People with insomnia have problems falling asleep or staying asleep. You may wake up during the night or wake up too early the next morning.
Insomnia is a common problem that affects almost everyone at some point. Without enough sleep, you may feel sleepy during the day. This can make you more likely to have an accident and also makes driving dangerous. You may also feel grumpy from lack of sleep. Some people have trouble remembering things, don't get as much done, and don't enjoy being with family and friends.
Having trouble sleeping from time to time is often linked to short-term stress. It can last for days to weeks. It often gets better in less than a month.
Insomnia can also develop into an ongoing sleep problem, especially when you worry about not sleeping well. This is called chronic insomnia. It is often a symptom of another health problem, such as depression or chronic pain. Chronic insomnia is less common than short-term sleep problems. It affects up to 10% to 15% of adults.1
What causes insomnia?
There are many things that can cause sleep problems. Insomnia may be caused by:
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Stress. Stress can be caused by fear about a single event, such as giving a speech. Or you may have ongoing stress, such as worry about work.
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Depression, anxiety, and other mental or emotional conditions.
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Poor sleep habits, such as watching TV in bed or not having a regular bedtime schedule. If you have trouble sleeping, you may worry about being able to fall asleep. This can make the problem worse.
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Changes in your sleep habits or surroundings. This includes changes that happen where you sleep, such as noise, light, or sleeping in a different bed. It also includes changes in your sleep pattern, such as having jet lag or working a late shift.
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Pain, breathing problems, restless leg syndrome, and many other health problems.
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Using certain things known to cause sleep problems. These include stimulants, such as tobacco and caffeine, as well as certain medicines, alcohol, and drugs.
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Lack of regular exercise.2
What are the symptoms?
The symptoms of insomnia vary. You may have difficulty falling asleep, so you may toss and turn for what seems like a long time. You may wake up and have trouble falling back to sleep, perhaps several times during the night. You may wake up too early and feel unrefreshed in the morning or tired or irritable during the day.
How is insomnia diagnosed?
Insomnia is not a disease, and no test can diagnose it. But when you can't sleep well, it often has to do with some other cause. Your doctor will probably assess your current health and ask about any health problems you have had and if you are taking any medicine.
Sometimes a doctor will do a physical exam, blood tests, and, in some cases, sleep studies to help find out if you have a health problem that may be causing the insomnia.
Your doctor may also ask about your sleep history—how well you sleep, how long you sleep, bedtime habits, and any unusual behaviors. Your doctor may ask you to keep a sleep diary, which is a record of your sleep patterns, for a week or two. He or she may recommend a counselor if your symptoms point to a mental health problem, such as depression or anxiety.
How is it treated?
Treatment for insomnia focuses on the reason why you don't sleep well. If you have a medical problem, such as chronic pain, or an emotional problem, such as stress, treating that problem may help you sleep better. You may be able to sleep better by making some small changes. It may help to:
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Go to bed at the same time each night.
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Get up at the same time each day.
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Avoid caffeine or alcohol for several hours before bedtime.
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Get regular exercise.
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Avoid daytime naps.
Some people may need medicine for a while to help them fall asleep. Doctors often prescribe medicine for a short time if other treatment isn't working. But medicine doesn't work as well over time as do lifestyle and behavior changes.3 It can also become habit-forming. Medicine works best as a short-term treatment combined with lifestyle and behavior changes.
Your doctor may also recommend counseling, which can help you learn new habits that may help you sleep better.
Talk to your doctor about your sleep problems and any other health issues you may have. This is important, because lack of sleep can lead to depression, accidents, problems at work, marital and social problems, drinking more alcohol than usual, and poor health. Treatment may help you avoid these problems and feel better.
How common is insomnia?
Insomnia is very common and can affect people at any stage in life. One recent study reported that about 1 out of 5 children has insomnia.4 It is more common in women and older people. Almost half of older adults are affected by sleep problems, and up to 14% use sleeping pills.5
Sleep patterns also change as you get older, and many older adults sleep less than younger adults. If you are an older adult, you may have a harder time falling asleep, and your sleep may not be as deep. Health problems and medicines can also affect how much or how well you sleep. But having trouble getting to sleep or not sleeping well is not normal, no matter what your age. If you are having trouble sleeping, discuss it with your doctor at your next checkup.
Symptoms of insomnia can be different for each individual, and people with insomnia might experience a variety of symptoms, such as:
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Difficulty falling asleep, which can mean lying in bed for up to an hour or more, perhaps tossing and turning, wishing for sleep to begin.
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Awakening during sleep and having trouble getting back to sleep.
It's common for older adults to sleep less deeply and for less time than they did earlier in life, and to experience fragmented sleep. But these normal changes in the sleep patterns of older adults do not mean that the sleep they get is enough—many experts believe older adults may need as much sleep as younger adults.6, 7 Routine poor-quality sleep due to health problems, medication use, and major life changes can lead to chronic sleep problems. While chronic insomnia may increase the chances of serious health problems, such as depression, few seniors seek or receive treatment for sleep problems.8
What makes people with insomnia different from people who generally sleep fewer hours or have a different sleep disorder is the quality of their day. Insomnia results in such disturbed sleep that you feel and perform poorly during the day. Sometimes people worry about the amount of sleep that they get most nights because they think people their age need a certain number of hours. It is possible to be a short sleeper or a restless sleeper and yet get the amount of sleep you need. If you awaken refreshed with energy and are able to conduct your needed tasks during the day, then you are probably getting adequate sleep.
If you think that you routinely are not getting enough sleep, do not feel refreshed when you rise in the morning, and constantly feel tired during the day, you could have insomnia. It is important that you talk with your health professional about your sleep problem, because daytime drowsiness can lead to serious problems, including injury or accidents.
Insomnia is not a disease, and no specific test can diagnose it. Your health professional may want to do blood tests to rule out certain medical conditions such as thyroid problems. "Normal sleep" differs for each individual. Since poor-quality sleep often is related to an underlying cause, an evaluation of your health and sleep history is an important first step. Talk with your doctor about your medical history and any current medical problems or medications you are taking.
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Your doctor can learn a lot about your insomnia and its causes by assessing your sleep history.
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You may be asked to keep a sleep diary for 1 or 2 weeks to document your sleep patterns and related lifestyle factors. See an example of a sleep diary(What is a PDF document?).
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If your symptoms point to mental health concerns, such as depression or anxiety, you may be referred for an assessment by a mental health professional.
If your doctor evaluates your present condition, health, and sleep history and suspects that you may be suffering from certain sleep disorders, you may be referred for a clinical sleep study (polysomnography), in which you sleep overnight in a laboratory. This type of study is sometimes used to assess breathing-related sleep disorders, such as sleep apnea.
It can be difficult to assess chronic insomnia with a clinical sleep study, because there are often no concrete features of poor-quality sleep that can be measured. Further, insomnia is often specific to your lifestyle and environment, which would not be duplicated in a lab setting. Still, a clinical sleep study may be useful in ruling out certain causes of your insomnia or if the diagnosis is uncertain and behavioral or medication therapy is not working.
