stop breathing periodically throughout the night, interrupting your sleep. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.
- Caffeine, nicotine and alcohol. Coffee, tea, cola and other caffeinated drinks are stimulants. Drinking them in the late afternoon or evening can keep you from falling asleep at night. Nicotine in tobacco products is another stimulant that can interfere with sleep. Alcohol may help you fall asleep, but it prevents deeper stages of sleep and often causes awakening in the middle of the night.
Insomnia and aging
Insomnia becomes more common with age. As you get older, you may experience:
- Changes in sleep patterns. Sleep often becomes less restful as you age, so noise or other changes in your environment are more likely to wake you. With age, your internal clock often advances, so you get tired earlier in the evening and wake up earlier in the morning. But older people generally still need the same amount of sleep as younger people do.
- Changes in activity. You may be less physically or socially active. A lack of activity can interfere with a good night’s sleep. Also, the less active you are, the more likely you may be to take a daily nap, which can interfere with sleep at night.
- Changes in health. Chronic pain from conditions such as arthritis or back problems as well as depression or anxiety can interfere with sleep. Issues that increase the need to urinate during the night ―such as prostate or bladder problems ― can disrupt sleep. Sleep apnea and restless legs syndrome become more common with age.
- More medications. Older people typically use more prescription drugs than younger people do, which increases the chance of insomnia associated with medications.
Insomnia in children and teens
Sleep problems may be a concern for children and teenagers as well. However, some children and teens simply have trouble getting to sleep or resist a regular bedtime because their internal clocks are more delayed. They want to go to bed later and sleep later in the morning.
Nearly everyone has an occasional sleepless night. But your risk of insomnia is greater if:
- You’re a woman. Hormonal shifts during the menstrual cycle and in menopause may play a role. During menopause, night sweats and hot flashes often disrupt sleep. Insomnia is also common with pregnancy.
- You’re over age 60. Because of changes in sleep patterns and health, insomnia increases with age.
- You have a mental health disorder or physical health condition. Many issues that impact your mental or physical health can disrupt sleep.
- You’re under a lot of stress. Stressful times and events can cause temporary insomnia. And major or long-lasting stress can lead to chronic insomnia.
- You don’t have a regular schedule. For example, changing shifts at work or traveling can disrupt your sleep-wake cycle.
Sleep is as important to your health as a healthy diet and regular physical activity. Whatever your reason for sleep loss, insomnia can affect you both mentally and physically. People with insomnia report a lower quality of life compared with people who are sleeping well.
Complications of insomnia may include:
- Lower performance on the job or at school
- Slowed reaction time while driving and a higher risk of accidents
- Mental health disorders, such as depression, an anxiety disorder or substance abuse
- Increased risk and severity of long-term diseases or conditions, such as high blood pressure and heart disease
Good sleep habits can help prevent insomnia and promote sound sleep:
- Keep your bedtime and wake time consistent from day to day, including weekends.
- Stay active — regular activity helps promote a good night’s sleep.
- Check your medications to see if they may contribute to insomnia.
- Avoid or limit naps.
- Avoid or limit caffeine and alcohol, and don’t use nicotine.
- Avoid large meals and beverages before bedtime.
- Make your bedroom comfortable for sleep and only use it for sex or sleep.
- Create a relaxing bedtime ritual, such as taking a warm bath, reading or listening to soft music.
Depending on your situation, the diagnosis of insomnia and the search for its cause may include:
- Physical exam. If the cause of insomnia is unknown, your doctor may do a physical exam to look for signs of medical problems that may be related to insomnia. Occasionally, a blood test may be done to check for thyroid problems or other conditions that may be associated with poor sleep.
- Sleep habits review. In addition to asking you sleep-related questions, your doctor may have you complete a questionnaire to determine your sleep-wake pattern and your level of daytime sleepiness. You may also be asked to keep a sleep diary for a couple of weeks.
- Sleep study. If the cause of your insomnia isn’t clear, or you have signs of another sleep disorder, such as sleep apnea or restless legs syndrome, you may need to spend a night at a sleep center. Tests are done to monitor and record a variety of body activities while you sleep, including brain waves, breathing, heartbeat, eye movements and body movements.
Changing your sleep habits and addressing any issues that may be associated with insomnia, such as stress, medical conditions or medications, can restore restful sleep for many people. If these measures don’t work, your doctor may recommend cognitive behavioral therapy (CBT), medications or both, to help improve relaxation and sleep.
Cognitive behavioral therapy for insomnia
The behavioral part of CBT-I helps you develop good sleep habits and avoid behaviors that keep you from sleeping well. Strategies include, for example:
- Stimulus control therapy.
- Relaxation techniques.
- Sleep restriction.
- Remaining passively awake.
- Light therapy.
Your doctor may recommend other strategies related to your lifestyle and sleep environment to help you develop habits that promote sound sleep and daytime alertness.
Prescription sleeping pills can help you get to sleep, stay asleep or both. Doctors generally don’t recommend relying on prescription sleeping pills for more than a few weeks, but several medications are approved for long-term use.
Prescription sleeping pills can have side effects, such as causing daytime grogginess and increasing the risk of falling, or they can be habit-forming, so talk to your doctor about these medications and other possible side effects.
Over-the-counter sleep aids
Nonprescription sleep medications contain antihistamines that can make you drowsy, but they’re not intended for regular use. Talk to your doctor before you take these, as antihistamines may cause side effects, such as daytime sleepiness, dizziness, confusion, cognitive decline and difficulty urinating, which may be worse in older adults.
Multiple studies have demonstrated acupuncture to be an effective treatment for insomnia. Acupuncture lessens anxiety, stimulates melatonin production, induces sleep onset, and reduce sleep disruption and arousal during the night. All of these effects amount to an overall increase in total sleep time. In some instances, acupuncture is used as a treatment not for insomnia itself, but for pain from other physical conditions that in turn make it difficult to fall asleep at night.
Caution regarding herbal and dietary sleep aids
Because the Food and Drug Administration does not mandate that manufacturers show proof of effectiveness or safety before marketing dietary supplement sleep aids, talk with your doctor before taking any herbal supplements or other OTC products. Some products can be harmful and some can cause harm if you’re taking certain medications.
Lifestyle and home remedies
No matter what your age, insomnia usually is treatable. The key often lies in changes to your routine during the day and when you go to bed. These tips may help.
- Stick to a sleep schedule.
- Stay active.
- Check your medications.
- Avoid or limit naps.
- Avoid or limit caffeine and alcohol and don’t use nicotine.
- Don’t put up with pain.
- Avoid large meals and beverages before bed.
- Make your bedroom comfortable for sleep.
- Find ways to relax.
- Avoid trying too hard to sleep.
- Get out of bed when you’re not sleeping.