What is insomnia?

Insomnia, which means difficulty initiating or maintaining sleep, is a symptom, not a diagnosis or a disease. It may be due to a lack of sleep or poor quality of sleep.

You’ve probably had nights when you couldn’t fall asleep, no matter how desperately you tried.

When you can't sleep, the ticking of the clock only reminds you of your exhaustion and the endless hours until morning. And perhaps you finally drop off around dawn, only to be jarred awake by the alarm an hour later.

Insomnia is one of the most common sleep complaints. About 1 in 3 adults has bouts of insomnia that last a few days at a time. This is acute insomnia. But 1 in 10 adults suffers ongoing difficulty sleeping, known as chronic insomnia. This is defined as insomnia that occurs more than 3 nights a week for over a month.

Insomnia affects people in different ways. If you suffer from it, you may not be able to go to sleep or you may not be able to stay asleep. You might constantly wake up earlier than you would like, perhaps in the wee hours of the morning, and find yourself unable to go back to sleep. 

Women are more likely to have insomnia than men. It is also more common among shift workers, who don't have consistent sleep schedules; people with low incomes; people who have a history of depression; and those who don't get much physical activity.

What causes insomnia?

Insomnia has many possible causes. The reasons you're lying awake when you don't want to be are individual. They can include any or all of these:

• Medications that interfere with sleep

• Dietary choices, such as caffeine late in the day, that interfere with sleep

• Stressful thoughts

• Depression

• Recent upheavals in your life, such as a divorce or death of a loved one

• Hormone changes, such as those accompanying menopause

• Bedtime habits that don't lead to restful sleep

• Sleep disorders

• Chronic pain

• Medical conditions such as acid reflux, thyroid problems, stroke, or asthma

• Substances like alcohol and nicotine

• Travel, especially between time zones

What are the symptoms of insomnia?

These are common symptoms of insomnia:

• Frustration and preoccupation with your lack of sleep

• Physical aches and pains, such as headaches and stomachaches

• Impaired performance at work

• Daytime drowsiness or low energy

• Difficulty paying attention

• Anxiety

• Tension and irritability

• Depression and mood swings

How is insomnia diagnosed?

You may need to see a sleep medicine specialist to find out what's causing your insomnia. It will be helpful to bring a record of your sleep patterns.

The process of making a diagnosis may include:

• Your medical history. Your doctor will consider any medical conditions, any medications you're taking, and stressful life changes that could be causing insomnia.

• Your sleep history. Be prepared to describe your insomnia with details such as how long it's been going on, what you think could be contributing to it, and what your sleep is like, such as whether you can barely get to sleep at all or if you wake up too early.

• Physical exam. The doctor will look for any physical reasons that could be causing sleep problems.

• Sleep study. You may need to sleep overnight in a sleep lab where researchers monitor your sleep.

Diagnosis of insomnia begins with a good medical history. The physician will seek to identify any medical or psychological illness that may be contributing to the patient’s insomnia, as well as screen for drug and alcohol use. The patient may be asked about chronic snoring and recent weight gain, which may lead to the possibility of obstructive sleep apnea. In such cases the doctor may request an overnight sleep test, or polysomnogram, though sleep studies are not part of the routine initial workup for insomnia. Patients may also be asked to keep a daily diary of their alertness

How is insomnia treated?

You have many options for treatment:

• Medications to help you get to sleep and stay asleep

• Change in existing medication if that's what's causing the problem

• Counseling to help relieve stress and other issues bothering you

• Change in lifestyle choices that may interfere with sleep

• Insomnia generally resolves itself when the underlying medical or psychiatric cause is removed. Treating the symptoms of insomnia without addressing the main cause is rarely successful. Most people seek medical attention when their insomnia becomes chronic. Therapies include both nonpharmacologic and pharmacologic treatments. Studies have shown that combining medical and nonmedical treatments typically is more successful in treating insomnia than either one alone.

What are the complications of insomnia?

Insomnia can have serious complications. Poor sleep quality is linked to:

• Increased risk for heart disease

• Increased risk for stroke

• Increased risk for diabetes

• Excessive weight gain or obesity

• Depression

• Increased risk for injury to yourself or others, such as a car accident caused by driving while drowsy

Key points

Insomnia, the term for having trouble sleeping at night, is one of the most common sleep complaints. About 1 in 3 adults has bouts of insomnia that last a few days at a time. Women are more likely to have insomnia than men.

• Insomnia has many possible causes. You may need to see a sleep medicine specialist to find out what's causing your insomnia.

• Common symptoms of insomnia include impaired work performance, daytime drowsiness or low energy, difficulty: paying attention and others.

• Diagnosis may involve a sleep study in which a sleep specialist monitors your sleep.

Next steps

Tips to help you get the most from a visit to your health care provider:

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.