A Complete Guide to Insomnia: Symptoms, Causes, and Treatment
Not getting enough sleep? We’ve all been there, and it’s not fun. As a parent of 7 children, something always seems to keep me up at night.
For most of us, sleep problems are only temporary and resolve on their own once the mind and body adjust to changes like stress or a new schedule. But sometimes poor sleep is caused by more serious issues.
The good news is that insomnia can generally be overcome once the underlying causes are identified and treated. This guide will tell you everything you need to know about insomnia including how to recognize the signs, when to seek professional help, and things you can do at home. I’ve also included some fun and surprising facts about insomnia and other sleep disorders.
Read on if you’re ready to tackle your sleep problems and rest easier at night.
Do I Have Insomnia?
According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), insomnia is defined as a sleep disorder characterized by difficulty falling or staying asleep, or waking up too early and not being able to go back to sleep. These sleep problems occur even though the person has the opportunity for adequate sleep.
Moreover, sleep issues cause significant distress or impairment in social, occupational, or other important areas of functioning. The condition must occur at least three nights per week for at least three months to meet the DSM-5 criteria for insomnia disorder.
A Large Percentage of People Experience Symptoms of Insomnia
If you’re having trouble sleeping at night, you’re not alone. Insomnia is the world’s most common sleep disorder. 30-50% of adults will experience acute insomnia symptoms in their lifetime, and 10% will suffer from chronic insomnia. 75% of adults age 65 and older have insomnia symptoms as well as 20% of preteens.
For many, insomnia feels like being trapped in a cycle of fatigue. You're exhausted all day, counting down the hours until you can again try to sleep, only to find the same restless struggle waiting for you. It's as if your body forgot how to fall asleep naturally, leaving your mind to race with thoughts, worries, or even just blankness that's somehow too loud.
This ongoing battle doesn't just affect your nights. It seeps into your days, making you feel like you're always lagging behind, clouded by a fog of sleepiness that no amount of coffee can clear. You might find yourself more irritable, less focused, and struggling to remember things. Social gatherings become energy-draining instead of enjoyable, and work or school performance may suffer.
On a more emotional level, insomnia can make you feel isolated. When you’re awake while the world sleeps, it can feel like you're the only one missing out on something essential and natural. It's not just about losing sleep; it's about feeling disconnected from a basic human need and experience.
Symptoms of Insomnia
As mentioned above, Insomnia is fundamentally defined as the inability to fall asleep or remain asleep, or experiencing consistently poor quality sleep, despite ample opportunity to do so. This condition disrupts nocturnal rest and also significantly impairs daytime functionality and well-being. Poor sleep quality results in extreme sleepiness during the day, resulting in a lack of energy.
You might have insomnia if you experience:
Difficulty falling asleep at night
Frequent awakenings during the night
Waking up earlier than desired and being unable to fall back to sleep
Experiencing non-restorative sleep (sleep that doesn't feel refreshing)
Daytime fatigue or sleepiness
Mood disturbances, such as irritability or anxiety
Decreased attention, concentration, or memory
Increased errors or accidents
Ongoing concerns about sleep
Types of Insomnia
There are two types of insomnia. Short-term insomnia and chronic insomnia.
Short-term insomnia is a temporary condition that lasts for less than three months. It's usually triggered by stressors such as life changes, loss, stressful events, drug withdrawal, or significant emotional distress.
Chronic insomnia is identified by a long-term pattern of having difficulties in either falling asleep or staying asleep. This condition is classified as chronic when sleep troubles occur at least three nights a week for more than three months.
In addition, Insomnia can manifest in a few ways. Some people experience just one nighttime insomnia symptom, while others have all of them. This can change over time as well. Insomnia is categorized as:
Sleep onset insomnia, which makes it difficult to get to sleep at a reasonable time. You may find yourself lying awake for hours. Lifestyle factors like caffeine use or mental health issues are common causes of sleep-onset insomnia.
Sleep maintenance insomnia is defined by difficulty staying asleep. People with this type of insomnia may wake up several times throughout the night or wake up earlier than they intend to. Underlying health issues or extreme worrying are the most common causes of sleep maintenance insomnia. Poor sleep hygiene, sleep apnea, or alterations in your sleep schedule can also disrupt the internal circadian rhythm, which leads to insomnia.
Early morning awakening insomnia is characterized by consistently waking up significantly earlier than planned or desired, with an inability to fall back to sleep. Unlike other forms of insomnia that might involve difficulty falling asleep or staying asleep throughout the night, early morning awakening specifically pertains to premature awakening and marks a distinct disruption in the latter part of the sleep cycle.
