Insomnia

Key Takeaways

• Insomnia disorder (ID) involves dissatisfaction with sleep quantity or quality, leading to significant distress or impairment in daily functioning. This includes difficulties with drifting off, staying asleep, or waking prematurely.
• Nighttime symptoms include trouble falling asleep, frequent awakenings, difficulty returning to sleep, and waking up excessively early. Daytime manifestations encompass fatigue, poor concentration, cognitive difficulties, irritability, anxiety, and a low mood.
• Cognitive-behavioral therapy for insomnia (CBT-I) is the first-line treatment for the disorder, and medications may be considered for short-term use if CBT-I is unavailable or not fully effective.

Understanding Insomnia

Insomnia disorder (ID) includes both nighttime and daytime symptoms that significantly impact quality of life and overall well-being. Nighttime sleep-related issues involve struggles with falling asleep, staying asleep, and waking up too early, while daytime manifestations include difficulties with concentration, fatigue, cognitive challenges, anxiety, irritability, and a depressed mood. ^[1]

Additionally, insomnia poses a significant risk factor for both physical and, primarily, mental health. In fact, recent research indicates that addressing insomnia could play a crucial role in preventing mental health disorders worldwide. However, studies regarding these preventative treatments are still in the early stages. ^[1]

The Classification of Insomnia

Insomnia is not a new diagnosis, and over the past half century, all major medical diagnostic systems have included the disorder. However, today, the criteria have been updated in the primary clinical guides for diagnosis, including: ^[1]

• Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5)
• International Classification of Sleep Disorders (ICSD)
• International Classification of Diseases, 11th revision (ICD-11)

Revisions involved removing the distinction between primary insomnia (insomnia occurring without an underlying health condition) and secondary insomnia (insomnia resulting from another medical or psychiatric disorder). ^[1]

This reclassification was a significant step forward in recognizing insomnia as a standalone disorder rather than merely a symptom of other health conditions. That said, many experts in the field feel that grouping all types of insomnia into a single category may be too simplistic. ^[1]

There is still ongoing debate surrounding the classification of different types of insomnia, such as trouble falling asleep, difficulties staying asleep, or insomnia without actual short sleep duration. ^[1]

Despite the controversy, subtyping insomnia based solely on sleep patterns may not be very reliable, as symptoms tend to fluctuate over time. Emerging research has shown that more consistent subtypes have been found by analyzing personality traits rather than sleep patterns. ^[1]

How Common is Insomnia?

Studies looking at the prevalence of insomnia in various European countries showed substantial differences between countries. It was found that in Germany, just under 6% of people are affected by the disorder, while in France, insomnia was found in 20% of the population. ^[1]

Overall, chronic insomnia affects approximately 10% of the adult population, making it a fairly common condition. The disorder is more prevalent in females than males, and prevalence rises with age. ^[1]

Symptoms of Insomnia

According to the DSM-5, which is used by psychiatric healthcare providers worldwide, insomnia is characterized by “dissatisfaction with sleep quantity or quality.” Additionally, the disorder leads to significant distress or impairment in social, work, academic, or other areas of functioning. ^[2]

Insomnia is diagnosed if an individual meets one or more of the following criteria: ^[2]

• Trouble falling asleep: (Children may require caregiver assistance in order to sleep)
• Difficulty staying asleep: Frequent awakenings or challenges with resuming sleep after waking (children may require caregiver assistance to return to sleep)
• Waking up abnormally early: Waking up excessively early and being unable to go back to sleep

The condition is only diagnosed if sleep difficulties occur more than three nights a week, for at least three months. That said, short-term (acute) insomnia can be diagnosed as “other specified insomnia disorder” if symptoms have lasted less than three months. ^[2]

The disorder is not diagnosed if: ^[2]

• Sleep problems are a result of having inadequate opportunities to sleep
• The symptoms are better accounted for by another sleep disorder
• Insomnia is due to the effects of a substance (eg, medication or substance abuse)
• Coexisting mental or medical conditions explain the sleep complaint

