Insomnia

What Is Insomnia? 

Insomnia is a sleep disorder characterized by difficulty with falling asleep, staying asleep, or both. An insomnia diagnosis requires these sleep troubles to also cause daytime impairments, such as sleepiness or difficulty concentrating.

Insomnia that goes untreated, leading to long-term sleep deprivation, is linked with a number of harmful effects Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source , including lower quality of life and increased risk for substance abuse, heart disease, and diabetes.

Insomnia vs. Occasional Sleepiness 

Up to two-thirds of people occasionally experience insomnia symptoms. These bouts of sleeplessness may or may not meet the criteria for a formal diagnosis of insomnia, depending on how long they last and whether they cause distress or interfere with daily functioning. But it is important for anyone who has concerns about their sleep to discuss them with a health professional for proper diagnosis and treatment.

Types of Insomnia

The two main types of insomnia are acute insomnia and chronic insomnia. The primary difference between these two types is that acute insomnia is a short-term condition, while chronic insomnia causes sleep issues for at least three months. 

Researchers have attempted to further categorize Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source insomnia based on other characteristics, including whether the insomnia is caused by another medical condition or not. Some physicians use terms like “sleep onset insomnia” to describe difficulty falling asleep and “sleep maintenance insomnia” to refer to difficulty staying asleep. 

However, the most current evidence shows that understanding whether a person has acute or chronic insomnia carries more significance for making decisions about medical care than these other distinctions.  

Acute Insomnia 

Acute insomnia describes sleep difficulties that last for a few days or weeks, but not longer than three months. Short-term insomnia can often be traced to an external cause or life stressor like divorce, the death of a loved one, or a major illness. 

If acute insomnia persists over multiple months, it becomes classified as chronic insomnia.

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Chronic Insomnia 

Chronic insomnia is when a person experiences sleeping difficulties and related daytime symptoms, like sleepiness and attention issues, at least three days per week for longer than three months. It is estimated that about 10% to 15% of people have chronic insomnia.

People with chronic insomnia commonly feel distressed about their inability to sleep and the daytime symptoms caused by those sleep issues. Symptoms are generally severe enough to affect a person’s work or school performance as well as their social or family life.

Symptoms of Insomnia

The symptoms of insomnia include various sleep difficulties and daytime problems. Common sleep issues that can signal the presence of insomnia include:

• Trouble falling asleep
• Trouble staying asleep throughout the night
• Unwanted early morning waking
• Resisting sleeping at bedtime in children and teens
• Difficulty sleeping without a caregiver’s help in children and teens

In addition, insomnia causes daytime symptoms related to the sleep loss:

• Fatigue
• Impaired attention or memory
• Trouble with work, school, or social performance
• Irritability or disturbed mood
• Sleepiness
• Decreased motivation
• Increased accidents or mistakes
• Worries about or discontent with one’s sleep
• Behavioral issues, like hyperactivity or aggressiveness, especially in children

Talk with your doctor if you are having difficulty falling asleep or staying asleep. You should also talk with a doctor if you have significant sleepiness or other daytime symptoms.

A doctor can ask questions to better understand your situation and order tests to determine if an insomnia diagnosis is appropriate. Symptoms of insomnia can overlap with symptoms of other sleep disorders, so it is important to work with a doctor rather than try to self-diagnose.

What Causes Insomnia 

There is no single established cause of insomnia. However, research suggests that in many people insomnia likely results from certain types of physiological arousal at unwanted times, disrupting normal patterns of sleep. Examples of such arousal can include a heightened heart rate, a higher body temperature, and increased levels of specific hormones, like cortisol.

Insomnia disorders often occur alongside mental health disorders. It is believed that the cause of insomnia may be distinct in people who have both insomnia and mental health conditions.

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Risk Factors for Insomnia

While there is no single cause of insomnia, studies have identified factors that can put a person at a greater risk for experiencing insomnia. These include, but are not limited to Trusted Source American Academy of Sleep Medicine (AASM) AASM sets standards and promotes excellence in sleep medicine health care, education, and research. View Source :

• Being a woman or assigned female at birth
• Older age
• Lower socioeconomic status
• Medical conditions like diabetes and chronic pain
• Other sleep disorders such as restless legs syndrome and sleep apnea
• Mood disorders including depression and anxiety
• Having an immediate family member with insomnia

It is important to note that not everyone who has one or more of these risk factors will have insomnia, and not everyone with insomnia will have one of these risk factors.

How Is Insomnia Diagnosed? 

Doctors generally diagnose insomnia by asking questions about a person’s sleep habits and medical history. They may administer specific questionnaires to assess fatigue, sleepiness, and other symptoms. Sometimes they will request keeping a sleep diary for a short period of time. 

If the doctor needs to rule out other sleep disorders that could be causing a person’s symptoms, other assessments, such as a sleep study, may be ordered.

Treatments for Insomnia 

Treatment for insomnia depends on how long a person has been experiencing sleep issues and any specific factors that are contributing to their sleep loss. 

People with short-term insomnia might not need any treatment at all, and care may be focused on discussing practices to support sleep hygiene. Temporary use of a prescription sleep aid may be an option if the insomnia is causing high levels of concern or distress. 

A few treatment approaches are available for people with insomnia that persists for weeks or months.

• Cognitive behavioral therapy for insomnia (CBT-I): Experts consider cognitive behavioral therapy for insomnia to be the best, most effective initial treatment for chronic insomnia. CBT-I helps people manage anxiety they feel about their sleep issues and establish better sleep habits.
• Sleep medications: If a person experiences significant symptoms from insomnia, or in cases where CBT-I does not help, medication may be recommended. Medication can help promote sleep but may also come with side effects, such as daytime drowsiness or confusion.
• Other treatments: Some people with insomnia may be interested in exploring other options, such as melatonin or dietary supplements, yoga, hypnosis, or aromatherapy. However, scientific evidence supporting the use of these methods to treat insomnia is lacking at this time Trusted Source National Center for Complementary and Integrative Health (NICCH) NCCIH funds and conducts research to help answer important scientific and public health questions about complementary health approaches. View Source . 

If insomnia is associated with another condition, such as sleep apnea or depression, treatment of the other condition often improves sleep. If one’s insomnia is a side effect of another medication they are taking, a doctor may adjust the drug or its dose to improve sleep. Do not adjust any medications without speaking with a physician first. 

It is important to get help with insomnia sooner than later. Sometimes, people with insomnia enter into a difficult cycle in which their sleep issues exacerbate anxiety at night, which then worsens their sleep. Treatment for insomnia can help prevent or break this cycle and keep acute insomnia from becoming chronic.

Additionally, maintaining healthy sleep habits after insomnia treatment may help keep insomnia from returning Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . These include:

• Maintaining the same bedtime and wake time every day, even on weekends
• Reserving use of the bed for only sex and sleep
• Getting out of bed if falling asleep is taking too long or causing anxiety
• Not consuming caffeine, alcohol, or nicotine, especially near bedtime
• Keeping the bedroom both dark and quiet
• Refraining from watching television or using other electronics before bed
• Not checking the clock to see how long it is taking to fall asleep
• Avoiding eating large meals too close to bedtime