Insomnia: what is it, symptoms, causes, treatments

If you can't seem to get enough sleep, you're not alone. Insomnia, or the inability to fall or stay asleep, affects millions of people worldwide. About one-third of people in the U.S. experience insomnia, but it's short-term for most of those people (Kaur, 2020).

The American Academy of Sleep Medicine recommends adults get at least seven hours of sleep every 24 hours. However, teenagers and children need more hours—anywhere from eight to 12 hours. Children under five need the most, up to seventeen hours a day (Watson, 2015). Let's look at what happens when you consistently have trouble falling or staying asleep, and what you can do about it.

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You know your smartphone needs to charge itself to function optimally. Humans do, too! The way your body recharges itself is through sleep. Sleep clears your brain and body of the day’s accumulation of buildup—kind of like clearing out the trash and emptying the recycle bin. This clearing out helps keep your body healthy and prevents certain diseases. If you don’t clean out the gunk, your brain won’t function at its best. You may not think clearly, process information, focus properly, or form and store memories the way you’d like to.

Your body has its own clock that controls your sleep cycle, letting you know when it’s time to go to sleep or wake up. It’s called the circadian rhythm, and it works on a 24-hour cycle. When you wake up in the morning, your body starts getting tired as the day goes on. Scientists who study sleep say that adenosine, a chemical produced in the brain, increases as the day wears on and you get more tired. When you go to sleep, your body breaks down the adenosine compound, restarting the process the following day when you wake up (Basit, 2021). 

Your circadian rhythm is also affected by light. Light tells your brain whether it is day or night. Your brain processes both natural and artificial light from your eyes. When the sun sets and natural light fades away, your body releases melatonin—also known as the “sleep hormone.” As the sun starts to rise, your body releases cortisol, the hormone that wakes you up with energy to start the day (Basit, 2021).

Insomnia can have several causes. Sometimes insomnia is temporary or short-term because you’re under a lot of stress or are experiencing life events that change your sleep schedule. Three-quarters of all insomnia cases are short-term insomnia. Other times, it is caused by other factors and can become chronic insomnia. About 25 percent of insomnia cases are long-term or chronic insomnia (Kaur, 2020).

If you have a family history of insomnia, are female, pregnant or in menopause, an older adult over age 50, or have certain physical or mental health conditions, you may be at higher risk of insomnia (Bollu, 2019).

Lifestyle factors

Several lifestyle factors can contribute to insomnia. These include (Bollu, 2019):

• Time changes: Night shift work, jet lag, daylight savings time—anything that affects your body’s internal time clock

• Technology: Using screens that emit blue light can disturb your circadian rhythm—including using a smartphone, tablet, or television screen right before bed 

• Sleep hygiene: If your bedroom is too noisy, hot, cold, too bright, or your bed is not comfortable, you may not be able to sleep well.

• Body movement: Not getting enough physical exercise during the day doesn’t leave your body “tired enough” to sleep.

• Substance abuse: Using stimulants like caffeine, cocaine, ecstasy, or other drugs that rev you up

• New baby or ill family member: Caring for someone else in your house that wakes you during the night

• Excess stress: Anxiety and worry can cause sleeplessness

Medical causes of insomnia 

Insomnia can also come from certain medical factors, including (Karna, 2020):

• Medical conditions: Some people with a medical condition may find it difficult to sleep. Medical conditions include having an overactive thyroid, gastroesophageal reflux disease (GERD), chronic obstructive pulmonary disease (COPD), Parkinson’s disease, restless legs syndrome, sleep apnea, and chronic pain. Menopause or pregnancy can also cause sleep disturbances based on hormonal changes.

• Mental health conditions: Mental health issues affect the brain and can cause sleep disruption. Mental health conditions like anxiety, depression, bipolar disorder, schizophrenia, and Alzheimer’s disease may all cause sleep problems.

• Medications: Medications and substances can also affect sleep. Heart medications like statins, alpha-blockers, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and cholinesterase inhibitors all can cause poor sleep quality (Krystal, 2019). Other medications that affect sleep include selective serotonin reuptake inhibitors (SSRIs), antidepressants, steroids medications to treat attention deficit hyperactive disorder (ADHD), non-drowsy H1 agonists used to treat chronic itching and allergies, and joint supplement glucosamine and chondroitin (Buysse, 2013).

Insomnia doesn’t just make you feel bad; it can severely impact your life. Insomnia is a leading cause of workplace errors and car accidents (Momin 2020).

