What science says about insomnia: Types, causes, and the best treatments

Imagine a night spent tossing and turning under the covers. You check the time on your phone and squeeze your eyes shut after turning off the screen—only to have its outline still flashing behind your eyelids as you try to adjust to total darkness once again.

Slowly, the hours tick by until your alarm goes off and it’s time to get ready for a long day, even though you’re running on empty. Every once in a while, this is normal. But when insomnia becomes a repeat occurrence, it can cause major issues in someone’s ability to function daily.

If you’ve experienced these symptoms, you’re among millions of others dealing with this challenge. Research suggests that more than 30% of adults experience insomnia. Read on for information about what insomnia looks like, effective treatments, and warning signs that it might be happening to you.

What Is Insomnia?

Insomnia is a condition that makes it difficult for people to fall asleep, stay asleep, or fall back asleep, usually leading to daytime fatigue, irritability, memory problems, difficulty concentrating, and more.

Insomnia can occur on its own (primary insomnia) or as a result of certain medical or mental health conditions (secondary insomnia). It can also be classified as “short-term” or “chronic.”

Short-term insomnia: Lasts a few days to a few weeks; often caused by stress, environmental changes, or other life shifts.

Chronic insomnia: Occurs three or more times per week for longer than three months, and cannot be attributed to other physical or mental health problems.

Short-term insomnia is relatively common, as is chronic insomnia: About 10% to 15% of adults experience short-term symptoms, while 5% to 10% struggle with chronic insomnia.

Caitlin Opland, a licensed clinical social worker at Thriveworks, knows the frustrations firsthand. “As someone who has insomnia, it can be incredibly frustrating and debilitating at times. Your mind is constantly racing or unable to shut down,” she says. “Insomnia causes constant exhaustion and fatigue, making you feel almost like a zombie. Your body is physically tired, but your brain won’t stop.”

What Are the 3 Types of Insomnia?

Aside from the above classifications—short-term, chronic, primary, and secondary—there are three main types of insomnia based on when sleep difficulties occur:

Because our body’s circadian rhythms are quite sensitive to change, insomnia can become behaviorally and biologically reinforced over time. In simple terms, if you keep waking up early, looking at your phone late at night or when you wake up, and maintaining other habits that reinforce your current sleep pattern, your body will eventually adapt to believe you’re supposed to sleep this way.

What Are 5 Major Insomnia Symptoms?

The five major insomnia symptoms are:

1. Difficulty falling asleep
2. Frequent nighttime awakenings
3. Early morning awakenings
4. Bedtime anxiety about sleep
5. Daytime grogginess

Sleep challenges arise from various circumstances, which means people can experience different symptoms. Though the core symptom of insomnia is trouble sleeping, the effects of lack of sleep can also be warning signs. Aside from daytime fatigue, examples of issues caused by lack of sleep include:

• Irritability
• Trouble focusing
• Lack of motivation
• Making simple or repeated mistakes
• Poor memory
• Anxiety about sleep
• Low mood/depression
• Racing thoughts when trying to sleep
• Muscle soreness
• Headaches

Through other people’s eyes, some symptoms might be more obvious. “To friends and family, people with insomnia may appear to have dark circles, puffy eyes, flat affect, and slower movements. They may snap at seemingly small things, struggle to focus on what you’re saying, zone out, or forget about plans,” Opland says.

What Is the Main Cause of Insomnia?

Primary insomnia occurs on its own, though behavioral or life circumstances might make sleeping more difficult. However, secondary insomnia occurs as a result of another condition.

Examples of these conditions and causes include:

• Stress
• Changing schedules or environments
• Mental health conditions, such as anxiety or PTSD
• Physical illness (chronic pain, sleep apnea, gastrointestinal issues, heart disease, etc.)
• Substance use
• Caffeine, nicotine, or alcohol consumption

Insomnia is also incredibly prevalent in older adults: One study found that almost 30% of participants over age 70 had diagnosable insomnia.

While these major issues might be the root cause of someone’s insomnia symptoms, the condition worsens due to smaller habits that make the situation worse, including:

• Late-night electronics usage, due to boredom and an inability to sleep
• Stress or anxiety related to frustration with being unable to sleep
• Staying up late performing routine tasks and activities
• Working nights or evenings
• Eating late at night

While circumstances may vary widely, the main takeaway is that multiple issues are usually part of the problem. Because these causes are so varied, finding the root cause first is essential to successfully treating insomnia symptoms.

What Are Red Flags for Insomnia?

“Red flags” or warning signs that you might be developing insomnia can include:

• Bedtimes becoming later
• Going to bed becomes anxiety-inducing
• Energy levels decline during the day but peak at night
• Caffeine consumption dramatically increases in order to stay awake
• Using alcohol to try to stay asleep—which can actually worsen insomnia symptoms

It depends on the sleep schedule, but really, anyone from a child to the elderly can develop insomnia. There’s no age range; it matters more what the root problem is and what functional impairments it’s causing.

How Is Insomnia Treated?

To find a lasting solution to insomnia symptoms, it’s best to talk to a clinician who specializes in sleep-related issues. If you’ve experienced insomnia symptoms lasting a week or more, it’s important to begin seeking assistance so that you do not reinforce your symptoms with behaviors that can make the condition more severe.

There are several commonly used treatments for insomnia, many of which can (and should) be used together.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

A behavioral therapist or psychiatric provider can help you through therapeutic approaches, the most common being cognitive behavioral therapy for insomnia.

