Insomnia Causes and Treatment

Sleep Disorders

What Is Insomnia?

Insomnia is the perception or complaint of inadequate or poor-quality sleep because of one or more of the following:

  • Difficulty falling asleep
  • Waking up frequently during the night with difficulty returning to sleep
  • Waking up too early in the morning
  • Unrefreshing sleep

Insomnia is not defined by the number of hours of sleep a person gets or how long it takes to fall asleep. Individuals vary normally in their need for, and their satisfaction with, sleep. Insomnia may cause problems during the day, such as tiredness, a lack of energy, difficulty concentrating, and irritability.

Insomnia can be classified as transient (short term), intermittent (on and off), and chronic (constant). Insomnia lasting from a single night to a few weeks is referred to as transient. If episodes of transient insomnia occur from time to time, the insomnia is said to be intermittent. Insomnia is considered to be chronic if it occurs on most nights and lasts a month or more.

What Causes Insomnia?

Certain conditions seem to make individuals more likely to experience insomnia. Examples of these conditions include:

  • Advanced age (insomnia occurs more frequently in those over age 60)
  • Female gender

If other conditions (such as stress, anxiety, a medical problem, or the use of certain medications) occur along with the above conditions, insomnia is more likely.

There are many causes of insomnia. Transient and intermittent insomnia generally occur in people who are temporarily experiencing one or more of the following:

  • Stress
  • Environmental noise
  • Extreme temperatures
  • Change in the surrounding environment
  • Sleep/wake schedule problems such as those due to jet lag
  • Medication side effects

Chronic insomnia is more complex and often results from a combination of factors, including underlying physical or mental disorders. One of the most common causes of chronic insomnia is depression. Other underlying causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, narcolepsy, restless legs syndrome, Parkinson’s disease, and hyperthyroidism. However, chronic insomnia may also be due to behavioral factors, including the misuse of caffeine, alcohol, or other substances; disrupted sleep/wake cycles as may occur with shift work or other nighttime activity schedules; and chronic stress.

In addition, the following behaviors have been shown to perpetuate insomnia in some people:

  • Expecting to have difficulty sleeping and worrying about it
  • Ingesting excessive amounts of caffeine
  • Drinking alcohol before bedtime
  • Smoking cigarettes before bedtime
  • Excessive napping in the afternoon or evening
  • Irregular or continually disrupted sleep/wake schedules

These behaviors may prolong existing insomnia, and they can also be responsible for causing the sleeping problem in the first place. Stopping these behaviors may eliminate the insomnia altogether.

Who Gets Insomnia?

Insomnia is found in males and females of all age groups, although it seems to be more common in females (especially after menopause) and in the elderly. The ability to sleep, rather than the need for sleep, appears to decrease with advancing age.
Transient and intermittent insomnia may not require treatment since episodes last only a few days at a time. For example, if insomnia is due to a temporary change in the sleep/wake schedule, as with jet lag, the person’s biological clock will often get back to normal on its own. However, for some people who experience daytime sleepiness and impaired performance as a result of transient insomnia, the use of short-acting sleeping pills may improve sleep and next-day alertness. As with all drugs, there are potential side effects. The use of over-the-counter sleep medicines is not usually recommended for the treatment of insomnia.

Treatment for chronic insomnia consists of:

  • First, diagnosing and treating underlying medical or psychological problems.
  • Identifying behaviors that may worsen insomnia and stopping (or reducing) them.
  • Possibly using sleeping pills, although the long-term use of sleeping pills for chronic insomnia is controversial. A patient taking any sleeping pill should be under the supervision of a physician to closely evaluate effectiveness and minimize side effects. In general, these drugs are prescribed at the lowest dose and for the shortest duration needed to relieve the sleep-related symptoms. For some of these medicines, the dose must be gradually lowered as the medicine is discontinued because, if stopped abruptly, it can cause insomnia to occur again for a night or two.
  • Trying behavioral techniques to improve sleep, such as relaxation therapy, sleep restriction therapy, and reconditioning.

Relaxation Therapy

There are specific and effective techniques that can reduce or eliminate anxiety and body tension. As a result, the person’s mind is able to stop “racing,” the muscles can relax, and restful sleep can occur. It usually takes much practice to learn these techniques and to achieve effective relaxation.

Sleep Restriction

Some people suffering from insomnia spend too much time in bed unsuccessfully trying to sleep. They may benefit from a sleep restriction program that at first allows only a few hours of sleep during the night. Gradually the time is increased until a more normal night’s sleep is achieved.

