How do you know if you have insomnia and what to do about it?

Overview

If you have trouble falling or staying asleep, or if your sleep is not refreshing, you may be suffering from insomnia. The condition also includes sleep that is of poor quality, resulting in excessive daytime sleepiness. It is the most common sleep disorder and affects almost everyone at some point in our lives. There may be recognizable factors that disrupt sleep, such as a poor sleeping environment, pain, stress, or getting up to urinate (nocturia). For example, insomnia may be episodic and only occur during periods of stress, but if it persists chronically at least three nights a week for at least three months, treatment may be necessary.

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Types

There are two types of insomnia: acute (short-term) or chronic (persistent). Other sleep disorders can have insomnia as a part, including:

Regardless of the type of insomnia you experience, you can discover solutions and effective treatments.

prevalence

Insomnia is one of the most common medical complaints. It is estimated that about 20% of American adults experience insomnia.

Women are more likely to report insomnia. Insomnia becomes more common as we get older. People who are unemployed, live alone and have a lower socio-economic status also have more complaints about insomnia.

Symptoms

Insomnia is characterized by difficulty falling or staying asleep or by poor quality sleep. It may be associated with waking up in the early morning. However, there are other symptoms that may be related to insomnia. These symptoms include:

  • Excessive daytime sleepiness
  • Fatigue
  • Malaise (feeling unwell)
  • Difficulty concentrating or paying attention
  • Mood problems (anxiety or depression)
  • Headache
  • Reduced energy
  • Difficulty at work, school, or social activities
  • upset stomach

It’s no surprise that if we don’t sleep well, we don’t feel well when we’re awake.

Causes

Most acute insomnia is caused by stress, while most cases of chronic insomnia are secondary, or a symptom or side effect of another problem. Insomnia can occur in the context of other sleep disorders (usually sleep apnea and restless leg syndrome), general medical conditions (especially those that cause pain), or illnesses. The triggers can be temporary or persistent.

Insomnia can be the result of stress. Losing a job with financial problems, the death of a loved one, or a divorce can cause stress, which in turn causes insomnia. It can be associated with other psychiatric problems, such as anxiety or depression, post-traumatic stress disorder (PTSD), or even neurological conditions such as dementia.

Insomnia can result from the use of certain prescription or over-the-counter medications or street drugs. It can also occur during withdrawal from certain substances. Insomnia can occur due to shift work or travel (as with jet lag). It can occur temporarily if caffeine or cigarettes are consumed too close to bedtime or as a result of other poor sleep habits. People with insomnia often spend too much time in bed while awake. Limiting time spent in bed can restore a consistent sleep schedule.

While insomnia is unlikely to occur due to a vitamin deficiency, it often occurs when the sleeping environment is disrupted, such as when pets, television, or other devices are present.

Insomnia may not have a recognized cause.

Diagnosis

Most people with insomnia can be diagnosed after a short talk with their doctor. However, several tests are available to diagnose insomnia if they are needed. Some of these are:

Additional tests are often needed if another condition is suspected, such as sleep apnea, narcolepsy, or circadian arrhythmias.

Therapy

medication

If insomnia results in disrupted daytime function, especially if it persists chronically, treatment may be necessary. There are many effective drugs that can be useful for short-term use. Two main classes include benzodiazepine and non-benzodiazepine medications. Some of these prescription and over-the-counter medications include:

Non-medication

There are also alternatives to drug treatment, including making changes in behavior or sleeping habits. Some of the most common alternative therapies for insomnia include:

A word from Verywell

Insomnia is the most common sleep complaint and affects almost everyone at some point in our lives. It can appear in multiple subtypes or even as part of other sleep disorders or medical conditions. There may be associated symptoms, such as problems with memory, concentration, and mood. Insomnia can be caused by many things and a careful evaluation by a doctor is usually enough to make a diagnosis.

Occasionally, further tests may be indicated. Fortunately, there are effective treatments for insomnia, including many prescription and over-the-counter sleeping pills, as well as alternative therapies, such as improving sleep habits or the sleeping environment.

If it persists, cognitive behavioral therapy for insomnia (CBTI) may be the most effective treatment option. Our Doctor Discussion Guide below can help you start that conversation with a doctor to find the best treatment option.

Insomnia Doctor Discussion Guide

Get our printable guide to your next doctor’s appointment to help you ask the right questions.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to back up the facts in our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable and trustworthy.

  1. National Heart, Lung and Blood Institute. Insomnia.

  2. Walsh JK, Coulouvrat C, Hajak G, et al. Nocturnal insomnia symptoms and perceived health in the America Insomnia Survey (AIS). sleep. 2011;34(8):997-1011. doi: 10.5665/SLEEP.1150

  3. Bollu PC, Kaur H. Sleep medicine: insomnia and sleep. Mo Med. 2019;116(1):68-75.

  4. Sleep Foundation. Cognitive behavioral therapy for insomnia (CBT-I).

  5. Pharmacy Times. FDA approves daridorexant for the treatment of insomnia.

  6. Merck Consumer Version Manual. Insomnia and excessive daytime sleepiness (EDS). Reviewed in May 2019.

Additional reading

  • American Academy of Sleep Medicine. “International Classification of Sleep Disorders: Guide to Diagnosis and Coding.” 2nd ed. 2005.
  • Ohayon, MM. “Epidemiology of Insomnia: What We Know and What We Still Need to Learn.” Sleep with Rev. 202; 6:97.
  • Shochat, T et al. “Insomnia in Primary Care Patients.” sleep. 1999; 22 Supplement 2:S359.

By Brandon Peters, MD

Brandon Peters, MD, is a board-certified neurologist and specialist in sleep medicine.

How do you know if you have insomnia and what to do about it?

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