Insomnia: causes, symptoms, treatments and how it affects you

Lindsay Boyers
Woman unable to fall asleep
Inability to fall asleep at night can lead to serious health concerns — it's important to manage your insomnia and get a better night's rest. (Getty Images) (Oleg Breslavtsev via Getty Images)

Sleep is something you may take for granted — until it becomes elusive. While an occasional sleepless night is nothing to worry about, chronic insomnia is a different story altogether.

Affecting an estimated one-third of the population, insomnia can lead to significant short- and long-term health effects. Insomnia isn't just about fatigue; it can increase the risk of chronic diseases, diminish quality of life and impair daily functioning.

But what is insomnia exactly, and how can it be managed? To explore these questions, we consulted four sleep experts. Their expert advice offers hope for anyone struggling to reclaim restful nights.

Insomnia is a sleep disorder marked by difficulty in falling asleep, maintaining sleep or achieving restorative sleep.

"When you have insomnia, you tend to wake up feeling as though you’re not fully rested or as though you didn’t get enough sleep. As you can imagine, this can affect your mood, focus, performance and overall quality of life," says Marissa Alert, a clinical health psychologist and founder of MDA Wellness.

There are three main types of insomnia, according to Dr. Samuel Mathis, assistant professor of family medicine at the University of Texas Medical Branch:

  • Onset insomnia is characterized by difficulty falling asleep at night, leaving people tossing and turning for hours.

  • Maintenance insomnia involves the inability to stay asleep throughout the night. This can manifest as waking up multiple times during the night or waking up once and struggling to fall back asleep. As Mathis explains, this type of insomnia disrupts the continuity of sleep, leading to fragmented rest.

  • Mixed insomnia is a combination of both onset and maintenance insomnia. Individuals with mixed insomnia experience trouble both falling asleep and staying asleep, dealing with the challenges of both types of insomnia simultaneously. It's particularly disruptive, as it affects both the beginning and the continuity of sleep.

Insomnia can be either acute or chronic. According to Alert, acute insomnia generally lasts from a few days to several weeks and is often triggered by stressful or traumatic life events. "For instance, you might have trouble falling asleep the night before a big presentation or an exam. Fortunately, this type of insomnia typically fades away on its own once the stressful event passes," she explains.

On the other hand, chronic insomnia lasts for at least three months, with sleep disturbances happening at least three nights a week. Chronic insomnia is further broken down into primary or secondary insomnia.

Primary insomnia occurs independently and is often the most frustrating type. It's not related to any other medical or mental health issues and can be difficult to treat. Secondary insomnia develops in response to a medical condition, mental health problem, medications, substances or other chronic stressors, according to Alert. "For example, someone with chronic pain may develop insomnia if their pain leads to them waking up often in the middle of the night and makes it hard for them to fall back asleep," she says.

While sleepiness might be the most obvious outcome, insomnia can cause both short- and long-term health issues. Initially, people with insomnia experience fatigue, low energy, difficulty concentrating and impaired memory. Some other short-term effects include:

  • Mood disturbances, such as irritability or depression

  • Increased risk of accidents and errors

  • Impaired cognitive function and reduced productivity

  • Poor quality of life

  • Frequent napping

Over time, insomnia can also contribute to chronic health issues like heart disease, high blood pressure, obesity, chronic pain syndrome and diabetes.

Identifying a direct cause for insomnia, particularly in cases of primary insomnia, can be challenging. However, various issues can contribute. Here are some of the most common causes and risk factors:

  • Medical conditions: Chronic pain, respiratory problems, gastrointestinal issues and other health conditions can interfere with sleep, contributing to insomnia. It's estimated that 75%-90% of people with insomnia have some comorbidity or related medical condition.

  • Mental health conditions: Depression, anxiety disorders, post-traumatic stress disorder, schizophrenia and other mental health issues can affect sleep. "Stress and anxiety can also contribute to insomnia since it might make it hard to relax and fall asleep. In some instances, people may worry about being able to fall asleep, which in turn can make it harder to sleep," says Alert.

  • Medications: Certain medications can cause insomnia as a side effect. They include medications for asthma, allergies, depression, high blood pressure and more.

  • Lifestyle: An inconsistent or irregular sleep schedule, lack of physical activity and excessive consumption of caffeine or alcohol can worsen insomnia. Maintaining a regular sleep routine and incorporating physical activity can help improve sleep quality.

  • Age: Insomnia becomes more common as people age. People 60 or older are more likely to experience insomnia due to changes in sleep patterns and health conditions.

  • Gender: Women are more likely to experience insomnia, particularly during hormonal shifts such as menstruation, pregnancy and menopause. Hormonal changes can significantly affect sleep quality and duration.

  • Environment: A poor sleep environment can make it difficult to fall or stay asleep. "If it’s too loud, hot or bright, it can be hard to fall or stay asleep. Sleeping with pets or on an uncomfortable mattress can also contribute to sleep problems," says Alert. Creating a comfortable, quiet and dark sleep environment is essential for good sleep hygiene.

According to Alert, diagnosing insomnia usually begins with a conversation with a doctor or sleep specialist about your sleep habits, lifestyle, family history and any underlying health issues. "Your provider might ask you to keep a sleep diary for about one to two weeks to get a better sense of your sleep patterns and factors that might be contributing to the problem. You might also complete questionnaires so your provider can gauge how severe your insomnia is," she says.

