Insomnia

Overview

Woman awake in bed trying to sleep.

Insomnia is a common sleep disorder. With insomnia, you may have trouble falling asleep, staying asleep, or getting good quality sleep. This happens even though you have the time and the right environment to sleep well. Insomnia interferes with your daily activities, and may make you feel unrested or sleepy during the day. 

Short-term insomnia may be caused by stress or changes in your schedule or environment. It can last for a few days or weeks. Chronic (long-term) insomnia occurs three or more nights a week, lasts more than three months, and cannot be fully explained by another health problem or a medicine. 

To diagnose insomnia, your doctor may ask about your sleep habits and ask you to keep a sleep diary. Your doctor may recommend healthy lifestyle habits such as a regular sleep schedule, cognitive behavioral therapy for insomnia, and medicines to help you manage your insomnia.

Insomnia can affect your memory and concentration. Chronic insomnia raises your risk of high blood pressure, coronary heart disease, diabetes, and cancer.

Explore this Health Topic to learn more about insomnia, our role in research and clinical trials, and where to find more information.

Risk Factors - Insomnia

You may have a higher risk of insomnia because of your age, family history and genetics, environment or occupation (work), lifestyle, stress or worrying about sleep, or your sex.

Age

Insomnia can occur at any age but your chances of having it increase as you get older.

Family history and genetics

Your genes may raise your risk of insomnia, as insomnia sometimes runs in families. Your genes may also affect whether you are a deep or light sleeper.

Environment or occupation

The following can disturb your sleep–wake cycle:

  • Shift or night work
  • Noise or light during the night
  • Uncomfortably high or low temperatures
  • Traveling frequently to different time zones

Lifestyle

Lifestyle habits can raise your risk of sleep problems.

  • Following an irregular sleep schedule or changing your normal routine often
  • Experiencing interruptions in your sleep, such as waking up often to care for a baby
  • Frequently taking long naps during the day
  • Getting too little physical activity during the day
  • Using caffeine, nicotine, alcohol, or illegal drugs
  • Watching TV or using electronic devices close to your bedtime

Stress

Stress or worrying about school or work, relationships, money, or the death of a loved one raises the risk of insomnia.

Worrying about whether you will get enough sleep and monitoring the clock can also raise your risk of insomnia or make it worse.

Sex

Insomnia is more common in women than in men. Feeling uncomfortable and experiencing hormone changes during pregnancy and menopause can cause problems with sleep.

Screening and Prevention - Insomnia

To screen for insomnia, your doctor will ask how you are sleeping and ask about your risk factors.

Your doctor may talk to you about steps you can take to help you sleep better and prevent chronic insomnia.

  • Adopt healthy sleep habits and a regular daytime schedule to help you maintain a regular sleep-wake cycle.
  • Avoid caffeine, nicotine, and alcohol close to your bedtime, as these can make it more difficult for you to fall asleep.

Go to treatment to learn more about healthy sleep habits that may help prevent or manage insomnia.

Signs, Symptoms, and Complications - Insomnia

The main symptom of insomnia is trouble falling or staying asleep, even if you have enough time and the right conditions for good sleep. Over time, untreated insomnia may raise your risk of certain health problems or workplace or road accidents. 

Signs and Symptoms

If you have insomnia, you may:

  • Lie awake for a long time before you fall asleep. This is more common in younger adults.
  • Sleep for only short periods. You may wake up often during the night or be awake for most of the night. This is the most common symptom and affects mostly older adults.
  • Wake up too early in the morning and not be able to get back to sleep.
  • Have poor-quality sleep. You may wake up feeling unrested, and you may feel sleepy during the day. You may also have trouble focusing on tasks. Insomnia can cause you to feel anxious, depressed, or irritable. 

Complications

Sleep is important for your body and mind. To understand how sleep is important for good health, read our How Sleep Works and Sleep Deprivation and Deficiency Health Topics.

In the short term, insomnia can make it hard to concentrate or think clearly. You may feel irritable, sad, and unrested or have headaches. Insomnia raises your risk of falling, having a road accident, or missing work. 