However, insomnia can co-occur with: ^[2]

• Other psychiatric disorders (including substance use disorders)
• Medical conditions
• Other sleep disorders

Diagnosing Insomnia with Co-Occurring Conditions

Insomnia disorder can be diagnosed whether it occurs as a standalone condition or alongside another psychiatric disorder, medical condition, or sleep disorder. However, since the relationship between insomnia and comorbid conditions can vary over time, it is often difficult to determine a clear causal link between them. ^[2]

Therefore, when insomnia occurs alongside another disorder, the diagnosis should specify the presence of the comorbid condition without assuming that either disorder is caused by the other. However, the diagnosis of co-occurring insomnia should only be made if the sleep disturbance is severe enough to require separate clinical attention. ^[2]

Diagnostic Tests for Insomnia

The diagnosis of insomnia disorder is primarily based on self-reported information. A key component of insomnia assessment is the use of sleep diaries, such as the Consensus Sleep Diary (now available as an app), which allow clinicians to monitor sleep and wake patterns over time in the form of graphs. ^[1]

In addition to sleep diaries, specific insomnia questionnaires like the Insomnia Severity Index and the Sleep Condition Indicator are valuable assessment tools used to quantify the severity and impact of insomnia symptoms. ^[1]

Insomnia Severity Index (ISI).pdf)

This seven-item questionnaire uses a rating scale to assess the nature and impact of sleep problems. It evaluates sleep quality, symptom severity, satisfaction with sleep patterns, the effect of insomnia on daily functioning, perceived visibility of sleep issues to others, and overall distress caused by the sleep difficulties. ^[3]

Sleep Condition Indicator (SCI)

An eight-item questionnaire that can identify sleep disturbances and evaluate the severity and duration of insomnia symptoms. The SCI assesses sleep patterns over the previous month, focusing on sleep onset, duration of awakenings, sleep quality, and the impact of sleep difficulties on daily life. ^[4]

Diagnostic Challenges

In addition to challenges in identifying whether insomnia is a standalone condition or a symptom of a medical or psychiatric disorder, diagnosing the condition is based on subjective data reported by individuals with the disorder. This presents difficulties when self-reported sleep disturbances are not aligned with findings highlighted by technology. ^{[1] [2]}

As a result, there is ongoing debate as to whether technology-based sleep tests that can measure a person’s sleep should be used as part of the diagnostic procedure. One of the most accurate sleep tests is the polysomnography (PSG), which is a lab test that uses electrodes to monitor the brain, heart, breathing, and muscles to measure sleep. ^[1]

Recent research has revealed a significant gap between subjective sleep reports (like sleep diaries) and objective PSG data, with PSG often showing less severe sleep disturbances than individuals report. In other words, a person may believe they are sleeping less than the data reveals. This is known as paradoxical insomnia and presents a major challenge in research. ^[1]

Additionally, scientists are starting to find brain patterns during sleep that match reports of the disordered waking state given by people with insomnia, such as simultaneous sleep-like and wake-like brain activity. This could explain the reason that some individuals who suspect they have insomnia are unaware that they have slept more than they believe. ^[1]

How Harmful to Health Can Insomnia Be?

Research suggests that the long-term health risks of insomnia might be linked to consistently sleeping less than six hours a night. However, studies show that people with insomnia who sleep less than six hours on one night often sleep more on other nights, making it hard to confirm this connection. ^[1]

That said, it has been found that insomnia can have serious health consequences, including an increased risk of heart disease, obesity, and diabetes. The disorder also contributes to mental health problems such as depression, anxiety, and psychosis, with chronic sleep deprivation affecting emotional stability and increasing the risk of suicidal thoughts. ^{[1] [5]}

Furthermore, a 2025 meta-analysis indicates that insomnia is associated with an increased risk of dementia, Alzheimer’s disease, and vascular dementia. These findings suggest that insomnia could play a significant role in the development of dementia, underscoring the need for early intervention and management. ^[6]

What Causes Insomnia?

