Insomnia: Why it Happens and How to Treat It

Kristin Hall, FNP
Medically reviewed by Kristin Hall, FNP Written by Our Editorial Team Last updated 08/16/2020

Can’t sleep? Insomnia is an exceptionally common issue, with about one in every four American adults experiencing some form of difficulty sleeping every year. 

Insomnia is a type of sleep disorder. If you’re affected by insomnia, you might find it harder than normal to fall asleep. You may also find it difficult to stay asleep, to wake up at a normal time, or to wake up without feeling tired. 

Dealing with insomnia can be an incredibly stressful experience that affects you not just during the night, but also throughout the day.

Luckily, options are available. Below, we’ve explained what insomnia is and how it happens, as well as the numerous treatment options that are available to help you enjoy better, deeper sleep and fewer sleep-related difficulties.

What is Insomnia?

Insomnia is a sleep disorder that makes it harder than normal to fall asleep, stay asleep or sleep a typical amount of time. 

There are two different types of insomnia. The first is primary insomnia, which is insomnia that isn’t associated with any other health problem. People that have primary insomnia may struggle to sleep normally even if they’re otherwise completely healthy. 

The second is secondary insomnia. This is insomnia that occurs as a result of another health issue, such as a disease or condition, pain, or use of medication or alcohol. 

Like many other sleep disorders, insomnia can come and go. People with insomnia that’s lasted for a long time are referred to as having chronic insomnia, whereas insomnia that occurs over the short term is usually referred to as acute insomnia.

Insomnia can cause a range of symptoms, including:

  • Difficulty falling asleep after going to bed
  • Frequently waking up during the night
  • Waking up too early in the morning 
  • Not feeling refreshed and rested after waking up
  • Feeling tired and sleepy during the day
  • Difficulty focusing or memorizing information
  • Making avoidable errors and mistakes
  • Feeling irritated, anxious or depressed
  • Worrying or feeling nervous about sleep

These symptoms can vary in severity. While some people might find it difficult to fall asleep after spending hours in bed, other people with insomnia might fall asleep quite easily, only to wake up an hour or two later and struggle to fall asleep again.

What Causes Insomnia?

Insomnia can occur for a variety of reasons, from underlying health issues or use of medication to anxiety, travel across time zones or just drinking too much coffee. The most common causes of insomnia include:

  • Stress. Stress is closely associated with both acute and chronic insomnia. When you’re stressed, you may find it more difficult to relax after going to bed, making it more difficult to fall asleep and enjoy a full night of sleep.
  • Jet lag. As we’ve explained in our guide to jet lag cures, traveling across time zones can make falling asleep difficult. Luckily, this type of insomnia normally gets better on its own as your body adjusts to your new time zone.
  • Work schedules. If you work long hours at the office, or work late-night or early-morning shifts, you may find it harder than normal to fall asleep due to the effects of your work on your sleep-wake cycle.
  • Poor sleep habits. Going to bed at a different time every night, staying up late watching TV or gaming, using your smartphone in bed, sleeping in a noisy environment and other poor sleep habits can all contribute to insomnia.
  • Stimulants and food. Stimulants, such as caffeine and nicotine, can make sleeping far more difficult when consumed in the afternoon and evening. Likewise, eating too late at night can affect your ability to fall asleep and cause insomnia.
  • Alcohol. Although alcohol often makes falling asleep easier, drinking too much alcohol can affect sleep quality, prompt you to wake up during the night and cause certain other symptoms of insomnia.
  • Health conditions. Numerous diseases and health conditions can cause and contribute to insomnia. Some health conditions, such as sleep apnea, may cause you to frequently wake up during the night, affecting your sleep quality.

  • Medications. Insomnia is a common side effect of many medications, including common medications used to treat depression, high blood pressure, heart disease, allergies, pain and asthma.

  • Mental illness. Many people with mental health disorders such as depression, anxiety, post-traumatic stress disorder (PTSD) and others have difficulties falling asleep, waking up on a normal schedule and maintaining normal sleep habits.

There are also several risk factors for insomnia. Your risk of insomnia is higher than the average if you’re over 60 years of age, you have a mental health disorder, you’re female or you often go to sleep at irregular times due to your career, travel schedule or general lifestyle. 

How to Treat Insomnia

There are a range of ways to treat insomnia. Sometimes, making changes to your sleep habits may be enough to make sleeping easier. In other cases, you may need to use over-the-counter sleep aids or prescription medication.

Lifestyle Changes

It’s often possible to overcome insomnia by making changes to your lifestyle, particularly your sleep habits and consumption of stimulants like caffeine. Try the following lifestyle changes to treat insomnia and enjoy better sleep:

  • Give it time. Stressful or traumatic events, such as the death of a loved one, can often cause insomnia. This type of insomnia often gets better without medical treatment after enough time has passed.
  • Consider cognitive behavioral therapy. Called CBT-I, cognitive behavioral therapy for insomnia is a common non-pharmaceutical treatment for insomnia. It involves identifying thoughts that prevent you from sleeping and replacing them with sleep-promoting ones.

    If you’re interested in cognitive behavioral therapy for insomnia, it’s best to talk to a sleep therapist.
  • Reduce or manage sources of stress. Stress, whether from your work or personal life, is a common cause of insomnia. While it can be difficult to completely eliminate stress, it can help to either reduce or manage the major sources of stress in your life.

