What Is Insomnia?

Poor sleep can harm your mood, energy levels, and overall health long-term. “Epidemiological studies show that lack of sleep is associated with obesity, diabetes, and heart disease, even Alzheimer’s,” says Sara Nowakowski, PhD, a clinical psychologist and associate professor at Baylor College of Medicine in Houston, Texas. But thankfully, it’s treatable with lifestyle changes.

Types of Insomnia

Two types of insomnia — acute and chronic — involve the inability to sleep, says Gerard J. Meskill, MD, a neurologist and sleep disorders specialist with the Tricoastal Narcolepsy and Sleep Disorders Center in Sugar Land, Texas.

People with chronic insomnia often need to work with a medical professional to help resolve the underlying cause of the sleep condition.

Signs and Symptoms of Insomnia

• Fatigue
• Problems with focusing or concentration
• Poor memory
• Mood changes or irritability
• Daytime sleepiness
• Issues doing work, school, or other activities
• Delayed reflexes (which can lead to increased errors or accidents)

If you’re at all concerned about your sleep issues, talk with your doctor. Your doctor can then direct you to a qualified sleep specialist.

Causes and Risk Factors of Insomnia

• Medical conditions, such as asthma, chronic pain, sleep apnea, and neurological conditions (including Parkinson’s disease)
• Medications like antidepressants, asthma, blood pressure meds, allergy and cold medications, or other stimulants
• Mental health conditions such as depression and post-traumatic stress disorder
• Dietary habits, such as consuming heavy meals too close to when you go to sleep, or consuming too much caffeine or alcohol
• Nicotine use
• Jet lag
• Unhealthy sleep habits, such as having an inconsistent or irregular sleep schedule

To better understand how insomnia develops and its causes in a specific individual, sleep experts often use what’s called the “Spielman model” or “3P behavioral model” of insomnia. It helps sleep doctors chart factors that may trigger insomnia and account for possible causes.

• Predisposing Factors This category includes most psychological, biological, and social factors that could make you more prone to insomnia. For example, anxiety, being a woman (because statistics show insomnia is more common in women than in men), and hyperarousal (meaning that you’re at greater risk of anxiety or have a higher wake drive than normal) are all predisposing psychological or biological factors. Predisposing social factors include an unconventional work schedule and a bed partner whose sleep schedule doesn’t align with yours.
• Precipitating Factors These are new and often stress-related events that trigger insomnia. For instance, you might be dealing with stress at work, financial worries, bad news about something important in life, or travel. Pain, depression, illnesses, and medication may also play into this, and all of these factors can lead to chronic insomnia. Note, though, that an ongoing medical issue like chronic pain or untreated obstructive sleep apnea can serve as both precipitating and perpetuating factors, Meskill says.
• Perpetuating Factors These are generally behaviors or beliefs people have adopted that either maintain their sleep difficulties or make them worse, all of which perpetuate chronic insomnia. This could include changes in daytime behaviors — many people take naps or try to sleep in later, which can, in some cases, make insomnia worse — or beliefs about sleep that fuel the insomnia flame. For instance, people with insomnia often develop anxieties connected to their bed, fear about not sleeping, and even worries about how lack of sleep will affect their daytime routines. Medical issues, as Meskill mentioned, can also fall into this category.

Sometimes, a combination of factors from each category can contribute to insomnia.

How Is Insomnia Diagnosed?

In many cases, your doctor will be able to tell whether you have insomnia just by talking with you. Along with discussing your medical and family history, your doctor will ask about your sleep habits and patterns. You must be clear and precise with your doctor when describing your symptoms.

All of this information can help your doctor determine whether you have insomnia and how best to manage it. (Note: Write all of this information down in the morning, after you’ve gotten up for the day. If you’re trying to document middle-of-the-night arousals as they happen, you could be making the awakenings worse.)

Most of the time, your primary care provider can evaluate and diagnose these symptoms of insomnia. Sometimes, they may refer you to a sleep specialist if your symptoms are complex or for certain treatments.

