Insomnia: Causes, symptoms, effects, and treatments
Reviewed by therapist.com team
Written bytherapist.com team
Last updated: 10/06/2022
Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, and/or getting restful sleep. People with insomnia may spend hours trying to fall asleep, or they may stay awake the entire night. They may fall asleep without issue but wake up after only a few hours and struggle to fall back asleep. When people with insomnia do fall asleep, the quality of their sleep is often lacking, leaving them feeling unrested.
Not everyone experiences insomnia the same way. In fact, the various types of insomnia are differentiated by four distinct features:
- Duration: Acute insomnia is a short-term sleep disorder that may be caused by a specific stressor. Chronic insomnia lasts for at least a month, if not longer, and persists even when stressors pass.
- Cause: If your insomnia is primary, it is the main health problem you’re facing. Secondary insomnia, also known as comorbid insomnia, occurs alongside another medical problem, such as depression.
- Severity: Some people suffer from mild insomnia that simply leaves them feeling fatigued for a day or two. Others have more moderate cases that affect their ability to function. Severe cases of insomnia result in serious limitations on a person’s ability to live their life and may endanger their health.
- Timing: Onset insomnia is characterized by having trouble falling asleep. Maintenance insomnia involves having trouble staying asleep. Terminal insomnia involves waking up early without intending to do so. Some people may suffer from more than one type of insomnia.
There are multiple causes of insomnia. Some can be changed or altered by your behavior, decreasing your risk for continued sleeplessness. Others may be difficult, impossible, or inadvisable to change. Common causes of insomnia include:
- Stress: Stress affects both our physical and mental well-being. Insomnia is one common side effect of stress.
- Medications: Insomnia may be an unintended side effect of certain medications. Your doctor may be able to switch you to a different medication if your current prescription is causing insomnia. However, you should not stop taking your medication without consulting with your doctor first, even if it seems to be causing your insomnia.
- Travel: Traveling can be stressful, which can cause insomnia. Flying across two or more time zones in particular can wreak havoc with your sleep schedule. Jet lag may trigger a few days of insomnia.
- Stimulants: Stimulants like caffeine and nicotine can make it difficult for you to fall asleep at night. If taken late enough in the day (typically anytime after 2 p.m.), they may keep you awake for most of the night.
- Alcohol or drug use: Although alcohol is a depressant that may cause you to fall asleep faster, it actually interferes with sleep quality and prevents you from getting restful sleep. Other drug use can also disrupt your sleep schedule.
- Poor sleep habits: It’s important to create a dark, quiet, and calm environment to sleep in. Poor habits such as using your phone in bed or eating right before bed can keep you awake at night.
- Certain mental health disorders: Secondary insomnia may be attributed to certain mental health disorders, such as anxiety or depression.
- Hormonal changes: People who menstruate may notice that insomnia occurs at the same time in their cycle each month. Additionally, pregnancy can alter your sleep schedule.
- Other health conditions: Secondary insomnia can be caused by physical health problems in addition to mental health ones, such as acid reflux disease or restless leg syndrome.
Lack of sleep affects your physical health as well as your mental and emotional health. The effects of chronic insomnia can build up over time and put your health in jeopardy.
Over time, insomnia can increase your risk for:
- High blood pressure
- Heart disease
Insomnia can have lasting effects on your mental health and cognitive abilities, increasing your risk for:
Cognitive behavioral therapy for insomnia (CBT-I) is a specific type of CBT that addresses the thoughts, feelings, and behaviors that are negatively affecting your ability to sleep. CBT-I retrains your brain so it learns to associate the bed with sleeping and not with other activities (like eating, working, or watching TV). It helps you create healthy habits that promote restful sleep.
Your CBT-I therapist may recommend sleep restriction therapy to help you overcome insomnia. Sleep restriction helps people with insomnia re-establish a sleep schedule by limiting the time they spend in bed awake. Although this seems paradoxical, it works by restoring your natural sleep drive through temporary sleep deprivation.
With sleep restriction, you start off by calculating the average amount of hours you’re sleeping each night and only allowing yourself to spend that amount of time in bed. For example, if you’re only sleeping an average of six hours a night, you begin by adjusting your bedtime to spend only six hours in bed. That means if you need to wake up at 7:00 a.m., you purposely don’t try to sleep until 1:00 a.m. (It’s generally not recommended to limit your time in bed to less than five and a half hours, even if your average sleep time is less than this.)
At first, your schedule may not allow you to get a healthy amount of sleep, but as your sleep drive intensifies and your time spent asleep becomes more consistent, you gradually increase the time spent in bed by 30 minute intervals. Eventually, the goal is to strengthen your ability to sleep soundly through the night for a healthy amount of time (typically seven or eight hours).
Although sleep restriction can be a very useful component of CBT-I, it is inadvisable for certain conditions, like sleep apnea or seizure disorders, since it can worsen symptoms.
If you’re interested in learning how to reframe your thought patterns and adjust your behaviors to promote healthy sleep habits, help is available. Click here to find a CBT-I therapist near you.
Medication can provide a brief intervention for people struggling with acute insomnia. However, medication is less effective against chronic insomnia. Ask your doctor about the potential side effects of sleep medication before trying over-the-counter sleeping pills. Do not take medication for other conditions simply for their drowsiness side effects, such as Benadryl or other antihistamines.
You may be able to overcome acute insomnia by practicing healthier sleep habits, such as:
- Not using your phone in bed
- Avoiding screens for at least an hour before bed
- Staying out of bed until you are ready to sleep
- Avoiding naps
- Following a regular sleep schedule, even on weekends
- Eating dinner at least two hours before bed
- Avoiding caffeine, drugs, or alcohol before bed
- Creating a dark, quiet, cool sleeping environment
Certain supplements, like melatonin, may be able to help you sleep better at night. However, the effectiveness of sleep supplements is debatable. Be sure to speak with your doctor before trying any over-the-counter sleep supplements.
Acute insomnia may last a few days, but chronic insomnia occurs at least three times a week for at least one month. If your insomnia affects your ability to function and shows no signs of improvement after a couple weeks, it’s time to see a doctor.
Anyone can develop insomnia. If you have a family history of sleep disorders, you may be at a greater risk for developing insomnia. Age also increases your risk for insomnia. However, many people struggle with insomnia because of changeable factors like stress or poor sleep habits. No matter the cause, you may be able to overcome insomnia with professional treatment.
Can’t sleep? Try these techniques:
- Get out of bed until you feel tired enough to sleep.
- Avoid using your phone or engaging with screens at night.
- Meditate or practice mindfulness to help you relax your body.
- Turn down your thermostat to a cooler temperature at bedtime.
- Practice deep breathing.
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