Although the exact cause of insomnia is not fully understood, it is thought that the disorder can develop and persist due to a combination of influences, including underlying vulnerabilities, triggering events, and ongoing factors that sustain it over time. These factors include emotional, cognitive, psychological, physical, and behavioral components and are categorized as follows: ^{[1] [7]}

Predisposing Causes of Insomnia

Predisposing factors are inherent traits or characteristics that increase the likelihood of insomnia, including:

• Genetics and early life stress: Genetics can increase an individual’s susceptibility to insomnia. Additionally, childhood trauma further predisposes individuals to insomnia by impacting the brain circuits involved in emotion regulation.
• Personality traits: Individuals with a history of heightened anxiety responses, perfectionism, neuroticism, or those who are predisposed to internalize problems, are all more vulnerable to developing insomnia.
• Sleep-wake regulation: Imbalances in the brain’s sleep-wake mechanisms, particularly hyperarousal (an overactive and anxious mind) and dysfunctional circadian rhythms (the body’s internal clock system), can predispose individuals to insomnia.

Precipitating Insomnia Triggers

Precipitating causes of insomnia involve major life events or stressors that spark the initial onset of insomnia or trigger acute episodes:

• Stressful life events: Severe insomnia often begins after significant stressors, such as trauma in the form of family, health, or work-related crises. However, not everyone who experiences trauma develops insomnia, but it is more likely that those who are predisposed will develop the disorder.

Perpetuating Factors of Insomnia

Perpetuating influences are ongoing behaviors or patterns that sustain or worsen insomnia over time, including:

• Disrupted brain mechanisms: Insomnia can be seen as an imbalance between sleep-promoting and wake-promoting systems in the brain. An over- or underactive wake system (or a combination) may cause insomnia.
• Hyperarousal: An overactive wake system linked to physical, mental, and emotional hyperarousal can persist both day and night in people with insomnia, perpetuating the condition.
• Rapid eye movement (REM) instability: REM is a stage of sleep that plays a crucial role in emotional processing and regulation, which may perpetuate insomnia and emotional distress.
• Maladaptive behaviors: Habits that interfere with a healthy sleep cycle (eg. irregular sleep schedules, excessive time in bed, alcohol, and excessive screen use) are likely to prolong insomnia symptoms.
• Cognitive biases: Excessive worry about getting enough sleep, unrealistic beliefs about sleep needs, and fixating on sleep-related stimuli (attentional bias) can maintain or worsen insomnia.

At the end of the day, acute insomnia often starts with a stressful life event, but not everyone who experiences it goes on to develop chronic insomnia. The reason why some people do and others do not is not fully understood, but it likely involves a combination of genetic factors and early life stress, making some people more vulnerable. ^[1]

Once insomnia takes hold, a cycle of cognitive, emotional, and brain hyperactivity, unstable REM sleep, and unhealthy sleep habits can keep it going. Additionally, over time, people with insomnia may associate their bed with being awake rather than sleeping, reinforcing the problem and making it harder to break the cycle. ^[1]

Risk Factors

Insomnia is linked to various emotional, psychological, and biological risk factors, making it essential to identify potential vulnerabilities early on. In doing so, should a traumatic event trigger short-term insomnia, individuals who are at higher risk of developing the disorder can seek preventive treatment and potentially halt the progression into chronic insomnia. ^[1][7][8]

Emotional Risk Factors

• Emotional vulnerabilities: Personality traits such as neuroticism, perfectionism, anxiety sensitivity, and a tendency to internalize problems

• Emotional distress response: People with heightened emotional responses to stress are more likely to experience disruptive sleep

• Early childhood adversity: Traumatic experiences in childhood can alter brain circuits related to emotion regulation

• Lingering emotional distress: Insomnia can be both a symptom and a predictor of prolonged emotional distress, including depression and anxiety

• Socio-emotional difficulties in childhood: Insomnia in children has been linked to challenges in emotion regulation and social interactions