Treatment and Medication Options for Insomnia

People with insomnia might feel there’s no hope for relief, but it can be overcome, and current treatment therapies are highly effective.

Tried-and-true sleep hygiene strategies, like keeping consistent sleep and wake times, avoiding stimulating activities before bed, and shutting down electronic devices 30 to 60 minutes before bed, usually help sleep problems and often alleviate them completely. These strategies are recommended for insomnia prevention, too.

Once sleep problems become chronic, these strategies aren’t as effective in reversing sleep difficulties — though they’re often still recommended to keep insomnia from becoming worse and help make other treatments more effective, Meskill says.

Cognitive Behavioral Therapy

With CBTi, you’re essentially retraining your brain and body on how to sleep. “People with chronic insomnia develop an aversion to their bed and bedroom and the act of sleeping,” Meskill says. CBTi works to erase that aversion by training people to use techniques specifically targeting the psychological factors associated with insomnia, such as having negative emotions and worries about not being able to sleep.

CBTi can involve breathing techniques, muscle relaxation practices, and other complementary therapies that can help you get to sleep. It can also involve changing your sleep routines or bedroom environment in ways that promote sound sleep.

Although doing CBTi with a trained specialist in person is the best option, online programs can also be effective, especially with people who are self-motivated and highly disciplined, or who live somewhere where there is no CBTi specialist, Meskill says.

How long it will take to overcome chronic insomnia depends on each individual. For some, the therapy may reverse sleep problems in just a few weeks, while others need several months. Just like other health conditions, though, there is a chance of relapse, which is why it’s important to remember the behavioral skills you learn in CBTi and practice them if and when your sleep starts to get disrupted again, Nowakowski says.

Medication Options

Still, medicine may help prevent a bout of short-term insomnia from turning into a chronic problem, or help jump-start a healthier sleep pattern for someone with chronic insomnia. The idea is that you use the medication for a few nights to get back to a healthy sleep schedule, then stop the pill after you’ve fallen back into that good routine.

Lifestyle Changes and Prevention of Insomnia

• Get up and go to sleep at the same time every day, even on weekends
• Get regular physical activity, which includes walking and other low-impact exercises (but avoid vigorous exercise too close to bedtime, which tends to wake up and energize your body)
• Avoid taking long or frequent naps
• Limit your caffeine and alcohol intake
• Don’t eat heavy meals before bed
• Avoid nicotine

Complications of Insomnia

• Asthma
• Heart disease
• Pregnancy complications
• Worsened chronic pain
• A weakened immune system

Conditions Related to Insomnia

Sleep is so important to overall health that a lack of it is linked, directly or indirectly, to almost every health condition. In some cases, insomnia is thought to be a cause or contributing factor to a condition or makes other symptoms worse. And for many conditions, other symptoms (like pain, anxiety, itching, and heartburn, among many others) make it more difficult to sleep and contribute to insomnia.

• Mental health disorders, including depression and anxiety
• High blood pressure and heart disease
• Cancer
• Chronic pain
• Parkinson’s disease
• Alzheimer’s disease
• Thyroid disorders
• Obesity

The Takeaway

• Insomnia is a sleep condition characterized by the inability to fall and stay asleep. There are two main types of insomnia, acute and chronic, the second of which affects about 10 percent of adults.
• Chronic insomnia, which is the inability to sleep three or more nights per week for at least three months, can increase the risk of long-term health complications such as depression and anxiety, high blood pressure, obesity, and diabetes.
• Insomnia is often diagnosed through a sleep study, talking with your doctor about symptoms, and a variety of bloodwork to rule out underlying causes. Your doctor might refer you to a sleep specialist for follow-up tests.
• Insomnia is treatable, with cognitive behavioral therapy for insomnia and medications being the primary treatment options. Treating underlying health issues, such as sleep apnea or anxiety, can also help treat and prevent insomnia. Lifestyle changes like a healthy sleep routine, regular exercise, and avoidance of nicotine can also help improve sleep.