What Is Insomnia? Symptoms, Causes, Diagnosis, Treatment, and Prevention

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 nights of sleep qualifies as a bout of insomnia. (1) 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 persistent problem. And it’s the repetitive nights of continued sleep woes that are the biggest drain on the body and brain.

RELATED: What Happens to Your Body and Your Mind When You Don’t Sleep

If you struggle to sleep, you’re not alone. Estimates suggest approximately 10 percent of adults suffer from chronic insomnia, and between 15 and 35 percent of adults suffer from some level of short-term insomnia lasting anywhere from a few days to up to three months. (2)

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

RELATED: How Much Sleep Do You Really Need Each Night?

“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 of insomnia include increased risk for 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 insomnia, 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. Unlike many other medical conditions, it has a relatively simple definition. “Insomnia means an inability to sleep,” says Gerard J. Meskill, MD, a neurologist and sleep disorders specialist with the Tricoastal Narcolepsy and Sleep Disorders Center in Texas. Characteristics of insomnia 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 that once the cause behind it disappears, you return to your normal sleep patterns. (3)

Acute insomnia can still be a problem, however, 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, Dr. Nowakowski says.

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.

Learn More About Acute and Chronic Insomnia

Determining if you have insomnia usually isn’t difficult. In most cases, you know if you’re not sleeping well. “Most patients see me already knowing their diagnosis,” Meskill says.

But there are also some people who may not be aware that they have insomnia. “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,” he says.

Taking 30 minutes or longer to fall asleep at night suggests you have insomnia. (4) When it comes to middle-of-the-night awakenings, most people have a few of those each night. But if yours tend to last more than a few seconds or minutes — that is, you’re fully awake and can’t get back to sleep — that’s indicative of insomnia. (5)

Waking up early in the morning before you intend to (and therefore cutting your total sleep time for the night short) can also be a sign of insomnia. (1)

Keep in mind that adults need seven or more hours of sleep each night. There are individual differences in sleep needs: some people need just seven hours to feel perfectly rested and others need closer to nine. And everyone’s going to have a poor night of sleep from time to time. But if you’re waking up just four or five hours after going to bed often, that’s a problem, according to the Centers for Disease Control and Prevention (CDC). (6)

In addition to having trouble falling asleep at night, staying asleep, or waking up too early in the morning, common insomnia symptoms include: (2)

• Fatigue
• Problems with focusing or concentration
• Poor memory
• Mood disturbance
• Daytime sleepiness
• Low motivation or energy
• 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.

Learn More About the Symptoms of Insomnia

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

According to the National Sleep Foundation, these causes can include: (7)

• 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, attention deficit hyperactivity disorder (ADHD), and bipolar disorder (insomnia can also contribute to or raise your risk for anxiety and depression.)
• 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

RELATED: How to Fix Your 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 various factors that might trigger insomnia, and account for any possible contributing causes.

Per past research, here’s what each “P” means, and how each can potentially contribute to insomnia: (8)

1. 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 also a bed partner whose sleep schedule doesn’t align with yours.
2. 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.
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 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 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.

Learn More About What Causes Insomnia

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. It’s important that you’re clear and precise with your doctor when describing your symptoms.

To help with this, many sleep experts recommend that you keep an accurate sleep journal or “sleep history” for two weeks (or more) before visiting a doctor to talk about your insomnia. (10) Write down when you go to bed, approximately how long it takes you to fall asleep, when you wake up, and the frequency and duration of any middle-of-the-night awakenings. 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. He or she may, however, refer you to a sleep specialist if your symptoms are complex, or for certain treatments.

Your doctor or sleep specialist will also likely perform a medical exam. Your doctor will listen to your heart and lungs, and perform other routine screening measures for health problems that could be causing your insomnia.

Your doctor may also order some follow-up tests that can help determine the cause of your insomnia. These could include blood tests to check for medical issues or an actigraphy test, a small device that you wear while sleeping to measure your sleeping patterns. (1)

Insomnia doesn’t mean you don’t sleep at all; it can come and go from night to night, week to week, or month to month. You might experience several weeks or months of poor sleep, followed by a period of relatively easeful slumber.

Again, doctors tend to differentiate between “acute” and “chronic” insomnia based on its duration. Chronic insomnia is three or more nights of poor sleep each week for a period of three months or longer. Acute insomnia is anything that falls below those time thresholds.

For those who have dealt with chronic insomnia, research has noted that relapse is common. One study from 2019 found that, among people with chronic insomnia who recovered, about 57 percent relapsed within four years. (11)

Making behavioral changes and getting treatment (if necessary) to address the problem as soon as possible after noticing insomnia symptoms can help shorten the duration. Continuing to practice healthy habits around sleep (like sticking to a consistent bed and wake time and limiting screen exposure before bed) also helps keep insomnia relapse at bay. (1)

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, patience, and some effort.

For people with acute insomnia, 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, usually help sleep problems and often alleviate them completely. They’re the same strategies that, unsurprisingly, are recommended to prevent insomnia.

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.

Learn More About Home Cures for Insomnia

Cognitive Behavioral Therapy

Although prescription medication may be used in some cases, cognitive behavioral therapy for insomnia (CBTi) — a type of psychotherapy or talk therapy — is now considered the gold standard for chronic insomnia treatment. “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 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. (1)

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.

Medication Options

Prescription sleeping pills do play a role in insomnia management, but they should be used with caution and 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. (12) “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.

Benzodiazepines, hypnotics, and orexin receptor antagonists are all classes of drugs that can be habit-forming. (13)

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 stop the pill after you’ve fallen back into that good routine.

