What Causes Insomnia

What Is Insomnia?

Insomnia is when you have a hard time falling or staying asleep, or you wake up too early. It can happen for short periods of time and then go away. But for some people, insomnia is an ongoing (chronic) problem. Insomnia can make it hard to function during the day. It can cause problems at work or school, and with relationships. It can cause concentration and mood problems. But insomnia can be treated to help you get back to a healthier sleep cycle.                  

Causes of insomnia

You may have insomnia for a few nights in a row from time to time. This is called acute insomnia. Or your sleep trouble may be ongoing for a longer period of time. This is called chronic insomnia.

Acute insomnia can be caused by things such as:

Stress
Jet lag
Short-term illness or pain
Medicines for colds, allergies, or mental health concerns
Hormonal changes due to menstruation, pregnancy, or menopause
Major life changes (death, loss of a job, moving, divorce)

Chronic insomnia can be caused by the same factors as acute insomnia. However, chronic insomnia is often maintained by behavior, lifestyle, and other factors such as: 

Lying in bed awake, trying too hard to sleep
Sleeping later than usual in the morning
Taking naps during the day
Ongoing stress
Watching TV or using electronic devices in bed   
Shift work that changes your sleep hours
Caffeine, nicotine, or alcohol use too close to bedtime
Thoughts and beliefs such as “I’ll never get to sleep”

Chronic insomnia can happen at the same time as other health problems such as:

Ongoing illness or pain
Stimulant medicines for the treatment of medical and mental health conditions
Depression or anxiety
Posttraumatic stress disorder (PTSD)
A sleep disorder such as apnea or restless legs syndrome

Symptoms of insomnia

The symptoms of insomnia can include:

Trouble falling asleep
Waking in the night
Trouble getting back to sleep
Waking up too early in the morning
Not feeling refreshed by sleep
Daytime tiredness
Low energy
Mood problems (irritability, depression)
Trouble concentrating

Diagnosing insomnia

Your healthcare provider will ask about your sleep pattern and your daily routine. Tell them how you feel during the day. They will ask about your medical history. Tell them about all your symptoms and any other health problems. Tell the healthcare provider about all medicines and supplements you take.

Your healthcare provider may ask that you do:

A sleep diary (for a week or more). A sleep diary helps you track information about your sleep. This includes information such as your bedtimes and wake times and how rested you feel.
A sleep study. This is a painless test done in a hospital or clinic overnight. It uses wires and electrodes attached to your body while you sleep. These measure brain waves and other signals from your body during sleep. This helps to diagnose medical sleep disorders but is not necessary for an insomnia diagnosis.

Different Types Of Insomnia

There are a few different types of insomnia. Each type is characterized by how long it lasts, how it affects your sleep, and the underlying cause.

Acute Insomnia

Acute insomnia is short-term insomnia that can last from a few days to a few weeks. It’s the most common type of insomnia. Acute insomnia is also referred to as adjustment insomnia because it typically occurs when you experience a stressful event, such as the death of a loved one or starting a new job.

Along with stress, acute insomnia can also be caused by:

environmental factors that disrupt your sleep, such as noise or light
sleeping in an unfamiliar bed or surroundings, such as a hotel or new home
physical discomfort, such as pain or being unable to assume a comfortable position
certain medications
illness
jet lag

Chronic Insomnia

Insomnia is considered chronic if you have trouble sleeping at least three days per week for at least one month.

Chronic insomnia can be primary or secondary. Primary chronic insomnia, which is also called idiopathic insomnia, doesn’t have an obvious cause or underlying medical condition. Secondary insomnia, also called comorbid insomnia, is more common. It’s chronic insomnia that occurs with another condition.

Common causes of chronic insomnia include:

chronic medical conditions, such as diabetes, Parkinson’s disease, hyperthyroidism, and obstructive and central sleep apnea, mental health conditions, such as depression, anxiety, and attention deficit hyperactivity disorder medications, including chemotherapy drugs, antidepressants, and beta-blockers
caffeine and other stimulants, such as alcohol, nicotine, and other drugs
lifestyle factors, including frequent travel and jet lag, rotating shift work, and napping

Onset Insomnia

Onset insomnia is trouble initiating sleep. This type of insomnia can be short-term or chronic.

Any of the causes of acute and chronic insomnia can make it difficult to fall asleep. Psychological or psychiatric issues are the most common causes. These include stress, anxiety, or depression. According to a 2009 study, people with chronic onset insomnia often have another sleep disorder, such as restless leg syndrome or periodic limb movement disorder.

Caffeine and other stimulants can also prevent you from falling asleep.

Maintenance Insomnia

Maintenance insomnia is difficulty staying asleep or waking up too early and having trouble getting back to sleep. This type of insomnia causes you to worry about not being able to fall back asleep and not getting enough sleep. This interferes with sleep further, creating a vicious cycle.