Paradoxical insomnia is when you get what experts would consider to be an adequate amount of sleep yet still experience some or all symptoms of insomnia. Individuals with paradoxical insomnia report feeling as if they have slept very little or not at all during the night, experiencing what feels like severe insomnia. However, when their sleep is monitored, the results often show normal sleep patterns with no significant disruptions that would typically account for their reported lack of sleep.
Insomnia can also be described based on whether it occurs independently or is caused by another comorbid condition:
Primary insomnia, also known as idiopathic insomnia, is a sleep disorder characterized by chronic difficulty in falling asleep, staying asleep, or experiencing restorative sleep, without an identifiable external cause or underlying medical condition. This type of insomnia is defined by its standalone nature, not triggered by stress, medication, substance use, or health issues.
Secondary Insomnia is a sleep disorder where the difficulty in falling asleep, staying asleep, or achieving restorative sleep is directly linked to another underlying health condition or external factor. Unlike primary insomnia, secondary insomnia can arise from a variety of causes, such as medical conditions (e.g., chronic pain, depression), substance use (e.g., caffeine, alcohol), or side effects of medications.
Healthy Sleep and Why It Matters
Understanding what healthy sleep looks like is crucial for knowing whether you’re affected by sleep issues.
Healthy sleep is characterized by getting uninterupted, deep sleep each night. You should be able to fall asleep easily, stay asleep throughout the night, and wake up feeling well-rested, refreshed, and energized. While sleep quality is more important than quantity, 7–9 hours of sleep is the ideal amount for most adults.
Consistently experiencing sleep that doesn’t hit the above criteria isn’t normal and could begin to impact your everyday life and health.
The impact of insomnia extends far beyond just feeling tired. It carries significant costs, both personally and economically, and has wide-ranging effects on health that ripple through every aspect of life.
From a personal finance perspective, insomnia can lead to increased spending on healthcare due to frequent doctor visits, prescriptions for sleep aids, and possibly therapies aimed at treating underlying causes. There's also the potential for lost income due to decreased productivity, increased absenteeism, and a higher risk of accidents on the job due to fatigue.
Health-wise, the effects of insomnia can be both immediate and long-term. In the short term, lack of sleep can impair cognitive functions such as attention, concentration, and decision-making, leading to errors and accidents. It can also have a significant impact on mood, increasing the likelihood of irritability, anxiety, and depression.
Sleep Stages and Cycles
Scientists have identified the stages of each sleep cycle by analyzing brain activity. Sleep typically consists of 4 to 6 cycles. Each sleep cycle differs in length but, on average, lasts 90-120 minutes. However, the first sleep cycle of every night is usually a bit shorter, from about 70 to 100 minutes, and later sleep cycles last between 90-120 minutes. It gets harder to wake someone with each progressive stage within each cycle.
When you wake, the brain begins producing an organic compound called adenosine, which in large enough quantities, makes you feel tired. The longer you’re awake, the more adenosine your body produces and the more tired you feel.
As you sleep, the body breaks adenosine down and your cortisol levels rise, which helps you wake up and feel alert. Cortisol levels usually peak at between 6:00 am and 8:00 am, helping most people feel alert at the start of the day.
The interplay between adenosine and cortisol shapes the 24-hour sleep/wake cycle known as the circadian rhythm. Light also plays a pivotal role in regulating our body's internal clock, which in turn influences the release of cortisol, a hormone associated with stress and wakefulness.
Exposure to natural sunlight or bright artificial light in the morning helps signal the body to wake up by inhibiting the production of melatonin, the hormone that promotes sleep, and increasing cortisol levels to promote alertness and readiness for the day. As the day progresses into evening, decreased light exposure leads to a reduction in cortisol levels, facilitating the body's preparation for sleep.
Why Do We Sleep?
Your brain is far from dormant while you sleep. Instead, it performs many important functions. Research indicates that the following things happen in your body while you sleep:
The metabolic rate — the speed at which the body uses energy — slows down during sleep compared to wakefulness. This reduction allows the body to conserve energy, to the extent of saving approximately 35% of the daily energy expenditure.
Your body produces cytokines, antibodies, and immune cells which ward off sickness and increase the effectiveness of vaccines.
Your body synthesizes proteins, releases hormones, and grows tissue.
Short-term memories are converted to long-term memories and unneeded information is erased or forgotten, clearing your brain to retain new information.
Good sleep fixes and strengthens the connection between the area of the brain that makes decisions (the medial prefrontal cortex) and the part that deals with emotions (the amygdala) – meaning when we’re well-rested we get better at managing our emotions and overall feel happier and more stable.
How Insomnia Impacts Your Mental Health
Sleep and mental health can form a self-perpetuating negative feedback loop. Stress and worry, which may arise from various sources like work, personal life, or health, may start to take a toll on a person. This emotional burden can lead to a noticeable decline in mental health, manifesting as anxiety, depression, or other mental health disorders. As mental health deteriorates, it can disrupt sleep and lead to insomnia.
