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.

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.

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 symptoms, risk 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. 

• A sleep study to look for other sleep problems, such as circadian rhythm disorders, sleep apnea, and narcolepsy.
• Actigraphy to measure how well you sleep. This requires you wear a small motion sensor three to 14 days.
• Blood tests to check for thyroid problems or other medical conditions that can affect sleep.

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.