In addition, chronic insomnia can affect how well your brain, heart, and other parts of your body work. It can raise your risk of certain health problems or make existing problems worse. These conditions include:

  • Breathing problems such as asthma
  • Heart problems such as arrhythmia, heart failure, coronary heart disease, and high blood pressure
  • Mental health conditions such as anxiety, depression, and thoughts of suicide. Insomnia can also make it difficult for you to stick to treatment for a substance use disorder.
  • Pain. People who have chronic pain and insomnia may become more aware of and distressed by their pain.
  • Pregnancy complications such as having more pain during labor, giving birth preterm, needing a cesarean section (C-section), and having a baby with low birth weight.
  • Problems with your immune system, your body’s natural defense against germs and sickness. These problems can lead to inflammation in your body or make it harder to fight infections.
  • Problems with your metabolism. Not getting enough sleep can change the levels of hormones that control hunger and how you break down food. This can raise the risk of overweight and obesity, metabolic syndrome, and diabetes.

Diagnosis - Insomnia

If lack of sleep is affecting your daily activities, talk to your doctor. You may be diagnosed with insomnia if you have difficulty falling or staying asleep for at least 3 nights a week. Short-term insomnia lasts less than 3 months. Chronic insomnia lasts for 3 months or more. Your doctor may do more tests to see whether your insomnia has caused any complications.

It may be helpful to keep a sleep diary for 1 to 2 weeks before seeing your doctor. A sleep diary can help your doctor understand your sleep problem and whether certain activities are affecting your sleep. Write down when you go to sleep, wake up, and take naps each day. Also write down how sleepy you feel throughout the day, when you drink caffeine or alcohol, and when you exercise.

You can print and use the NHLBI’s sleep diary.

Medical history and physical exam

Your doctor will want to learn about your signs and symptomsrisk factors, health history, and family health history. To better understand your sleep problem, your doctor may have you fill out a questionnaire or ask you for details such as these about your sleep habits: 

  • How often you have trouble sleeping and how long you’ve had the problem
  • When you go to bed and get up on workdays and days off
  • How long it takes you to fall asleep, how often you wake up at night, and how long it takes you to fall back asleep
  • How refreshed you feel when you wake up and how unrested you feel during the day
  • Whether you use electronic devices with artificial light or watch TV before bed
  • Whether you snore loudly and often or wake up gasping or feeling out of breath

To find the cause of your sleep problems, your doctor may ask whether you:

  • Have any new or ongoing health problems
  • Take any medicines
  • Are pregnant or going through menopause
  • Use caffeine, nicotine, alcohol, or illegal drugs

Your doctor will do a physical exam to rule out other medical problems that might affect your sleep. He or she will listen to your heart and lungs and look for risk factors for sleep apnea, such as large tonsils or a large neck circumference.

Diagnostic tests

In addition to finding out your medical history, your doctor may have you take the following tests. 

Treatment - Insomnia

Lifestyle changes can often help improve short-term insomnia. A type of counseling called cognitive behavioral therapy for insomnia is usually the first treatment recommended for chronic insomnia. Several medicines can also help manage insomnia and help you have a regular sleep schedule. You may need to visit a doctor who specializes in treating sleep problems.

Healthy sleep habits

In addition to following a heart-healthy lifestyle, try to adopt the following bedtime habits. These habits can make it easier for you to fall asleep and stay asleep.

  • Make your bedroom sleep-friendly. Sleep in a cool, quiet place. Avoid artificial light from the TV or electronic devices, as this can disrupt your sleep-wake cycle.
  • Go to sleep and wake up around the same times each day, even on the weekends. If you can, avoid night shifts, irregular schedules, or other things that may disrupt your sleep schedule.
  • Avoid caffeine, nicotine, and alcohol close to your bedtime. Although alcohol can make it easier to fall asleep, it triggers sleep that tends to be lighter than normal. This makes it more likely that you will wake up during the night.
  • Get regular physical activity during the daytime (at least 5 to 6 hours before going to bed). Exercising close to bedtime can make it harder to fall asleep.
  • Avoid daytime naps, especially in the afternoon. This may help you sleep longer at night.
  • Eat meals on a regular schedule and avoid late-night dinners. This helps maintain a regular sleep-wake cycle.
  • Limit how much fluid you drink close to bedtime. This may help you sleep longer without having to use the bathroom.
  • Learn new ways to manage stress. Follow a routine that helps you wind down and relax before bed. For example, read a book, listen to soothing music, or take a hot bath. Your doctor may also recommend massage therapy, meditation, or yoga to help you relax. Acupuncture may also help improve insomnia, especially in older adults.
  • Avoid certain over-the-counter and prescription medicines that can disrupt sleep (for example, some cold and allergy medicines). Talk with your doctor about which medicines will not disrupt your sleep.

