People with insomnia can have frequent difficulty falling asleep, staying asleep, and getting good-quality sleep.
You’re tossing and turning, counting sheep for what seems like forever, and still, sleep won’t come. You’re tired but can’t sleep and wonder, Why can’t I sleep? It could be insomnia.
In the moment, it’s easy to feel like you’re the only one struggling to get some shut-eye. However, you’re absolutely not alone. Having trouble getting (and staying) asleep is actually a lot more common than you’d think.
According to the Centers for Disease Control and Prevention (CDC), roughly 37 percent of adults in the U.S. reported getting less than the recommended seven or more hours of sleep in 2022. And an estimated 14.5 percent of adults have trouble falling or staying asleep most days.
Insomnia is a sleep disorder where you have frequent difficulty falling and staying asleep. Continue reading for a deep dive into insomnia, its symptoms, causes, risk factors, treatments, and prevention tips.
Insomnia is a common sleep disorder. A 2020 review noted that about 22 percent of American adults meet the diagnostic criteria for insomnia.
People with insomnia can have frequent difficulty falling asleep, staying asleep, and getting good-quality sleep. This results in feeling sleepy during the day, affecting your mood and ability to do daily activities.
There are two types of insomnia: short-term insomnia and chronic insomnia.
Short-term insomnia is when you have trouble sleeping for a period of days or weeks. Here are a few examples of things that could lead to short-term insomnia:
Preparing for a big work presentation
Having a rocky period in a relationship
Dealing with a short-term illness
This type of insomnia often happens due to a specific stressor that crops up in your life.
Chronic insomnia is when you struggle to get good sleep at least three nights a week for at least three months. It’s often related to more lasting physical, psychological, or social issues like:
An existing mental health disorder
Health problems that could keep you up, such as chronic pain, sleep apnea, or restless leg syndrome (RLS)
Big life events like going through a divorce or losing a loved one
Your healthcare provider may also classify your insomnia as primary or secondary. Secondary insomnia happens due to a known medical, psychological, or environmental issue.
Primary insomnia isn’t due to any of those things. Often, the cause of primary insomnia remains unknown.
If you’ve ever had difficulty getting to sleep, you’re probably already familiar with some insomnia symptoms. Let’s look into these now.
The main symptom of insomnia is trouble getting sufficient sleep. This can include:
Lying awake in bed for a long time before falling asleep
Waking up often in the night, only getting short chunks of sleep
Waking up earlier in the morning than you want to and not being able to fall back to sleep
Feeling unrested when it’s time to get up and start your day
The effects of not getting enough sleep can bleed into your daily life. If you feel very tired during the day, it can be challenging to do your daily activities.
This isn’t just about physical fatigue, though. Being sleep-deprived may also lead to issues with concentration, attention, and memory that can impact your day-to-day life. It can also increase your risk of developing a whole host of medical problems, including weight gain, high blood pressure, heart disease, diabetes, a weakened immune system, and accelerated aging. Poor sleep may not sound like a big deal, but it is.
What’s more, lack of sleep can lead to mood changes. For instance, people with insomnia might experience irritability, anxiety, or depression.
What causes insomnia? Experts aren’t entirely sure what exactly causes insomnia. Let’s look into what we know about the causes of insomnia so far.
When it comes to insomnia, different factors may be at play. These include hyperarousal and changes to your circadian rhythm.
Hyperarousal. On a basic level, hyperarousal is a state of heightened awareness or alertness. This is obviously the polar opposite of what you want when you’re getting into bed at night.
Circadian rhythm changes. Your circadian rhythm influences your sleep-wake cycle, essentially telling your body when it’s time for sleeping or waking. When your circadian rhythm is disrupted, you may not fall asleep or wake up on a regular schedule.
One example of a circadian rhythm change is the release of the hormone melatonin. As it gets darker, your body makes melatonin, which promotes sleep. On the other hand, light in the morning lowers melatonin production, boosting wakefulness.
