What is insomnia?

Do you struggle to fall asleep at bedtime or have a hard time getting back to sleep if you’ve woken up at night? If so, you may be living with insomnia.

Insomnia¹ is the inability to fall or stay asleep, leading to non-restorative sleep. People with insomnia usually have difficulty falling asleep. Insomnia often causes you to wake up too early, feeling tired or not well-rested no matter how much sleep you’ve gotten. This condition can be extremely draining. It may affect not just your daily mood, but also your physical and emotional health, productivity, and overall quality of life.

Many adults will experience a disruption in their sleep cycle from time to time. This can lead to acute (short-term) insomnia, which lasts for a few days or weeks. Others, however, may suffer from chronic (long-term) insomnia that lasts for months or even years.

Although it’s more commonly seen in adults, insomnia can also affect children. It may come on as early as infancy and continue throughout adolescence. In some cases, insomnia in children may develop into a long-term problem.

The causes, symptoms, and severity of insomnia vary from person to person. Additionally, different individuals may need different amounts of sleep to feel refreshed. While adults typically need seven to eight hours of sleep a night, some may feel well-rested in six, while for others, eight hours is barely enough. Because of these natural differences, insomnia is defined by a person’s sleeping behaviors rather than the duration of their sleep.

How common is insomnia?

According to the National Institute of Health (NIH), insomnia is the single most common sleep complaint, affecting as much as 30% of the adult population². Additionally, approximately 10% of people show insomnia-related symptoms during the daytime.

In a 2005 poll conducted by the National Sleep Foundation (NSF)³, more than 50% of respondents said they had experienced at least one symptom of insomnia (such as struggling to fall asleep, frequently waking up at night, waking up too early and having difficulty getting back to sleep, or waking up tired or unrefreshed) for at least a few nights per week in the past year. Up to 33% reported having had at least one of these symptoms almost every night of the previous year. The most common symptoms experienced by respondents were frequent nighttime awakenings and waking up tired or unrefreshed.

Insomnia is more common in women than in men. This is likely because hormonal changes during the menstrual cycle, pregnancy, and menopause can cause the symptoms of insomnia. In the United States, more than one in four women⁴ lives with the condition, compared to fewer than one in five men. Additionally, while older women are at a higher risk of having insomnia, one study found that women of all ages reported worse sleep quality than men (including sleeping for shorter periods of time, taking longer to fall asleep, and feeling more tired when awake).

In other polls⁵, 68% of adults between the ages of 18 and 29 reported having symptoms of insomnia, compared to 59% of those aged 30–64 and only 44% of those older than 65. This is an interesting trend, as previous studies have shown older people to be at a greater risk for insomnia.

The stress of having children may also contribute to insomnia: 66% of parents have reported symptoms of insomnia, compared to 54% of adults without children.

Insomnia causes

There are many potential causes of insomnia, ranging from psychiatric and physical health conditions to biological factors and lifestyle choices. Some potential causes of insomnia include⁶:

• Health conditions: A wide variety of health conditions, both mild and severe, can cause insomnia. In certain cases, insomnia is a direct symptom of the condition, while in others, the discomfort caused by the symptoms of the condition makes it difficult to experience restorative sleep. Some conditions associated with insomnia include nasal allergies (hay fever), gastroesophageal reflux disease (GERD), hyperthyroidism, asthma, arthritis, Parkinson’s disease, chronic pain, and lower back pain.

• Medications: Some medicines may trigger insomnia, including those used for heart disease, thyroid disease, asthma, birth control, depression, high blood pressure, nasal allergies (hay fever), and the common cold.

• Sleep disorders: Insomnia may also be caused by underlying sleep disorders, such as restless legs syndrome (RLS). RLS⁷ is a neurological condition characterized by an uncomfortable sensation that causes the patient to almost incessantly move their legs. The sensation typically occurs during periods of inactivity (such as while sitting or lying down) and may worsen later in the day. This makes it difficult for people with the condition to fall and stay asleep.

  Another sleep disorder known to cause insomnia is sleep apnea. In people with sleep apnea, the airways are partially or completely obstructed during sleep, leading to breathing problems and lowered blood oxygen levels. This causes one to wake up for brief periods of time frequently throughout the night, which may cause insomnia in some people.