Maintenance insomnia can be caused by mental health conditions, such as depression. Other medical conditions that can cause you to wake up include:

gastroesophageal reflux disease
sleep apnea
asthma and other respiratory conditions
restless leg syndrome
periodic limb movement disorder

Sometimes Lifestyle Changes Alone Can Help With Insomnia

For a mild case of insomnia that’s only been a problem for a few days or weeks, doctors will first likely recommend making a few lifestyle changes to promote better sleep. Rita Aouad, MD, an assistant professor of sleep medicine at The Ohio State University Wexner Medical Center in Columbus, says she always starts with tweaking a person’s sleep hygiene, the daily habits and routines you follow that affect sleep.

Good sleep hygiene includes:

Sticking to a Sleep Schedule This means going to bed and waking up around the same time no matter if it’s Wednesday or Sunday.

Avoiding Anything That Could Mess With Your Ability to Fall Asleep This means substance as caffeine and tobacco, for instance, that can stay in your system for eight hours. And don’t rely on a nightcap, either. “Some people think alcohol can help with sleep onset, but it actually fragments your sleep,” Dr. Aouad says.

Not Exercising Too Late in the Day Ideally, you’ll hit the gym more than three hours before bedtime, Aouad says, otherwise, the activity can stimulate your body and make it tougher to fall asleep.

Limiting Daytime Naps to No More Than 30 Minutes Aouad suggests this.

Turning Off Electronics At Least One Hour Before Bedtime

Reserving the Bed Solely for Sleep and Sex

Creating a Sleep-Promoting Environment That’s Quiet, Dark, and Cool

And if you’re doing all that and still have trouble sleeping, keep a few tips in mind, such as don’t lie in bed for hours if you can’t sleep. “If it’s been 20 minutes and you’re frustrated you’re not asleep and you’re thinking, ‘Why am I not asleep yet?’ or ‘I need to do this, this, and this tomorrow’ — that’s counterproductive,” Aouad says.

You can start to work yourself up and associate the bed with not sleeping, making it tougher to fall asleep like you want to do. “Leave the bedroom and do something boring,” she says, such as washing the dishes or folding laundry until you start to feel tired.

Or, if it’s an anxious mind that’s keeping you up, try scheduling worry time for tomorrow. “The worries tend to come out at night when there are fewer distractions and you’re not busy with tasks,” Aouad says. By writing the worries down on paper and setting aside time to address them the following day, you’re more likely to be able to let them go and get some rest. “The goal is to control your worries and not have your worries control you,” Aouad says.

Cognitive Behavioral Therapy Is the Gold-Standard for Treating Chronic Insomnia

If improving sleep hygiene and other lifestyle changes alone don’t help with your sleep, the next step is cognitive behavioral therapy to improve sleep and reverse chronic insomnia. Aouad says it’s a better option than medication.

“Medication will help you as long as it’s in your system, so that’s a day or two,” she says. While there are some appropriate uses for prescription sleep aids (if they are used correctly), they can come with extremely dangerous side effects, and they tend to be highly addictive.

“The benefits of cognitive-behavioral therapy, a specific type of counseling to help with the anxiety around sleep that comes with chronic insomnia, have been shown to far outlast medication,” Aouad explains.

According to a study published in May 2012 in the journal BMC Family Practice, cognitive behavioral therapy is better at improving sleep efficiency than common drugs and led to an extra 30 to 60 minutes in sleep time when the two treatment strategies were compared.

Cognitive-behavioral therapy focuses on teaching techniques to help you relax, control your breathing and mood, slow down your racing mind, and get to sleep. “Really, the basis of it is providing education, talking about sleep drive and teaching people things like stimulus control and avoiding anything stimulating around bedtime,” Aouad says. Think of it as reteaching your body how to sleep.

The therapy also involves sleep restriction. “Some people have this misunderstanding that if I can’t sleep, then I should spend more time in bed to try to get myself to sleep,” Aouad says.

“Actually you should really only be in bed for the time that you’re sleeping.” The idea is by cutting down on the amount of time you spend lying in bed awake, you’ll be more tired and more likely to fall asleep quickly next time.

A study published in June 2015 in the journal Sleep found just one session of cognitive-behavioral therapy plus a self-help pamphlet effectively treated about half of the cases of acute insomnia. Aouad suggests seeking a therapist who has experience providing cognitive behavioral therapy for insomnia — the American Board of Sleep Medicine has a helpful list published on its website. Usually, it’s offered as a series of in-person sessions over the course of four to six weeks, though there are some online programs that could be helpful for people living in remote areas or for those without insurance, Aouad says.