Insomnia is a common sleep disorder in which you may have trouble falling asleep, staying asleep or getting good quality sleep, and it happens even if you have the time and the right environment to sleep well, so a dark bedroom and no screens before bed may not be enough to end it. Trouble sleeping almost every night for more than 2 weeks is reason to talk to your healthcare provider, and you can walk into that appointment with a record of your nights and a named treatment to ask for.
When bad sleep is worth a doctor's time
If not getting enough sleep is affecting your daily activities, talk to your doctor, even if it has been less than 2 weeks. In the short term, insomnia can make it hard to concentrate or think clearly, and you may feel irritable, sad and unrested or have headaches. It also raises your risk of falling, having a road accident or missing work.
Insomnia is considered chronic, or long-term, when it occurs 3 or more nights a week and lasts for 3 months or longer, and you can book an appointment long before that.
Experts recommend that adults sleep between 7 and 9 hours a night, which gives you a measure that does not depend on how tired you feel. Adults who sleep less than 7 hours a night may have more health issues than those who sleep 7 or more, so if you think you are sleeping too little, tell your doctor that as well.
Insomnia that started with stress or comes with age is still insomnia. Stress or worrying about school or work, relationships, money, or the death of a loved one raises your risk of insomnia, and your chances of having it increase as you get older, though it can develop at any age. Once insomnia is chronic, it raises your risk of high blood pressure, coronary heart disease, diabetes and cancer.
If you feel sleepy at the wheel, pull over and take a break, because lack of restful sleep can put you at risk for auto accidents. Mental health conditions such as anxiety, depression and thoughts of suicide may occur with chronic insomnia, and if thoughts of suicide come, phone or text 988 for the Suicide & Crisis Lifeline, or use its chat at 988lifeline.org. When someone's life is at risk, call 911.
What else keeps you awake when it is not night shifts or snoring
A health problem, a medicine or a substance keeps many people awake: most cases of insomnia that last a month or longer are secondary, the symptom or side effect of something else, such as certain medical conditions, medicines and other sleep disorders, and caffeine, tobacco and alcohol can also be a cause. Where insomnia comes from another problem, treating that problem, if possible, is important, and treatment often begins by reviewing any medicines or health problems that may be causing or worsening it. The health problems that may be reviewed include:
- an enlarged prostate gland or another medical condition that causes men to wake at night to urinate
- pain or discomfort from muscle, joint or nerve disorders, such as arthritis and Parkinson disease
- other medical conditions, such as acid reflux, allergies and thyroid problems
- mental health disorders, such as depression and anxiety (see Flat and tired for weeks while eating less? Book a doctor's visit)
Some medicines and substances may also affect sleep, including too much caffeine through the day or caffeine late in the day (see How much caffeine is in a day of coffee instead of meals?), some cold medicines and diet pills, and other medicines, herbs or supplements.
Worrying about whether you will get enough sleep and watching the clock can also raise your risk of insomnia or make it worse. Insomnia is more common in women than in men, and hormone changes during pregnancy and menopause can cause problems with sleep.
Sleep apnea is one of the other sleep disorders worth ruling out, even if no one has heard you snore. Insomnia can itself be a symptom of sleep apnea, one you may pick up on yourself, and it is a more common one in women. You may not know about the signs during sleep, such as breathing that stops and starts, until someone tells you. Tell your healthcare provider about any of these, since you may need a sleep study to help diagnose the condition (see Do you need a sleep study if you stop breathing at night?).
Tell your doctor, too, if you fall asleep during the day, snore or make choking sounds in your sleep, or have odd feelings in your legs or feel like you need to move them, which can come with more serious sleep problems.
To find the cause, your provider may ask whether you have any new or long-standing health problems, take any medicines, are pregnant or going through menopause, or use caffeine, nicotine, alcohol or illegal drugs. A physical exam is done to rule out other medical problems that might affect your sleep: your provider listens to your heart and lungs and looks for risk factors for sleep apnea, such as large tonsils or a large neck circumference.
