Symptoms and causes

Symptoms

Insomnia symptoms may include:

  • Difficulty falling asleep at night
  • Waking up during the night
  • Waking up too early
  • Not feeling well-rested after a night's sleep
  • Daytime tiredness or sleepiness
  • Irritability, depression or anxiety
  • Difficulty paying attention, focusing on tasks or remembering
  • Increased errors or accidents
  • Ongoing worries about sleep

When to see a doctor

If insomnia makes it hard for you to function during the day, see your doctor to identify the cause of your sleep problem and how it can be treated. If your doctor thinks you could have a sleep disorder, you might be referred to a sleep center for special testing.

Causes

Insomnia may be the primary problem, or it may be associated with other conditions.

Chronic insomnia is usually a result of stress, life events or habits that disrupt sleep. Treating the underlying cause can resolve the insomnia, but sometimes it can last for years.

Common causes of chronic insomnia include:

  • Stress. Concerns about work, school, health, finances or family can keep your mind active at night, making it difficult to sleep. Stressful life events or trauma — such as the death or illness of a loved one, divorce, or a job loss — also may lead to insomnia.
  • Travel or work schedule. Your circadian rhythms act as an internal clock, guiding such things as your sleep-wake cycle, metabolism and body temperature. Disrupting your body's circadian rhythms can lead to insomnia. Causes include jet lag from traveling across multiple time zones, working a late or early shift, or frequently changing shifts.
  • Poor sleep habits. Poor sleep habits include an irregular bedtime schedule, naps, stimulating activities before bed, an uncomfortable sleep environment, and using your bed for work, eating or watching TV. Computers, TVs, video games, smartphones or other screens just before bed can interfere with your sleep cycle.
  • Eating too much late in the evening. Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable while lying down. Many people also experience heartburn, a backflow of acid and food from the stomach into the esophagus after eating, which may keep you awake.

Chronic insomnia may also be associated with medical conditions or the use of certain drugs. Treating the medical condition may help improve sleep, but the insomnia may persist after the medical condition improves.

Additional common causes of insomnia include:

  • Mental health disorders. Anxiety disorders, such as post-traumatic stress disorder, may disrupt your asleep. Awakening too early can be a sign of depression. Insomnia often occurs with other mental health disorders as well.
  • Medications. Many prescription drugs can interfere with sleep, such as certain antidepressants and medications for asthma or blood pressure. Many over-the-counter medications — such as some pain medications, allergy and cold medications, and weight-loss products — contain caffeine and other stimulants that can disrupt sleep.
  • Medical conditions. Examples of conditions linked with insomnia include chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson's disease and Alzheimer's disease.
  • Sleep-related disorders. Sleep apnea causes you to stop breathing periodically throughout the night, interrupting your sleep. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.
  • Caffeine, nicotine and alcohol. Coffee, tea, cola and other caffeinated drinks are stimulants. Drinking them in the late afternoon or evening can keep you from falling asleep at night. Nicotine in tobacco products is another stimulant that can interfere with sleep. Alcohol may help you fall asleep, but it prevents deeper stages of sleep and often causes awakening in the middle of the night.

Insomnia and aging

Insomnia becomes more common with age. As you get older, you may experience:

  • Changes in sleep patterns. Sleep often becomes less restful as you age, so noise or other changes in your environment are more likely to wake you. With age, your internal clock often advances, so you get tired earlier in the evening and wake up earlier in the morning. But older people generally still need the same amount of sleep as younger people do.
  • Changes in activity. You may be less physically or socially active. A lack of activity can interfere with a good night's sleep. Also, the less active you are, the more likely you may be to take a daily nap, which can interfere with sleep at night.
  • Changes in health. Chronic pain from conditions such as arthritis or back problems as well as depression or anxiety can interfere with sleep. Issues that increase the need to urinate during the night ―such as prostate or bladder problems ― can disrupt sleep. Sleep apnea and restless legs syndrome become more common with age.
  • More medications. Older people typically use more prescription drugs than younger people do, which increases the chance of insomnia associated with medications.

Insomnia in children and teens

Sleep problems may be a concern for children and teenagers as well. However, some children and teens simply have trouble getting to sleep or resist a regular bedtime because their internal clocks are more delayed. They want to go to bed later and sleep later in the morning.

Risk factors

Nearly everyone has an occasional sleepless night. But your risk of insomnia is greater if:

  • You're a woman. Hormonal shifts during the menstrual cycle and in menopause may play a role. During menopause, night sweats and hot flashes often disrupt sleep. Insomnia is also common with pregnancy.
  • You're over age 60. Because of changes in sleep patterns and health, insomnia increases with age.
  • You have a mental health disorder or physical health condition. Many issues that impact your mental or physical health can disrupt sleep.
  • You're under a lot of stress. Stressful times and events can cause temporary insomnia. And major or long-lasting stress can lead to chronic insomnia.
  • You don't have a regular schedule. For example, changing shifts at work or traveling can disrupt your sleep-wake cycle.

Complications

Sleep is as important to your health as a healthy diet and regular physical activity. Whatever your reason for sleep loss, insomnia can affect you both mentally and physically. People with insomnia report a lower quality of life compared with people who are sleeping well.

Complications of insomnia may include:

  • Lower performance on the job or at school
  • Slowed reaction time while driving and a higher risk of accidents
  • Mental health disorders, such as depression, an anxiety disorder or substance abuse
  • Increased risk and severity of long-term diseases or conditions, such as high blood pressure and heart disease
Oct. 15, 2016
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