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Insomnia: Causes & Common Questions

Treating the underlying causes of insomnia can help you get a better night’s sleep.
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Last updated January 5, 2021

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What is insomnia?

Pro Tip

Insomnia is a common sleep issue. Worrying about not getting enough sleep makes insomnia worse and people get stuck in a negative sleep cycle. —Dr. Bobbi Wegner

If you have trouble falling asleep at night, you may have insomnia, a common sleep disorder. Waking up in the middle of the night and taking a long time to fall back to sleep is also considered insomnia. So is waking up too early in the morning and feeling exhausted.

Some people have insomnia every night for years—or a lifetime. Others may have it for a short period of time during stressful situations.

Insomnia affects people of all ages, though it becomes more common in older adults. It can negatively affect your quality of life—such as how productive you are at school or work, your health, and your mental health.

It can be treated through a combination of behavioral strategies, therapy, and/or medications. Though it can be difficult to treat in some people.

Symptoms of insomnia

  • Difficulty falling asleep at night.
  • Waking up throughout the night.
  • Waking up earlier than you would like.
  • Having a hard time concentrating during the day.
  • Feeling tired or falling asleep during the day.
  • Having a hard time remembering things you have to do.
  • Feeling depressed, anxious, or irritable.

There are many other sleep disorders that have symptoms that are similar to insomnia. Obstructive sleep apnea, narcolepsy, circadian rhythm disorder, depression, and restless legs syndrome are a few of them. Your doctor can help figure out if you have one of these sleep disorders.

Insomnia causes

Pro Tip

A misconception is that sleep doesn’t matter. Sleep matters a lot. It is a building block of health and fundamental in both feeling good and functioning well. Although it takes time and effort to adjust your sleep hygiene, it is well worth the effort. —Dr. Wegner

The most common cause of insomnia is anxiety. Anxiety or stress make your mind active throughout the night, which makes it hard to fall and stay asleep. Insomnia is also a symptom of depression and other mental health conditions like post-traumatic stress disorder (PTSD).

Also, there are certain behaviors that can make insomnia worse, such as watching TV or looking at your phone before bed.

The following conditions and behaviors can increase your risk of developing insomnia.

  • Anxiety and/or depression.
  • Post-traumatic stress disorder (PTSD).
  • Having short-term or chronic pain.
  • Working nights or traveling a lot.
  • Having a medical condition that affects sleep, like hyperthyroidism or gastroesophageal reflux disease (GERD).
  • Consuming caffeine.
  • Eating before bedtime.
  • Taking weight loss medications.
  • Drinking alcohol.
  • Sensitivity to light, noise, and temperatures.
  • Having poor or irregular sleep habits.

How can I stop my insomnia?

Dr. Rx

Ask your doctor: What type of insomnia do you think I have—primary or secondary (related to another issue)? What can I do at home, starting today, to work on this? Who treats insomnia—mental health clinician, sleep specialist, etc? —Dr. Wegner

If you are having trouble sleeping, see a mental health clinician or sleep specialist. They can help you figure out lifestyle changes to help with your insomnia. In some cases, they may prescribe medication.

Often, treating insomnia involves changing your bedtime routine and other daily habits that may affect sleep. It is known as having good sleep hygiene.

  • Avoid eating an hour or two before bed.
  • Don’t look at your phone or television at least two hours before bed.
  • Avoid caffeinated beverages, especially in the afternoon and evening.
  • Exercise daily.
  • Limit or eliminate naps.
  • Follow a consistent sleep schedule, going to sleep and waking up at the same time every day.
  • Practice relaxation techniques or activities like yoga and meditation.
  • If you are suffering from anxiety or depression, it’s important to treat these conditions with therapy and/or medications.
  • Do your best to decrease the stressors in your life.

If these don’t help, your therapist may suggest cognitive behavioral therapy (CBT). This teaches you how to control and get rid of any negative thoughts that might keep you awake at night. It also incorporates sleep hygiene recommendations.

Medication

Melatonin is the most common over-the-counter remedy for insomnia. It is a natural hormone that signals your body that it’s time to go to sleep.

Or, your doctor might write you a prescription for a sleep medication. Most likely it would be zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata), and others. However, these come with side effects and risks if using over the long term. In some cases, antidepressants have sedating effects and can help with insomnia.

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Resident Physician, The Mount Sinai Hospital

Dr. Becker is a psychiatry resident at the Mount Sinai Hospital. He received his undergraduate degree in Urban & Regional Studies from Cornell University (2012) and completed his medical degree at the Perelman School of Medicine at the University of Pennsylvania (2018). Prior to medical school, he worked as a pre-medical teaching assistant at Weill Cornell Medicine-Qatar, where he received an Excellence in Teaching Award. His research has focused on global health (including explanatory models of mental illness in Botswana, epidemiology of head trauma, and psychosocial aspects of HIV), adolescent and young adult mental health, and quality improvement. He enjoys communicating health-related science through writing and teaching and joined Buoy Health as a writer in 2018. In his free time he enjoys running, hiking, and exploring new places.

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