Insomnia: Symptoms, Causes, and Treatments



You know how awful one night of bad sleep can make you feel. Now multiply that one bad night by weeks, even months, and it’s easy to understand why insomnia can take a tremendous mental and physical toll on people.

By definition, even having just a few restless night of sleep qualifies as a bout of insomnia. In and of itself, a night or two of bad sleep isn’t a critical problem. But one or two nights of bad sleep can easily turn into a chronic problem with sleep. And it’s the repetitive nights of continued sleep woes that exact the biggest drain on the body and brain. If you fall into any of those categories, you’re not alone.

Estimates suggest approximately 10 percent adults suffer from chronic insomnia and between 15 and 35 percent of adults suffer from some level of short-term insomnia lasting a few days or up to three months.

Those numbers are problematic because sleep is one of the foundations of good health — and if you’re not getting the slumber you need, you could be putting your health in jeopardy.

“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 sleep researcher at the University of Texas Medical Branch in Galveston. Other consequences include increased risk of psychiatric disorders and motor vehicle accidents. When it comes to health, she adds: “Sleep is just as important as diet and other lifestyle behaviors.”

That’s why dealing with insomnia and getting the help you need is critical. So how do you know if you have it, and how do you treat it if you do have it? Read on to get answers to your most pressing questions.

What Is Insomnia: Defining Both Acute and Chronic Insomnia

Insomnia is the most common sleep disorder, but unlike other medical conditions, it has a relatively simple definition. “Insomnia means an inability to sleep,” says Gerard J. Meskill, MD, neurologist and sleep disorders specialist with Comprehensive Sleep Medicine Associates in Houston. Characteristics include not being able to fall asleep, not staying asleep throughout the night, and waking up too early in the morning.

More specifically, there are two types of insomnia: acute and chronic. Acute insomnia means you have trouble sleeping for only a short period of time, even if that means only for one night. “Virtually everybody gets acute insomnia every once in a while,” Dr. Meskill says. But this insomnia is so short lasting, according to a study in the journal Chest, that once the cause behind it disappears, you return to your normal sleep patterns. Still, acute insomnia can be a problem because if ignored and not addressed it can lead to longer-term chronic insomnia.

Chronic insomnia is more severe and involves difficulty sleeping three or more days per week over the course of three months. Individuals with chronic insomnia also report disruptions in their daytime functioning, including sleepiness, irritability, or anxiety, or difficulty paying attention, focusing on tasks, or remembering.

While acute insomnia can usually be solved without professional help, the same isn’t true for people with chronic insomnia. These individuals need to work with a trained professional, and the sooner they bring someone on board, the more quickly they can stop problems from becoming even more severe and thus taking longer to solve.

What Causes Insomnia? Stress, Other Medical Problems, and More

Insomnia doesn’t just have one cause — it can be caused by a number of factors.

These causes can include:

• Medical conditions, such as arthritis, asthma, chronic pain, sleep apnea, and neurological conditions (including Parkinson’s disease)
• Medication
• Psychiatric conditions, such as depression, anxiety, schizophrenia, bipolar disorder, and ADHD (Note though that insomnia can raise the risk of anxiety and depression, too.)
• 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

o better understand how insomnia develops and the specific causes in any one individuals, sleep experts often use what’s called the Spielman 3-P Model of Insomnia. It helps sleep medicine providers chart various factors that might trigger insomnia, and account for any possible contributing causes. Here’s what each P means, and how each can potentially contribute to insomnia:

1. Predisposing Factors Any psychological or biological factors that would make you more prone to insomnia fall into this category. This could include anxiety, being a woman (because statistics show insomnia is more common in women than in men), hyperarousal (meaning that you’re at greater risk of anxiety or have a higher wake drive than normal), and family history. Type A, goal-driven personalities often fall into this category.

2. Precipitating Factors Life events and medical, environmental, or psychological factors can often trigger acute 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.

3. 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 actually makes insomnia worse — or beliefs about sleep that give fuel to the insomnia flame, so to speak. For instance, people with insomnia often develop anxieties connected to the bed, fear about not sleeping, and even worries about how lack of sleep will affect their daytime routines. Medical issues, as Meskill mentioned above, can also fall into this category.

Though in some cases any one of these causes may be problematic enough to trigger insomnia, for most individuals who have trouble sleeping, a combination of factors from each of these categories contributes to insomnia.