Psychological Risk Factors

• Cognitive biases: Worrying about sleep, overestimating the consequences of sleep loss, or fixating on sleep-related stimuli can perpetuate insomnia

• Psychiatric disorders: Insomnia prevalence reaches 83.3% in schizophrenia and 74.2% in eating disorders, with mental disorders doubling the risk of insomnia

Biological Risk Factors

• REM sleep disturbances: Restless REM sleep can exacerbate emotional distress, making individuals more prone to anxiety and depression over time

• Disrupted brain mechanisms: Imbalances between sleep-promoting and wake-promoting systems can contribute to persistent insomnia

• Hyperarousal: Persistent mental, physical, or emotional hyperarousal can keep the wake system activated, preventing restful sleep and potentially leading to insomnia

• Circadian misalignment: Disruptions to the body’s internal clock (such as shift work or caring for an infant) can interfere with sleep patterns and contribute to insomnia

• Reduced sleep drive: A diminished need for sleep or difficulties maintaining sleep pressure can also elevate the risk of insomnia

• Screen use in bed: Individuals who use devices in bed are at a 59% higher risk of developing insomnia due to the impact of blue light exposure on the sleep-wake cycle

• Irregular sleep schedules: Frequently changing sleep and wake times disrupt the body’s internal clock, making it harder to maintain consistent sleep patterns

• Excessive time in bed: Spending too much time in bed can lead to poor sleep quality and longer periods of wakefulness, especially if sleep is not achieved

• Alcohol use: While alcohol may initially cause drowsiness, it disrupts the sleep cycle and leads to poor sleep quality, particularly during the second half of the night

• Medical conditions: Insomnia prevalence is nearly 50% higher in individuals with physical conditions

Prevention

While research has not yet confirmed preventative measures for insomnia, the disorder is influenced by both factors that are beyond one’s control, and influences that can be managed. Unchangeable vulnerabilities include genetic predisposition, childhood trauma, and personality traits like perfectionism, anxiety, and neuroticism. ^[1]

With this in mind, there are steps that can be taken to reduce the risk of developing insomnia even in vulnerable individuals. While stressful or traumatic life events can trigger acute insomnia episodes, seeking professional treatment may help prevent the impact of these circumstances from progressing into long-term insomnia.

Additionally, ongoing behavioral patterns can perpetuate chronic insomnia over time. These include an irregular sleep schedule, excessive screen use, and spending too much time in bed. Addressing these habits and establishing a consistent bedtime routine while limiting screen exposure before bed can reduce the risk of insomnia by 37%. ^{[1] [7]}

Persistent worry about sleep, overactive thinking at night, and fixating on sleep difficulties can keep the mind in a heightened state of alertness, preventing relaxation and rest. Fortunately, cognitive behavioral therapy for insomnia (CBT-I) can help promote healthier sleep-related attitudes and may aid in preventing the perpetuation of insomnia. ^[1]

Complications

There are numerous complications linked to insomnia, including physical, cognitive, and mental health difficulties, financial hardship, substance dependence and overdose, as well as suicide. Fortunately, it is possible to treat insomnia, and studies have found that reducing its symptoms can lead to better mental, physical, and cognitive health and an enhanced quality of life. ^[1]

Potential complications associated with insomnia include: ^{[1] [2] [5] [6] [9] [10]}

• Obesity and diabetes: Insomnia is linked to an increased likelihood of obesity and type 2 diabetes, as poor sleep can disrupt metabolic processes

• Heart and blood vessel issues: Insomnia raises the risk of developing cardiovascular diseases, putting extra strain on the heart and blood vessels

• Vascular dementia: Insomnia might impair blood flow to the brain, increasing the risk of vascular dementia due to reduced brain health and function

• Cognitive decline: Insomnia may cause cognitive decline due to the link between decreased gray matter and damage to white matter seen in people with the disorder

• Dementia: Insomnia may lead to changes in the brain that increase the risk of developing dementia over time

• Alzheimer’s disease: Chronic sleep disturbances like insomnia could contribute to the accumulation of amyloid plaques in the brain, a key feature of Alzheimer’s disease

• Mental health problems: Chronic lack of sleep affects emotional stability and is associated with a higher risk of depression, anxiety, and other mood disorders.

