Insomnia: Causes, Symptoms, Prevention & Treatment

Insomnia is a common sleep disorder that affects millions of people worldwide, disrupting their ability to fall asleep, stay asleep, or wake up feeling rested. While everyone experiences the occasional sleepless night, those suffering from insomnia face chronic difficulties that can have a significant impact on their physical health, emotional well-being, and daily functioning. Insomnia can be triggered by a variety of factors, from stress and anxiety to lifestyle habits and underlying medical conditions, making it a complex issue to address.

Understanding the causes, symptoms, and treatment options for insomnia is crucial for managing this disorder effectively. In this guide, we will explore the root causes of insomnia, examine the common symptoms, and provide insight into how to prevent and treat this pervasive condition. Whether you’ve been struggling with sleepless nights or are seeking ways to improve your overall sleep health, this comprehensive overview will help you understand insomnia and how to achieve restful, restorative sleep.

Types of Insomnia

Insomnia is a sleep disorder that can vary significantly from person to person, both in terms of severity and underlying causes. Understanding the different types of insomnia can help individuals and healthcare providers better identify the root of the problem and develop effective treatment strategies. Insomnia is generally classified into two main types: acute and chronic, though there are other distinctions based on causes and patterns. Below are the primary types of insomnia:

1. Acute Insomnia

Acute insomnia is short-term insomnia that typically lasts for a few days to a few weeks. It is often triggered by stressful life events or sudden changes in routine. For instance, stress from a work deadline, a family emergency, or even jet lag can lead to a brief period of sleeplessness. Acute insomnia usually resolves on its own once the stressor has passed or the individual adjusts to the new situation.

While acute insomnia can be disruptive, it generally does not require extensive treatment unless it persists. Lifestyle adjustments, such as better sleep hygiene or relaxation techniques, can often help restore normal sleep patterns. If acute insomnia continues for longer periods, it may evolve into chronic insomnia.

2. Chronic Insomnia

Chronic insomnia is characterized by difficulty sleeping that occurs at least three times a week for three months or more. This type of insomnia can have a wide range of causes, including long-term stress, underlying medical conditions, or mental health disorders like anxiety or depression. Unlike acute insomnia, chronic insomnia is a more persistent problem and can lead to serious long-term effects on physical and mental health.

Chronic insomnia often requires more comprehensive treatment, which may include cognitive behavioral therapy (CBT), medication, or addressing any underlying health issues. This form of insomnia can significantly impact daily life, leading to ongoing fatigue, irritability, and difficulty concentrating.

3. Onset Insomnia

Onset insomnia refers to difficulty falling asleep at the beginning of the night. Individuals with onset insomnia may find themselves lying awake for extended periods before they are able to fall asleep. This type of insomnia can be caused by anxiety, overthinking, or an inability to relax before bed.

Certain lifestyle factors, such as consuming caffeine or stimulants close to bedtime or engaging in stimulating activities like watching TV or using electronic devices, can also contribute to onset insomnia. Treatment often involves lifestyle modifications, such as reducing screen time and creating a calming bedtime routine.

4. Maintenance Insomnia

Maintenance insomnia involves difficulty staying asleep throughout the night. People with this type of insomnia may wake up frequently during the night and struggle to return to sleep. This can result in fragmented sleep and a lack of restorative rest, even if the total amount of time spent in bed is adequate.

Maintenance insomnia can be caused by underlying medical conditions, such as sleep apnea or restless leg syndrome, which disrupt sleep. It may also be linked to mental health conditions like depression. Treatment for maintenance insomnia often involves addressing the root cause of the disruptions and improving sleep habits to encourage more consistent, uninterrupted sleep.

5. Comorbid Insomnia

Comorbid insomnia occurs when insomnia is linked to another underlying condition, such as a mental health disorder (e.g., anxiety or depression), chronic pain, or another sleep disorder. In comorbid insomnia, the primary condition exacerbates the insomnia, and the lack of sleep may, in turn, worsen the symptoms of the underlying issue.

Treating comorbid insomnia usually involves addressing both the insomnia itself and the associated condition. For instance, treating anxiety or depression with therapy or medication may help alleviate the insomnia, and improving sleep can contribute to better overall mental health.

6. Mixed Insomnia

Some individuals may experience mixed insomnia, which involves a combination of both onset and maintenance insomnia. This means they may have difficulty falling asleep and then struggle to stay asleep throughout the night. Mixed insomnia can be particularly frustrating because it involves multiple sleep disruptions, making it difficult to achieve restful sleep.

