Written by: Katy Foster
Updated March 10, 2021
We’ve all had restless nights at some point, but what if counting sheep becomes the norm? As much as 35% of the adult population experiences transient insomnia, while an added 10% to 15% suffers from chronic insomnia (1). Adults are not alone, as a quarter of young children have sleeping problems (2). With this high prevalence of sleep issues, it’s useful to differentiate between occasional sleeplessness and insomnia.
People with insomnia suffer from one or more of the following issues: difficulty falling asleep, trouble staying asleep, and poor sleep quality (3). These symptoms occur despite adequate sleep opportunity and result in diminished daytime productivity and/or sleepiness.
Occasional sleeplessness is common (4) and is often triggered by life stressors related to work, academic performance, or relationships. Transient insomnia lasts anywhere from a few nights to a few weeks and usually resolves once the stressor disappears. In chronic insomnia, however, symptoms occur at least three nights a week and for three months or longer (5).
In addition to a decreased quality of life, insomnia is associated with a number of health conditions, such as depression and anxiety, type 2 diabetes, gastrointestinal problems, hypertension, and cardiovascular disease. Because of its link to a range of comorbidities, insomnia is often misdiagnosed or underreported by patients to their physicians. To further complicate matters, it can be difficult to distinguish primary causes of insomnia from conditions caused or aggravated by insomnia itself.
Certain lifestyle factors and health conditions are commonly associated with insomnia (6).
Lifestyle factors related to insomnia include:
- Excessive caffeine, alcohol, or tobacco consumption
- Irregular work schedule, such as night shifts
- Lack of exercise
- Using a computer, phone, or other device right before bed
- Inconsistent sleep schedule
Also, many health-related issues are associated with insomnia, such as:
- Anxiety disorders
- Sleep apnea
- Chronic pain
- Urinary disorders
- Neurological conditions
Regardless of the cause, insomnia is characterized by certain core features.
Trouble Falling Asleep
Many people fall asleep within 20 minutes of going to bed. For people suffering from insomnia, though, just initiating sleep can be challenging. It’s not uncommon for a person to have trouble falling asleep because of nerves, excitement, or stress. Consuming caffeine or a heavy meal too close to bedtime, or taking a longer daytime nap, can significantly delay sleep onset.
With insomnia, difficulty initiating sleep becomes a recurring pattern and isn’t always attributable to lifestyle factors or stress. Certain health conditions like gastroesophageal reflux disease (GERD), sleep apnea (7), or chronic pain can make falling asleep challenging and contribute to long-term insomnia. Addressing these issues can often alleviate this type of insomnia.
Difficulty Staying Asleep
Even if you fall asleep quickly, waking up multiple times throughout the night can significantly reduce sleep duration and quality. With insomnia, you might feel like you’re awake most of the night because you’re only sleeping for brief intervals. Difficulty staying asleep is the most common symptom of insomnia, particularly in older adults (8).
Conditions like sleep apnea, restless leg syndrome (RLS), and nocturnal cramps can also result in frequent wakings. Addressing related health concerns, as well as identifying that your insomnia results in difficulty staying asleep, can help determine treatment plans and improve sleep outcomes.
In "early morning insomnia," a sleeper awakens prematurely despite both the desire and opportunity to sleep more. The tendency to wake up early due to insomnia should not be confused with being an “early bird,” or someone who is more inclined to rise early in the morning.
Those suffering from early morning insomnia want to sleep more but cannot fall back asleep. As a result, they don’t feel rested and can experience many of the daytime symptoms associated with sleep deprivation. While delayed-onset insomnia is more common in younger adults, early waking insomnia is more prevalent in older adults (9).
Poor Quality or Non-Restorative Sleep
Regularly feeling unrefreshed after waking can also be a sign of insomnia. Poor quality sleep results in fatigue, malaise, and decreased productivity during the day.
A person can have symptoms of sleep deprivation despite falling asleep easily and sleeping enough hours. Non-restorative sleep most commonly occurs in young adults (10) and usually presents as sleepiness, fatigue, and other signs of decreased daytime performance. Nonrestorative sleep is also linked to a quicker onset of depression (11) when compared to other insomnia subtypes.
Daytime Symptoms of Insomnia
Occasionally not being able to get adequate sleep certainly impacts our ability to function and enjoy life, but the cumulative effects of nonrestorative sleep can be much more significant. People experiencing insomnia report at least one of the following daytime symptoms.
- Fatigue and/or sleepiness
- Irritability or mood disorders
- Reduced cognitive function, including memory impairment
- Diminished work or school performance
- Decreased energy and drive
- Headaches and/or tension
- Gastrointestinal problems
- Anxiety over not being able to sleep
When to Talk to Your Doctor
Since insomnia is associated with a number of health conditions and can greatly reduce performance and life satisfaction, it’s important to speak to your doctor if you’re experiencing these symptoms. Your healthcare provider will likely ask about your caffeine, alcohol, and nicotine use, as well as any medications you might be taking. Your physician can also run tests to rule out underlying conditions that might be causing your insomnia.
Depending on your evaluation, your doctor might suggest visiting a sleep clinic, or enrolling in a sleep study. Both options likely involve undergoing testing and receiving recommendations based on your results. Some people seek alternative treatments, like hypnosis, to help manage their insomnia. Studies have shown that cognitive-behavioral therapy (CBT) (12) can be effective for adults suffering from chronic insomnia.
As difficult as insomnia can be, the good news is that there are a number of effective treatment options. Even recording daily habits like alcohol and caffeine intake, meal and exercise times, and napping can reveal patterns related to your sleep quality. Better sleep hygiene often entails lifestyle tweaks, but improved health and satisfaction are well worth the tradeoff.
- https://pubmed.ncbi.nlm.nih.gov/16686591/ Accessed on March 6, 2021.
- https://pubmed.ncbi.nlm.nih.gov/15129213/ Accessed on March 6, 2021.
- https://www.ncbi.nlm.nih.gov/books/NBK526136/ Accessed on March 6, 2021.
- https://medlineplus.gov/insomnia.html Accessed on March 6, 2021.
- https://pubmed.ncbi.nlm.nih.gov/31466529/ Accessed on March 6, 2021.
- https://medlineplus.gov/ency/article/000805.htm Accessed on March 6, 2021.
- https://pubmed.ncbi.nlm.nih.gov/28687968/ Accessed on March 6, 2021.
- https://www.nhlbi.nih.gov/health-topics/insomnia Accessed on March 6, 2021.
- https://pubmed.ncbi.nlm.nih.gov/20845423/ Accessed on March 6, 2021.
- https://pubmed.ncbi.nlm.nih.gov/23423416/ Accessed on March 6, 2021.
- https://pubmed.ncbi.nlm.nih.gov/33540204/ Accessed on March 6, 2021.
- https://pubmed.ncbi.nlm.nih.gov/26054060/ Accessed on March 6, 2021.