Insomnia is the most prevalent sleep disorder, affecting millions of people across the globe. The American Academy of Sleep Medicine reports that about 30% of adults have short-term insomnia, and nearly ten percent will have chronic insomnia that lasts months or years.

Insomnia can also affect much more than going to sleep or staying asleep; it can contribute to daytime fatigue, irritability, poor concentration, and long-term health complications including both heart disease and depression.

In this blog, we will look at some of the main factors in living with insomnia, including symptoms, causes, and practical strategies for managing insomnia.

What is Insomnia?

Insomnia is a common sleep disorder characterized by the inability to sleep, stay asleep, or obtain restful quality (good) sleep despite plenty of opportunity. Insomnia can be short-term (acute), and last a few days or weeks, often precipitated by stress or changes in lifestyle, to long-term (chronic), i.e., lasting for months or years.

Insomnia can affect quality, duration, and consistency of sleep, and often leads to notable daytime impairment such as fatigue, irritability, and reduced effectiveness and productivity.

Types of Insomnia

Acute Insomnia: Short-term insomnia lasting a few days to weeks, often from stress, traveling, or sudden changes in lifestyle.

Chronic Insomnia: Long-term insomnia occurring for three nights a week for three months, or longer, often associated with medical conditions, health problems, or ongoing stress.

Onset Insomnia: Having trouble initiating sleep at the start of the night, often from anxiety, stress, or bad sleeping habits.

Maintenance Insomnia: Waking during the night or waking too early in the morning and having difficulty falling back asleep.

Behavioral Insomnia of Childhood (BIC): Is common among children; the primary causes for BIC can be poor sleep routines, too many boundaries, or defiance about going to sleep.

Comorbid Insomnia: Insomnia that occurs in relation to another medical or psychiatric condition, such as depression, anxiety, or chronic pain.

Symptoms of Insomnia

  • Difficulty falling asleep at night
  • Waking up frequently during the night
  • Trouble returning to sleep after waking
  • Waking up too early and being unable to fall back asleep
  • Feeling tired or unrefreshed even after a full night’s sleep
  • Daytime sleepiness or fatigue
  • Mood disturbances such as irritability, anxiety, or depression
  • Difficulty concentrating, remembering, or focusing
  • Increased errors or accidents due to lack of alertness

Insomnia can occur at any age, and can affect anyone, but it is more prevalent in adults, especially women and the elderly.

Causes of Insomnia

There are numerous reasons for insomnia, which can also overlap with each other, that influence the content and duration of sleep.

1. Stress & Anxiety – Worrying about anything like work, school, health, or personal problems, even if you are not presently facing a challenge, can keep your brain active at night and this makes it difficult to fall asleep or stay asleep.

2. Poor Sleep – Two examples of poor sleep habits that can cause insomnia are: Go to bed and wake-up at the same time; Using electronics immediately before sleep. These habits disrupt our natural circadian rhythms.

3. Mental Health Conditions – Such disorders may include depression, anxiety, post-traumatic stress disorder (PTSD), and bipolar disorders as they are often associated with insomnia.

4. Medical Conditions – Overall, many medical conditions may also impact our ability to sleep, including chronic pain, asthma/chronic pulmonary disease, arthritis, diabetes, heart disease, gastrointestinal problems, to name a few.

5. Medication - Some prescription medications can cause insomnia. For example, inhalers for asthma, high blood pressure medications, antidepressants, and allergy medications may all cause potential sleeping problems depending on the way the medication is designed to work in your body.

6. Caffeine, Nicotine, and Alcohol – The caffeine and nicotine are stimulants, whilst the alcohol could stand to inhibit your ability to go into REM sleep, and contribute to uninterrupted sleep cycles.

7. Hormonal Changes – Insomnia may be affected by changes in hormone cycles, including menopause, normal pregnancy, and menstrual cycle variation.