• Depression: Insomnia and depression have been found to be closely interconnected: having either one of the conditions may trigger or worsen the other. While the psychological and emotional struggles associated with depression can cause sleeping problems, insomnia can also affect mood, hormones, and physiology, contributing to or worsening mental health conditions like depression.

• Anxiety: Most adults lose some sleep from time to time due to worry and nervousness. For some, however, anxiety is a daily struggle that interferes with their sleep on an ongoing basis. If not promptly addressed, anxiety and insomnia can cause an individual to become anxious at the very thought of sleeping, making it even more difficult to fall asleep.

  It’s important to understand what is causing your anxiety and address it as quickly as possible. Some signs of anxiety that can cause sleeplessness include tension over an upcoming event, fixation on particular memories, worry, feeling overwhelmed, and overstimulation (being too excited).

• Lifestyle: A person’s sleep behaviors and patterns can trigger and perpetuate insomnia. Some of these behaviors include:

  • Working late into the night, which causes the brain to remain alert when bedtime comes
  • Taking naps, which can make it more difficult to fall asleep at night
  • Sleeping in to make up for lost sleep
  • Eating heavy meals right before bed

  Shift workers may also experience insomnia due to their unusual work-sleep schedules.

• Alcohol: While alcohol is a sedative that can help you fall asleep faster, it can also disrupt your sleep later in the night, triggering insomnia.

• Caffeine: Many people use caffeine to help them stay alert and feel productive during the day. However, excess consumption of caffeine can cause insomnia. A 2005 study by the NSF found that drinking four or more cups of caffeinated beverages on a daily basis increases the risk of insomnia.

Since the effects of caffeine are long-lasting (it can stay in the system for up to eight hours), it’s best to avoid consuming caffeinated foods or drinks close to your bedtime—especially if you have insomnia.

• Nicotine: Like caffeine, nicotine is a stimulant. Consuming nicotine through cigarettes and tobacco products near bedtime can make it hard for you to fall and stay asleep.
• Brain chemistry: Recently, researchers have begun to look into how chemical interactions in the brain cause insomnia. These interactions could explain why some people seem to struggle with the condition even after years of practicing healthy sleeping habits.

Pregnancy insomnia

Insomnia is a common occurrence during pregnancy, affecting approximately 78% of expectant mothers⁸. Luckily, insomnia isn’t harmful to an unborn child. However, it’s important that a pregnant mother learn how to cope with insomnia in order to get a good night’s sleep.

There are many causes of pregnancy insomnia, including:

• Discomfort caused by the distension (swelling) of the abdomen
• Frequent nighttime urination
• Anxiety
• Excitement over the arrival of the baby
• Back pain: In a study by Yale University School of Medicine, out of 950 pregnant women, about 68% reported back pain⁹, with most saying it caused sleep disturbances.

• Heartburn: During pregnancy, the lower esophageal sphincter (LES) may become loose, allowing stomach acid into the food pipe and causing heartburn.
• Hormonal changes
• Dreams, which may be frequent and vivid
• A kicking baby
• Snoring: Increased swelling in the nasal passages can block airways and cause snoring, which can lead to more complications. Severe blockages may lead to sleep apnea.
• Leg cramps and RLS: Most pregnant women experience cramps in their lower leg muscles during the second and third trimesters. These cramps (which occur as painful spasms) are common at night, potentially disrupting your sleep. RLS is usually experienced by pregnant women in their third trimester.

There are a few things you can do to manage pregnancy insomnia, including:

• Changing sleeping positions: Sleep on your side to allow blood flow into your uterus and kidneys. Avoid lying on your back for long periods of time.
• Perform relaxation exercises before bed: You may have learned a few relaxation exercises in childbirth class. A warm bath and massage should also help you relax and get ready for bed.
• Make your room comfortable for sleeping: Adjust the heat and play relaxing sounds that can help you fall asleep.
• Do a relaxing activity: If you can’t sleep, get up and do a light exercise or read a book. You can also eat a snack or drink warm milk.
• Take short naps If you can, take a short nap during the day. Be careful not to interfere with your nighttime sleep schedule, however, as long naps may make it more difficult to fall asleep at night.

