Insomnia: What You Need to Know

Medically Reviewed by Jabeen Begum, MD on January 14, 2025
Written by Matt McMillen
15 min read

Insomnia is a sleep disorder in which you have trouble falling asleep, staying asleep, or waking up too early.

The condition can be short term (acute) or can last a long time (chronic). It may also come and go.

Acute insomnia lasts from one night to a few weeks. Insomnia is chronic when it happens at least three nights a week for three months or more.

Adults need seven to nine hours of sleep every day. While experts don't yet fully understand sleep's effects on the body, it is clear that getting inadequate sleep can do more than just make you feel tired during the day. Over time, it can be a threat to your health. For example, poor sleep has been linked to serious health problems such as high blood pressure, heart attack, and depression.

There are two types of insomnia: Primary and secondary.

Primary insomnia. This means your sleep problems aren't linked to any other health condition or problem.

Secondary insomnia. This means you have trouble sleeping because of a health condition (like asthma, depression, arthritis, cancer, or heartburn), pain, medication, or substance use (like alcohol).

You might also hear about:

Sleep-onset insomnia. This means you have trouble getting to sleep.

Sleep-maintenance insomnia. This happens when you have trouble staying asleep through the night or wake up too early.

Mixed insomnia. With this type of insomnia, you have trouble both falling asleep and staying asleep through the night.

Paradoxical insomnia. When you have paradoxical insomnia, you underestimate the time you're asleep. It feels like you sleep a lot less than you really do.

The causes depend on whether you have primary insomnia or secondary insomnia, also called comorbid insomnia because it develops as a result of another health condition. Many of these causes can be addressed, such as lifestyle habits and treating ongoing medical problems. However, some causes can't be changed, such as your genes.

Causes of primary insomnia include:

  • Stress related to big life events, like a job loss or change, the death of a loved one, divorce, or moving
  • Your sleep environment, or the things around you while you are trying to sleep, like noise, light, or a room temperature that's either too hot or too cold for you to sleep comfortably
  • Changes in your sleep schedule like jet lag, a new shift at work, waking up to care for a new baby, or moving to a new home
  • Your genes, as research has found that a tendency for insomnia may run in families
  • Eating too close to bedtime, which can leave you feeling quite uncomfortable when lying in bed and prevent sleep, as can heartburn, which also may happen after overeating
  • Caffeine and nicotine, which are both stimulants and can keep you up if you consume them too soon before bedtime
  • Alcohol, which can interfere with your ability to get deep, restful sleep and may cause you to wake up during the night
  • Not getting enough exercise or other physical activity in the daytime

Your sleep habits, or sleep hygiene, play a major role in how well you sleep. The following habits can lead to insomnia:

  • Going to bed at different times rather than sticking to a regular sleep schedule
  • Waking up at different times from day to day
  • Taking naps during the day
  • Being very active and having too little time to relax before your bedtime
  • Working, eating, or watching TV in bed
  • Too much screen time with your phone, TV, computer, or video games right before you try to fall asleep

If you share a bed with someone, that person's habits can affect your sleep. For example, if they snore, you might not be able to sleep.

Secondary causes of secondary insomnia include:

  • Mental health issues like depression and anxiety
  • Certain prescription and over-the-counter medications, including some for colds, allergies, depression, high blood pressure, and asthma
  • Pain or discomfort at night, such as that caused by back pain or arthritis
  • Substance use disorders, such as drug and alcohol abuse
  • Hyperthyroidism, or an overactive thyroid gland
  • Other sleep disorders, like sleep apnea or restless legs syndrome
  • Hormone changes that happen during menstruation, pregnancy, and menopause
  • Alzheimer's disease and other types of dementia
  • ADHD
  • Parkinson's disease
  • Cancer
  • Diabetes
  • Heart disease
  • Benign prostatic hyperplasia
  • Gastroesophageal reflux disease
  • Chronic obstructive pulmonary disease
  • Epilepsy

Insomnia affects women and people assigned female at birth (AFAB) more than men and people assigned male at birth and older people more than younger ones. Young and middle-age African Americans also have a higher risk of insomnia.