• Psychosis: Severe sleep deprivation can contribute to psychosis, indicating a potential link between chronic insomnia and mental health disorders.

• Alcohol Use Disorder: Persistent insomnia can increase the risk of developing alcohol use disorder and may remain as a residual symptom even after treatment.

• Higher healthcare costs: Insomnia leads to greater healthcare use, as individuals with poor sleep often need more medical attention for various health issues.

• Impaired functionality and disability: Insomnia is a significant predictor of increased sick leave and long-term disability, potentially leading to financial hardship.

• Sleep medication dependence: Both over-the-counter and prescription sleeping pills can lead to symptoms of addiction, which may worsen insomnia and lead to overdose

• Risk of suicide: Insomnia is a contributing factor to a higher likelihood of suicidal thoughts and actions, especially when left untreated.

Suicide Hotlines

Suicide hotlines are private, 24/7 phone services where individuals in crisis can connect with trained professionals for support, guidance, and immediate assistance during difficult times. These hotlines offer resources, referrals, and help with accessing local mental health services.

• American Suicide Hotline: Call 988

• Global Suicide Hotlines: Access a list of suicide hotlines worldwide here. If your country isn’t listed, search “24/7 suicide hotline” to locate a local number.

Treatment Options

Insomnia is primarily treated with cognitive behavioral therapy for insomnia (CBT-I), which involves a range of techniques, although medications may be prescribed short-term. It is important to note that when insomnia coexists with another disorder, treatment needs to address both conditions simultaneously under professional supervision. ^{[1] [2]}

That said, CBT-I not only significantly improves insomnia symptoms in many people, but also benefits co-occurring physical and mental health conditions as well as a person’s overall quality of life. Additionally, research shows that the treatment may even prevent the onset of other mental health disorders. ^[1]

Cognitive-Behavioral Therapy for Insomnia (CBT-I)

Cognitive-behavioral therapy for insomnia (CBT-I) is consistently recommended as the first-line treatment for insomnia, and can be delivered effectively both in person and online. CBT-I is a multifaceted treatment approach that includes various cognitive and behavioral strategies rather than a single method. Key techniques involve: ^[1]

• Sleep restriction: Limits time in bed to match actual sleep duration, gradually increasing as sleep improves
• Stimulus control: Aims to train the mind to associate the bed only with sleep and intimacy, instead of wakefulness
• Cognitive reappraisal: Addresses and reframes unhelpful beliefs or negative thought patterns surrounding sleep and insomnia
• Cognitive control: Aims to prevent intrusive thoughts by encouraging the journaling of any pressing concerns before bed
• Paradoxical intention: Reduces sleep anxiety by instructing individuals to stay awake rather than trying to sleep

Relaxation therapies and sleep hygiene education are also included in CBT-I, though they are typically not effective on their own, and are only of benefit as valuable components of the overall treatment approach: ^[1]

• Sleep hygiene education: Teaches healthy sleep habits, such as managing light, temperature, and activity levels
• Relaxation techniques: Assists in reducing physical and mental hyperarousal through methods like muscle relaxation, deep breathing, and meditation.