A lack of restful sleep results in fatigue and tiredness, which effects your cognitive functions and makes engaging in daily activities like work or school more difficult, and more stressful.
As established, sleep is also a crucial process for regulating your emotions. Insufficient sleep can negatively impact one’s mood and emotional reactivity, and is even linked to mental health risks like suicidal ideation.
In fact, people with insomnia are 20 times more likely to develop a panic disorder. Insomnia can heighten one's sensitivity to anxiety by amplifying the brain's anticipatory reactions, making individuals more susceptible to anxiety and panic. This heightened state of anxiety can lead to panic attacks and, eventually, panic disorder.
All of this to say insomnia’s relationship with mental health is bidirectional. Sleeping issues and mental health issues can be both causes and effects of one another.
Anxiety
Everyone has fears and unhealthy preoccupations at times, but for those with an anxiety disorder, these thoughts are persistent and can significantly impact daily life. There are many different types of anxiety disorders, each with specific symptoms, like Generalized anxiety disorder, OCD, social anxiety, and phobias.
All types of anxiety disorders can result in insomnia if the fears, thoughts, and worries they cause keep the sufferer up at night. Mental hyperarousal, a key factor for insomnia, is higher in people with anxiety disorders and results in increased awake time and inefficient sleep.
Anticipatory anxiety (distress about falling asleep) is common even when there are no immediate triggers. Worrying about not being able to fall asleep can be a self-fulfilling prophecy that causes difficulties in falling asleep.
Studies also show that being anxious and thinking too much before sleep can cause more vivid and emotionally intense dreams. This can lead to scary dreams or nightmares, that can wake the person up and make them even more afraid of trying to sleep, exacerbating insomnia symptoms.
Taking steps to manage your anxiety can include therapeutic interventions like CBT as well as lifestyle changes like better nutrition, more exercise, and cutting back on substance use. Some medications can be helpful as well, but can also exacerbate insomnia.
Depression
Unlike short periods of sadness that occur in response to a specific trigger, depression sticks around and can cause hopelessness along with sleeplessness. Insomnia is not a given for everyone who suffers from depression, but sleep problems often occur when you’re depressed for a few different reasons.
If depression isn't treated, you might feel really sad, hopeless, like you don't matter, or guilty. These thoughts and feelings can make it hard to sleep. Sometimes, you might find yourself thinking too much about things you can't change. This overthinking can make you feel very anxious, worry a lot about not sleeping well, not want to do much during the day, and not understand your sleep problems correctly.
Moreover, sleep problems can start a vicious cycle by affecting the regulation of neurotransmitters such as serotonin, which can potentially lead to depression. These sleep disturbances can also interfere with the body's stress management systems and disrupt circadian rhythms, thereby increasing susceptibility to depression. This creates a cycle in which sleep disturbances and depressive symptoms perpetuate and intensify each other.
In addition, depression actually changes brain chemistry and alters the production of hormones like cortisol, which play a role in controlling circadian rhythms. In the struggle to control depression or feel better, patients may also take medications, or self-medicate with alcohol or other substances, that disrupt sleep patterns.
Not being able to sleep and sleeping too much are both common signs of major depression. While having a sleep problem by itself doesn't cause depression, not getting enough sleep can make depression symptoms worse. Continuous sleep problems can be a major hint that someone might be experiencing depression.
Depression is a serious mood disorder. It makes you feel sad, hopeless, and unimportant for long stretches of time, with feelings that are much stronger than just feeling down temporarily. These strong feelings can prevent you from leading a normal life.
Sleep plays a crucial role in our well-being. Good sleep helps us recover from the day and balance our hormone levels, but when we don't sleep well, we can become tense, easily upset, and irritable.
Events like personal loss or health issues can disrupt our sleep. Bad sleep leads to tiredness, which means we might exercise less. Less exercise can reduce our overall health, creating a cycle where poor sleep affects our physical condition and mood, making it hard to break free from the pattern of not sleeping well and feeling bad.
ADHD
As both an adult with ADHD and a parent of children and teens who suffer from the condition, I know firsthand that it’s not just about an overactive body. People with ADHD have very active brains, and it’s often hard to quiet (even mundane) thoughts when trying to sleep. ADHD can alter the internal clock and disrupt the circadian rhythm, affecting sleep.
Many of the most common medications to control ADHD are stimulants, which can be effective for the brain during the day but can keep someone up at night. People with ADHD are also prone to anxiety disorders, increasing their risk for insomnia.
