Insomnia: Symptoms, Causes and Care

What insomnia is

Insomnia is a common sleep disorder. You may have trouble falling asleep, staying asleep, or getting good quality sleep, even when you have the time and the right environment to sleep. [1] It is sometimes called sleeplessness. The NHS describes insomnia as regularly having problems sleeping, which usually gets better by changing sleeping habits. [2] Only a clinician can say whether you have insomnia; this page is general education.

Common features

• Lying awake for a long time before falling asleep, which is more common in younger adults. [3]
• Waking up often during the night or being awake for most of it, the most common symptom and one that mostly affects older adults. [3]
• Waking too early and not getting back to sleep. [3]
• Waking unrested, feeling sleepy in the day, trouble focusing, or feeling anxious, depressed or easily annoyed. [3]

An occasional bad night is not insomnia. Stress is a common cause of a night of poor sleep. [4]

Short-term and long-term insomnia

Definitions differ slightly by source. The NHS calls insomnia of less than 3 months short-term and 3 months or longer long-term. [2] The NHLBI describes chronic insomnia as occurring 3 or more nights a week, lasting more than 3 months, and not fully explained by another health problem. [1] MedlinePlus uses a month or longer for chronic insomnia and notes that most chronic cases are secondary, meaning they are a symptom or side effect of another problem such as a medical condition, a medicine or another sleep disorder. [5]

The American Academy of Sleep Medicine's patient page reports that as many as 35 percent of adults complain of insomnia, and that chronic insomnia affects about 10 percent of people. [4]

Common causes and contributors

• Stress, anxiety or depression; noise; a room that is too hot or cold; uncomfortable beds; alcohol, caffeine or nicotine; jet lag; shift work. [2]
• Conditions such as restless legs syndrome, an overactive thyroid, menopause, long-term pain, sleep apnea and some medicines. [2]
• Age: chances increase as you get older. Insomnia can also run in families. [6]
• Some cold and allergy medicines contain pseudoephedrine, which can make it harder to fall asleep. [4]

What an evaluation looks like

A clinician may ask about sleep habits, health, medicines and substance use, and may ask you to keep a sleep diary for 1 to 2 weeks. [7] A sleep study is not needed unless sleep apnea or another sleep disorder is suspected. [4] Actigraphy, a wrist motion sensor worn for 3 to 14 days, is sometimes used. [7]

Care that is well established

Established recommendation: cognitive behavioral therapy for insomnia (CBT-I). The American College of Physicians recommends that all adults receive CBT-I as the initial treatment for chronic insomnia disorder (strong recommendation, moderate-quality evidence). [8] A meta-analysis of 20 trials found it improved the time to fall asleep by about 19 minutes and time awake after sleep onset by about 26 minutes, with no adverse outcomes reported. [9] See CBT-I.

Healthy sleep habits are also part of care. See Sleep hygiene and How to fall asleep faster.

Medicines and over-the-counter products

• Prescription sleep medicines are meant for short-term use in some cases; some can cause rare complex sleep behaviors such as walking, eating or driving while asleep. [10]
• The NHS says GPs now rarely prescribe sleeping pills for insomnia because of serious side effects and dependence. [2]
• Over-the-counter sleep aids that contain antihistamines can make you sleepy but can be unsafe for some people. [10] Never stop a prescribed medicine without talking to your prescriber.
• See Sleep safety.

What complementary approaches have shown

For a wider comparison, see Natural sleep aids compared.

Why it matters

Chronic insomnia can raise the risk of road accidents, falls and missed work, and can affect the heart, mood and other conditions. [12]

When to get help

See a GP or doctor if changing habits has not helped, trouble sleeping has lasted months, or it affects daily life. [2] Ask about sleep apnea if you snore loudly or gasp (Sleep apnea). Chronic insomnia can come with anxiety, depression and thoughts of suicide. [12] If you are having thoughts of suicide, in the US call or text 988, the Suicide & Crisis Lifeline, free and open 24/7; elsewhere, use your local emergency number.