Other risk factors include:

  • Rising age, as insomnia becomes more common as you get older
  • Being a woman or person AFAB because hormonal changes during menstruation and menopause can disrupt sleep
  • Long-term illness, such as diabetes and heart disease
  • Mental health issues, such as depression and anxiety
  • Working night shifts or shifts that rotate
  • Frequent travel, which can disrupt your regular sleep pattern
  • Being a light sleeper
  • Drinking alcohol
  • Feeling unsafe in your home because of domestic violence or abuse
  • Having disorder sleep issues like nocturnal panic attacks or nightmare disorder that make you afraid or anxious about sleep

Insomnia in pregnancy

If you're pregnant, you're very likely to experience insomnia at some point during your pregnancy, particularly in the later stages. About 25% of pregnant people will have episodes of insomnia during their first trimester. By the end of the third trimester, that number rises to 80%.

The primary reason for insomnia in early pregnancy: Rising levels of the hormones estrogen and progesterone, which play a role in regulating your sleep cycle as well as your breathing pattern. In late pregnancy, the weight of the fetus becomes the culprit. It presses on your joints and back, making it very difficult to get comfortable. It also pushes against your bladder, which makes you need to get out of bed to pee more frequently. Other pregnancy-related factors include:

  • Vomiting and nausea due to morning sickness, which also can happen at night
  • Leg cramps or other leg discomforts
  • Back pain
  • Pain in your round ligaments, which are bands on either side of your uterus
  • Contractions
  • Movement of your fetus
  • Shortness of breath
  • A faster than normal heartbeat
  • Heartburn

Insomnia has many symptoms. These symptoms can be divided into two categories according to how they affect you: During the night as you try to sleep and the impact your insomnia has on your day after a night of lost sleep.

Trouble sleeping

These signs of insomnia are classified by when your sleep problems happen.

  • Initial insomnia. Also called sleep onset insomnia, this is difficulty falling asleep.
  • Middle insomnia. Also called maintenance insomnia, this is difficulty staying asleep through the night.
  • Late insomnia. Also called early wake insomnia, this causes you to wake up earlier than normal.

Daytime effects

These signs of insomnia result from lack of sleep caused by your insomnia.

  • Feeling run down, fatigued, or generally unwell
  • Slower reflexes, such as while you're driving
  • Difficulty concentrating and remembering things
  • Confusion and trouble putting thoughts together
  • Mood changes, such as irritability or feelings of depression or anxiety
  • Disruptions in your day to day life, such as at work, in your social life, and with your hobbies

Diagnosing insomnia involves several steps, including questionnaires, medical tests, and more. Your doctor will determine what types of tests you require, but in general you can expect the following:

Initial exam

Your doctor will do a physical exam and ask about your medical history, sleep history, and symptoms. You'll discuss how often you have trouble sleeping, how long these troubles have been happening, and the impact your sleep problems have on your daily life, as well as lifestyle factors like how often you drink alcohol, the level of stress you experience, whether you've had significant changes in your life recently, and more.

Your physical exam and health history may identify illnesses that could explain your insomnia. For example, a blood test could reveal the culprit to be an overactive thyroid.

Sleep diary

Your doctor may ask you to keep a sleep diary for two weeks. During this time, you will keep a daily record of the following:

  • What time you went to bed
  • How long it took you to fall asleep
  • How many times you woke up during the night
  • When you got up in the morning
  • What times you consumed caffeine and alcohol

If you share your bed with someone, your bed partner may be asked to describe your sleep behavior.

Insomnia test

You can't diagnose insomnia with a test, but your doctor may have you undergo certain tests to rule out other conditions that could be causing your symptoms. For example, you may undergo a sleep study, also called polysomnography, to determine if you have a sleep disorder like sleep apnea, narcolepsy, or restless leg syndrome. This takes place in a sleep center, where you will spend the night while medical staff monitor and record the following:

  • Brain activity
  • Breathing
  • The movement of your body
  • Your heartbeat
  • Your eye movements

Another test your doctor may recommend: actigraphy. This involves wearing a watch-sized device on your wrist or ankle to track your movements while you're in bed. You'll wear the device for up to two weeks. It may be used in conjunction with a sleep diary because the device will record your movements in bed so that you don't have to. Actigraphy can tell you the following:

  • When you fell asleep and how long it took you do so
  • How long you slept and whether and when you woke up during the night
  • How long you remained awake if you woke up during the night
  • When you woke in the morning

Insomnia doesn't always require treatment. If it's short-term (acute) insomnia caused by stress or by changes in your environment or schedule, for example, when traveling, your insomnia may last only a few days or weeks before clearing up on its own.