Treatment for mixed insomnia may require a multi-faceted approach, combining cognitive behavioral therapy, lifestyle changes, and potentially medication, depending on the severity and underlying causes.

Who is Affected by Insomnia?

Insomnia is a widespread issue, affecting millions of people across the globe. According to the Health Resources & Services Administration, an estimated 50 to 70 million American adults suffer from chronic sleep disorders. A survey conducted by Canadian researchers further highlighted the impact of insomnia, finding that 36.5% of insomniacs do not feel rested upon waking. The study also revealed that people with insomnia sleep, on average, one hour less per night compared to those without sleep issues.

However, the exact prevalence of insomnia can vary depending on the survey or study, largely due to differences in how insomnia is defined. Some researchers focus on the duration of symptoms, others on their severity, and still others on whether the symptoms persist. The most commonly used criteria involve the frequency of insomnia symptoms, making it difficult to pinpoint a universally agreed-upon statistic. Regardless of the exact numbers, it’s clear that insomnia is a significant public health concern affecting a large portion of the population.

Causes of Insomnia

Insomnia can be caused by a wide range of factors, from psychological issues to lifestyle habits and underlying medical conditions. Understanding the root cause of insomnia is key to finding effective treatment and improving sleep quality. While insomnia often results from a combination of factors, it generally falls into two categories: primary insomnia, which occurs without any other medical or psychological condition, and secondary insomnia, which is linked to other health issues or environmental factors. Below are some of the most common causes of insomnia.

1. Stress and Anxiety

One of the leading causes of insomnia is stress. Worrying about work, relationships, health, or finances can create a heightened state of arousal, making it difficult to relax and fall asleep. Individuals who experience chronic stress are at a higher risk of developing insomnia, as their bodies may remain in a constant state of fight-or-flight, preventing them from achieving restful sleep. In addition, anxiety disorders often cause excessive rumination or racing thoughts at night, further delaying sleep onset and contributing to frequent awakenings during the night.

2. Depression

Depression is closely linked to insomnia, as the two conditions often coexist. People with depression may struggle to fall asleep due to negative thoughts or feelings of hopelessness, or they may wake up frequently throughout the night. In some cases, depression causes early-morning awakenings, where individuals wake up much earlier than desired and cannot fall back asleep. Insomnia can also worsen depression symptoms, leading to a cycle where poor sleep exacerbates mental health issues.

3. Irregular Sleep Schedule

Disruptions to the body’s circadian rhythm—its natural sleep-wake cycle—are a common cause of insomnia. Shift work, frequent travel across time zones, or irregular sleep patterns can confuse the body’s internal clock, making it difficult to maintain consistent sleep habits. For example, jet lag or night shifts can misalign the body’s natural rhythm, resulting in difficulty falling asleep or staying asleep during regular nighttime hours.

4. Poor Sleep Hygiene

Sleep hygiene refers to the daily habits and routines that promote healthy sleep. Poor sleep hygiene is a common cause of insomnia. Factors like consuming caffeine or nicotine close to bedtime, eating heavy meals late in the evening, or using electronics before bed can all interfere with the ability to fall asleep and stay asleep. Activities such as watching TV in bed, scrolling through social media, or working late into the night stimulate the brain and delay the body’s natural relaxation process.

5. Medical Conditions

Several medical conditions can cause or contribute to insomnia. Conditions that cause chronic pain, such as arthritis or fibromyalgia, can make it difficult to get comfortable in bed, leading to frequent awakenings. Respiratory issues, such as asthma or sleep apnea, can cause breathing difficulties that disrupt sleep. Gastroesophageal reflux disease (GERD) is another condition that can cause discomfort during the night, leading to insomnia.

Neurological disorders, including Parkinson’s disease and Alzheimer’s disease, can also affect sleep by altering sleep patterns and making it difficult for individuals to maintain a consistent sleep routine.

6. Medications

Certain medications can interfere with sleep and lead to insomnia. Stimulants, such as those used to treat ADHD or narcolepsy, can make it difficult to fall asleep. Antidepressants, beta-blockers, and steroids may also cause insomnia as a side effect. Additionally, over-the-counter medications, such as cold and allergy medications that contain decongestants, can disrupt sleep by overstimulating the central nervous system.

