Causes

The causes of insomnia are often an interaction of biological, psychological, and environmental factors. 

  • Stress Concerns about work, school, health, finances, or a major life event (e.g., death of a loved one, divorce, job loss) are common triggers.

  • Medical Conditions Various physical health problems, such as chronic pain (arthritis, back problems), heart disease, asthma, GERD, an overactive thyroid, or neurological disorders, can interfere with sleep.

  • Mental Health Disorders Insomnia often co-occurs with conditions like depression, anxiety disorders, and PTSD, which can disrupt sleep patterns.

  • Medications Certain prescription drugs (e.g., some antidepressants, blood pressure medicines, asthma medications) and over-the-counter products (e.g., some cold/allergy medicines, weight-loss products) can contain stimulants or otherwise interfere with sleep.

  • Poor Sleep Habits (Sleep Hygiene) Inconsistent bedtimes and wake times, napping during the day, using the bed for activities other than sleep, and an uncomfortable sleep environment contribute to insomnia.

  • Substances Caffeine, nicotine (both stimulants), and alcohol can significantly disrupt sleep patterns, especially if consumed close to bedtime.

  • Travel or Work Schedule Disruptions to the body's internal clock (circadian rhythm) caused by jet lag or shift work can lead to insomnia.

  • Genetics A family history of insomnia can increase a person's risk.

Insomnia Disorder

Insomnia disorder is a common sleep disorder characterized by persistent difficulty with the quality or duration of sleep, despite having adequate opportunity to sleep. It can be acute (short-term, lasting days or weeks) or chronic (long-term, at least three nights a week for three months or more). 

Symptoms

Symptoms are categorized into nighttime experiences and daytime consequences. 

Nighttime Symptoms:

  • Difficulty falling asleep (sleep onset insomnia).

  • Difficulty staying asleep (sleep maintenance insomnia), with frequent or prolonged awakenings.

  • Waking up too early in the morning and being unable to go back to sleep.

  • Feeling unrested or not refreshed upon waking. 

Daytime Symptoms:

  • Fatigue or low energy.

  • Daytime sleepiness.

  • Impaired attention, concentration, or memory.

  • Mood disturbances, such as irritability, anxiety, or depression.

  • Reduced performance at work or school and an increased risk of errors or accidents.

  • Ongoing worries or anxiety about sleep

Treatments

Treatment focuses on identifying and addressing the underlying causes and changing habits to promote better sleep. 

  • Cognitive Behavioral Therapy for Insomnia (CBT-I) The American College of Physicians recommends CBT-I as the first-line treatment for chronic insomnia. It helps individuals identify and replace negative thoughts and behaviors that disrupt sleep. Key components include:

    • Stimulus control therapy Retraining the brain to associate the bed/bedroom only with sleep and sex. This includes getting out of bed if unable to sleep within about 20 minutes and only returning when sleepy.

    • Sleep restriction Limiting the amount of time spent in bed to the actual amount of time spent sleeping, which helps build a stronger drive for sleep.

    • Relaxation techniques Methods like mindfulness, progressive muscle relaxation, and breathing exercises to reduce anxiety and muscle tension before bed.

    • Cognitive therapy Challenging and reframing unhelpful beliefs and worries about sleep.

  • Medication Prescription and over-the-counter sleep aids may be used for short-term or severe cases, but they are generally not a first-line, long-term solution due to potential side effects and the risk of dependence. It is important to discuss any medication or supplement use with a doctor.

  • Lifestyle Changes (Sleep Hygiene) Practicing good sleep habits can prevent and alleviate insomnia:

    • Maintain a consistent sleep-wake schedule every day, including weekends.

    • Avoid napping, especially in the late afternoon or evening.

    • Limit or avoid caffeine, alcohol, and nicotine, particularly close to bedtime.

    • Ensure the bedroom is dark, quiet, and cool.

    • Avoid large meals or excessive fluids before bed.

    • Engage in regular physical activity during the day, but not too close to bedtime.

    • Create a relaxing bedtime ritual (e.g., warm bath, reading).