What Causes Insomnia?

Stress

Difficulty sleeping because of stress is likely a familiar issue. You might lie awake late into the night worrying about a big work presentation, a loved one’s health, or money troubles. But the more you try to force yourself to fall asleep, the more elusive sleep becomes.

Stress can be a huge contributor to insomnia, and the relationship can be cyclical. Stress in your life might keep you awake, and then your inability to sleep might make you feel even more stressed out. Stress about sleep itself can also build up and make the problem worse. 

When you feel worried, the brain triggers the release of stress hormones like cortisol. These hormones can provide extra energy to help respond to stress, but elevated cortisol levels, especially at night, have been found in some people with insomnia. 

The way stress impacts your sleep may depend on deep-seated elements of your personality, as certain people are naturally more prone to having their sleep disrupted by stress.

Mental Health

There's a close connection between mental health and sleeping problems. Around 50% of people with chronic insomnia also have a mental health disorder. That can sound overwhelming, but treating one of these problems can often lead to relief from the other.

It helps to look at specific mental health conditions to understand their interplay with sleep.

• Anxiety: If you have anxiety, it can lead to racing thoughts and persistent worries that keep you awake. What’s more, the lack of sleep from insomnia can make it harder to regulate emotions during the day, which can feed a negative cycle between poor sleep and anxiety.
• Depression: Sleeping problems are one of the main symptoms of clinical depression, affecting about 80% of people with depression. The connection is powerful in the other direction, too, as people with insomnia are two times as likely to develop depression. There's strong evidence to suggest that treatment can help with insomnia and depression simultaneously.
• Addiction: Alcohol and certain drugs can mess with the sleep stages and make you wake up more easily, especially later in the night. In turn, sleep deprivation can make it harder to manage emotions and combat cravings, increasing risk of substance abuse. 
• Post-traumatic stress disorder (PTSD): It's estimated that over 70% of people with PTSD experience sleeping problems like insomnia. Nightmares, which frequently affect people with PTSD, can cause a fear or avoidance of sleep. PTSD also leads to hyperarousal, which means the mind and body go into overdrive when reminded of a traumatic episode, instead of relaxed and ready to fall asleep.

While mental health conditions can contribute to insomnia, they may not be its only cause, especially if sleeping problems evolve over time. As a result, insomnia may require its own treatment plan. It may be helpful to talk with your doctor or a mental health professional about the best steps to treat insomnia, including whether to treat it separately.

Lifestyle

Lifestyle choices can have a big impact on sleep, and there might be choices in your day that are leading to or worsening insomnia without you even realizing it. The good news is these are relatively simple things to change. 

• Too much stimulation before bed: This can include anything from working late to watching an action-packed TV show right before bed. It can be hard to go straight from something stimulating into sleep. Instead, try something relaxing, like reading a book or journaling.
• Screen time: Cell phones, TVs, tablets, and computers all emit a type of light called blue light. Blue light suppresses melatonin, the hormone that tells us it’s time to sleep. 
• Using your bed for more than sleep: Ideally, our beds should be reserved just for sleep and sex. If you use your bed for other activities, like watching TV or working, your mind can start to associate bed with these instead of sleep.
• Caffeine late in the day: Coffee and tea in the morning is just fine, but think about switching to decaf after lunch. That’s because it can take up to eight hours for caffeine to stop affecting your brain and body. 
• Alcohol close to bed: Alcohol makes many people drowsy, which is why it may seem like a good way to fall asleep. The problem is that after that initial drowsiness, alcohol disrupts our natural stages of sleep and can lead to fitful sleeping, especially in the second half of the night.
• Irregular sleep schedule: When you go to bed and wake up at very different times every day, simply put, the internal clock in your brain gets confused. That might lead to you feeling tired during the day or tossing and turning at night. Having a regular sleep schedule can help signal to your brain and body that it’s time to go to sleep when you lie down at night.
• Napping too late: Naps can be refreshing when they’re relatively brief and early in the day. Napping too late in the day, though, could mean you’re not tired enough to go to sleep at bedtime.

Injury or Illness

Injury and illness commonly contribute to insomnia. About 40% of people with some sort of medical problem experience chronic insomnia. A medical issue might cause anything from trouble breathing to pain to emotional distress, all of which may make it hard to sleep. 

In this way, insomnia is connected to a variety of medical challenges.

• Pain: Short-term and chronic pain, especially when it’s widespread, makes it hard to get comfortable during the night and can make it hard to calm the mind. Pain may be caused by a recent injury or a longstanding medical problem.
• Pulmonary disease: Lying down at night can make it harder to breathe for people with lung diseases. Medications for pulmonary disease can also cause insomnia.
• Cancer: Cancer can lead to sleep problems for many reasons, including pain, medication or treatment side effects, and stress. 
• Diabetes: Having diabetes can lead to trouble sleeping, possibly because of diabetic nerve pain. 

Many other issues that affect hormones, the kidneys, or the digestive or cardiovascular systems can also interfere with normal sleep patterns. 