    This could mean taking up a stress-reducing practice like meditation or meeting with an expert to discuss how you can better manage the factors that contribute to stress.
  • Set a consistent bedtime and wake time. If you often wake up and sleep at different times of day, try setting a specific bedtime and wake time. Then, make an effort to stick to your sleep schedule.

  • Talk to your healthcare provider about your medications. If you use medications for other health conditions, check to see if they’re linked to insomnia or other sleep issues.

    If they are, it’s important to talk to your healthcare provider before making any changes. Depending on your health and symptoms, they may recommend adjusting your dosage or changing to a different type of medication. 

  • Reduce your caffeine consumption. Caffeine is a powerful stimulant with a half-life of several hours. It’s also closely linked to insomnia.

    If you often drink coffee or other drinks containing caffeine, try to limit your consumption after midday to avoid disrupting your sleep.
  • Exercise. Research shows that moderate aerobic exercise helps you fall asleep faster and increases deep, slow-wave sleep. According to Johns Hopkins Medicine, getting at least 30 minutes of exercise per day can have a positive effect on sleep quality.

  • Stop smoking. Studies show that the nicotine in cigarettes is linked to increased sleep latency, reduced slow wave sleep, daytime sleepiness and several other symptoms of insomnia.

    Smoking can also worsen respiratory and cardiovascular diseases that may affect your ability to fall asleep. If you smoke and have insomnia, consider quitting to improve both your sleep and your general health.
  • Create a more comfortable sleep environment. If your bedroom is too bright, noisy or uncomfortable for healthy sleep, take steps to make it a more relaxing, sleep-promoting environment.
  • Try not to sleep. As strange as it sounds, going to bed and trying not to sleep may help you fall asleep. This technique is referred to as paradoxical intention and is designed to reduce the anticipatory anxiety that can sometimes contribute to difficulty sleeping.
  • If you’re traveling, take steps to get a better night’s sleep. Simple changes to your habits can make sleeping easier while traveling. We’ve outlined several of these in our guide to dealing with jet lag.

Over-the-Counter Sleep Aids

Although the scientific evidence is mixed overall, some over-the-counter sleep aids appear to be helpful for improving insomnia symptoms. These sleep aids often contain herbal ingredients and are available without a prescription. Options include:

  • Melatonin. A hormone responsible for regulating the sleep-wake cycle, melatonin is one of the most popular over-the-counter sleep aids on the market.

    Although research on melatonin’s benefits for insomnia is limited, some studies do show that it can improve sleep quality and decrease sleep latency. We’ve looked at these, and more, in our guide to using melatonin to improve sleep.
  • Other sleep aids. From valerian to chamomile, many herbal ingredients are associated with better sleep. We’ve included many of these in The Sleeping Tea, which is designed to help you zen out and get ready for bed.

    Our guide to natural sleep aids goes into more detail on how natural sleep products work and the science behind their effects on sleep.

Prescription Medications

Several prescription medications are available for treating insomnia. Although older prescription sleeping pills were often habit-forming, many of the new medications available today can help to treat insomnia without a significant risk of dependence or addiction. Options include:

  • Doxepin. Doxepin is a non-habit forming prescription medication used to treat insomnia. Studies show that it can increase sleep duration, sleep maintenance and sleep quality in people with insomnia without any next-day drowsiness.

    We’ve covered the effects and advantages of doxepin as an insomnia treatment in more detail in our guide to doxepin and sleep.
  • Ramelteon. Ramelteon is a medication that’s used to treat sleep-onset insomnia — the type of insomnia that prevents people from falling asleep easily. Like doxepin, it has no evidence of abuse or dependence, making it a non-habit forming sleep medication.

    We’ve looked at the effects, advantages and side effects of ramelteon in more detail in our complete guide to this medication.
  • Zolpidem (Ambien®). Another sleep medication, zolpidem reduces sleep latency (time to fall asleep), prevents nighttime waking and increases sleep duration in people affected by insomnia.

    In certain cases, zolpidem may cause side effects such as next-morning drowsiness. It’s currently approved by the FDA only for short-term use (up to 35 days).
  • Eszopiclone (Lunesta®). Lunesta is a sleep medication that belongs to the same class of drugs as zolpidem. Unlike zolpidem, it’s been approved by the FDA for nightly use for up to six months. 

Many older medications that were previously used to treat insomnia, such as benzodiazepines like lorazepam (Ativan®) and alprazolam (Xanax®), are no longer widely prescribed for insomnia due to their potential for abuse and dependence. 

If you’re considering using a prescription medication to treat insomnia, you’ll need to talk to your healthcare provider. We offer several FDA-approved insomnia medications on our online platform following a medical consultation via an online assessment.

In Conclusion

Dealing with insomnia is never fun. Whether your insomnia is an occasional, mild annoyance or an ongoing, chronic problem, it’s important to remember that a wide range of treatment options are available. 

From lifestyle changes to medications, the options listed above can help you treat insomnia and enjoy the deep, refreshing sleep you need to look, feel and function your best. 

Looking for more sleep tips? Our guide to science-backed tactics for better sleep lists a variety of techniques that you can use to improve your sleep habits and enjoy better, more consistent sleep. 

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.