People with ADHD may struggle to adopt and stick to schedules. People with the disorder also often experience time blindness — an inability to estimate how long tasks will take, remember deadlines, or simply be aware of the passing of time. This can be especially true when they are hyperfocused on preferred tasks, and creates the perfect recipe for accidentally staying up late at night.
Trauma Disorders
Like anxiety disorders, trauma disorders manifest as a cluster of conditions. REM sleep is commonly impacted after exposure to a traumatic event such as crime, war, or other type of violence, and nightmares often occur.
Insomnia related to trauma may dissipate over time without specific interventions, but it can also persist long-term. Numerous studies indicate that people with posttraumatic stress disorder (PTSD) experience significant sleep issues, with insomnia being notably prevalent among them.
About 10% of people exposed to trauma develop PTSD, which may result in a state of hyperarousal that causes insomnia. Adults with adverse childhood experiences (ACES) are more than twice as likely to have trouble sleeping as adults, with the risk increasing 20% for each additional ACE an adult suffered in their youth.
How Insomnia Impacts Your Physical Health
Insomnia can disrupt any phase of the sleep cycle, including the stages of light sleep, deep sleep, and REM (rapid eye movement) sleep. This disruption leads to a range of physical and mental effects that can manifest immediately or develop over time.
In the short term, you may experience fatigue, mood swings, decreased focus, and impaired memory. Over the long term, the consequences can become more severe, including increased risk of chronic health issues like heart disease, obesity, diabetes, and mental health disorders such as depression and anxiety.
Many of the symptoms caused by insomnia—such as stress, anxiety, and physical health problems—can, in turn, make it more challenging to achieve restful sleep, thereby increasing the likelihood of ongoing insomnia. This cycle can be difficult to break, as initial episodes of sleeplessness may escalate into more persistent patterns of insomnia.
Immune System
Your immune system defends your body against illness by responding to environmental threats. The immune system needs to be both strong and balanced so it can respond to triggers without being on constant alert.
Sleep is a major factor in building up the immune system. T helper cells defend your body against viruses, bacteria, and antigens, and they also operate more efficiently when you get good quality sleep.
When we sleep, our bodies release proteins called cytokines, which are important for controlling the immune system. These are required to fight pathogens or when you’re under stress. Decreasing the amount of sleep is, therefore, also associated with a reduction in cytokines and a weakening of the immune system and your body’s ability to fight infection. Sleep also strengthens immune memory, so your immune system is better able to respond appropriately to future threats.
Cardiovascular
Research suggests that difficulty initiating sleep is strongly associated with incident myocardial infarction (MI). Regularly getting 5 or fewer hours of sleep increases your risk of heart attack by 56% compared to those who sleep 7 or 8 hours a night.
There are many reasons why insomnia affects heart health. If you're sleep deprived, your body compensates by releasing extra cortisol during the day, potentially to stimulate a more alert state. However, increased cortisol can cause high blood pressure. Blood pressure also naturally dips while you’re asleep, but poor sleep leads to “non-dipping.”
Heightened blood pressure (especially as a result of non-dipping) is associated with a heightened risk of cardiovascular issues like heart disease, heart attack, and stroke.
Short sleep is also associated with increased inflammation, which is your body’s response to disease and injury. Increased levels of inflammation can cause a buildup of plaque deposits in the arteries of the heart, which is linked to heightened blood pressure and risk of coronary heart disease.
Diabetes
Diabetes, which is marked by high blood sugar levels, can be preceded by insulin resistance, where the body struggles to effectively use insulin, leading to glucose buildup. While insomnia doesn't directly cause diabetes, it exacerbates risk factors like insulin resistance.
Poor sleep disrupts hormone regulation and glucose use, increasing the hunger hormone ghrelin and decreasing the satiety hormone leptin. This imbalance often results in higher consumption of sugary foods and potential weight gain, elevating diabetes risk.
Research suggests that people with insomnia have higher blood sugar levels, increasing their predisposition to obesity and thereby increasing their risk of diabetes. This highlights the indirect link between sleep disturbances and diabetes risk.
Increased Risk of Accident
We’ve all made the mistake of trying to do too much without enough sleep. When performing certain tasks, sleep deprivation — which can be caused by insomnia — can lead to an inability to concentrate and can impair a person’s ability to make good decisions. It can also hinder a person’s reaction time, reducing their ability to respond quickly to their environment. In situations like driving or operating machinery, this can be deadly.
Sleep deprivation also puts a person at risk of falling asleep unexpectedly; drowsy driving is responsible for more than 6,000 fatal car crashes every year in the United States.
Life Expectancy
No, you won’t drop dead if you pull an all-nighter, but that doesn’t mean that insomnia isn’t life-threatening. While cases of death related directly to sleep deprivation are rare, the effects of insomnia inevitably take their toll on the body and even lead to death in some cases.