Unfortunately, sleep is vital to recovering from an injury or illness. That’s why it’s important to talk to your doctor about insomnia so you can get some rest and try to feel better.

Medications

What complicates sleep even further is that medications can cause insomnia, including those used for many of the health issues already discussed. 

The relationship between certain medications and insomnia is complicated, and it depends on the specific drug. In the simplest terms, medications change brain activity, and sometimes a side effect is disrupted sleep. 

There are several different types of medications that are associated with insomnia:

• Certain antidepressants
• Respiratory stimulants
• Some blood pressure drugs
• Glucocorticoids, which are a type of steroid
• ADHD medication
• Over-the-counter drugs to treat congestion and colds

Sometimes sleep can be disturbed when you stop taking medications. Withdrawal after using a drug for a period of time may provoke changes in brain activity that can temporarily throw off sleep patterns.

Depending on the situation, it may be possible to switch the medication you take, modify the dosage, or change when you take it. The important thing is to talk to your doctor about your sleep challenges while bringing a list of any drugs or supplements that you are taking. In this way, you can help determine if any medications are harming your sleep.

Sleep Apnea

Sleep apnea causes a person to briefly stop breathing at multiple points during the night, which can lead to restless and shallow sleep. Sleep apnea is one of the sleep disorders that can go hand in hand with insomnia. As many as 55% of people with sleep apnea have insomnia-like symptoms.

Because sleep apnea and insomnia can have similar symptoms, it's important to talk to a doctor who can review your sleeping problems and overall health. In this conversation, it is essential to mention things that could be symptoms of sleep apnea, such as: 

• Loud, chronic snoring, which may first be noticed by a bed partner
• Gasping, snorting, or choking during sleep
• Morning headaches
• Dry mouth when you wake up
• An increased need to urinate during the night

Finding the right diagnosis can help make sure the best treatment is prescribed. Treatment may involve CPAP therapy, which frequently improves sleep and reduces daytime symptoms. Careful collaboration with the doctor can also avoid unwanted side effects of treatment and identify the best methods to start getting better sleep.

Shift Work Disorder

Shift work is any work that falls outside of typical daytime work hours. These shifts might be fixed, meaning the same times and days each week, or rotating. Shift work is required for many people, but it can wreak havoc on sleep.

If you’re a shift worker, you’re probably intimately familiar with how an irregular schedule impacts your sleep. That’s because shift work interferes with natural sleep-wake rhythms. Circadian rhythms are 24-hour cycles in our bodies, and they help regulate sleep and wakefulness. When you work at night and try to sleep during the day, this sleep-wake cycle gets thrown off and can cause shift work disorder.

The impact of shift work on sleep depends a lot on the type of schedule you’re on.

• Rotating night work: Rotating night work is perhaps the most difficult type of schedule when it comes to getting quality sleep. Not only are you working when your body naturally wants to sleep, but your schedule is always changing, making it difficult for you to adjust. 
• Fixed night work: While working at night is difficult, being on a fixed work schedule can help you stick to regular sleep times when you’re not working.
• Early morning or evening work: Working at these times tends to be a bit less disruptive to sleep than a night shift. That’s because you may still get to do the majority of your sleeping during the night. It’s also a little easier to tweak your schedule to get the right amount of sleep.

To cope with the impacts of shift work on sleep, focus on developing some sort of regular  schedule, if you can. For example, even if you work the night shift on a rotating schedule, it may help to request forward-rotating shifts, which get progressively later in the day and are often easier to adapt to.

Restless Legs Syndrome

Another sleep disorder connected with insomnia is restless legs syndrome (RLS). RLS leads to discomfort in the legs. If you have RLS, you often feel tingling or the need to move your limbs, especially while you’re resting. 

Around 85% of people with RLS find that this sensation makes it hard to fall asleep. In addition, even after falling asleep, that uncomfortable tingling might keep waking you up throughout the night.

Though the sleep problems caused by RLS can be frustrating, treating RLS often improves sleep. The choice of treatment for RLS depends on a lot of different factors but might include iron replacement, behavioral changes, or medication.

Working With a Sleep Coach

If insomnia is becoming a regular part of your life, personalized support may help you better understand and address the underlying causes of your sleep problems. Sleep Doctor’s Sleep Consult offers a one-on-one session with a sleep expert who can help identify habits, routines, and lifestyle factors that may be interfering with sleep.

For people looking for more ongoing guidance and accountability, Sleep Doctor Sleep Coaching provides personalized coaching designed to help improve sleep habits, build healthier routines, and support long-term sleep improvement.

When to See a Doctor

Occasional sleepless nights are common, but ongoing insomnia may be a sign of an underlying health or sleep issue that deserves medical attention. Consider talking to a doctor if your sleep problems last for several weeks, happen frequently, or begin affecting your daily life.

You may also want to seek medical advice if insomnia is causing excessive daytime sleepiness, mood changes, difficulty concentrating, poor work or school performance, or trouble completing everyday activities.

A doctor or sleep specialist can help identify potential causes of insomnia and recommend treatments, lifestyle changes, or behavioral therapies that may improve sleep.