Insomnia in Adults: Symptoms, Causes, Diagnosis and Treatment
Key takeaways
- Insomnia is trouble falling asleep, staying asleep or waking too early, along with feeling its effects during the day.
- Insomnia that happens at least 3 nights a week for 3 months or longer is called chronic insomnia.
- Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first treatment for most adults.
- Insomnia often appears with anxiety, depression and other conditions, so the full picture matters.
1. Overview
Insomnia is a common sleep problem where it is hard to fall asleep, hard to stay asleep, or you wake up too early and cannot get back to sleep, even when you have the chance to rest. It also affects your days, with tiredness, low energy, trouble focusing or irritability.
Short-term insomnia often follows stress, travel or a change in routine and gets better on its own. When it happens at least 3 nights a week for 3 months or longer, it is called chronic insomnia. Chronic insomnia is very common in adults and is treatable.
2. Symptoms
Common signs include lying awake for a long time before falling asleep, waking often during the night, waking too early, and feeling that sleep is not refreshing. Many people start to worry about sleep itself, which can make it even harder to fall asleep.
During the day, insomnia can cause tiredness, low energy, trouble concentrating, mood changes, irritability and more mistakes at work or while driving. The articles below explain specific symptoms in more detail.
3. Causes
Insomnia usually comes from a mix of factors. Stress, worry and life changes can start it. Habits that develop to cope, such as spending long hours in bed, napping, irregular sleep times, or using screens in bed, can keep it going long after the original stress has passed.
Other conditions can cause or worsen insomnia, including anxiety, depression, chronic pain, sleep apnea and restless legs syndrome. Caffeine, alcohol, nicotine, some medications and shift work can also disrupt sleep.
4. Diagnosis
Insomnia is diagnosed through a clinical evaluation, where a qualified clinician asks about your sleep patterns, daytime symptoms, routines, stress, health conditions and medications. Keeping a sleep diary for 1 to 2 weeks before your visit, noting when you go to bed, roughly when you fall asleep, when you wake and how rested you feel, is very helpful.
A careful evaluation also looks for other sleep disorders, such as sleep apnea, and for conditions like anxiety or depression that often come with insomnia. If another sleep disorder is suspected, you may be referred for a sleep study.
5. Treatment
Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first treatment for chronic insomnia in adults. It is a structured program that resets your sleep patterns and changes the thoughts and habits that keep you awake. Its benefits tend to last after treatment ends.
Medication can help some people, especially for short periods or when other approaches are not enough. Treating any related condition, such as anxiety, depression or pain, often improves sleep too. We build the plan with you and adjust it over time.
6. Medications
Several types of medication are used for insomnia. Options include orexin receptor antagonists, low-dose doxepin, ramelteon, and sedative-hypnotics such as zolpidem. Each works differently and fits different sleep problems, such as trouble falling asleep versus trouble staying asleep.
Sleep medications can cause side effects such as next-day grogginess, and some can lead to dependence or unusual behaviors during sleep, so they are chosen carefully and reviewed regularly. Over-the-counter sleep aids and supplements also have risks and can interact with other medications. We will talk through your options with you.
7. Co-occurring conditions
Insomnia often appears with anxiety and depression, and each can make the other worse. Chronic pain, sleep apnea, ADHD, PTSD, substance use and some medical conditions are also commonly linked with poor sleep.
Treating insomnia alone may not be enough when another condition is also present. We look at the whole picture so your plan addresses everything that is affecting your sleep.
8. Living with Insomnia
A few steady habits support better sleep. Wake up at the same time every day, even after a poor night. Use your bed only for sleep and intimacy. If you cannot sleep after a while, get up and do something calm in dim light until you feel sleepy. Limit caffeine after midday, avoid alcohol close to bedtime, and keep your bedroom cool, dark and quiet.
Try not to watch the clock or force sleep, because effort tends to keep the brain alert. Better sleep usually returns gradually, and consistency matters more than any single night.
9. Getting help and starting care with us
If trouble sleeping has lasted for weeks or is affecting how you feel and function during the day, it is worth talking to a professional. At Peak Wellness Psychiatry, our psychiatric nurse practitioners provide insomnia evaluations and ongoing care through secure video visits for adults in California, Arizona, Washington and Nevada.
Your first visit is about 60 minutes. We review your history and symptoms, answer your questions and, when it is appropriate, build a treatment plan with you. You can book online in a few minutes or call us at 888-909-8676. We take most major insurance plans.
We take most major insurance plans.
Appointments available in as little as a couple of days.
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