What Is Insomnia? Causes, Symptoms, and Treatments Explained

What is insomnia?

Insomnia is a common sleep disorder that makes it hard to fall asleep, stay asleep, or a combination of both. People with insomnia also have a poor quality of sleep and don’t feel rested when they wake up. Up to 40% of adults in the U.S. experience symptoms of insomnia every year.

Having trouble taking a short nap isn’t considered insomnia. But if you often spend hours tossing and turning and not sleeping, then you might have insomnia. In rare cases, symptoms of insomnia are due to the sleep disorder alone. But most often, there’s another factor that causes it. Only 6% of people have insomnia that isn’t related to an underlying cause.

Quiz: Do I have insomnia?

What causes insomnia?

There are many different reasons why you might have symptoms of insomnia. Your lifestyle, medical conditions, or certain medications can all make it hard to sleep well. 

Lifestyle

Some common lifestyle factors that may contribute to insomnia include:

• Eating late at night 

• Drinking caffeinated beverages or alcohol

• Having disruptive sleep habits (no nightly routine, bright lights, TV or computer use at bedtime)

• Experiencing stress 

Medical conditions

The following medical conditions are often associated with insomnia:

• Chronic pain

• Restless leg syndrome

• Obstructive sleep apnea

• COVID-19

• Dementia

• Acid reflux or gastroesophageal reflux disease (GERD)

• Thyroid disorders

• Asthma

• Chronic obstructive pulmonary disease (COPD) 

Although it’s not exactly a medical condition, pregnancy can also lead to insomnia. 

Medications

Many medications can make it harder to get a good night’s sleep. Some of the medications associated with insomnia include: 

• Stimulants for attention-deficit hyperactivity disorder (ADHD)

• Steroids

• Decongestants (like pseudoephedrine)

• Beta blockers 

• Weight-loss supplements

• Thyroid replacement hormones

• Nicotine replacements

• Antidepressants

• Asthma medications

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Insomnia symptoms

Symptoms of insomnia vary from person to person. Some people have trouble actually getting to sleep, while others have trouble staying asleep. So insomnia may look different for you than it does for someone else. You may have insomnia if you:

• Struggle to fall asleep

• Wake up frequently

• Wake up earlier than you planned

• Don’t feel rested after you sleep

Besides a lack of sleep, some insomnia symptoms can affect how you function when you are awake. These include:

• Daytime sleepiness

• Fatigue

• Irritability

• Problems with concentration

• Feeling unrested in the morning

• Headaches

• Lack of motivation or energy

• Waking up early

If you’re having any of these symptoms, talk with a healthcare professional. You may need an evaluation for insomnia.

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How is insomnia diagnosed?

Insomnia is usually diagnosed using a combination of your medical history and clinical testing. Healthcare professionals will likely ask questions about your symptoms, sleep habits, and what you’re experiencing when trying to sleep. 

To get the diagnosis of insomnia, you must have difficulty either falling asleep or staying asleep, and at least one of the following daytime symptoms:

• Fatigue

• Daytime sleepiness

• Trouble with memory, concentration, or focus

• Difficulty in school, work, family, or social settings

• Feeling aggressive, hyperactive, or impulsive

• Decreased energy

In some cases, a healthcare professional may decide that you need additional tests to look for other causes of your symptoms. Testing for insomnia could include:

• Sleep study

• Actigraphy tests (sleep studies done over time at home)

• Blood tests

Not all trouble falling asleep is actually insomnia. For it to be insomnia, you must have problems getting to sleep despite having enough time to fall asleep. And it has to happen for at least 3 nights per week.

Insomnia treatments

There are different approaches to treating insomnia. So it’ll be important to connect with a healthcare professional to see what may be best for you. 

For some, cognitive behavioral therapy (CBT) is useful. It’s a form of therapy that people use to identify and change patterns and behaviors that result in poor sleep. A therapist specializing in insomnia can provide these resources to promote better sleep.

For others, changes in bedtime routines and sleep hygiene can help. Sleep hygiene refers to practices that can help to make sure that you have a good bedtime routine and comfortable space to sleep in. Here are some ways to promote quality sleep hygiene:

• Make sure that your sleep areas are clean and comfortable. 

• Keep your room quiet and avoid background distractions. 

• Turn off your devices — cellphone, television, computer — and avoid bright lights in your room. 

• Avoid energy drinks and beverages with alcohol and caffeine before bedtime.

• Practice meditation or deep breathing before you go to sleep.

• Exercise earlier in the day.

• Try to go to sleep at the same time each day.

• Avoid taking naps throughout the day.

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Insomnia medication

There are times when changes in your bedtime routine aren’t enough to get rid of your insomnia. Medications can be helpful in these cases. Many of the medications that treat insomnia require a prescription.  

Medication for insomnia can either help you fall asleep, stay asleep, or both. Here are some common medications that your primary care provider may recommend in the treatment of insomnia:

• Ramelteon (Rozerem)

• Zolpidem (Ambien)

• Zaleplon (Sonata)

• Eszopiclone (Lunesta)

• Antidepressants

• Benzodiazepines

• Melatonin

• Antihistamines

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