8. Neurological Conditions – For example, Parkinson's disease, Alzheimer's disease, and other neurodegenerative disorders may exacerbate insomnia.

9. Shift Work or Traveling - Irregular work hours or jet lag interrupt the body's natural sleep/wake cycle and can create insomnia.

10. Underlying Sleep Disorders - Sleep disorders such as sleep apnea or restless leg syndrome can create poor sleep quality and chronic insomnia.

An illustrative representation of the causes of insomnia in people

Risk Factors of Insomnia

Here are some potential risk factors of insomnia:

  • Older adults are more prone to insomnia due to changes in sleep patterns and health conditions.
  • Women are at higher risk because of hormonal fluctuations during menstruation, pregnancy, and menopause.
  • High-stress levels from work, relationships, or major life events can trigger insomnia.
  • Conditions such as depression, anxiety, and PTSD are strongly linked to sleep disturbances.
  • Shift work, frequent travel, or inconsistent bedtimes can disrupt circadian rhythm.
  • Diseases like arthritis, asthma, diabetes, heart disease, and chronic pain often affect sleep.
  • Certain drugs for blood pressure, allergies, depression, and asthma may interfere with sleep.
  • These substances can disrupt sleep quality and delay sleep onset.
  • Insomnia can run in families, suggesting a genetic predisposition.
  • Sedentary lifestyle contributes to poor sleep quality and difficulty falling asleep.

Insomnia during Pregnancy

Insomnia is a quite common during pregnancy, impacting nearly 80% of pregnant mothers at some stage. Hormonal variances, physical pain, frequent need to urinate, and anxiety can alter a pregnant woman's sleep. Other sleep interfering physiological issues such as back pain, heartburn, baby movement, and vivid dreams making falling asleep or staying asleep more challenging.

During early stages of pregnancy, changing levels of progesterone can produce excessive daytime sleepiness and allow for irregularities in sleep and sleep cycles. In the later stages, extra weight, discomfort from shortness of breath, or sleeplessness from cramping legs can escalate nighttime disrupted sleep.

The potential range of emotional stress surrounding giving birth, and being a parent, can lead to insomnia. Following are the risk factors of insomnia during pregnancy:

  • First-time pregnancy (due to increased anxiety and adjustments)
  • History of insomnia or sleep disorders
  • Pre-existing anxiety or depression
  • Physical discomfort (e.g., back pain, pelvic pain)
  • Frequent nighttime urination
  • Heartburn or gastrointestinal issues
  • Obstructive sleep apnea
  • High levels of stress or lack of emotional support

How to Diagnose Insomnia?

Sleep History

A thorough sleep history, lifestyle, and medical history will typically be evaluated to assess for insomnia. The doctor would ask about the sleep difficulties in detail, how long they have been occurring, and how they impact daily functioning. The review may also inquire about typical bedtime routines, as well as caffeine/alcohol intake, medications taken, and current stressors and mental health status.

Sleep Diary

Doctors often advise patients to keep a sleep diary with tracking of sleep-wake patterns, sleep onset times, and disturbances for at least a week, and at most two weeks. If necessary, the doctor will conduct a physical examination to exclude other medical conditions that can contribute to insomnia, including chronic pain or thyroid conditions.

Sleep Study

A sleep study (polysomnography) may be recommended in certain circumstances. During the sleep study, whole-night recordings of brain waves, heart rate, and breathing patterns will be obtained alongside recordings of body movements.

This information can suggest the possibility of an underlying sleep disorder, such as sleep apnea or restless leg syndrome. Psychological testing may also be recommended to assess for anxiety, depression, or other mental health concerns with potential to contribute to sleep issues.

Treatment of Insomnia

Here are some effective treatments recommended by healthcare professionals:

Cognitive Behavioral Therapy for Insomnia (CBT-I)

This is regarded as the first-line treatment for chronic insomnia. This therapy will help examine and modify negative thinking or behaviors about sleep. Cognitive Behavior Therapy for Insomnia (CBT-I) may include components of stimulus control, sleep restriction therapy, and relaxation training.