Medication

CBT-I is strongly recommended as the primary treatment for insomnia, with medications only suggested for short-term use if CBT-I is not available or doesn't work. Medications such as melatonin, benzodiazepines, sedative antidepressants, and others are generally only recommended for short periods (less than 4 weeks). ^[1]

This is due to the fact that while these pharmaceuticals can provide short-term relief, many of them (with the exception of melatonin) carry the risk of addiction. Unfortunately, insomnia can lead individuals to self-medicate, with many insomniacs ultimately using more and more pharmaceuticals in an effort to acquire a good night’s rest. ^[9]

Abusing prescription or over-the-counter sleeping medication can cause withdrawal and exacerbate insomnia (or induce anxiety and physical distress) when stopped. Although melatonin is considered non-addictive, the supplement is also only safe for short-term use, as it is thought to mask symptoms without addressing the root causes of insomnia. ^[9]

Management and Sleep Improvement at Home

Creating a bedtime routine that promotes relaxation can be a powerful tool for managing insomnia. By setting up a screen-free sleep space, engaging in soothing activities, and focusing on relaxation rather than forcing yourself to sleep, you can potentially shift your mindset and reduce bedtime anxiety.

Make Your Bed a Screen-Free Sleep Space

Research has revealed a strong link between screen use and insomnia, so it is important to keep your bed a calm, tech-free zone dedicated to sleep. This means avoiding using devices in bed wherever possible, whether recreationally or for work. By compartmentalizing screen time and resting time, it may help to shift your mindset regarding your experience with your bed. ^[7]

Soothing Bedtime Routine

While it is not possible to control when you will fall asleep, you can take steps to manage your anxiety by developing a calming bedtime routine. This could involve creating a relaxing environment with an essential oil diffuser, reading a self-help book, and journaling or drawing before heading to bed at a consistent bedtime (which may help train your body to rest). ^[1]

Aim to Rest, Not to Sleep

While meditation apps like Insight Timer offer a variety of shorter guided meditations that can be calming, the benefit of sleep hypnosis videos on YouTube is that they are longer, sometimes lasting up to 8 hours. This means that you can rest in bed, listening to encouraging and uplifting messages, without pressurizing yourself to fall asleep in a set amount of time.

Notable Research and Studies

Researchers are now combining advanced brain imaging and other techniques to understand how insomnia affects the brain and body. This could help identify why people with insomnia often feel distressed overnight and lead to better treatments. Understanding what makes some treatments more effective for different people is key to personalizing care. ^[1]

Recent studies show that treating insomnia could do more than just improve sleep - it may also help prevent mental health issues like depression and anxiety. Therefore, by improving sleep, it could be possible to reduce the global impact of these mental health disorders and improve overall well-being. ^[1]

Digital tools like online CBT for insomnia are being explored as a cost-effective way to treat sleep problems. These digital programs could provide an easy, accessible treatment option for people struggling with insomnia, especially in places where resources are limited. Combining these tools with other methods, like self-help books, could make treatment more flexible. ^[1]

In the future, researchers want to integrate insomnia treatment into mental health care for conditions like anxiety and depression. Since sleep problems are common in these conditions, addressing them may improve overall treatment success. Early insomnia treatment could even help prevent mental health issues, especially in people most at risk. ^[1]

Final Thoughts

Affecting a considerable portion of the adult population, insomnia presents with both nighttime sleep disturbances and daytime consequences (such as fatigue) that can severely diminish an individual's quality of life.

Fortunately, evidence-based treatments like cognitive-behavioral therapy for insomnia (CBT-I) offer a robust first-line approach, empowering individuals to develop healthier sleep habits and challenge maladaptive sleep-related thoughts.

While medications may offer short-term relief, their long-term use is generally discouraged due to the risk of dependence and the potential for exacerbating sleep issues. CBT-I is the strongest option for those struggling with insomnia to regain restful sleep and reclaim their quality of life.

Author

Star Gorven

Star Gorven is a wellness and mental health writer with a talent for crafting evocative and evidence-based content across a wide range of topics. Her work blends analytical research with imagination and personality, offering thoughtful insights drawn from her exploration of subjects such as psychology, philosophy, spirituality, and holistic wellbeing.

Activity History - Last updated: March 19, 2026, Published date: March 19, 2026

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Reviewer

Kaye SmithPhD

Dr. Smith is a behavioral health coach, clinician, writer, and educator with over 15 years of experience in psychotherapy, coaching, teaching, and writing.

Activity History - Medically reviewed on April 5, 2026 and last checked on March 19, 2026