“CBT-I is the gold standard treatment for insomnia,” Opland says. “It targets the thoughts and behaviors that fuel insomnia using sleep restriction therapy, which may seem counterintuitive but is powerfully effective.”

CBT-I works through several key techniques:

• Sleep restriction therapy: Limiting time in bed to build stronger sleep drive
• Stimulus control: Retraining the brain to associate the bed with sleep only
• Cognitive restructuring: Challenging anxious or catastrophic thoughts about sleep

“For example, instead of thinking, ‘If I don’t sleep, I’ll ruin tomorrow,’ you might shift to, ‘If I don’t fall asleep right now, there’s no evidence that I will ruin tomorrow. The day could still be OK,'” Opland explains.

The overall goal of CBT-I is to foster healthy sleep hygiene, build up sleep drive, and strengthen the bed-sleep connection to encourage sleeping soundly at appropriate times.

Lifestyle Changes and Sleep Hygiene

Outside of CBT-I, there are various habits that can work alongside your therapy to improve your ability to sleep. Examples include:

• Relaxation techniques before bed or when feeling anxious, like breathing exercises, progressive muscle relaxation, or meditation
• Getting in bed and waking up at the same time every day
• Controlling the light, temperature, and noise in your bedroom (as best you can)
• Avoiding electronics 2-3 hours before bed (or using blue-light glasses to filter the light)
• Lowering or stopping your caffeine consumption
• Staying out of your bed until bedtime

Using these and other positive habits, you will likely be able to curb your insomnia and recover your old sleep schedule.

Medication and Supplements

Sleep medications, such as hypnotics, benzodiazepines, and other non-controlled substances, can be prescribed by a qualified medical professional. However, they’re typically a second line of defense, as they aren’t a permanent solution.
Within these medications, hypnotics are usually prescribed first, though benzodiazepines, which are a type of hypnotic, are often a second approach due to being highly controlled substances.

Hypnotics

• Sonata (Zaleplon)
• Lunesta (Eszopiclone)
• Ambien (Zolpidem)
• Zolpimist (Zolpidem)

Benzodiazepines

• Temazepam (Restoril)
• Triazolam (Halcion)
• Estazolam (ProSom)
• Quazepam (Doral)
• Flurazepam

Non-Controlled Substances

• Trazadone
• Mirtazapine (Remeron)
• Doxepin (Silenor)
• Hydroxyzine (Atarax, Vistaril)

Inside CBT-I: What to Expect in a Session

A typical course of CBT-I lasts six to eight sessions, each about an hour long on average. At the start, CBT-I sessions, much like other types of therapy, will involve one-on-one talks with your provider about your symptoms, health history, life circumstances, and more. Providers need to get a full picture of who you are and how you live to create a strong, effective treatment plan.

Here’s what may happen in a typical session, according to Opland:

• Reviewing your sleep diary from the past week
• Making adjustments to your “sleep window”
• Practicing relaxation techniques
• Identifying unhelpful thoughts and reworking them
• Planning specific behavioral changes for the upcoming week

For real progress to occur, work needs to be done outside the session as well—perhaps more so than standard therapy. That’s because sleep takes place at home. During sessions, your provider will likely focus on mindset changes and adjusting thought processes, while changes in sleep habits will need to be made at home. Using a sleep diary to track your time before, during, and after sleep can help uncover what factors could be impacting your sleep.

When to Seek Professional Help for Insomnia

If you are experiencing problems with sleep that persist for more than a couple weeks and are starting to impact your ability to function, you should consider seeking help from a mental health professional.

Why it matters: Insomnia can have a huge impact on your ability to live, making tasks like driving, doing your job, cooking, and taking care of yourself much harder—even dangerous.

Getting comprehensive care: Seeing a medical professional alongside a mental health practitioner can help ensure that your treatment is comprehensive and effective.

Frequently Asked Questions

Why can’t I sleep, even though I’m tired?

You can’t sleep despite being tired because your mind, not your body, is preventing sleep. Common culprits include racing thoughts about the next day, physical tension from the day’s stress, or poor sleep associations with your bed. Solutions include writing down worries, taking a warm shower to lower body temperature, avoiding screens before bed, and working with a therapist to address underlying sleep hygiene issues and anxiety patterns.

Can insomnia be cured permanently?

Yes, insomnia can be effectively treated and often cured permanently through cognitive behavioral therapy for insomnia (CBT-I). Research shows CBT-I provides lasting results without the dependency risks of sleep medications. CBT-I addresses the root thoughts and behaviors that fuel insomnia, helping people develop sustainable sleep habits that persist long after treatment ends. Unlike medications, which only work while you’re taking them, CBT-I teaches skills that create permanent improvements in sleep quality.

How long does CBT-I take to work?

Most people see improvement from CBT-I within six to eight weeks. A typical course involves six to eight one-hour sessions with a trained therapist. Many patients notice some positive changes within the first few weeks, with significant improvement occurring by the end of treatment. The skills learned in CBT-I continue to benefit people long after the sessions end, making it a lasting solution rather than a temporary fix.

Is insomnia more common in women or men?

Women are 40% more likely to have insomnia than men. This gender difference is attributed to hormonal fluctuations during menstruation, pregnancy, and menopause, as well as higher rates of anxiety and depression in women. Sleep disorders affect 39% to 47% of perimenopausal women and 35% to 60% of postmenopausal women. Despite this higher prevalence, insomnia can affect anyone regardless of gender.​​​​​​​​​​​​​​​​