Cognitive behavioral therapy for insomnia (CBT-I)

CBT-I is a 6- to 8-week detailed treatment plan to help you learn how to fall asleep faster and stay asleep longer. This is usually recommended as the first treatment option for long-term insomnia and can be very effective if done properly. CBT-I can be done in person by a doctor, nurse, or therapist; by telephone; or online. It involves the following parts: 

  • Cognitive therapy to feel less nervous about sleep and have more positive thinking.
  • Relaxation or meditation therapy to teach you how to relax and fall asleep faster.
  • Sleep education to help you learn good sleep habits.
  • Sleep restriction therapy, which gives you a specific amount of time to spend in bed, whether or not you are able to sleep during this time. With time, this helps you sleep better when you go to bed. Your sleep time can be increased when you start to sleep better.
  • Stimulus control therapy to help you have a regular sleep-wake cycle and link being in bed with being asleep. This involves going to bed only when you are sleepy, getting out of bed if you cannot sleep, and using your bed only for sleep and sexual activity.

Medicines

Prescription medicines

Many prescription medicines are used to treat insomnia. Some are meant for short-term use while others are meant for longer-term use. Some insomnia medicines can be habit-forming and all of these medicines may cause dizziness, drowsiness, or worsening of depression or suicidal thoughts. All of the medicines listed below may cause insomnia. Talk to your doctor about the benefits and side effects of insomnia medicines.

  • Benzodiazepines, which can be habit-forming and should be taken for only a few weeks.
  • Benzodiazepine receptors agonists, such as zolpidem, zaleplon, and eszopiclone. Additional side effects may include anxiety. Rare side effects may include a severe allergic reaction or unintentionally doing activities while asleep such as walking, eating, or driving.
  • Melatonin receptor agonists, such as ramelteon. Rare side effects may include doing activities while asleep such as walking, eating or driving or a severe allergic reaction. 
  • Orexin receptor antagonists, such as suvorexant. This medicine is not recommended for people who have narcolepsy. Rare side effects may include doing activities while asleep such as walking, eating, or driving or not being able to move or speak for several minutes while going to sleep or waking up.

Off-label medicines

In some special cases healthcare providers may prescribe medicines that are commonly used for other health conditions but are not yet approved by the FDA to treat insomnia. Some of these medicines may include antidepressants, antipsychotics, and anticonvulsants.

Over-the-counter medicines and supplements

Some over-the-counter (OTC) products that contain antihistamines are sold as sleep aids. Although these products might make you sleepy, talk to your doctor before taking them. Antihistamines can be unsafe for some people. Also, these products may not be the best treatment for your insomnia. Your doctor can advise you whether these products will help you.

Melatonin supplements are lab-made versions of the sleep hormone melatonin. Many people take melatonin supplements to improve their sleep. However, research has not proven that melatonin is an effective treatment for insomnia. Talk to your doctor before using these supplements. Dietary supplements can be beneficial to your health, but they can also have health risks.

The U.S. Food and Drug Administration regulates dietary supplements under a different set of regulations than those covering "conventional" foods and medicines. It does not have the authority to review dietary supplement products for safety and effectiveness before they are marketed.

Side effects of melatonin may include daytime sleepiness, headaches, upset stomach, and worsening depression. It can also affect your body's control of blood pressure, causing high or low blood pressure.

Other medicines

Your doctor may also prescribe medicines to treat other diseases that you may have in addition to your insomnia.

Other treatments

Your doctor may recommend that you use light therapy to set and maintain your sleep-wake cycle. With this treatment, you plan time each day to sit in front of a light box, which produces bright light similar to sunlight. 

Living With - Insomnia

If you have been diagnosed with insomnia, follow your treatment plan and make healthy lifestyle and sleep changes. The following steps can help prevent your insomnia from returning or getting worse. 

