Between 10% and 15% of adults suffer from chronic insomnia, while as many as 40% to 50% experience occasional symptoms, according to Wendy Troxel, a senior behavioral and social scientist specializing in sleep at the RAND Corporation, in comments reported by USA Today.
Insomnia is widely recognized as the most common sleep disorder, and specialists say the anxiety of lying awake can make falling asleep even harder, creating a cycle in which poor sleep fuels further insomnia.
What insomnia actually is
Insomnia is a sleep disorder that makes it difficult to fall asleep or stay asleep through the night, causes waking up too early, or prevents restful sleep even when there is enough opportunity to get it, according to Dr. Raj Dasgupta, a pulmonology and sleep specialist at Huntington Memorial Hospital in California.
Dasgupta said the defining feature of insomnia is not simply too little sleep, but that nighttime difficulties lead to daytime consequences such as fatigue, trouble concentrating, and reduced performance at school or work.
Over time, chronic insomnia can also affect mood, memory, concentration, energy, relationships and overall health, he added. Troxel noted that people with chronic insomnia face double the risk of depression and an increased risk of cardiovascular disease.
While an occasional bad night's sleep is normal for most people, Dasgupta said chronic insomnia is typically diagnosed when symptoms occur at least three nights a week for three months or longer. He added that the diagnosis is usually made based on a person's sleep history, symptoms, medical history and how the sleep problem affects them during the day.
What causes insomnia
Insomnia rarely has a single cause. It usually develops from a combination of biological, psychological and lifestyle factors.
Stress is one of the most common triggers, Troxel said, whether it stems from work, finances, relationships or major life changes. She added that anxiety and depression are also closely linked to insomnia, with each condition capable of worsening the other.
Physical conditions such as chronic pain, asthma, acid reflux, neurological disorders, sleep apnea and thyroid disease can also interfere with healthy sleep.
Troxel said perimenopause and menopause are significantly underestimated as triggers in women. She added that certain medications, including some antidepressants, stimulants, decongestants and corticosteroids, can sometimes contribute as well.
Habits and lifestyle also frequently play a role. Dasgupta said consuming caffeine or alcohol too late in the day, an irregular sleep schedule, working night shifts, frequent daytime napping, or using a phone or other bright screens before bed can all disrupt the body's natural sleep-wake cycle.
How insomnia is treated
Regardless of the cause, Dasgupta said the most effective long-term treatment for chronic insomnia is not medication but cognitive behavioral therapy for insomnia, known as CBT-I.
CBT-I is a structured program that helps people identify and replace thoughts and behaviors that interfere with sleep while building healthier sleep habits and routines.
It is effective enough that major sleep organizations typically recommend CBT-I as a first-line therapy, since research consistently shows it produces lasting improvement without the risks associated with long-term use of sleeping medication.
Other treatments and recommendations for insomnia can include improving sleep habits, such as keeping a consistent bedtime and wake time, limiting caffeine and alcohol intake, especially in the afternoon and evening, exercising regularly but not right before bed, keeping the bedroom cool, dark and quiet, and avoiding prolonged screen use before sleep, Dasgupta said.
Doctors may also recommend sleep medications for short-term relief, but these are typically viewed as a temporary measure rather than a permanent solution, Troxel explained.
When to see a doctor
Troxel advised that anyone whose sleep problems significantly affect daytime functioning, occur several nights a week over an extended period, or are accompanied by unusual nighttime behavior should seek a medical evaluation rather than try to manage the problem alone.
She added that people should also talk to a doctor if they experience loud snoring, choking at night, restless legs syndrome, morning headaches or unexplained mood swings.