Reconditioning

Another treatment that may help some people with insomnia is to recondition them to associate the bed and bedtime with sleep. For most people, this means not using their beds for any activities other than sleep and sex. As part of the reconditioning process, the person is usually advised to go to bed only when sleepy. If unable to fall asleep, the person is told to get up, stay up until sleepy, and then return to bed. Throughout this process, the person should avoid naps and wake up and go to bed at the same time each day. Eventually the person’s body will be conditioned to associate the bed and bedtime with sleep.

National Center On Sleep Disorders Research (NCSDR)

The preceding material was prepared by the National Center on Sleep Disorders Research (NCSDR), part of the National Heart, Lung, and Blood Institute of Health. It appears here courtesy of the NCSDR. This article was originally published in 1995, and does not reflect developments in the treatment of insomnia since 1995. It is intended as an introduction and overview for those interested in learning about insomnia.

The NCSDR, located within the National Heart, lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH), supports research, scientist training, dissemination of health information, and other activities on sleep disorders and related concerns. The NCSDR also coordinates sleep research activities with other Federal agencies and with public and nonprofit organizations.

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Comments (20)

  1. i would like to have some info on light box, or light therapy. not sure if im saying it right. second time ive posted this. thank you very much. joanierav

  2. Sorry my last comment was
    To long and ambit off. It’s 6:30 am
    And I’m wide
    Awake I go days sometimes without sleeping. I need help severly

  3. I do not sleep for a couple of nights, I see spider figures with long legs, for me spiders are GOD creatures, so for me they represent good things, but these night visions do not bring me good sensations, it’s strange, like If there was a presence in my room. I lose sleep when this happens.

  4. I also have trouble staying awake while reading, listening to a speaker, or any activity that involves video or television screens. No questions relating to that were asked. My hours for sleeping and staying awake seem random. I can have a good 8 hr sleep and stay awake only a few hours, or sleep for 3 hr and be up for 16. Worse in winter.

  5. HEY I AM CRAIG BUTTON I HAVE BE SUFFING WITH THIS INSOMMA FOR QUITE A WILE I WANT TO HAVE SLEEP ND INPROVE MY SELF IN WAKING UP IN THE MORNING AND HAVING GREAT TIME BUT I CAN’T I NEED HELP WITH THIS PLEASE HELP ME TO GET ME TO SLEEP AGAIN

  6. I need help, I’m a 13 year old girl and I’m unable to sleep. I’ve taken many online tests from different sites which all lead to me having insomnia. I don’t want to tell my parents because I’m too afraid but I just don’t know what to do . I can’t go on like this. I’ve tried lots of ways to help but it doesn’t work, I don’t want to live like this and I hope someone can help me. I beg you, I have to get better but I don’t know how 🙁

    • Would your parents be able to take you to a doctor or a sleep clinic? If so, it would be best to tell them as soon as possible.

    • Hey! I’m a 13 year old girl too! 😀

      Anyways,i always have trouble getting to sleep and staying asleep, and sometimes I go a few nights in a row without sleeping… i think I have insomnia…

      But I just told my parents that I was having trouble sleeping and their going to take take me to a doctor… and hopefully that helps

      I think you should just tel your parents that you can’t sleep and ask them for help

  7. I am suffering from insomnia for a long time. I have difficulty falling asleep and I’m wide awake all night. I can’t do my work accordingly the way it is because I’m feeling dizzy and sleepy during daytime. I’m already having goose bumps, puffy eye bags and I’m looking older inappropriate to my age. I shared this problem to my co-worker and he introduced me this item called D’oxyva. I searched over the internet for facts about this product and I read good comments and feedbacks for fast recovery. Does anyone have some information with this? I just want to have a good sleep and be back to my normal life. I wanna try this so help me. Thanks.

  8. This is good information. I am having problems falling asleep, and being sleepy during the day. I have done the sleep study and started using the c-pap machine. However , it still takes me along time to fall asleep. I often feel hot when I first go to bed, and I feel sleepy when I get up after two hours. I would like some help.

  9. I spe d hours upon hours on my bed trying to fall asleep, sometimes I’d fall asleep at 9am and wake up at 7pm. If I can’t sleep I’d just play/read on my phone all day. And once I do put my device away my brain would just keep talking and talking. Now I have surgery and I’m getting sleep, but not at nigh but in the morning and evening.

  10. I was looking for a comment close to today’s date and I seen Anna’s comment and thank you and I will tell my parents because for a little over a year I think it is maybe more I have had problems with sleeping and I started recently looking for reasons and the reason is because I might have chronic insomnia but I still have to talk to a doctor to be sure but thx

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