Is It Insomnia? When to Talk to Your Doctor About Sleep Problems

Determining if you have insomnia usually isn’t too difficult. In most cases, you know if you’re not sleeping well. “Most patients see me already knowing their diagnosis,” Meskill says. Most people, after all, either know they’re having trouble falling asleep, staying asleep, or waking up too early. Many people can also tell when the next day they’re more irritable and fatigued.

But, there are also some people who may not be aware that they have insomnia: the insomnia deniers. “It’s possible that these people have so much going on that they might perceive symptoms of daytime fatigue as a result of other chronic health conditions or a busy schedule,” she says.

What’s more surprising, though, is that these individuals actually do quite well on cognitive performance tests, even scoring similar results in terms of attention and performance as people are good sleepers, according to research from Nowakowski and her colleagues. (6) What gives? People may have habituated to their insomnia, Nowakowski explains. “They don’t realize how sleepy they are or how bad the insomnia is, and not until they actually get treatment do they wake up to this fact.”

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. Treatment and practicing better sleep habits can help anyone improve their sleep, feel more energized, and be healthier in the long run.

The Mainstay of Insomnia Treatment Is Cognitive Behavioural Therapy

Insomnia sufferers, especially those with the chronic type, might feel like there’s no hope in sight. “Many people think they’re broken and can’t be fixed,” Nowakowski says. Yet the good news is that insomnia can be overcome and sufferers really can learn how to sleep again, as current treatment therapies are highly effective. It just takes time and patience.

Although prescription medication may be used in some cases, cognitive behavioral therapy for insomnia (CBTi) is the gold standard. “CBTi is generally recommended as first-line therapy for chronic insomnia,” says Sheila Tsai, MD, pulmonologist and section head of sleep medicine at National Jewish Health in Denver.

With CBTi, you’re essentially retraining your body 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.

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 someplace 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.

Meanwhile, people with acute insomnia can use tried-and-true sleep hygiene strategies, like keeping consistent wake and sleep times, avoiding stimulating activities before bed, and shutting down electronic devices 30 to 60 minutes before bed. These same strategies, by the way, can be used to prevent insomnia, but once those sleep woes progress to a chronic state, these strategies aren’t effective in reversing sleep difficulties, Meskill says.

Prescription sleeping pills do play a role in insomnia management, but they should be used with caution and usually only for a short period of time. They can come with serious side-effects and they can be habit forming if relied on for too long.

Still, medicine may be helpful in preventing a bout of short-term insomnia from turning into a chronic problem, or in order to 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 drop the pill after you’ve fallen back into that good routine.

Many people also reach for over-the-counter sleep aids, which should be used with caution, too. “Taking these on a frequent basis can lead to physical dependency, so that when you go to sleep you need more to fall asleep or just can’t sleep without them,” Dr. Tsai says. Limit their use to just one or two nights.

Insomnia and Mental Health Have a Complicated Relationship

As mentioned above, mental health problems, such as depression or anxiety, can contribute to insomnia. It makes sense that if you have a lot of anxiety it will be tougher to relax and fall asleep. But chronically not getting enough sleep, which happens if you suffer from chronic insomnia, can be a cause of mental health problems, too.

A key function of sleep is to literally clean toxins out of the brain each night, so you wake up refreshed with a mind functioning at 100 percent. Not sleeping, not getting enough sleep, or not getting good quality sleep therefore affects how prepared your brain is to face the next day’s challenges. That means it may be tougher to concentrate, it may be harder to remember things, hand-eye coordination may be off, and psychologically you may be more moody or irritable, your judgment may be skewed, you may have less patience, you may make rash decisions, and you may be more emotional than usual. Sleep disruptions can also affect the levels of neurotransmitters and stress hormones that get released in the brain.

That means disrupted sleep can wreak havoc on everyday processes in the brain, like thinking and regulating your emotions, which can contribute to psychological problems.

Insomnia Can Affect Anyone — Even the Rich and Famous

Everyone is vulnerable to the stressors and lifestyle habits that can trigger insomnia. Renée Zellweger says the on-the-go schedule and travel that comes with being an actor has caused sleep problems for her. Kim Cattrall has had to cancel performances due to her struggle with insomnia.

Their stories and those of other high-profile individuals remind us that we all need sleep no matter what’s booked for the day.