Tests are possible too. A sleep study looks for other sleep problems, such as circadian rhythm disorders, sleep apnea and narcolepsy. Actigraphy looks at your periods of rest and activity through a small motion sensor worn on your wrist for 3 to 14 days. Blood tests check for thyroid problems or other medical conditions that can affect sleep.
What a doctor can offer when a dark room and no screens have not worked
Beyond a dark room and no screens, a doctor can offer cognitive behavioral therapy for insomnia, or CBT-I, which is usually recommended as the first treatment option for long-term insomnia. It is a 6- to 8-week treatment plan that a doctor, nurse or therapist can deliver in person, by telephone or online. Good sleep habits, the kind you have been practicing, make up one of its five parts:
| Part of CBT-I | What it involves |
|---|---|
| Cognitive therapy | work on feeling nervous about not being able to sleep |
| Relaxation or meditation therapy | learning how to relax |
| Sleep education | learning good sleep habits, the part you have already tried |
| Sleep restriction therapy | a specific amount of time to spend in bed, even if you are not able to sleep during it |
| Stimulus control therapy | going to bed only when sleepy, getting out of bed if you cannot sleep, and using the bed only for sleep and sex |
According to the American College of Physicians' 2016 guideline, CBT-I is recommended as the first treatment for all adults with chronic insomnia. Under the American Academy of Sleep Medicine's 2021 guideline, the full CBT-I program is recommended for the same adults, and three of its parts, stimulus control, sleep restriction and relaxation, are each suggested as a treatment by themselves. Good sleep habits used as the only treatment are suggested against.
Good sleep habits often help relieve short-term insomnia, the kind that lasts days or weeks. For insomnia that has gone on longer, they are the sleep education part of CBT-I.
If you are wary of leaving with a sleeping pill, medicine comes second. According to the same 2016 guideline, for adults in whom CBT-I alone has not worked, the recommendation is to decide together with your doctor whether to add medicine, after talking through the benefits, harms and costs of short-term use.
Over-the-counter products that contain antihistamines are sold as sleep aids, and although they might make you sleepy, talk to your doctor before taking them for insomnia, because antihistamines can be unsafe for some people. Research has not proven that melatonin is an effective treatment for insomnia.
What to bring so the appointment covers more than a few bad nights
A sleep diary is worth bringing, because it can help your doctor understand the problems you are having and whether certain activities are affecting your sleep. It may be helpful to keep one for 1 to 2 weeks before seeing your doctor, writing down when you go to sleep, wake up and take naps each day, how sleepy you feel through the day, and when you drink caffeine or alcohol and when you exercise. A ready-made sleep diary from the National Heart, Lung, and Blood Institute can be downloaded and printed.
Your provider may also ask for details about your sleep habits, such as:
- how often you have trouble sleeping and how long you have had the problem
- when you go to bed and get up on days you go to work and on days off
- how long it takes you to fall asleep, how often you wake at night, and how long it takes you to fall back asleep
- how refreshed you feel when you wake up and how unrested you feel during the day
Tell your doctor about every medicine, herb and supplement you take, including any over-the-counter products, since some of them may affect sleep and some prescription medicines used to treat other health conditions can also increase your risk of insomnia.
The appointment itself is usually a conversation and an exam. Your health care provider will do a physical exam and ask about your current medicines, drug and substance use, and medical history, and usually these are the only methods needed to diagnose insomnia. Ask whether what you have is insomnia, whether anything you take or any condition you have needs checking, and, if it is chronic, where you can get CBT-I.
Poor sleep has been linked to a high BMI in research (see Why the same dinners move one partner's weight and not yours), but the reason to book this appointment is the sleep itself. If you get weight care through NicoCares, your treatment rests with a physician who has a license for your state, so let your care team know about any sleep aid or new prescription you start. You reach them through Spruce Health, a secure messaging app, and those messages have no stated turnaround, so save them for news that can wait.