A person who sleeps on average less than 6 hours per night has a 13% higher mortality risk than someone sleeping between 7 and 9 hours. In fact, 8% of deaths for any reason are attributed to poor sleep patterns.
It’s not just the quantity of sleep that matters, however, but the quality. While sleep quantity is associated with achieving repeated cycles of sleep, it’s high-quality, deep sleep that’s truly restorative.
Lifestyle Factors That Contribute to Insomnia and How to Manage Them
Various lifestyle choices and daily habits can significantly influence the quality of our sleep, potentially leading to insomnia. These choices include poor diet, lack of physical activity, overuse of stimulants like caffeine and nicotine, irregular sleep schedules, and engaging in stimulating activities before bedtime.
Lifestyle Factors We Can Control
Sleep Hygiene
Sleep hygiene refers to the practices and habits that are conducive to sleeping well regularly. It involves creating an environment and adopting behaviors that promote consistent, uninterrupted sleep, helping to improve your overall health, mood, and well-being.
Here are some key sleep hygiene tips to consider:
Stick to a consistent sleep schedule: Go to bed and wake up at the same time every day, even on weekends. This helps regulate your body's internal clock and can improve the quality of your sleep.
Create a bedtime routine: Establish a relaxing pre-sleep ritual to signal your mind and body it's time to wind down. This could include reading, taking a warm bath, or practicing relaxation exercises.
Make your sleeping environment comfortable: Ensure your bedroom is conducive to sleep – cool, quiet, and dark. Consider using earplugs, a sleep mask, or a white noise machine to block out disturbances.
Invest in a good mattress and pillows: Make sure your mattress and pillows are comfortable and supportive. The quality of your bedding can significantly impact your sleep.
Limit exposure to screens before bedtime: The blue light emitted by phones, tablets, and computers can interfere with your ability to fall asleep. Try to avoid these screens for at least an hour before bed.
Avoid caffeine and nicotine late in the day: These stimulants can hinder your ability to fall asleep. Try to avoid them for several hours before bedtime.
Be mindful of your eating habits: Avoid large meals, spicy foods, or anything that might cause discomfort or indigestion right before bed. A light snack before bedtime, however, may help you sleep.
Exercise regularly: Regular physical activity can help you fall asleep faster and enjoy deeper sleep, but try not to exercise too close to bedtime as it may energize you.
Limit naps: If you must nap, try to keep it short (20-30 minutes) and avoid napping late in the day, as it can disrupt your nighttime sleep pattern.
Manage stress: Try to resolve your worries or concerns before bedtime. Journaling, meditation, or deep breathing exercises can help manage stress and improve your sleep.
Get sunlight exposure: Natural light exposure during the day helps to regulate your sleep-wake cycle. Try to spend some time outside every day or use bright light therapy if necessary.
Avoid alcohol before bed: While alcohol might help you relax, it interferes with your sleep cycle once you're asleep, leading to disrupted and poor-quality sleep.
Light
Light plays a crucial role in regulating our body's circadian rhythm, acting as a signal for when to wake up and when to sleep. Special cells in the retina alert the brain about light levels, influencing the production of hormones like cortisol for daytime alertness and melatonin for sleep readiness at night.
The presence of blue light, especially, can suppress melatonin production and keep us alert, significantly impacting our sleep-wake cycle. Research shows that blue light suppresses melatonin more than other colors of light. Compared to green light, blue light suppressed melatonin for twice as long and shifted circadian rhythms twice as much (3 hours vs 1.5).
Given the strong impact of blue light, which we receive not only from the sun but also from electronic devices like TVs, computers, and smartphones, managing our exposure to it is important.
By using dark curtains, dimming lights in the evening, and reducing screen time at least two hours before bed, we can better mimic natural light patterns. Similarly, exposing ourselves to bright lights in the morning can help wake our brain, aligning our internal clock with the natural day-night cycle for improved sleep.
Smells
The sense of smell can play a pivotal role in the battle against insomnia. Pleasant and soothing scents, such as lavender, jasmine, or chamomile, have been found to significantly impact our ability to relax and fall asleep.
These scents work by triggering a calming response in the brain, which can lower heart rate and blood pressure, easing the transition into sleep. Incorporating these scents into your bedtime routine can create a relaxing environment conducive to sleep. This can be achieved through various means, such as aromatherapy diffusers, scented candles, or even essential oil-dabbed pillows, all aimed at enveloping your sleep space in a fragrance that promotes restfulness.
Sounds
Sounds can have a profound effect on our sleep quality. While unexpected or loud noises can disrupt sleep, leading to insomnia, consistent and calming sounds can have the opposite effect, aiding in sleep induction and continuity.
