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You don’t know what time it is but you’re pretty sure it’s late. You’ve been tossing and turning in bed for at least an hour or two.

You grab the phone on your nightstand and see that it’s 1 am. “Oh great,” you think to yourself. “My alarm is going to go off in five hours.”

You turn back over, willing yourself to shut your eyes and get some sleep. But, your brain and body refuse to cooperate. 

Sound familiar? If so, you might be dealing with insomnia — and you’re definitely not alone. 

Insomnia is a sleep condition that makes it tough for you to sleep, even when you’re attempting to do so. If you have insomnia, you might have trouble: 

• Falling asleep
• Staying asleep
• Getting high-quality sleep

…or even all of the above. 

Insomnia is a frustrating condition and one that can feel isolating. It can seem like everybody else is effortlessly getting quality sleep while you’re the only one struggling. But, that’s not the case. In fact, insomnia symptoms occur in up to 50% of the adult population. 

All insomnia makes it difficult for you to get the amount and quality of sleep that you need. 

But, not all insomnia is the same. There are different types, and understanding them can help you figure out exactly what you’re dealing with. 

Many medical professionals separate the types of insomnia by duration: 

• Short-term insomnia: A short episode (less than three months) of trouble sleeping, usually related to a stressful event.
• Chronic insomnia: A long pattern of trouble sleeping, defined as difficulty sleeping three nights per week for three months or longer. 

Others look at insomnia related to its root cause. Using that filter, there are two distinct types of insomnia: primary insomnia and secondary insomnia.

The American Academy of Sleep Medicine explains that primary insomnia is a lack of sleep that can’t be attributed to any sort of existing cause. Basically, you can’t pinpoint the root of your sleeplessness. 

In contrast, secondary insomnia is the result of a medical illness, mental disorder, or other sleep disorder. It could also be related to the use of certain substances.

Whether you’re dealing with short-term or chronic or primary or secondary, you’re bound to have this question: Why can’t I sleep? What causes insomnia? What’s behind this frustrating sleeplessness?

Well, the answer isn’t always straightforward. As the Mayo Clinic explains, there’s a slew of potential factors that contribute to insomnia—from your lifestyle to your health. 

• Diet: From eating too much before bedtime (which can cause heartburn) to consuming caffeine, nicotine, or alcohol, what you put into your body has a major impact on your sleep.
  
• Sleep habits: Too much screen time before bed? Irregular bedtime schedule? Too many naps during the day? These seemingly harmless habits can all throw your nighttime sleep off track.
• Stress: Worrying about work issues, relationship problems, or other life events can keep you awake at night. 
  
• Travel: Jet lag or unfamiliar sleeping environments can also make it tough for you to fall or stay asleep.

• Mental health disorders: Anxiety and depression can cause or worsen your insomnia. In fact, the National Alliance on Mental Illness estimates that 50% of insomnia cases are related to depression, anxiety, or psychological stress. 

• Sleep disorders: Other sleep conditions like sleep apnea or restless leg syndrome can also keep you up at night. 
• Medications: Many prescription or over-the-counter medications contain caffeine or other stimulants that will make it more challenging for you to fall asleep.
  
• Medical conditions: Conditions like asthma, cancer, chronic pain, diabetes, and more can contribute to insomnia.

Even your age can play a major role in insomnia. The Sleep Foundation explains that our internal clocks change as we get older. As a result, people over the age of 60 are more susceptible to insomnia. 

Everybody has had the occasional bad night of sleep. So, how can you know if you’re actually dealing with insomnia? 

According to the Cleveland Clinic, signs of insomnia to keep an eye out for include: 

• Difficulty falling asleep
• Difficulty returning to sleep 
• Feeling tired during the day
• Frequently waking in the middle of the night
• Irritability or a depressed mood
• Problems with concentration or memory

Again, experiencing these symptoms on a random and infrequent basis is much different than dealing with them regularly. Pay close attention to how often they’re creeping in so you can differentiate between an off night and actual insomnia.

Anybody who has ever had a bad night of sleep (which is all of us) will tell you that it can majorly throw you off the next day—and maybe even longer. 

But, the effects of insomnia extend beyond just feeling grumpy and sluggish the next morning. Insomnia can have major impacts on your cognitive and physical well-being. The American Academy of Sleep Medicine says insomnia can lead to: 

• Anxiety about sleep
• Daytime sleepiness
• Fatigue
• Headaches or tension
• Irritability or anger
• Lack of concentration
• Lack of motivation or energy
• Mistakes or accidents at work or while driving
• Moodiness
• Poor memory
• Poor quality performance at work
• Upset stomach

When you continue to get insufficient sleep, it leads to sleep deprivation. That can have plenty of negative effects on its own, including the development of chronic conditions like cardiovascular disease, depression, obesity, and Type 2 diabetes. 

As Stanford Medicine explains, insomnia itself isn’t a disease. That means there isn’t a tried and true test that can diagnose it.

If you suspect you have insomnia, the best thing you can do is to connect with a medical professional. They’ll conduct an exam and ask you thorough questions about your health, lifestyle, existing medications, sleep history, and symptoms. 

That conversation can reveal a lot. However, keeping a sleep journal for a few weeks or participating in a sleep study (which can be done in a lab or at home) will give you and your doctor even more information about what next steps you should take. 

You’ve determined that you have insomnia. Now what? Is there any way that you can get the sleep you so desperately need?

Rest assured, when it comes to how to treat insomnia, there are several options.

Usually, the first-line treatment is with cognitive behavioral therapy for insomnia (CBTi), which is therapy provided by a licensed psychologist who can help you understand the anxieties that are contributing to your insomnia and provide relaxation techniques and behavioral changes to help you sleep better. CBTi doesn’t have the side effects or risks that sleep medications can have, and has been shown to significantly improve sleep in 70-80% of participants. 

If those interventions aren’t effective, a doctor can prescribe medication or sleep aid. But again, those are usually only recommended after trying CBTi and other lifestyle changes, or if you aren’t a candidate for CBTi.

People with insomnia are all too familiar with the dreaded alarm clock countdown. “Oh no, I have to be awake in four hours. Now three hours. Ugh, two hours.” That makes you feel even more anxious, which makes it even tougher to doze off. 

Not getting the sleep that you need is more than just frustrating. It can have major impacts on your overall well-being, not to mention your quality of life.

Fortunately, there are things you can try to get the good night’s sleep you deserve—and we can help.

Article Reviewed By

Joshua Roland, MD, FAASM - River's Medical Director

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