If you have insomnia, you may find it difficult to fall or stay asleep. You might be waking up too early in the morning. This lack of sleep can lead to mood changes, including anxiety, daytime fatigue, and feeling sick both mentally and physically. If you have been diagnosed with an anxiety disorder, your anxiety may make it hard to sleep well, and insomnia can, in turn, make anxiety worse (Karna, 2020).

Insomnia can increase your risk of obesity and developing diseases like diabetes, heart disease, and high blood pressure. Lack of sleep can also affect how your brain works when processing memories, staying alert, and making good decisions. When you're feeling exhausted, anxious, and irritable, your work performance may suffer. You also may avoid seeing your friends and stop doing the things you love. Ongoing sleep problems can lead to anxiety and depression.

Luckily, if you treat insomnia right away, your prognosis for its impact on many of these conditions is good (Karna, 2020).

If you have insomnia, you may feel anxious and tired during the day. Physical symptoms include tension headaches and gastrointestinal symptoms. Emotional or mental symptoms include low energy, inability to concentrate, and poor coordination (Karna, 2020).

About 10–15 percent of adults have insomnia at any given time, and women have twice the risk of reporting or being diagnosed with insomnia than men do (Karna, 2020). 

Short-term insomnia is when you can't fall or stay asleep for a few days to a few weeks (Momin, 2020). On the other hand, chronic insomnia is when sleep disturbances or poor sleep happen at least three times a week for three months (Kaur, 2020).

A healthcare provider may refer you to a sleep specialist to help with your diagnosis. You will give your medical history, including your use of alcohol, medications, recreational drugs including stimulants, and your sleep patterns. You’ll have a complete physical examination with tests to see if any underlying health problems are causing your insomnia. You will then give a sleep history (Kaur, 2020). 

To understand your sleep history, the specialist may want you to keep a sleep diary or sleep log to see when your sleeplessness happens. You’ll write down how long you are in bed for sleep, how quickly you fall asleep, how many times you wake up during the night, your total sleep time, and how satisfied you were with your sleep quality. You will usually be asked to keep a sleep diary for two weeks to one month and bring it to your sleep specialist to review (Krystal, 2019).

The sleep specialist may want to order one of two tests to track your sleep patterns. 

The first is an actigraphy test. You will wear a device that looks like a fitness tracker or wristwatch 24 hours a day for several days up to 14 days. Actigraphy measures your movement and not your sleep. It looks at your sleep-wake patterns, like daytime sleepiness and circadian rhythm sleep disorders (Krystal, 2019).

The second is a sleep study, also called polysomnography. This type of test captures your breathing, heart rate, and brain waves and records your eye and limb movements and your blood oxygen levels as you sleep. You will need to sleep overnight in a sleep center or hospital. Sleep studies give your sleep specialist the best evaluation of your sleep quality (Krystal, 2019).

There are several ways to treat insomnia. Most sleep specialists and healthcare providers prefer to start with nonpharmacologic or non-drug therapies to help improve your sleep quality (Bollu, 2018).

Stimulus control therapy

Stimulus control therapy is where you use your bed for only two things: sleep and sex. With this approach, you should not work, catch up on emails, speak on the phone, or watch TV in bed. You only go to bed when you feel sleepy. If you can’t fall asleep within 15 minutes of being in bed, you’ll get out of bed until you feel drowsy again. Some sleep specialists have you create a sleep schedule with strict sleep and wake times (Bollu, 2018).

Sleep hygiene

Sleep hygiene is where you recognize that certain behaviors create sleep problems for you and try to replace them with behaviors that help your body wind down. Some possible sleep-harming behaviors include napping during the day, exercising hard late at night, or drinking alcohol or caffeinated beverages just before bed. To improve your sleep hygiene, you'll create a customized sleep plan to curtail those behaviors that affect your sleep quality (Bollu, 2018).

Sleep restriction

Sleep restriction is where you limit your sleep time in bed to five to six hours spent total in bed. The objective of this therapy is to help increase your tiredness so you can sleep soundly through the night. Once you sleep soundly for that limited amount of time, you will increase your sleep time (Bollu, 2018). 

If you've tried these methods and still have difficulty sleeping, you may want to try cognitive behavioral therapy (CBT). This short-term therapy helps you manage any stress and worry that might be causing short-term or acute insomnia. Your therapist may guide you in establishing new thought processes about your sleep. These new thought processes can decrease anxiety and worry about your sleep patterns, helping you create new sleep habits.

