Insomnia: causes, symptoms and sleep habits that help explained

Many people have a poor night now and then. Insomnia is different because the trouble happens regularly and starts to affect how you feel and function in the day. This article explains what insomnia is, what can cause it, how it is assessed and which habits are recommended, using information from the NHS, MedlinePlus and the US National Heart, Lung, and Blood Institute.

1. Introduction

The NHS describes insomnia as regular difficulty sleeping, and says it often improves when a person changes their sleep habits ^[1]. MedlinePlus defines it as a common sleep disorder in which a person has trouble falling asleep, staying asleep, or both, which can lead to too little or poor quality sleep ^[2].

Sleep needs differ from person to person. The NHS gives general averages of 7 to 9 hours for adults, 9 to 13 hours for children and 12 to 17 hours for babies and toddlers. Feeling constantly tired in the day suggests you may not be getting enough sleep ^[1].

2. Types of insomnia

Insomnia is grouped by how long it lasts and by its cause.

• Short-term (acute) insomnia lasts days or weeks. MedlinePlus says it is common and is often linked to work stress, family pressures or a traumatic event ^[2].
• Long-term (chronic) insomnia lasts longer. The NHS counts it as 3 months or more ^[1], and the NHLBI describes it as happening at least three nights a week for more than three months ^[3].
• Secondary insomnia is the most common chronic form. It is a symptom or side effect of another problem, such as a medical condition, a medicine, another sleep disorder or use of substances like caffeine, tobacco and alcohol ^[2].
• Primary insomnia is not caused by another problem. Its cause is poorly understood, although long-lasting stress, emotional upset, travel and shift work may play a role ^[2].

3. Signs and symptoms

According to the NHS, you may have insomnia if you regularly ^[1]:

• find it hard to fall asleep
• wake several times in the night or lie awake
• wake early and cannot get back to sleep
• feel tired and unrefreshed after waking
• feel irritable or find it hard to concentrate during the day

MedlinePlus adds that insomnia can bring daytime sleepiness, low energy, anxiety, low mood and problems with memory and learning. It can also raise the chance of drowsy driving ^[2].

4. Causes and risk factors

The NHS lists common triggers including stress, anxiety or depression, noise, an uncomfortable room temperature or bed, alcohol, caffeine and nicotine, jet lag and shift work ^[1]. Some health problems can also disturb sleep, such as long-term pain, an overactive thyroid, restless legs syndrome (an urge to move the legs), sleep apnoea (breathing that stops and starts in sleep), menopause and some mental health conditions. Many medicines can cause insomnia too ^[1].

MedlinePlus notes that insomnia is more common in women, in older adults, in people under high stress or emotional strain, in night workers, in frequent long-distance travellers and in people with an inactive lifestyle ^[2].

5. Diagnosis and tests

A health professional usually takes a medical history, asks about your sleep history and habits and may carry out a physical examination to rule out other medical problems ^[2]. The NHLBI says you may be asked to keep a sleep diary, which is a daily record of when you sleep and wake ^[3]. If another sleep disorder such as sleep apnoea is suspected, the NHS says a doctor may refer you to a sleep clinic ^[1]. MedlinePlus says a sleep study, which measures sleep quality and how the body responds to sleep problems, may sometimes be advised ^[2].

6. Treatment and management

Your doctor decides what is right for you, and the first step is often to look for an underlying cause ^[1]. The sources describe these approaches:

• Healthy sleep habits. MedlinePlus says good sleep habits often help short-term insomnia ^[2].
• Cognitive behavioural therapy for insomnia (CBT-I). This talking therapy helps change thoughts and behaviours that interfere with sleep. The NHS says it can be delivered in person or through an online programme ^{[1, 3]}.
• Treating the other problem. If insomnia is secondary, treating the other condition is important where possible ^[2].
• Medicines. The NHLBI and MedlinePlus say medicines are sometimes used ^{[2, 3]}. The NHS notes that sleeping pills are now rarely prescribed because of serious side effects and the risk of dependence, and that they are usually limited to a few days or weeks ^[1]. Only a doctor can decide whether a medicine is suitable.

The NHS also says pharmacy sleep aids are meant only for short use, may cause drowsiness that makes driving unsafe, and should be checked with a doctor first ^[1]. Tell your doctor about every product you take, including herbal ones.

7. Prevention and self-care

The NHS suggests these habits ^[1]:

• Go to bed only when sleepy and get up at the same time each day.
• Wind down for at least an hour before bed.
• Keep the bedroom dark, quiet and comfortable.
• Take regular exercise during the day, but avoid it in the 4 hours before bed.
• Avoid smoking, alcohol, tea and coffee in the 6 hours before bed.
• Avoid large late meals, screens right before bed and daytime naps.
• Do not sleep in after a poor night, because it disturbs your routine.

8. Why it matters

The NHLBI notes that chronic insomnia is linked to a higher risk of high blood pressure, coronary heart disease, diabetes and cancer ^[3]. Daytime tiredness can also make driving and other daily tasks less safe ^{[1, 2]}. This is one reason not to ignore long-lasting sleep problems.

9. When to see a doctor

The NHS advises seeing a doctor if changing your sleep habits has not helped, if sleep problems have lasted for months, or if insomnia is affecting your daily life and your ability to cope ^[1]. Poor sleep can go together with anxiety and low mood ^{[1, 2]}. If you are in distress or having thoughts of suicide or self-harm, reach out for help right now. In India, call Tele-MANAS on 14416. In the United States, call or text 988. You do not have to cope alone.

In an emergency, call your local emergency number (112 in India, 911 in the United States).

10. Conclusion

Insomnia is a common problem with many possible causes, from stress and caffeine to other health conditions and medicines. Regular sleep habits and cognitive behavioural therapy are widely recommended, and a doctor can look for an underlying cause and decide on any further treatment. If sleep problems are lasting or affecting your life, seek advice rather than waiting.