Prescription Medications

Doctors may prescribe medications for short-term or severe insomnia, including:

  • Non-benzodiazepine hypnotics (e.g., zolpidem, zaleplon, eszopiclone)
  • Benzodiazepines (e.g., temazepam, triazolam – generally for short-term use only)
  • Melatonin receptor agonists (e.g., ramelteon)
  • Orexin receptor antagonists (e.g., suvorexant, lemborexant)
  • Low-dose antidepressants with sedative effects (e.g., doxepin, trazodone)

Treatment of Underlying Conditions

Management of medical or psychiatric issues (e.g., sleep apnea, depression, anxiety, chronic pain, hormonal issues) that may interfere with sleep strategies may improve sleep.

Short-term Use of Over-the-Counter (OTC - Under Medical Supervision Only)

Over-the-counter (OTC) options such as antihistamines (e.g., diphenhydramine, doxylamine) or melatonin supplements may be recommended by a physician, but not for long-term use due to side effects or decreasing effectiveness of the product over time.

|Note: Medical treatment should always be guided by a healthcare professional, as some medications carry a risk of dependence or side effects.

How to Prevent Insomnia?

Preventing insomnia is about embracing a balanced lifestyle and adopting good sleep practices that encourage relaxing and consistent sleep.

  • Be consistent with your sleep. Go to sleep and wake up at the same time every day, ideally, even on weekends.
  • Establish a calming pre-sleep routine (reading or meditating) to signal to your body it is time to rest.
  • Minimize your intake of caffeine, nicotine, and alcohol, especially in the evening, as all of these can alter your sleep cycle.
  • Make your sleep environment comfortable—it should be dark, quiet, and cool. Use your bed only for sleep and intimacy.
  • Avoid long naps during the day when possible, cope with stress using relaxation techniques at the moment, and when possible, be active but avoid vigorous exercise too close to bedtime.

Home Remedies to Control Insomnia

  • Practice relaxation techniques - Deep breathing, meditative breathing, or progressive muscle relaxation can help calm your mind.
  • Drink herbal teas - Chamomile tea, valerian root tea, and lavender tea have calming properties.
  • Use aromatherapy - Essential oils like lavender and sandalwood can help you relax before bed.
  • Try melatonin supplements - Melatonin can help you regulate your sleep-wake cycle when taken occasionally.
  • Limit screen time - Shut off TVs, phones, and tablets an hour before bed to keep away from blue light.
  • Adjust your diet - Avoid large meals close to bedtime, and consider sleep-inducing snacks like bananas or warm milk.
  • Warm bath before bed - A warm bath can help you relax your muscles and prepare your body to sleep.
  • Mindful journaling - Writing down your worries or tasks for the next day can clear your mind and assist in getting to sleep.

When to Consult with a Doctor?

If insomnia lasts for more than three nights a week for several weeks, or starts to impact your daily life, it's time to see a doctor. You should seek medical attention if you have excessive daytime fatigue, difficulties with concentration, frequent changes in your mood, or a decline in your work or school performance.

If you have a suspicion that the insomnia is caused by a medical condition, such as sleep apnea, depression, anxiety, or chronic pain, you should also see a doctor. You should also consult a health professional if you are currently using sleep medications or alcohol to assist with your sleep, or if your insomnia worsens quickly and without clear reason.

Final Thoughts

Insomnia is not just a few sleepless nights; it affects your health, mood, and quality of life if left untreated. Identifying the cause, risk factors, and treatment of insomnia is the first step to being able to sleep peacefully again. By maintaining healthy sleep habits, treating any medical disorder, and receiving medical advice when necessary, changes can be made.

If you are suffering from insomnia, or it is affecting your everyday life, it is important to schedule a visit with your doctor to receive a proper diagnosis and treatment as needed. Getting quality sleep is important for maintaining long-term health and well-being.