7. Hormonal Changes

Hormonal fluctuations can significantly impact sleep, making insomnia more common during certain periods of life. For example, pregnancy, menstruation, and menopause can all cause shifts in hormone levels that disrupt sleep. Women going through menopause may experience hot flashes and night sweats, which can wake them up during the night and make it difficult to return to sleep. Similarly, pregnancy-related discomfort or hormonal changes can lead to difficulty sleeping.

8. Chronic Pain

Individuals suffering from chronic pain conditions, such as arthritis, fibromyalgia, or lower back pain, often struggle with insomnia. Pain can make it hard to find a comfortable sleeping position, leading to frequent wake-ups throughout the night. The discomfort associated with chronic pain can also make it challenging to achieve deep, restorative sleep, leaving individuals feeling fatigued even after a full night in bed.

9. Substance Use

Alcohol, nicotine, and caffeine are all substances that can interfere with sleep. While alcohol may initially make you feel sleepy, it can disrupt your sleep cycle by reducing the amount of time spent in REM sleep, which is essential for restorative rest. Nicotine, found in tobacco products, is a stimulant that can keep you awake by increasing alertness and making it harder to relax. Caffeine, commonly found in coffee, tea, and energy drinks, stimulates the nervous system and blocks sleep-inducing chemicals in the brain, making it difficult to fall asleep or stay asleep.

10. Environmental Factors

Environmental disruptions can also contribute to insomnia. Noisy surroundings, uncomfortable room temperatures, and excessive light exposure can all interfere with the body’s ability to relax and fall asleep. For example, loud neighbors, street traffic, or even a partner who snores can cause frequent wake-ups throughout the night. Similarly, a bedroom that is too hot or too cold can prevent you from getting comfortable enough to fall asleep. Excessive light exposure, whether from streetlights or electronic devices, can also disrupt your body’s natural circadian rhythm.

Sleep needs with age

Contrary to popular belief, seniors do not really need less sleep than other adults, even if many sleep less, according to sleep specialist Charles Morin, psychologist and researcher at Laval University in Quebec. With age, periods of slow deep sleep decrease continuously. Because sleep is more fragile, older people are more likely to be awakened by external stimuli, be it noise, light or body pain. However, by taking naps when necessary and following the rules of sleep hygiene, it is quite possible for them to get enough sleep.

Average sleep requirements by age

Possible consequences of insomnia

The consequences of insomnia are quickly felt and include: fatigue, drowsiness, irritability, memory loss, and difficulty concentrating during the day. Insomnia also tends to exacerbate the symptoms of certain health problems: migraines, pain, digestive problems, etc.

While having a few sleepless nights occasionally isn’t worrisome, a chronic lack of sleep can disrupt daily activities and cause:

• academic difficulties, especially among primary school students;
• at work, absenteeism or presenteeism (being present in body and not in spirit);
• accidents at work and road accidents

Symptoms of insomnia

• Difficulty falling asleep.
• Intermittent awakenings during the night.
• A premature awakening.
• Fatigue upon waking up.
• Fatigue, irritability and trouble concentrating during the day.
• Decreased alertness or performance.
• Anxious anticipation of the coming of night.

People at risk of insomnia

• Women are more likely to suffer from insomnia than men, among other things due to certain hormonal changes before menstruation and during the years before and after menopause.
• People aged 50 and over.

Risk factors of insomnia

• Vulnerability to stress, a tendency to anxiety, depression, trauma or other psychological or psychiatric problems.
• An environment not conducive to sleep: an inadequate temperature, excessive lighting and noise, a night’s sleep at high altitude or with a snorer, etc.
• Jet lag, night work or frequent changes in the work schedule.
• Poor sleep hygiene (excessive napping during the day, lack of daytime physical activity, overly active evenings, irregular hours of sleep, etc.).
• Changes in night routine
• Excessive consumption of caffeine during the day or before bedtime: for example, consumption of tea, coffee, cola, energy drinks and chocolate. Mint herbal teas can also have an arousing effect.
• Alcohol consumption in the evening. Alcohol can make it easier to fall asleep. However, as the body metabolizes alcohol, sleep becomes fragmented and of poorer quality.
• Taking over-the-counter medications, such as certain decongestants, pain relievers, and weight loss products (often containing caffeine and other stimulants), or taking prescription medications, such as certain antidepressants, anti-stress medications hypertension and corticosteroids.
• Use of drugs that stimulate the central nervous system, such as methamphetamine (including crystal meth) and cocaine. These substances decrease the feeling of tiredness or the feeling of needing to sleep, as well as the appetite.
• Withdrawal (when you stop using tobacco, sleeping pills, antidepressants, anxiolytics, tranquilizers).
• Smoking, especially in the evening.
• For people with insomnia, anxiety about having trouble falling asleep exaggerates the problem.