If your insomnia lasts longer than a few weeks and happens several nights a week, meaning it has become chronic, your doctor may recommend the following approaches.

Better sleep hygiene

Your doctor likely will recommend that you focus first on improving your sleep hygiene, which includes:

  • Go to bed and get up at the same times each day.
  • Set your thermostat to a comfortable temperature for sleeping.
  • Make sure your room is dark and quiet.
  • Don't drink alcohol or caffeinated beverages close to bedtime, and avoid nicotine as well.
  • Exercise regularly during the day, at least five hours before you plan to go to bed.
  • Don't nap, especially in the afternoon.
  • Keep your meal times consistent, and don't eat too close to bedtime.
  • Drink less liquid close to bedtime so you don't have to pee during the night.
  • Relax before bedtime with a book, bath, or other low-key activity. Meditation also can help.
  • Ask your doctor if any of your medications — prescription or over the counter — could be keeping you up.

Cognitive behavioral therapy (CBT)

If your insomnia doesn't improve after changing your sleep habits, reducing stress, or addressing underlying health conditions, your doctor may recommend CBT, a type of psychotherapy. It helps you address worries and other negative thoughts that make it hard to sleep, and it teaches and reinforces good sleep habits. There are several approaches, including:

  • Stimulus control therapy, in which you use your bed only for sleep and sex. If you can't fall asleep within 20 minutes, you'll get up and leave your bedroom until you're sleepy again.
  • Relaxation techniques, such as breathing exercises and progressive muscle relaxation, can ease anxiety and help you sleep.
  • Sleep restriction, in which you spend less time than usual in bed and avoid naps. Doing so will make you more sleepy at night.
  • Paradoxical intention, or remaining passively awake, which involves being in bed but not trying to sleep. This may help lower your anxiety over not being able to sleep, eventually making sleep more likely.
  • Light therapy, which involves using light to reset your internal sleep clock if you fall asleep or wake up too early.

Insomnia medication

If it's hard for you to do everyday activities because you're tired, your doctor may prescribe sleeping pills for a short time.

Drugs won't cure your insomnia, but they can help you fall asleep, stay asleep, or both. If your doctor prescribes a medication, it likely will be just one part of your treatment plan. Keep in mind that these medications, like all medications, come with side effects. For example, they can make you groggy during the day, which raises your risk of falling. Sleep medications also can be habit forming. Discuss these risks with your doctor.

There are different types of prescription sleep aids. They include:

Sedative hypnotics

These drugs slow down your brain's activity, helping you fall asleep and stay asleep. However, some of these drugs can lead to dependence, meaning it may become difficult to sleep without them. They also may require higher and higher doses to be effective. There are a few different kinds.

Benzodiazepines act on a brain chemical called GABA to help you relax and become calm. This class of drug, introduced in the 1960s, comes with a variety of potential side effects, including:

  • Breathing problems
  • Worsening depression
  • Daytime drowsiness
  • Sleep walking, sleep driving, and eating while still asleep
  • Memory problems
  • Urinary incontinence

These drugs should not be used by pregnant people due to the risk of birth defects, and they should not be mixed with alcohol.

Nonbenzodiazepines are a newer class of drug that also acts on GABA and are usually the first type prescribed for insomnia. Your doctor likely will prescribe them for a week to 10 days, but not more than a month. They have fewer side effects than benzodiazepines, but you should be aware that they can cause:

  • Daytime drowsiness and fatigue
  • Dizziness
  • Headaches
  • Constipation or diarrhea

They should not be mixed with alcohol.

Melatonin receptor agonists affect melatonin, a hormone involved in sleep that's produced in your brain. Currently, only one has been approved by the FDA for insomnia: ramelteon (Rozerem). It is not habit forming. Its most common side effects are dizziness and drowsiness.

Dual orexin receptor antagonists block a brain chemical called orexin, which is involved in sleep and wakefulness. They do have the potential to be abused, and you can become dependent on them. The side effects are similar to other sleep medications and can cause sleep driving and other dangerous behaviors while still sleeping.

