Understanding Insomnia: How to Get the Sleep You Need
If your doctor finds an underlying cause, treating the cause may be enough to relieve insomnia. Otherwise, lifestyle changes can often be helpful.
Cognitive behavioral therapy may work for some people. Medications may also be useful. However, some insomnia drugs are habit-forming and have other side effects.
This article gives an overview of insomnia, including symptoms, causes, and treatment.
Insomnia is the most common sleep disorder. It disrupts the ability to fall asleep, stay asleep, and get quality sleep. Early morning awakenings and trouble going back to sleep can be part of insomnia.
Most sleep experts believe you should get 7 or more hours of sleep a night. This figure varies considerably across the age ranges and from person to person.
Still, if you are regularly getting less than 6 hours of sleep per night, chances are you are building up a “sleep debt.” This is the cumulative effect of not getting the quantity or quality of sleep that one needs. Eventually, it will affect both your body and mind.
Insomnia can cause daytime drowsiness, fatigue, slowed reaction times, anxiety, irritability, and depression. It can affect your performance at work or in school. Insomnia can also increase your risk of accidents and falls. According to estimates, drowsy drivers account for more than 90,000 automobile accidents each year.
Insomnia may be a short-lived problem that resolves on its own or it may become chronic. Seek medical care if you develop chronic insomnia. Contact your doctor if insomnia symptoms persist, recur, or worsen despite treatment.
The main way to classify insomnia is duration:
- Acute insomnia: This is short-term insomnia. Stress is often a trigger. It may last from a single night to a few weeks and resolve without treatment. Episodes may occur from time to time. The American Academy of Sleep Medicine estimates that about 30–35% of American adults have short-term insomnia.
- Chronic insomnia: This is long-term insomnia. It occurs on 3 or more nights a week and lasts more than 3 months. Treatment can be helpful for this more serious form. Up to 10% of American adults have chronic insomnia.
People with insomnia may not feel refreshed upon waking or may feel drowsy while awake. Drowsiness can contribute to accidents, lack of focus, inattention, and impaired work or school performance. Anxiety or depression may occur or worsen if already present.
Common symptoms of insomnia
You may experience insomnia symptoms daily or just once in a while. Common insomnia symptoms include:
- anxiety or irritability
- daytime drowsiness
- decreased attention, difficulty concentrating, or memory problems
- depressed mood
- difficulty falling asleep or staying asleep
- falling asleep or napping during the day
- fatigue or feeling like you have not had enough sleep
- increased incidents of accidents and falls
- impaired work or school performance
Various medical conditions, neurological and mental health conditions, lifestyle habits, sleep disorders, stress, and some medications can cause insomnia. Sometimes, doctors cannot find a cause.
Common causes of insomnia
Common insomnia causes include:
- anxiety or worry
- certain medications, particularly stimulants
- disruptions of normal sleep schedule, such as rotating shift work or travel across time zones
- coffee or other caffeinated beverages
- environmental distractions, such as noise, lights, sleep partner issues, and temperature extremes
- menopause symptoms such as hot flashes
- hormonal changes during pregnancy
Other causes of insomnia
Chronic conditions or sleep disorders are linked to insomnia. Examples include:
- dementia, including Alzheimer’s disease
- depression and anxiety
- medical conditions that cause chronic pain, such as arthritis, neuropathy, and injury
- medical conditions that interfere with breathing, such as asthma, chronic obstructive pulmonary disease (COPD), and congestive heart failure
- medical conditions that frequently awaken you or your sleep partner, such as overactive bladder or gastroesophageal reflux disease (GERD)
- sleep disorders, such as restless leg syndrome
A number of factors increase the risk of developing insomnia. Not all people with risk factors will get insomnia. Risk factors for insomnia include:
- advanced age
- depression or other psychological disorders
- female sex assigned at birth
- irregular schedule or work hours
Researchers have also found a connection between the type of carbohydrates (carbs) you eat and insomnia. Studies suggest that eating highly refined or processed carbs may contribute to insomnia. Processed carbs raise and subsequently lower your blood sugar quickly.
The blood sugar crash is what can trigger insomnia or disrupt your sleep. Eating complex carbs that take longer to digest has a more consistent effect on blood sugar. This is less likely to interfere with sleep.
To diagnose insomnia, your doctor will take a medical history, perform an exam, and possibly order testing. Questions your doctor may ask include:
- Do you have trouble falling or staying asleep?
- How often do you experience these sleep problems?
- How long have you had trouble sleeping?
- When you wake up during the night, how long does it take you to fall asleep again?
- Has anyone told you that you snore or stop breathing?