Prevention

Here are some tips that encourage sleep. The above risk factors should be avoided as much as possible.

Get 20 to 30 minutes of exercise per day

People who exercise regularly, even moderately, sleep better than others. A study from Stanford University (California) showed that adults aged 50 to 76 with moderate insomnia could improve the quality of their sleep with regular exercise of moderate intensity. Active subjects fell asleep twice as fast as sedentary subjects and slept 1 hour more per night.

However, many people sleep less well when they exercise vigorously less than 2 to 3 hours before bedtime.

Set up your bedroom to promote sleep

Sleeping on a good mattress and in a dark room helps sleep.

In the city, you can use curtains or blinds to cut off the exterior light Light acts directly on the pituitary gland, a gland that has a major influence on the body clock. A room that is too bright or too dark impairs the waking process.

If necessary, surrounding noises can be attenuated by arranging the bedrooms in the quietest rooms of the house or by soundproofing the walls, ceilings and floors. You can also simply use earplugs.

Some people sleep best when there is a light, constant background noise (such as a fan), which covers up louder noises coming from outside.

It is advisable to ensure that the temperature in the bedroom at night is slightly lower than the daytime temperature, and also to ventilate the room well. We generally recommend a temperature around 18 °C or 65 °F.

Pay attention to the evening meal

• Eat at regular times.
• Avoid eating late at night because digestion keeps you awake. This advice becomes more important with age, as digestion takes place more slowly.
• Eat a light, slightly spicy meal at dinner, which promotes sleep. To compensate, have a larger breakfast and dinner. Rich suppers help fragment sleep, especially if they are well watered.
• A supper rich in carbohydrates and low in proteins contributes to good sleep by stimulating the production of 2 hormones involved in sleep: melatonin and serotonin.

Avoiding the consumption of stimulants

• During the few hours before bedtime, avoid consuming stimulants, such as coffee, tea, chocolate, nicotine or colas. In general, it is recommended not to take more than 2 or 3 cups of coffee per day. Even if they only drink one coffee several hours before going to bed, some people, who are very sensitive to caffeine, will not be able to sleep overnight.
• Monitor the labels of the drugs consumed. Look for stimulants, such as pseudoephedrine. Check with your pharmacist if in doubt.

Relax before bed

• Certain relaxation routines can help you fall asleep. Relaxation of body and mind makes it easier to sleep.
• In the hours before bedtime, focus on calm activities that require little energy: a walk in the fresh air, a few yoga postures, a little reading or relaxation, a bath, a massage, meditation, etc.
• Calming music, inspiring reading or uplifting pictures are better than a newsletter or a violent movie.

Aim for regularity

Try to get up at around the same time every morning, even on days off. This habits helps to regulate the body clock and makes it easier to fall asleep at night.

Treatment of insomnia

Insomnia requires treatment tailored to each situation. The first step is to find the cause. Often, insomnia that has been present for several months requires reorganizing lifestyle habits to promote sleep.

To sleep better, start by changing your habits

The treatment with behaviors known as “stimulus control” is particularly effective. It aims to accustom the body to a routine conducive to sleep. It does, however, create sleep deprivation, which sometimes makes it difficult to apply. Once you regain deep, regular sleep, and the wake and sleep cycles are resynchronized, you can gradually return to a less restrictive routine.

Here are some behavioral rules to be scrupulously observed:

• Go to bed only when you want to sleep.
• Do not stay in bed when awake for more than 20 to 30 minutes. When this happens, get up, get out of your bedroom, do some relaxing activity, and go back to bed when you are sleepy. Repeat these gestures as often as necessary.
• Getting up in the morning at a fixed time, regardless of the day of the week, including Saturday and Sunday, and even if you did not sleep badly. It’s true that it cuts down on sleep time, but it helps to sleep all at once. In the beginning, you should not delay getting up to catch up with the hours that you were not able to sleep: in the long term, this may make the problem worse. When you finally have regular and uninterrupted sleep, you can slightly extend your nights (in 15-minute increments).
• Do not go to bed for less than 5 hours.
• Do no other activity in bed (ideally in the bedroom) other than sleeping or having sex.
• Regarding a nap during the day, opinions differ. Some experts ban it completely because it would meet part of the sleep needs. According to them, naps would make it more difficult to fall asleep. Others say a short 10-minute nap can be beneficial.