Risk factors for insomnia

The following factors¹⁰ can increase your likelihood of having insomnia:

• Age: Generally, people above the age of 60 are more likely to develop insomnia than younger people. This may be due to bodily changes that occur as a result of aging, as well as certain medications and underlying medical conditions.
• Chronic illnesses: Health conditions that cause chronic pain may trigger or contribute to insomnia. Some of these illnesses include diabetes, lung disease, kidney disease, Parkinson’s disease, Alzheimer’s disease, heart disease, gastroesophageal reflux disease (GERD), RLS, fibromyalgia, sleep apnea, and arthritis.
• Biological sex: As previously mentioned, hormonal changes cause women to suffer from insomnia at higher rates than men.
• Psychological factors: Stress is the most common cause of acute (short-lived) insomnia. Mental health conditions, such as depression, anxiety disorders, and bipolar disorder, may also cause insomnia.
• Jet lag: It’s typical to experience short-term sleep difficulties when traveling across multiple time zones in a short period of time.
• Irregular job schedule: If you work night shifts, your biological clock may be disrupted, leading to sleeping problems like chronic insomnia.

The more risk factors you have, the higher your chances of developing insomnia. If you have one or more of the factors mentioned above, consult your healthcare provider on what you can do to reduce your risk of developing insomnia.

Insomnia symptoms

People with insomnia may experience one or more of the following symptoms¹¹:

• Difficulty falling asleep
• Difficulty staying asleep
• Waking up earlier than usual
• Non-restorative (unrefreshing) sleep
• Decreased productivity
• Fatigue
• Low energy and lack of motivation
• Irritability, aggression, and impulsiveness
• Relationship problems with family, friends, spouses, and caregivers
• Difficulty concentrating

If you’re experiencing these symptoms and have tried to make adjustments on your own without success, talk to a healthcare provider to see what can be done. The amount of time for which you’ve been experiencing these symptoms will help the provider determine whether you have acute or chronic insomnia. Generally, insomnia is considered chronic if it occurs for at least three nights a week for three or more consecutive months.

Complications from insomnia

Many people with insomnia don’t get enough high-quality sleep. This can lead to serious health complications, including¹²:

• Heart disease: Lack of proper sleep has been shown to increase the risk of both cardiovascular disease and coronary disease. While it’s not clear how unhealthy sleep habits weaken the health of the heart, researchers have found that undersleeping and oversleeping cause disruptions in a number of biological processes, including glucose metabolism and blood pressure. Moreover, people with sleep apnea often report having compromised heart health.
• Stroke: According to the American Heart Association (AHA)¹³, insomnia can significantly increase the risk of stroke, especially in younger people. The link between these two conditions isn’t fully understood yet. However, research shows that insomnia may interfere with cardiovascular health¹⁴ through systemic inflammation, increased blood pressure, sympathetic hyperactivity, and impaired glucose tolerance.

• Diabetes: Sleep deprivation is a significant (but often overlooked) risk factor¹⁵ for type 2 diabetes. This is due to the fact that insufficient sleep disrupts the balance of hormones in the body. A persistent lack of sleep causes a decrease in the amount of insulin (the hormone that regulates blood sugar levels) released in the body after eating. With less insulin in the bloodstream when it’s needed most, the body’s ability to process glucose (sugar) declines, increasing the risk of diabetes.

• Obesity: Sleep deprivation has been termed the “royal route to obesity.”¹⁶ Studies have shown that insufficient sleep can impair metabolism and cause hormonal imbalances within just a matter of days. Inadequate sleep has also been linked to increased appetite: the fatigue that results from not getting enough sleep is often mistaken for hunger, causing the individual to eat. Over time (especially coupled with little to no physical exercise), this can result in weight gain.

• Depression: Insomnia and depression are so interlinked that the presence of one influences the other. Addressing insomnia as early as possible may help prevent depression from worsening (and vice versa).
• Injury: The fatigue caused by insomnia can increase the risk of hurting yourself or others. Drowsiness or fatigue while driving, for instance, could lead to a car accident.