  • Keep a regular schedule.
  • Get regular physical activity.
  • Avoid caffeine, nicotine, alcohol, and illegal drugs.

Talk with your doctor about how often to schedule follow-up visits. Between visits, tell your doctor if you have any new or worsening symptoms or if you have side effects from your medicines. He or she might prescribe a different medicine or treatment.

Your doctor may ask you to keep a sleep diary to help you keep track of how well you are sleeping during and after your treatment. 

Even when your sleep improves, you may need to keep a regular daily schedule, take your medicines regularly, and continue cognitive behavioral therapy for insomnia (CBT-I).

Other health conditions linked with insomnia

Often, people who have insomnia have other conditions that can affect sleep, such as:

Insomnia may also make these conditions or their symptoms worse. It is important to manage these conditions to prevent your insomnia from returning or getting worse. In addition, some medicines that are used to treat these conditions can also increase your risk of insomnia. Talk to your doctor about your medicines as there may be other options for treating your condition.

Research for Your Health

The NHLBI is part of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH)—the Nation’s biomedical research agency that makes important scientific discoveries to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders, including insomnia. Learn about current and future NHLBI efforts to improve health through research and scientific discovery.

Improving health with current research
- Insomnia

Learn about the following ways the NHLBI continues to translate current research into improved health for people who have insomnia. Research on this topic is part of the NHLBI’s broader commitment to advancing Sleep Science and Sleep Disorders scientific discovery. 

  • NHLBI's National Center on Sleep Disorders Research (NCSDR). For 25 years, the NCSDR has led foundational research on sleep and circadian biology across NIH and has worked with federal and private organizations to disseminate sleep health information. The NCSDR administers sleep and circadian research projects, offers training and educational awareness programs, and serves as an NIH point of contact for federal agencies and public interest organizations. The NCSDR also participates in research translation and dissemination of scientific sleep and circadian advances to healthcare professionals, public health officials, and the public.
  • Sleep Disorders Research Advisory Board (SDRAB). The NHLBI has administered this specialty program advisory panel since 1993. Board members, who include medical professionals, federal partners, and members of the public, meet regularly to provide feedback to NIH on sleep-related research needs and discuss how to move sleep research forward. Topics discussed at previous SDRAB meetings include how to coordinate care for insomnia and other sleep disorders for people in the military. Visit the Sleep Disorders Research Advisory Board for more information.
  • National Sleep Research Resource (NSRR). This resource was established by the NHLBI to provide biomedical researchers a large collection of well-characterized data from NIH-funded sleep research studies. The NSRR keeps data on how common and serious insomnia is in different age groups, genders, and ethnicities. The database also has questionnaires used for research into insomnia and other sleep disorders.
  • Improving the Quality of Medical School Education on Sleep Disorders. As part of its efforts to ensure that research advances are used by healthcare providers, the NCSDR has supported the development of medical school curricula and durable educational materials on sleep disorders. This includes recommendations for training healthcare providers to diagnose and treat insomnia, recognize the potential complications of insomnia, and identify why people who have insomnia might not stick to their treatment plans. Visit NHLBI Workshop to Investigate Short-Term Research Training Programs in Heart, Lung, Blood, and Sleep Disorders for Clinicians and PhDs for more information.
  • Exploring the Links Between Insomnia and Other Health Conditions. We have funded several research studies to understand the links between insomnia and serious health conditions such as depression, sleep apnea, asthma, and heart disease. We have also supported studies that showed that insomnia has long-term effects on quality of life and life expectancy. These studies have shown that many genes associated with insomnia are also linked to other serious health conditions. Visit Asthma and insomnia are common bed fellows and Genetic study of insomnia shows link with depression and heart disease for more information.
  • The NIH HEALSM (Helping to End Addiction Long-termSM) Initiative. We support the NIH HEAL Initiative, a comprehensive program to speed the discovery of scientific solutions to stop opioid addiction and help people manage chronic pain in more effective ways. As part of the HEAL Initiative, the NCSDR has begun looking at the connection between sleep and opioid use and misuse. In collaboration with the National Institute on Drug Abuse, we are funding projects to better understand the role that sleep and sleep disorders play in opioid use disorder and medication assisted therapies. Visit NIH HEAL Initiative and NIH HEAL Initiative: Science taking on pain, opioid misuse—and poor sleep for more information. 
  • Research Conference on Sleep and the Health of Women. This 2018 conference focused on the importance of sleep for women's health. The event showcased a decade of federally funded research advances in understanding the health risks, societal burden, and treatment options associated with sleep deficiency and sleep disorders in women. Speakers at the conference discussed risk factors for insomnia in women. Speakers at the conference discussed risk factors for insomnia in women, including puberty, having a child, and anxiety and depression. Learn more from the Research Conference on Sleep and the Health of Women.