Now that we’ve covered the biological aspects of insomnia, you may be wondering what exactly contributes to things like hyperarousal and circadian rhythm disruption. The short answer: lots of stuff.
Let’s examine the different risk factors for insomnia.
Some insomnia risk factors are biological. These include age, sex, genetics, and family history:
Age. While insomnia can happen to anyone at any time, it’s more common in older adults.
Sex. Insomnia is more prevalent in people assigned female at birth.
Genetics. Researchers have found genes associated with insomnia risk. Some of these are related to other psychological or metabolic conditions.
Family history. Since insomnia has a genetic risk component, you might have a higher risk if someone else in your family has experienced insomnia.
Having a psychological condition — like depression, anxiety, or post-traumatic stress disorder (PTSD) — can also boost your risk of insomnia. The National Alliance on Mental Illness (NAMI) notes that around half of insomnia cases are linked to psychological causes.
Various other medical conditions can also lead to disrupted sleep, increasing insomnia risk. A few examples include:
Chronic pain
Restless leg syndrome
Gastroesophageal reflux disease (GERD)
Overactive thyroid (hyperthyroidism)
Respiratory conditions where it’s harder to breathe, like asthma or COPD
Neurological conditions, such as Parkinson’s disease or Alzheimer’s disease
Menopause symptoms like hot flashes
Lastly, numerous environmental and lifestyle factors can increase your risk for insomnia. These include:
Changes to your daily routine that affect your sleep schedule
Napping frequently during the day
Certain occupations, such as shift work or working nights
Traveling across time zones (jet lag)
Pregnancy or having a new baby
High levels of psychological stress
A traumatic event or major life changes
Frequent exposure to excessive light or noise when trying to sleep
An uncomfortable sleeping environment
Side effects from medications
If any of these apply to you and you’re having trouble falling asleep or staying asleep, reach out to a healthcare professional.
We all lose a little bit of sleep every now and then. If it happens often, you may be wondering what to do when you can’t sleep.
Make an appointment with your primary care provider if you frequently have poor sleep, especially if it’s starting to impact your daily life.
If you can’t get enough shut-eye, keeping a sleep diary may be beneficial. A sleep journal contains information like:
When you go to sleep and wake up each day
If you take naps during the day and how long they are
How tired you feel during the day
Details on other factors that impact sleep, such as your diet, exercise routine, and caffeine and alcohol consumption
Bring your sleep diary to your appointment with your healthcare provider. They can use it to get a better idea of the specific problems you’re having and how your lifestyle and environment may be impacting your sleep.
There are several things a healthcare provider can do to help diagnose insomnia.
To start off, your provider will do a physical exam and get your medical history. Be prepared to answer several questions on numerous lifestyle and health topics like:
How long your sleeping difficulties have been going on
The number of days each week you’re having problems sleeping
Your sleep patterns, including when you typically go to bed and wake up, how long it takes you to fall asleep at night, how long you sleep each night, and how often you wake up during the night
Your level of daytime sleepiness and how it affects your daily activities and mood
Whether you have any preexisting health conditions that could affect your sleep
The types of activities you do before bed
Your use of caffeine, alcohol, nicotine, or recreational drugs
The medications (both prescription and over-the-counter (OTC)) and supplements you’re taking
Beyond a physical exam and reviewing your medical history and sleep diary, your healthcare provider can use several other tests to help diagnose insomnia.
One of these is called polysomnography, also known as a sleep study. Sleep studies get an idea of how well you sleep and can also help diagnose other sleep disorders like sleep apnea and narcolepsy.
On a basic level, a sleep study uses monitoring devices to track things like your brain waves, heart rate, breathing rate, and muscle movement over the course of one night. These tests may be done overnight at a sleep center.
Other types of tests for insomnia include:
Actinograph. An actinograph involves wearing a small motion sensor device for several days. This device notes periods of rest and activity as well as how well you’re sleeping. Smartwatches and rings can act as actinographs.
