Insomnia

People with insomnia have trouble falling asleep, staying asleep, or getting good-quality sleep.

Overview

Insomnia is a common sleep disorder. People with insomnia have trouble falling asleep, staying asleep, or getting good-quality sleep. This can happen even when they have enough time and a good environment for sleeping well.

Most adults need seven to nine hours of sleep each night. Both the amount and the quality of sleep are important. Getting too little sleep or low-quality sleep can disrupt daily activities and may make people feel sleepy during the day. It can also affect memory and concentration.

Short-term insomnia may result from stress or changes in a person’s schedule or environment. It can last a few days or weeks. Long-term, or chronic, insomnia happens three or more nights a week, lasts more than three months, and isn’t fully explained by another health problem.

Signs and Symptoms

People with insomnia may experience any of the following:

  • Trouble falling asleep
  • Trouble staying asleep
  • Waking up too early in the morning and being unable to fall back asleep
  • Getting poor-quality sleep
  • Feeling sleepy or unrested during the day
  • Difficulty with memory and concentration

Related Health Effects

Sleep is important for your body and mind. In the short term, insomnia can make it hard to concentrate or think clearly. People may feel irritable, sad, and unrested or have headaches.

Chronic insomnia can affect how well the brain, heart, and other parts of the body work. It can raise the risk of certain health problems or make existing problems worse, including:

Insufficient sleep can also:

  • Increase the risk of injury in adults, teens, and children
  • Lead to serious car crashes, injuries, and death
  • Increase the risk of falls and broken bones in older adults
  • Affect the immune system, the body’s natural defense against germs and sickness: These problems can lead to inflammation in the body or make it harder to fight infections.
  • Disrupt work, school, driving, and social activities
  • Make it harder to pay attention and learn, leading to problems performing well in school or at work
  • Make it harder to understand other people’s emotions and responses and react to them appropriately
  • Make people feel frustrated, irritable, or worried in social situations

In addition, sleep and lung health are closely connected. People with lung diseases, such as chronic obstructive pulmonary disease (COPD) and asthma, often have trouble sleeping, and poor sleep can make lung disease symptoms worse. 

Sleep apnea, a condition where breath stops and restarts during sleep, can also disrupt sleep and lead to serious health problems, including increased risk of heart attack or stroke.

Causes and Risk Factors

Changes in a person’s schedule or environment can cause insomnia or increase their risk of insomnia. There are also many other risk factors for insomnia. Some can be changed, such as a person’s job or lifestyle, but others like age and family history can’t be changed.

Age

People can develop insomnia at any age, but their risk increases as they get older. Insomnia is the most common sleep problem in adults age 60 and older. Older adults are also more likely to take medicines and have health conditions that affect sleep.

Family History and Genetics

Genes may increase your risk of insomnia, as insomnia can run in families. Genes may also affect whether someone is a deep or light sleeper. Scientists have identified several genes linked to sleep and sleep disorders. Some of these genes can influence the body’s daily sleep-wake cycle and the timing of sleep.

Sex

Insomnia is more common in women than in men. Additionally, hormone changes that take place during pregnancy and menopause can cause problems with sleep.

Environment or Occupation

The following factors can disrupt the sleep-wake cycle:

  • Shift work or night work
  • Noise or light at night
  • Temperatures that are too hot or too cold
  • Frequent travel across time zones

Lifestyle

Lifestyle habits that can increase the risk of sleep problems include:

  • Changes to routine, including sleep schedule
  • Sleep interruptions, such as waking up often to care for a baby
  • Taking long naps during the day
  • Getting too little physical activity during the day
  • Using caffeine, nicotine, alcohol, or drugs

Stress

Stress from school, work, relationships, money, or intense emotions like grief can increase the risk of insomnia. Worrying about getting enough sleep or watching the clock can also increase risk or make insomnia worse.

Medical Conditions and Medicines

Health conditions can make it hard to get a good night’s sleep. This could be because of side effects from medicines, mental health challenges, or pain.

Some prescription medicines used to treat other health conditions can also increase the risk of developing sleep conditions. For example, in people with cancer, sleep problems may be caused by the side effects of treatment, medicines, long hospital stays, and stress. Studies show that as many as half of all people receiving treatment for cancer have sleep-related problems.