The American Academy of Sleep Medicine recommends several prescription medications for short-term and chronic insomnia. Some people are very sensitive to medication side effects. Your healthcare provider can switch medications if one doesn’t work or agree with you (Watson, 2017).  

Prescription medications 

Benzodiazepine receptor agonist drugs are a type of sedative. Examples include lorazepam (Ativan), temazepam (Restoril), zolpidem (Ambien), and zaleplon (Sonata). These should not be used for more than a month unless otherwise directed by your healthcare provider (Hassinger, 2020).

Antihistamines like diphenhydramine (Benadryl) can come in prescription strength for insomnia (Hassinger, 2020).

Some sleep specialists may recommend antidepressants as a sleep aid. These can include tricyclic antidepressant amitriptyline (Elavil) or mirtazapine (Remeron).

Others may prescribe sedating antipsychotics quetiapine (Seroquel) or anti-seizure medications gabapentin (Neurontin). Older adults need monitoring of some of these medications to avoid over-sedation (Hassinger, 2020).

Over-the-counter sleep aids can help with occasional insomnia. Most of these sleep aids have an antihistamine in them. Even though they're available over the counter, many of these sleep aids can have side effects. You shouldn't use them for prolonged periods. Antihistamines may cause dry mouth, urinary retention, constipation, blurred vision, grogginess, and drowsiness in the morning. Your body may become accustomed to them, and you'll need to take more to get the same sleep as your tolerance increases (Hassinger, 2020).

Melatonin is a hormone that helps maintain your normal sleep-wake balance. It is sold as a supplement in the U.S. The U.S. Food and Drug Administration (FDA) has approved melatonin to treat people who have a hard time falling asleep. Some people like to use melatonin to treat jet lag. You can purchase over-the-counter melatonin supplements at any mass retailer or online. There is also a prescription form of melatonin available for severe insomnia. Side effects of melatonin include headache, fatigue, and dizziness (Hassinger, 2020).

Herbal supplements

Since ancient times, people have used herbs to help them relax and sleep better. Common herbs for sleep problems include chamomile, kava, lavender, and valerian. You can find these herbs in teas, extracts, or supplements. Some are combined together in a single supplement.

There is some research that chamomile can help people with insomnia function better in the daytime. People with allergies to ragweed should not use chamomile (Adib, 2017). Kava is well known for its hypnotic effects but may cause severe liver damage even with short-term use (NIDDK, 2018). Lavender is known for its scent and is used in aromatherapy to aid in relaxation (Seifritz, 2019). Valerian has shown some sleep benefits (Shinjyo, 2020). 

As with all herbal products, there is not much evidence-based research on the amount needed for a safe and effective dose.

Use with caution

Whether you are taking a prescription, over-the-counter, herbal supplement, or melatonin, please consult with your healthcare provider to determine the correct dose and to see if any of these interact with other medications or supplements you take.

These medications are for short-term use—usually no more than two weeks. They are meant to cause sleepiness, so do not drive or do anything that requires you to be awake and alert after taking them.

Do not drink any alcohol when you take sleep aids. If you want to take any “PM” medicine or antihistamine-based sleep aid, check the label, as they can make many medical conditions worse.

If you’re pregnant or breastfeeding, you should not take these medications without consulting your healthcare provider. If you’re an older adult over 75, there is an additional risk of dementia or stroke when taking some of these medications (Hassinger, 2020).

Sleep is vital for your overall health and wellness. There are many things you can do to go from sleepless to rested. If you have trouble sleeping for more than three months, see your healthcare provider.

Here’s a cheat sheet for better sleep:

1. Create a routine of going to bed at a specific time.

2. Wind down with a bath or shower to lower your body temperature.

3. Stop using screens before bed and keep all sorts of devices outside the bedroom.

4. Make sure the temperature of the bedroom is cool for sleep.

5. Keep the room dark with blackout shades or blinds.

6. Sleep with extra pillows if you’ve been diagnosed with acid reflux. 

7. Keep your diet healthy. 

8. Don’t eat anything heavy for at least three hours before bed to lessen the chance of acid reflux waking you up.

9. Reduce your overall caffeine and alcohol intake during the day and try not to have these at night.

10. Treat any pain issues that might affect your sleep.

11. Treat any anxiety that might affect your sleep.

12. Do meditation or breathing exercises before bed to help you relax.

13. Exercise in the mornings or at least three hours before bed.

14. Create a soothing ritual before bed by either listening to music or reading.

15. Don’t nap during the day so you can sleep better at night.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

June 08, 2021

Written by

Tobi Ash, MBA, RN, BSN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.