- What, if anything, seems to help your sleep or make it worse?
- What is your bedtime routine?
- How many hours do you typically sleep?
- Do you feel refreshed when you wake up? Or sleepy during the day?
- Do you nap or drink alcohol?
- What medical conditions do you have and what medications do you take?
- Have you been under unusual stress lately?
The physical exam will focus on ruling out the medical causes of insomnia. Your doctor may also order blood tests to help rule out underlying conditions, such as overactive thyroid.
In some cases, doctors may order a sleep study to look for specific disorders. This test may take place in a sleep lab to evaluate patterns and bodily functions, such as breathing, during sleep.
Insomnia treatment begins with an evaluation of possible causes. A sleep diary can be helpful in identifying sleep patterns and the severity of your insomnia. If your doctor finds a specific cause, insomnia may resolve with treatment of the underlying condition.
Common treatments for insomnia
Aside from treating its underlying causes, insomnia treatment may include:
- Cognitive-behavioral therapy (CBT): Therapy can help address sleep-disruptive thoughts and actions. It is usually the most effective treatment for chronic insomnia.
- Healthy sleep habits: See “Tips for improving your sleep,” below.
- Temporary use of medications to promote sleep: Doctors generally do not recommend sleep medication for long-term use due to the risk of dependence and rebound insomnia. Dependence can lead to addiction.
Tips for improving your sleep
You may be able to improve your sleep and reduce insomnia by:
- avoiding alcohol and large meals before bed
- avoiding coffee, tobacco, and other stimulants for at least 8 hours before bedtime
- avoiding chocolate as a bedtime snack, as cocoa contains caffeine
- avoiding daytime napping
- exercising early in the day
- keeping a regular sleep schedule
- limiting bedtime distractions than might keep you awake
- limiting fluids within 1–2 hours of bedtime to reduce sleep interruptions to urinate
- preparing your bedroom to enhance sleep
- relaxing before going to bed
- using your bed only for sleep or sexual intercourse
Certain herbs and supplements show modest effects on sleep and daytime functioning. These include:
- valerian root
Be sure to let your doctor know if you are taking supplements or other remedies. Some of them can interact with other medications.
Complications of untreated or unmanaged insomnia can be serious, even life threatening in some cases. Complications of acute insomnia include:
- car accidents and other types of accidents, such as falls
- impaired performance at school or work
- inattention or difficulty focusing on tasks
- reduced quality of life
Chronic insomnia can cause or worsen many medical problems, including:
- breathing problems
- heart conditions
- hormone imbalances, which can lead to problems with metabolism, obesity, and diabetes
- immune system problems, leading to increased infections and inflammation
- mental health conditions, such as anxiety and depression
- pregnancy complications
In the past, the prevailing medical view was that insomnia could contribute to a shorter life expectancy. However, recent research has challenged that belief. Investigators analyzed 17 studies that included nearly 37 million people. They found no increased risk of death with frequent or ongoing insomnia.
On the other hand, the researchers did find a trend toward higher mortality with the use of hypnotic medications. The researchers concluded that their findings reinforce the use of CBT to effectively treat insomnia.
Here are some other questions people have asked about insomnia.
How can you cure insomnia quickly?
You can treat insomnia by changing your sleep habits, including your routine and caffeine consumption. You can also avoid lifestyle habits that cause stress. Once you and your doctor evaluate all possible causes, insomnia may resolve.
Often, acute insomnia does not require treatment as it is likely due to a sudden change or event in a person’s life. Once you identify that specific stressor, you can work to resolve it. Chronic insomnia, however, typically takes time to improve and resolve.
Can insomnia go away?
With the correct treatment and lifestyle changes, most types of insomnia will go away. As stress is often a trigger for acute insomnia, it can go away on its own. Chronic insomnia may result from an underlying cause or from learned behavior over time. With treatment, chronic insomnia can also go away.
How can I force myself to sleep?
There are ways to improve your sleep and ways to fall asleep faster. Sleep tips include having a good sleeping pattern, regular physical exercise, avoiding stimulants and alcohol, and reducing light and noise.
What causes female insomnia?
Women are more likely to experience insomnia than men. Multiple elements can include sex and gender differences, hormones, predispositions to mental health, and societal disparities.
Insomnia is the most common sleep disorder. If you have insomnia, you have difficulty falling asleep, staying asleep, and getting quality sleep. Waking in the early morning and having trouble going back to sleep can also be part of insomnia.
Medical, neurological, and mental health conditions can contribute to insomnia. Lifestyle habits, stress, and some medications can also cause insomnia. Talk with your doctor about your symptoms. Treatment can prevent risks associated with daytime drowsiness.