Light Exposure

Exposure to light can make it harder to fall asleep or get back to sleep if it wakes someone up during the night. Specialized cells in the eyes sense light and signal the brain whether it’s day or night. This process can shift the sleep-wake cycle earlier or later.

Prevention Guidance

Your doctor or healthcare provider may talk with you about steps you can take to sleep better and prevent chronic insomnia.

Try these tips during the day to sleep better:

  • Follow a regular schedule. Try to go to bed and wake up at the same time each day, even on weekends or when traveling.
  • Get regular physical activity during the daytime, at least five to six hours before bedtime. Exercising close to bedtime can make it harder to fall asleep.
  • Avoid naps, especially in the afternoon. This may help you sleep longer at night.
  • Eat meals on a regular schedule and avoid late-night meals.
  • Get natural light each day. Spending time outside can help regulate your sleep.

And try these bedtime routine tips while you get ready to sleep:

  • Limit how much you drink close to bedtime: This can help you avoid waking up to use the bathroom.
  • Avoid caffeine, nicotine, and alcohol close to bedtime: Although alcohol may help you fall asleep, it can lead to lighter sleep and make you more likely to wake up during the night. Caffeine in drinks such as soda and coffee can stay in your body for up to 8 hours.
  • Manage stress: Follow a routine that helps you relax before bed. For example, read a book, listen to calming music, or take a warm bath.
  • Limit screen time before bed: Try not to use your computer, phone, or TV for about an hour before bed. The light from these devices can signal your brain to stay awake.
  • Make your bedroom sleep-friendly: Keep it cool, quiet, and dark.

Ask your healthcare provider about medicines that may disrupt sleep, such as some cold and allergy medicines.

People who work during the night should consider:

  • Using bright light at work
  • Talking with their employer about limiting shift changes
  • Limiting caffeine to the early part of their shift
  • Using light-blocking curtains if they need to sleep during the day

Diagnosis

If not getting enough sleep is affecting your daily activities, talk to your doctor. You may be diagnosed with insomnia if you have trouble falling or staying asleep at least three nights a week. Insomnia is considered chronic when it happens three or more nights a week and lasts for three months or longer.

Before your visit, it may help to keep a sleep diary for one to two weeks. A sleep diary helps you track your sleep quality, how long you sleep, and your daytime habits. In addition, you may consider using technology to help track your sleep. Millions of people use smartphone apps, bedside monitors, and wearable devices like bracelets, smartwatches, and headbands for this purpose. These devices can record sounds and movement during sleep, track sleep duration, and monitor heart rate and breathing.

Your doctor will want to learn about your symptoms, risk factors, health history, and family health history. You may be asked about:

  • How often you have trouble sleeping and how long you have 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 or watch TV before bed
  • Whether you snore loudly and often or wake up gasping or feeling out of breath
  • Whether you use caffeine, nicotine, alcohol, or illegal substances
  • Whether you’re pregnant or going through menopause
  • Whether you take any medications
  • Have any new or long-standing health problems

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

Several tests can help diagnose insomnia and related sleep disorders:

  • A sleep study (polysomnogram) can identify sleep problems like circadian rhythm disorders, sleep apnea, and narcolepsy. It records brain waves, breathing, oxygen levels, eye and limb movements, and heart rate throughout the night. Your doctor will tell you if you need to do your sleep study at a sleep center or at home.
  • Actigraphy is a measurement of periods of rest and activity through activity monitors. Activity monitors can also help doctors see how much people sleep and how well they sleep. People have to wear a small motion sensor on their wrist for 3 to 14 days.
  • Multiple sleep latency tests measure how quickly people fall asleep during a series of daytime naps and use sensors to record brain activity and eye movements.
  • A daytime maintenance of wakefulness test measures the ability to stay awake and alert.
  • Blood tests may be used to check for thyroid problems or other conditions that can cause sleep problems.

Treatment and Management

If you think you may have a sleep problem, tell your doctor. People with sleep disorders often benefit from treatment and ongoing care from a doctor.

Your doctor may recommend healthy lifestyle habits, cognitive behavioral therapy for insomnia (CBT-I), or medicines to help manage insomnia. Talk with them when starting any new treatment and tell them about any other health conditions you have or if you experience any side effects.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

The standard treatment for adults with chronic insomnia is multicomponent CBT-I. Doctors usually recommend it as the first treatment option for long-term insomnia since it can be very effective.