Blood tests. Blood tests can see if any underlying medical conditions are contributing to sleep problems.
It’s important to get treatment for insomnia. According to the CDC, getting enough sleep can reduce your risk of various health conditions, including:
High blood pressure (hypertension)
Type 2 diabetes
Stroke
What insomnia treatments are available?
When it comes to how to treat insomnia, there are several treatment approaches. The type of insomnia treatment recommended can depend on what type of insomnia you have and what’s causing it.
If another condition is contributing to your insomnia, your medical provider will work to address it as well.
Here’s a breakdown of treatment options for insomnia.
Your healthcare provider will likely recommend making adjustments to your lifestyle to promote better sleep habits. This is called good sleep hygiene.
Some strategies that can help:
Trying to go to bed and wake up at the same time each day
Making sure your bedroom is dark, quiet, and a comfortable temperature
Avoiding naps during the day
Not using electronic devices shortly before bed
Not eating large meals late in the evening
Limiting caffeine, alcohol, or nicotine later in the day
Doing relaxing activities before bed, such as listening to calming music, reading a book, or meditating
Exercising regularly — but not close to bedtime
Using your bed only for sleeping and sex
You can get professional support for insomnia as well.
Aside from lifestyle changes, additional therapies may be recommended to help with insomnia disorder.
One of these is cognitive behavioral therapy (CBT). With CBT, a therapist helps you identify thought patterns and behaviors interfering with your sleep. Then they’ll work with you to develop strategies to change the disruptive thoughts and behaviors.
There’s actually a specific type of CBT used for insomnia. It’s called CBT-I (cognitive behavioral therapy for insomnia).
According to the National Center for Complementary and Integrative Health (NCCIH), complementary therapies that may be used as sleep aids and help to improve sleep quality can include:
Melatonin supplements
Tai chi
These methods are always worth a shot. If they don’t help you get to sleep, they’ll at least benefit your overall wellness.
Insomnia medications might be used for chronic insomnia that doesn’t go away with other treatments. Generally speaking, healthcare providers prefer to use these on a short-term basis and focus on lifestyle changes and other therapies in the long term.
Several types of drugs are approved by the FDA (U.S. Food and Drug Administration) for the treatment of insomnia. You may hear many of these commonly referred to as “sleeping pills,” and they include:
Nonbenzodiazepine hypnotics like zolpidem (Ambien®), zaleplon (Sonata®), and eszopiclone (Lunesta®)
Benzodiazepines like triazolam (Halcion®) and temazepam (Restoril®)
Hypocretin/orexin receptor antagonists like suvorexant (Belsomra®) and lemborexant (Dayvigo®)
The melatonin receptor agonist ramelteon (Rozerem®)
The antidepressant doxepin (Silenor®)
Certain other medications may also sometimes be used off-label for insomnia. This means a drug is being prescribed for a condition it isn’t FDA-approved to treat.
Examples of drugs that may be used off-label for insomnia:
The antidepressant trazodone
Seizure drugs like gabapentin and pregabalin
Antipsychotics like olanzapine and quetiapine
If you’re interested in prescription medication for insomnia, contact your healthcare provider.
Now that we’ve discussed all of the ins and outs of insomnia, you may be wondering if there’s anything you can do to help prevent it. Let’s tackle this question below.
There’s no way to completely prevent insomnia. That’s because some of the risk factors associated with it are out of your control.
However, there are a few things you can do to reduce your risk. These include:
Practicing healthy sleep habits
Finding healthy, effective ways to deal with stress
Making other healthy lifestyle choices, such as getting regular physical activity, eating a healthy diet, limiting alcohol consumption, and quitting smoking
Getting treatment for existing medical or mental health conditions
Seeing your healthcare provider for regular check-ins
Having trouble sleeping can be rough, but know you’re not alone and treatment options are available.
Make an appointment with your healthcare provider to discuss your sleep issues and get started on a treatment plan to help you sleep better.
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.