White noise machines or apps that produce soothing sounds, like rain falling or waves crashing, can help mask disruptive environmental noises, providing a consistent auditory backdrop for sleep. The rhythmic nature of these sounds can also support relaxation techniques, making it easier for individuals with insomnia to drift off to sleep and stay asleep throughout the night.
Substance Use and Proper Medication
Substance use, including the consumption of caffeine, nicotine, and alcohol, can significantly impact sleep patterns and contribute to insomnia. Stimulants like caffeine and nicotine can delay sleep onset, while alcohol, despite its initial sedative effects, can lead to fragmented and non-restorative sleep.
On the other hand, the timing and type of medication can also affect sleep. Some medications may have stimulating effects or disrupt the natural sleep cycle if taken too close to bedtime. To control these factors, you should limit the intake of stimulants and alcohol, especially in the evening, and consult healthcare providers to ensure medications are taken at the most appropriate times to support sleep rather than hinder it.
Diet
The relationship between diet and sleep is complex but crucial. Eating heavy, spicy, or acidic foods too close to bedtime can lead to discomfort and indigestion, making it difficult to fall asleep or stay asleep. Conversely, certain foods can have sleep-promoting effects.
For instance, foods containing tryptophan, magnesium, or melatonin, such as turkey, almonds, and cherries, can naturally enhance sleep quality. To leverage diet in the fight against insomnia, it's recommended to avoid large meals and potentially disruptive foods late at night, opting instead for light snacks that support sleep if needed.
Exercise
Regular physical activity is beneficial for sleep, helping to improve both its quality and duration. However, the timing of exercise can influence its impact on sleep; engaging in vigorous exercise too close to bedtime can leave the body feeling energized, making it harder to wind down and fall asleep.
To use exercise as a tool against insomnia, you should consider the type of exercise you prefer, as well as your own body’s reaction to it. For some people, vigorous exercise elevates the body temperature too close to bedtime and reduces the quality of their sleep. However, light exercise, such as yoga and stretching, even close to bedtime, has been shown to improve sleep quality in some study participants.
Lifestyle Factors We Can’t Control
Age
Healthy and adequate sleep matters at any age, but we tend to get less sleep as we get older. On average, starting with middle age, a person loses 27 minutes of sleep per night for each decade they age.
At about 60-years-old, your circadian rhythm shifts earlier, known as a phase advance. It’s common for older adults to perform better in the earlier part of the day and feel very tired and unfocused in the late afternoon and evening. The circadian rhythm can also get more delicate with age, impacting sleep quality and duration.
Medical and mental health conditions in older age also have an impact on sleep. Many seniors are at a higher risk of experiencing depression and other mental health issues that can lead to insomnia. Chronic pain and illnesses are also more common as we get older, leading to discomfort and fitful sleep. Some of the medications used to treat geriatric illness cause insomnia.
Minority Status and Discrimination
Insomnia is one of many medical conditions and disorders that are more prevalent among certain racial groups and ethnicities. Studies have shown that white people in the US are least likely to suffer from sleep issues. Hispanics have higher rates of sleep insufficiency and Black people have higher rates of both short sleep and long sleep than white respondents.
We know the what, but the why is a bit more complicated. Researchers looking for an explanation of racial disparities in insomnia consider race to be a social construct and instead point to institutionalized racism as a main factor. Indeed, significant racial differences in insomnia symptoms were not found when studies were conducted in a controlled environment.
People of color are more likely to be working shift work and often have higher levels of exposure to stressors like racism, risky jobs, dangerous neighborhoods, financial stress, pollution, and reduced access to healthcare. Acculturation (i.e. the process of adjusting to a dominant culture) can be another stressor for minority communities.
Parenthood
I’m personally all too familiar with lost nights of sleep taking care of my children. Babies rely on their parents for nutrition, diaper changes, and comfort and, until 8–12 weeks, their circadian rhythm is not yet developed enough to tell night from day.
The problem is worse for single parents who have no one to share these parenting duties with. Two-parent households are only slightly more likely to get less than 7 hours of sleep a night than houses with no children (32.7% of adults vs. 31%). However, 42.6% of newly single parents get less than 7 hours sleep.
Feeding is the most common reason new parents must wake up throughout the night, reinvigorating the debate on breast milk vs formula. Research indicates that melatonin found in breast milk might enhance sleep quality by reducing instances of colic and irritability, and increasing sleep duration.
However, formula-fed babies don’t need to eat as often, leading to little evidence for a real difference between formula or breastmilk on sleep quality for the parents. By the age of 6 months, babies can start solid foods, so the issue is transitory regardless.