CBT-I is a treatment plan that usually lasts six to eight weeks. It can help people learn how to fall asleep faster and stay asleep longer. A doctor, nurse, or therapist can provide CBT-I in person, by telephone, or online.

CBT-I involves the following parts:

  • Cognitive therapy helps people feel less nervous about not being able to sleep.
  • Relaxation or meditation therapy teaches people how to relax and fall asleep faster.
  • Sleep education provides guidance for good sleep habits.
  • Sleep restriction therapy gives people a specific amount of time to spend in bed, even if they aren’t able to sleep during this time. With time, this helps people sleep better and for longer.
  • Stimulus control therapy helps people have a regular sleep-wake cycle so they can link being in bed with being asleep. This involves going to bed only when sleepy, getting out of bed if unable to sleep, and using the bed only for sleep.

A CBT-I therapist can also help people learn to change negative thoughts and beliefs about sleep into positive ones. They may also recommend treatments such as muscle relaxation, guided imagery, and self-hypnosis.

Light Therapy

Light therapy involves spending time each day sitting in front of a light box, which produces bright light similar to sunlight. Light therapy may help adjust the amount of the sleep-related hormone melatonin that the body needs to make in order to reset your sleep-wake cycle.

Side effects of light therapy may include agitation, eye strain, headaches, migraines, and nausea. Ask your doctor before using light therapy, especially if you have an eye condition or use medicines that make you sensitive to light.

Prescription Medicines

If you are having trouble falling asleep or staying asleep and improving your sleep habits and other therapies have not helped, your healthcare provider may talk to you about medicines to help you sleep. Many of these medicines have side effects and should not be taken long term.

A doctor may recommend:

  • Benzodiazepine receptor agonists, such as zolpidem, zaleplon, and eszopiclone. Side effects may include anxiety. Rare side effects include serious allergic reactions or doing activities while asleep like walking, eating, or driving.
  • Melatonin receptor agonists, such as ramelteon. Side effects may include dizziness and fatigue. Rare side effects include serious allergic reactions or doing activities while asleep like walking, eating, or driving.
  • Orexin receptor antagonists, such as suvorexant. However, they are not recommended for people with narcolepsy. Rare side effects include doing activities while asleep or being unable to move or speak for several minutes while falling asleep or waking up.
  • Benzodiazepines, but only if other treatments haven’t worked. Side effects may include dizziness, confusion, and muscle weakness. These medicines can interact with other drugs, may be habit-forming, and are usually prescribed for only a few weeks.

Off-Label Medicines

In some cases, doctors may recommend medicines that are commonly used for other health conditions but are not approved by the U.S. Food and Drug Administration (FDA) to treat insomnia. Some of these medicines include antidepressants, antipsychotics, and anticonvulsants.

Over-the-Counter Medicines and Supplements

Some over-the-counter (OTC) medicines may help with insomnia. Sleep medicines may help in the short term, but they carry risks and are not recommended for long-term use. Some medicines may also become less effective over time, so people may need higher doses to fall asleep.

Considerations for OTC medicines include:

  • OTC sleep aids often contain antihistamines. These products may make people sleepy, but they may not be safe for everyone.
  • Melatonin supplements are lab-made versions of the sleep hormone melatonin. Many people use them to try to improve sleep, but research has not shown that melatonin effectively treats insomnia. These supplements are not regulated by the FDA in the same way as medicines, so the dose and purity can vary. Side effects may include daytime sleepiness, headaches, changes in blood pressure, upset stomach, and worsening depression symptoms.
  • Dietary supplements like magnesium may help with sleep, but they can also pose health risks. The FDA does not review dietary supplements for safety and effectiveness before they are sold.

Find Treatment

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on insomnia.

Community Support

The following organizations offer information and support related to sleep disorders:

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH.  

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

Scientists funded by NIH continue to learn how sleep works and how the body controls it. Researchers are also studying the risks of long-term sleep loss and how sleep affects disease. For example, researchers still have many questions about how sleep is linked to Alzheimer’s disease and dementia, including whether lack of sleep leads to these conditions or whether these conditions cause sleep problems.

Scientists have identified several genes linked to sleep and sleep disorders, including genes that control brain cell activity and “clock” genes, which influence your body’s daily sleep-wake cycle and the timing of sleep. Scientists have also linked specific genes to sleep disorders such as familial advanced sleep-phase disorder, narcolepsy, and restless legs syndrome.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.