Learn about some of the pioneering research contributions we have made over the years that have improved clinical care.

  • Addressing sleep and health disparities. We are committed to addressing health disparities in sleep and sleep disorders. In 2005, we supported a meeting to discuss the diagnosis and treatment of insomnia, including evidence that links menopause to symptoms of sleep disorders. In 2011, the NHLBI convened experts in the fields of both sleep and health disparities to help set an agenda for future research that would ultimately help reduce disparities related to sleep health. We funded research on the link between having trouble falling asleep and high blood pressure and inflammation in women. We also funded studies on the connection between insomnia and Alzheimer’s disease in Hispanic populations. View Sleep Disorders and Health Disparities and Insomnia, longer sleep periods linked to Alzheimer’s in Hispanics and A Workshop Report on the Causes and Consequences of Sleep Health Disparities to learn more about our efforts to eliminate health disparities.
  • Treating insomnia in children and adults. The symptoms, complications, and treatment options of insomnia can differ by age. NHLBI-funded research has shown that CBT-I should be considered as the first treatment option for insomnia in young and middle-aged adults.We also supported research that evaluated the effective diagnosis and use of medicines to treat insomnia in children. 
  • Understanding how sleep problems affect the risk of heart disease. The Cardiovascular Health Study, which ran from 1989 to 1999, found that older people who had more trouble sleeping were more likely to have poor health, depression, and angina and were more likely to have trouble with the activities of daily living. Another NHLBI-supported study found that lack of sleep was linked with a higher heart rate and might raise blood pressure. View NHLBI-funded Study Links Insufficient Sleep to Heart Disease for more information. 
  • Discovering how our genes affect sleep. A study led by NHLBI scientists showed that our genes can control whether we naturally sleep for long periods or short periods, affecting our risk of insomnia. Visit Genome-wide Association Analysis of Self-Reported Daytime Sleepiness Identifies 42 Loci That Suggest Biological Subtypes for more information.

Another NHLBI-supported study, using fruit flies, showed that genes may explain sleep variations and may help to identify ways to treat insomnia. View To Sleep or Not: Researchers explore complex genetic network behind sleep duration for more information. 

Advancing research for improved health
- Insomnia

In support of our mission, we are committed to advancing insomnia research in part through the following ways.

Learn about exciting research areas the NHLBI is exploring about insomnia.

Participate in NHLBI Clinical Trials

We lead or sponsor many studies relevant to insomnia. See whether you or someone you know is eligible to participate in our clinical trials

Have you previously been prescribed opioid medicines?

This study will find out whether waking up frequently during the night can affect the way your brain processes certain medicines. To participate in this study, you must be 18 to 48 years old, have a normal sleep cycle, and have previously taken opioid medicines to treat pain. This study is located in Baltimore, Maryland.

Do you have pain from sickle cell disease and trouble sleeping?

This study will look at whether improving sleep can reduce pain in people who have sickle cell disease and chronic pain. To participate in this study, you must be at least 18 years old, have been diagnosed with sickle cell disease, and experience insomnia and chronic pain. This study is located in Baltimore, Maryland.
View more information about Sleep and Pain in Sickle Cell Disease.

Do you have asthma and insomnia?

This study is looking at whether two different education-based treatments can help improve the quality of life for people who have severe asthma and insomnia. To participate in this study, you must be 18 to 75 years old and have insomnia and moderate or severe asthma. This study is located in Pittsburgh, Pennsylvania.

Do you have HIV and insomnia?

This study is looking at whether insomnia increases pain and inflammation in people who have HIV. To participate in this study, you must be 18 to 85 years old and either be healthy or diagnosed with HIV, with or without insomnia. This study is located in Birmingham, Alabama.

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