Other factors of parenthood also take a toll on sleep. The pressure and responsibility of caring for a whole human produces anxiety and may also impact work schedules and other commitments. The important takeaway is that it gets better and parents should take steps to care for themselves so they have more to give to their children.
Seasons
Some animals hibernate in winter, but what about people? You may notice that you sleep more when it gets colder, and it’s not just your imagination.
While the research is conflicting about exactly how and why the weather and seasons affect sleep patterns and frequency of insomnia, a large-scale study in 2019 found that, relative to winter, during spring, participants slept on average for 25 fewer minutes, waking 25 minutes earlier. There is no definitive consensus for why this is the case, but a few theories prevail.
Scientists agree that melatonin production is suppressed by our brain’s response to light, so it makes sense that longer days result in less sleep. Spring time is when a lot of seasonal allergies act up, which can influence insomnia symptoms. Warmer weather also increases body temperatures, making people feel hot, sticky, and uncomfortable, making it more difficult to both get to sleep and remain asleep for some.
On a social level, people go into “vacation mode” in the late spring and summer and may let their schedules lapse. This is particularly true of parents like me, who don’t have to be so rigid with bedtimes when school isn’t in session.
Vitamin D and sunlight play significant roles in regulating our circadian rhythm, which in turn affects our sleep patterns. Sunlight exposure influences the production of serotonin, a neurotransmitter that impacts mood and arousal, laying the groundwork for healthy sleep by helping regulate melatonin production, the hormone responsible for sleep.
In winter, shorter days and reduced sunlight can disrupt this balance, leading to changes in serotonin and melatonin levels, which can disturb sleep patterns. This seasonal shift can contribute to Seasonal Affective Disorder (SAD), a type of depression more common in the winter months. SAD can lead to insomnia or hypersomnia (excessive sleepiness), along with poor sleep quality.
While we can't alter the weather or the changing seasons, we can adapt our routines to align with the available daylight to support our circadian rhythm. This might include spending time outside during daylight hours to maximize sunlight exposure or using light therapy boxes that mimic natural light, particularly in the morning.
These strategies can help maintain a more consistent circadian rhythm, counteracting the potential sleep disruptions associated with seasonal changes. By understanding the connection between light, Vitamin D, and sleep, we can take proactive steps to enhance sleep quality throughout the year, regardless of the season.
Additional Strategies for Improving Sleep Quality
Cognitive Behavioral Therapy for Insomnia
Cognitive Behavioral Therapy (CBT) is a widely respected form of psychological treatment that focuses on changing harmful thought patterns and behaviors. The idea behind CBT is that promoting healthy thoughts can lead to healthy feelings and behaviors.
Extensive research has found CBT to be more effective than other types of psychological therapy or pschiatric medications for some patients. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a specific form of CBT designed to change the way people think, feel, and behave about sleep and prevent and treat insomnia.
CBT-I treatment generally takes about 6 to 8 sessions, though the exact duration depends on the patient, therapist, and severity of insomnia. Telehealth CBT-I is available if you can’t get to a mental health provider and has similar efficacy to in-person treatment. CBT-I has been shown to increase total sleep time, reduce waking after sleeping, and improve sleep latency.
CBT-I works in 3 parts:
Cognitive interventions: Cognitive interventions to change your negative and damaging thoughts about sleep.
Behavioral interventions: Behavioral interventions change the body’s response to sleep and promote relaxation. Stimulus control trains the brain to see the bedroom as a place for sleep. Sleep restriction gradually increases the time spent in bed. Breathing exercises, hypnosis, and biofeedback may be used to calm and quiet the brain and respond in a healthy way to triggers.
Psychoeducational interventions: Psychoeducational interventions such as teaching about the connections between thoughts, behaviors, and sleep, as well as sleep hygiene and the components of healthy sleep.
Hypnosis
Hypnosis is often portrayed in novelty acts and in the media as mind control, but this isn’t how it’s practiced in reality. In fact, hypnotherapy is very successful in helping to manage many bad habits such as drinking, smoking, or overeating.
Contrary to what you might think, hypnosis doesn’t involve putting you to sleep. Instead, it aims to change negative thoughts that prevent you from getting good sleep. Many doctors suggest sleep hypnosis alongside other types of therapy like CBT to help you be more susceptible to performing major lifestyle changes.
Light Therapy
Light therapy is pretty straightforward, being exactly what it sounds like. A device emits artificial light that mimics sunlight, without UV rays, to help reset the circadian rhythm and realign your body’s schedule with the sun so you feel tired at night.
Light therapy devices currently come in many forms and can be ordered online and used at home. You can use light therapy tablets, lamps, watches, alarm clocks, and visors while you cook, write, work, or talk on the phone.