Many people also reach for over-the-counter sleep aids, such as melatonin. Our bodies naturally produce melatonin, a hormone that triggers a series of reactions that help our brains and bodies fall asleep. It’s available as a supplement and does not carry the same risk as other prescription sleep aids of becoming addictive, according to past research. (14)

Learn More About Treatments and Therapies for Insomnia

Prevention of Insomnia

Stress and anxiety are potent sleep slayers. If the stuff you’re doing before bed (or while you’re in bed) causes you to feel anxious — whether you’re watching the news, sending work emails, or scrolling your social media feeds — you’ll want to avoid those activities before they start messing with your slumber. (15)

Apart from avoiding anxiety triggers, these habits or behaviors can also help keep your sleep on track:

• 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

Finally, it can be helpful to create a consistent bedtime ritual, which helps signal to your brain and body that it’s time to sleep. Yours could be taking a shower and then reading a book or listening to some soft music, suggests the Mayo Clinic. (16)

As mentioned above, mental health problems, such as depression or anxiety, can fuel insomnia. It makes sense that if you have a lot of anxiety, it will be tougher to relax and fall asleep. But poor sleep can contribute to mental health problems, too.

Sleep plays key roles in maintaining brain health. Research suggests one of those functions is to clear toxins out of the brain each night. (17) Sleep also replenishes energy stores in brain cells. Disrupted sleep can therefore wreak havoc on everyday processes in the brain, like thinking and regulating your emotions, which can contribute to psychological problems, according to past research. (18,19)

The effects of poor sleep aren’t relegated to the brain. There’s evidence from studies that insomnia may disrupt appetite and hormones in ways that may promote obesity and high blood pressure. (20)

Chronic insomnia has also been linked to increased risk of the following problems: (1)

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

Learn More About the Complicated Relationship Between Sleep and Mental Health

Roughly 25 percent of the population experiences at least one bout of acute insomnia each year, according to a 2018 study, which also noted that about 1 in 4 of that group will develop persistent or chronic insomnia. (21)

The American Academy of Sleep Medicine reports that chronic insomnia affects 10 percent percent of U.S. adults, and 1 in 3 experiences at least mild to moderate insomnia. (2)

Statistics on “short sleep,” meaning those who sleep less than seven hours each night, find that men are very slightly more likely to get insufficient sleep than women. Also, people who are obese, as well as those who smoke or who do not exercise, are much more likely to sleep less than seven hours compared with people who do not check those boxes. (23)

Some of the latest research on insomnia has looked at its connections with other diseases or disorders, and especially diseases of the nervous system and brain. For example, there’s evidence that insomnia is both an early warning sign and a possible contributor to brain diseases like Alzheimer’s. (24)

There’s also research that suggests sleep helps you learn, even when it comes to muscle memory–related tasks like playing the piano. (25)

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 others 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.

Some of the conditions that insomnia is most closely associated with include (14):

• 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

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.

Learn More About These 11 Celebrities Who Struggle With Insomnia Just Like the Rest of Us

Favorite Orgs for Essential Insomnia Info

American Academy of Sleep Medicine (AASM)

The mission of the AASM is to promote health by promoting better sleep. The organization carries out this mission through advocacy, education, and research, and by publishing practice standards. The AASM website includes information for sleep medicine providers and insomnia patients about cognitive behavioral therapy for insomnia, as well as information on advocacy efforts.

American Sleep Association

The American Sleep Association is a nonprofit dedicated to improving public health by promoting awareness about the importance of sleep and facts about sleep disorders. You’ll find information on sleep health in general along with insomnia.

National Sleep Foundation

The National Sleep Foundation focuses on sleep education and advocacy that promotes health and well-being. Check out the foundation’s website for information on insomnia and other sleep disorders, as well tips on healthy sleep that everyone should know.

Favorite Insomnia Advocacy Groups

Project Sleep

Project Sleep is a nonprofit organization dedicated to raising sleep disorder awareness and providing help to those with sleep disorders. The group awards scholarships to support students with sleep disorders and hosts events to help raise awareness about sleep disorders and the importance of sleep health. The group also disseminates information about how to support sleep disorders research.

Favorite Insomnia Blogs and Podcasts

The Sleep Doctor

The Sleep Doctor blog is run by Michael J. Breus, PhD, a clinical psychologist, a diplomate of the American Board of Sleep Medicine, and a fellow of the American Academy of Sleep Medicine. Find blog posts by Dr. Breus on new insomnia research, tips on managing the sleep disorder, and sleep hygiene recommendations to help prevent the problem to begin with. Breus also publishes a list of sleep devices and products he recommends.

Favorite Products and Tech for People Who Have Trouble Sleeping

The Better Sleep Council (BSC)

The Better Sleep Council is the consumer-education arm of the International Sleep Products Association (the organization of mattress and bedding manufacturers that represents the sleep products industry). BSC’s purpose is to provide education for consumers about sleep, health, and the products that are involved (like mattresses, bedding, and more). BSC is run by bedding and sleep experts across the mattress and bedding industry. Find resources on the site about how to pick out a mattress, mattress upkeep, what else in your bedroom promotes a good night’s sleep, and more.

Relax and Sleep Well

This hypnosis and meditation app was created by the self-help audio author Glenn Harrold. The app features hypnotherapy and meditation recordings designed to alleviate stress and anxiety and help you get to sleep. The app was ranked as one of the top sleep apps by the American Sleep Association.

With additional reporting by Markham Heid.