In some cases, especially if another sleep disorder is suspected, your provider might recommend a sleep study, officially called a polysomnography. "This is where you spend a night in a sleep lab hooked up to monitors that track various bodily functions. Actigraphy, which involves wearing a small device that tracks sleep-wake patterns, might be used for a more extended period to gather objective data on sleep habits," explains Alert.

By keeping detailed records and carrying out the appropriate tests, health care professionals can diagnose insomnia accurately and develop an effective treatment plan tailored to your needs.

Once you're diagnosed with insomnia, treatment usually involves a multi-faceted approach. Given the numerous potential contributing factors, it's essential to address all underlying causes.

If a medical issue is causing your insomnia, part of the treatment will focus on managing that condition to provide relief. Outside of managing health issues, cognitive behavioral therapy for insomnia (CBT-I) is considered the most effective long-term insomnia treatment. According to Alert, CBT-I helps you identify and change the thoughts and behaviors that interfere with quality and restorative sleep.

Good sleep hygiene, which involves adopting a bedtime routine to promote healthy sleep, is also crucial. It might involve:

  • Establishing a sleep routine: Go to bed and wake up at the same time every day, even on weekends.

  • Optimizing your sleep environment: Keep your bedroom quiet, dark and cool. The best temperature for sleep is between 60-68 degrees Fahrenheit. You may also want to consider blocking out ambient light with one of the best sleep masks or blackout curtains.

  • Limiting electronics before bed: Shut down electronics like your phone, TV and laptop at least 30 minutes before bedtime.

  • Avoiding certain foods and drinks: Steer clear of large meals, fatty foods and alcohol before bedtime.

  • Limiting caffeine: Avoid coffee and other caffeinated drinks in the afternoon or evening. A small 2013 study showed that consuming caffeine within 6 hours of bedtime can negatively affect sleep quality.

  • Maintaining a healthy lifestyle: Exercise regularly and follow a balanced diet to promote overall well-being and improve sleep quality.

Keri Chiappino, a functional neurologist and neurofeedback therapist, also recommends avoiding long naps. "While short naps can be refreshing, long or irregular napping can affect nighttime sleep," she says.

In some cases, a doctor might prescribe medications to provide short-term relief. However, Alert warns that these medications can lead to side effects and dependence, so it's often a good idea to try CBT-I and lifestyle changes first.

Occasional disrupted nights of sleep are normal and usually don't require a visit to the doctor. However, some specific signs indicate it's time to seek medical advice.

Chiappino recommends seeing a doctor if:

  • Insomnia persists for more than a few weeks despite self-help efforts.

  • It significantly impacts your daily life, mood or performance.

  • You experience symptoms of other health conditions, such as depression or chronic pain.

It depends on your age and health status, but most adults need between 7 and 9 hours of sleep per night. While getting a little more is OK, sleeping less than seven hours a night increases your risk of developing health issues.

Instead of thinking in terms of a cure, Alert says it's more helpful to think about insomnia as a condition that can be effectively managed and often resolved.

"For people with acute insomnia, the condition might resolve on its own. Chronic insomnia often requires more comprehensive treatment to help you address underlying causes, implement healthy sleep habits and learn techniques to manage sleep-disrupting thoughts and behaviors," she says, adding that some people have a genetic predisposition to sleep difficulties that make them more vulnerable to insomnia. In these cases, maintaining good sleep practices and being prepared to address sleep issues if they recur can make a big difference in long-term management.

Yes, stress and anxiety are significant risk factors for insomnia. "When an individual is stressed or anxious, the body's arousal system is activated, making it difficult to relax and fall asleep. The mind may race with worries and concerns, leading to prolonged wakefulness and fragmented sleep," says Chiappino.

If stress and anxiety are causing your insomnia, effective management is crucial for achieving quality sleep. Techniques such as mindfulness, relaxation exercises and therapy can be beneficial in addressing these underlying issues and improving your sleep.

Certain foods and drinks can exacerbate insomnia, making it harder to get a good night's sleep. The greatest offender is caffeine. "Caffeine keeps your brain active when it should be winding down," says Dr. Dylan Petkus, a sleep apnea expert.

Alcohol and large meals before bedtime can also worsen insomnia. "While alcohol may help you fall asleep quickly, it often causes disrupted sleep, leaving you tossing and turning," says Petkus. Big meals before bed can also lead to heartburn and indigestion, which further contribute to insomnia.

Avoiding these substances and opting for lighter, healthier options in the evening can help improve your sleep quality.

The most effective approach is to maintain good sleep habits. In other words, go to bed at the same time every night, keep your room dark and cool, limit screen time before bed and avoid alcohol, caffeine and full meals prior to bedtime. A healthy lifestyle — eating a nutritious diet and getting regular exercise — can also help.

  • Marissa Alert, PhD, licensed clinical health psychologist, consultant and founder of MDA Wellness

  • Keri Chiappino, functional neurologist and neurofeedback therapist

  • Samuel Mathis, MD, board-certified family medicine doctor and assistant professor of family medicine at the University of Texas Medical Branch

  • Dylan Petkus, MD, family medicine doctor and sleep apnea expert

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