Light therapy has a few side effects like nausea, headaches, and eye strain, but they are usually minor and temporary, especially when compared to the effects of insomnia. However, always consult a doctor before beginning a light therapy regimen and if you feel side effects. They can help you avoid the worst of the issues and train you on proper use.
Speak to a Doctor about Your Medications
If you’re taking medications, talk to your doctor to see whether they may be the culprit of your insomnia. Both over-the-counter medications and prescriptions can affect sleep. If your medicine treats a serious ailment or symptom, there may be other options, but you shouldn’t switch up your medications without talking to a medical professional.
Melatonin
Not all sleep aids require a prescription. Melatonin, which is produced naturally in your body, can also be purchased over the counter. For adults, small doses can be taken 30 minutes to 1 hour before bed.
However, melatonin should be used carefully and sparingly. The reason for this is twofold: first, taking supplements can affect the body's internal production of melatonin, potentially disrupting natural sleep rhythms over time. Second, the dosage and purity of over-the-counter melatonin can vary widely between products, leading to inconsistency in effectiveness and potential side effects.
Moreover, relying on melatonin supplements without addressing underlying issues or poor sleep hygiene practices can be a temporary fix rather than a long-term solution.
In older adults dealing with insomnia, using melatonin as a supplement has shown considerable benefits by reducing the time it takes to fall asleep, enhancing overall sleep quality, and minimizing the periods of wakefulness after initially falling asleep.
Melatonin is effective in alleviating sleep difficulties associated with jet lag and has helped individuals experiencing delayed sleep phase syndrome, where sleep is initiated much later than desired, by advancing the time they fall asleep.
However, as with any medication, you should consult with your doctor about using melatonin for your specific case. They can help you find the correct dose and timing and ensure that the medicine doesn’t exacerbate an underlying cause of insomnia.
Mindfulness-Based Therapy for Insomnia
Mindfulness-Based Therapy for Insomnia (MBT-I) is a therapeutic approach that combines principles and practices from mindfulness meditation with conventional behavioral treatments for insomnia. This therapy aims to help people suffering from chronic sleep disturbances by teaching them to manage the stress and emotional reactions associated with insomnia.
Through mindfulness practices, patients learn to observe their present-moment experiences, thoughts, and feelings non-judgmentally. This increased awareness helps in reducing the anxiety and stress that can interfere with sleep, thereby promoting a more restful state conducive to sleep.
The focus of MBT-I is on more than achieving better sleep; it is on changing the patient's relationship with sleep and insomnia symptoms, enabling sleep to occur more naturally. It is designed for those seeking alternative, non-pharmacological options for managing insomnia, advocating for lifestyle adjustments to improve sleep quality and overall well-being.
Getting an Insomnia Diagnosis
Diagnosing insomnia can be tricky since it can vary from person to person, as well as in duration. There is no specific amount of sleep that labels someone an insomniac. Instead, insomnia refers to sleep problems that exist even when you have enough time and an adequate sleep environment.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides criteria that healthcare professionals use to diagnose insomnia. However, it's important to remember that only a qualified healthcare provider can officially diagnose and recommend treatment for insomnia.
To be diagnosed with insomnia, you typically need to experience difficulty initiating or maintaining sleep or waking up too early without being able to fall back asleep for at least three nights a week over a period of at least three months. These sleep disturbances should also cause significant distress or impairment in social, occupational, educational, or other important areas of functioning, and they should occur despite adequate opportunities for sleep.
It's also crucial to distinguish insomnia from other potential causes of poor sleep, such as underlying medical conditions, mental health issues, or the effects of substances, including medications. Therefore, when experiencing persistent sleep problems, consulting with a healthcare professional is vital. They can conduct a thorough evaluation, which may include a detailed medical history, a physical exam, and possibly even a sleep study.
Getting a proper diagnosis is the first step toward finding effective treatment and improving your sleep and, subsequently, your overall quality of life. If you suspect you might have insomnia, reach out to your doctor or a sleep specialist who can guide you through the diagnosis process and explore treatment options tailored to your needs.
The Bottom Line
Losing a little sleep here or there happens to everyone and might not seem like a big deal. When left untreated, though, insomnia is debilitating and causes other health issues. Many of the causes and impacts of insomnia are bidirectional and form a vicious cycle where not getting high-quality sleep puts you at risk for health conditions, which in turn puts you at greater risk for insomnia.
There’s no single cure for insomnia, but it is a highly treatable condition. Knowing your risk factors can help you find the right treatment for your insomnia, and patients often use more than one method simultaneously. Interventions for insomnia include sleep hygiene, mental health interventions, relaxation methods, lifestyle changes, and medications.
No matter which methods you try, remember to keep prioritizing your sleep; your waking hours depend on it!