Several scientific studies show that this method has been proven. An improvement in sleep is observed from the end of the first month. Its downside is that it takes discipline and motivation. You can try it yourself, but it can also be done as part of cognitive-behavioral psychotherapy.

Medicines to fight against insomnia

If insomnia persists despite the method mentioned above, sleeping pills (also called hypnotics) may be prescribed. These drugs can be helpful in the short term to recover a little (not more than 3 weeks), but they do not treat insomnia or eliminate its cause. They work by slowing the activity of the brain. Note that after 1 month of use, they often lose a lot of their effectiveness.

Benzodiazepines: These are the most commonly prescribed sleeping pills. If used regularly, they lose their effectiveness. These all have a sedative and anxiolytic effect, at various intensities. Benzodiazepines specifically indicated to treat insomnia are flurazepam (Dalmane®), temazepam (Restoril®), nitrazepam (Mogadon®), oxazepam and lorazepam (Ativan®). Diazepam (Valium®), marketed in the early 1960s, is hardly used any more, in part because it causes significant residual drowsiness the next morning.

Non-benzodiazepine sleeping pills: Including zopiclone (Imovane®) and zaleplon (Starnoc®)), they have been on the market for several years. Their duration of action is shorter than that of benzodiazepines, which eliminates the drowsiness effect that can occur the next morning.

Melatonin agonists: These help induce sleep by increasing levels of natural melatonin. They are used especially in cases of difficulty falling asleep.

Antidepressants: In low doses, they can also be used to help sleep better.

Note: Benzodiazepine and non-benzodiazepine sleeping pills have several side effects. For example, they can slow reflexes and interfere with coordination during the day, increasing the risk of falls and fractures, especially in older people. In the long term, they risk causing physical and psychological dependence. Finally, the sleep induced by sleeping pills is less restorative, because these drugs shorten the period of REM sleep (the period during which dreams occur).

It is important to consult your doctor when you want to stop taking sleeping pills or tranquilizers to avoid suffering from a withdrawal syndrome. Cognitive behavioral therapy, according to one study, facilitates complete withdrawal from chronic insomniacs who have been taking benzodiazepines; it also improves the quality of sleep. The results were visible after 3 months of treatment.

Other treatments

For severe anxiety, depression, or any other psychological disorder, your doctor may prescribe antidepressants that will relieve insomnia. He or she can also refer the patient to a psychologist or psychiatrist. If a physical health problem is the reason for insomnia, of course, you need to get adequate treatment for that particular problem.

In case of insomnia caused by pain, pain relievers may be used. However, some of them can cause insomnia. If so, don’t hesitate to ask your doctor to change the prescription.

Caution: When experiencing insomnia, it is not recommended to use antihistamines that cause drowsiness to sleep better. These drugs have little effect on chronic insomnia. They can even trigger a state of wakefulness.

Behavior therapy: According to the most recent studies, cognitive-behavioral psychotherapy is often more effective than medication in controlling insomnia. This therapy helps to deconstruct mistaken associations or beliefs fueling the distress associated with insomnia.

A personalized therapy can include:

• advice on sleep habits;
• work on unrealistic beliefs and thoughts related to insomnia or on the psychological causes of insomnia;
• learning a relaxation technique.

The number of sessions varies from person to person, but generally improvement is seen after 2 to 3 months of weekly treatments (8 to 12 sessions). Its efficiency rate would be 80% on average. People who are already taking sleeping pills may also benefit.

Sleep is crucial… it’s anything but a waste of time!

Getting a good night’s sleep is important not only for feeling good and energetic, but also for enjoying good long-term health. During sleep, several physiological processes take place: liver and muscle tissues regenerate, the immune system rebuilds its strength, memory strengthens, etc. The secretion of growth hormones is highest during sleep. The brain also takes advantage of this respite to eliminate its “waste” thanks to antioxidants. However, not much is yet known about how sleep triggers these restorative mechanisms.