Non-prescription sleep medications

Over-the-counter sleep aids also are available. They typically contain an antihistamine that will make you drowsy. Though you can buy them without a prescription, you should talk to your doctor first, as they can cause side effects, such as:

  • Daytime drowsiness
  • Confusion and other problems with thinking
  • Dizziness
  • Difficulty peeing

Too little research has been done to determine whether herbs and supplements truly help with insomnia. If you do decide to try them, talk to your doctor first. They may interact with drugs you already take. These herbs and supplements include:

  • Melatonin, which may help you fall asleep more quickly. Whether it's safe to use for more than a few weeks remains unknown.
  • Valerian root, a mild sedative which may improve the quality of your sleep. There's some concern that high doses or long term use may be linked to liver damage.
  • Acupuncture, which has not been shown to improve insomnia but remains a popular remedy.
  • Yoga and tai chi, which some studies suggest may help you sleep better if practiced on a regular basis; however, there's not enough research to recommend it for insomnia.
  • Meditation, which some research suggests could help you sleep better if practiced alongside more conventional insomnia treatment.

Our bodies and brains need sleep so they can repair themselves. It's also crucial for learning and keeping memories. If insomnia is keeping you awake, it can lead to:

  • A higher risk of health problems like high blood pressure, obesity, and depression
  • A higher risk of falling
  • Trouble focusing
  • Anxiety, depression, and thoughts of suicide, as well as problems managing substance use disorders
  • Grumpiness
  • Slow reaction time while driving that can lead to a car crash
  • A higher risk of asthma or other breathing problems
  • A weakened immune system, making you more vulnerable to illness and less able to fight infection, as well as raised inflammation
  • Metabolism problems due to insomnia's impact on hunger hormones and your digestion, which can lead to overweight, obesity, metabolic syndrome, and diabetes
  • Worsening of chronic pain if you already have this condition
  • Problems during pregnancy, such as low birth weight, preterm delivery, raised pain during childbirth, and a higher likelihood you will need a cesarean section (C-section)

Good sleep habits, also called sleep hygiene, can help you prevent insomnia. Here are some tips:

  • Go to sleep at the same time each night, and get up at the same time each morning.
  • Try not to take naps during the day because they may make you less sleepy at night.
  • Don't use phones or e-books before bed. Their light can make it harder to fall asleep.
  • Avoid caffeine, nicotine, and alcohol late in the day. Caffeine and nicotine are stimulants and can keep you from falling asleep. Alcohol can make you wake up in the middle of the night and hurt your sleep quality.
  • Get regular exercise. Try not to work out close to bedtime because it may make it hard to fall asleep. Experts suggest exercising at least three to four hours before bed.
  • Don't eat a heavy meal late in the day. But a light snack before bedtime may help you sleep.
  • Make your bedroom comfortable: Dark, quiet, and not too warm or too cold. If light is a problem, use a sleeping mask. To cover up sounds, try earplugs, a fan, or a white noise machine.
  • Follow a routine to relax before bed. Read a book, listen to music, or take a bath.
  • Don't use your bed for anything other than sleep and sex.
  • If you can't fall asleep and aren't drowsy, get up and do something calming, like reading until you feel sleepy.
  • If you tend to lie awake and worry about things, make a to-do list before you go to bed. This may help you put your concerns aside for the night.
  • Go easy on all liquids in the evening so you don't need to get up to pee during the night.

The same sleep habits that will help you prevent insomnia also can help if you already have it. In addition to practicing good sleep hygiene as outlined above, you also should do the following:

  • Talk to your doctor if your insomnia does not improve or gets worse.
  • Stick with your insomnia treatment plan even if your sleep improves.
  • Manage any health conditions that may be contributing to your insomnia.
  • Find ways to cope with stress, a common cause of insomnia.
  • Be patient because treating chronic insomnia may take months.

Insomnia does more than ruin your night's sleep. It raises your risk of serious health problems. However, treatment can be very effective. It will involve identifying and managing the causes of your insomnia, such as stress or underlying health conditions. Talk to your doctor if you struggle to sleep.

How do you fix insomnia?

It depends on what caused it. If it's triggered by a medical condition, for example, treating that condition likely will return your sleep to normal. Long-term, or chronic, insomnia not caused by a health problem can be more challenging to treat. In addition to practicing good sleep habits, you may benefit from psychological counseling and short-term use of sleep medications.

Will my insomnia go away?

In most cases, yes. If your insomnia was caused by stress, you should sleep better once that stress goes away. If you require treatment for chronic insomnia, it can be very effective. For example, about four out of five people who undergo CBT will no longer struggle with insomnia.