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Patient education: Insomnia (Beyond the Basics)

Patient education: Insomnia (Beyond the Basics)
Michael H Bonnet, PhD
Donna L Arand, PhD
Section Editor:
Ruth Benca, MD, PhD
Deputy Editor:
April F Eichler, MD, MPH
Literature review current through: Nov 2022. | This topic last updated: Nov 03, 2022.

INTRODUCTION — Insomnia is defined as difficulty falling asleep, difficulty staying asleep, or waking up early in the morning and not being able to fall back to sleep. People with insomnia sleep less or sleep poorly despite having an adequate chance to sleep. Sleeping poorly or not enough makes it harder to function during the daytime. Insomnia is not defined by the number of hours slept because different people need different amounts of sleep.

One-third to two-thirds of adults report occasional insomnia, and approximately 10 to 15 percent have chronic sleep difficulty. Insomnia is most common in older adults and women.

This article discusses the symptoms, causes, and diagnosis of insomnia. Information about the treatment of insomnia is available separately. (See "Patient education: Insomnia treatments (Beyond the Basics)".)

INSOMNIA SYMPTOMS — Common symptoms of insomnia include:

Difficulty falling asleep and/or staying asleep

Variable sleep, such as several nights of poor sleep followed by a night of better sleep

Daytime fatigue or sleepiness


Difficulty concentrating


Reduced motivation or energy

Making errors or having accidents more often than usual

Ongoing worry about sleep

Many people with insomnia also struggle with depression and/or anxiety.

For many people, the symptoms of insomnia interfere with personal relationships, job performance, and daily functioning. People with insomnia may have a small reduction in memory and problem solving compared with people without insomnia. However, they seem to have similar abilities on tests of general cognitive function, perception, verbal ability, attention, and complex thinking.

People with insomnia have an impaired sense of sleep. For example, you may feel like you have not slept, even if testing shows that you have. You may also feel more fatigued than people without insomnia, even if testing indicates that you are less sleepy. This impaired sense of sleep may be related to a problem with the body's "sleep-arousal" system, which normally helps you feel awake after sleeping and feel tired before going to bed.

People who are awake at night commonly become concerned that they will perform poorly the next day if they do not sleep enough. Such thoughts can initiate a cycle where being awake at night increases your anxiety, which then makes it more difficult to sleep.

INSOMNIA CAUSES — Insomnia may have many causes. These are divided into factors associated with short-term insomnia and factors typically associated with long-term insomnia.

Short-term insomnia — Short-term insomnia lasts less than three months and is usually associated with stress. Examples of stressful events that can lead to short-term insomnia include:

Changes in the sleeping environment (temperature, light, noise)

Loss of a loved one, divorce, or job loss

Recent illness, surgery, or onset of pain

Use or withdrawal from stimulants (caffeine), certain medications, illegal drugs (cocaine and methamphetamine), or alcohol

Short-term insomnia often resolves when the stressor is removed or has been addressed. However, changes in behavior made in an effort to treat short-term insomnia, such as spending more time in bed or using alcohol to fall asleep, can actually produce poor sleep that continues after resolution of the initial short-term stressor.

Situations that disrupt your normal sleep cycle can also cause short-term insomnia. Some examples of this include:

Jet lag – Traveling across time zones can cause temporary insomnia, also known as jet lag. Jet lag may occur regardless of the direction of travel, although it is most pronounced when traveling west to east. Most people require several days to adjust their sleep pattern to the new time zone. Some tips to aid in dealing with jet lag are provided here (table 1).

Shift work – People who work the night shift commonly experience insomnia. Shift workers may be sleepy at work and while driving home in the morning, but have difficulty staying asleep past noon. The sleep problems can be resolved by switching to a day shift, if possible, or by sleeping at the same time every day including weekends for several weeks. Shift work sleep disorder and other sleep timing disorders are summarized in the table (table 2).

Long-term insomnia — Long-term (or chronic) insomnia lasts longer than three months and occurs at least three nights per week. Chronic insomnia is associated with an increased risk of developing significant medical problems; if you have had problems with insomnia for more than three months, you should talk with your health care provider. Chronic insomnia often occurs with other conditions, including:

Mental health problems, such as depression, anxiety disorders (including panic attacks), and posttraumatic stress disorder (PTSD)

Medical illnesses such as respiratory disorders, high blood pressure, diabetes, and disorders that cause pain, stress, or limitation of movement

Neurological disorders, such as Parkinson disease and Alzheimer disease

Other sleep disorders, such as sleep apnea, restless legs syndrome, periodic limb movements, and circadian rhythm disorders (see "Patient education: Sleep apnea in adults (Beyond the Basics)")

Medications, caffeine, alcohol, over-the-counter aids (such as allergy medication or nasal decongestants), or illegal drug use

Irregular sleep habits

Chronic insomnia can also occur on its own. In some cases, it can be passed along in families. Chronic insomnia can exist in infants, children, and adolescents. Assessment of insomnia in children should also include information from the caregiver and is based on less strict criteria than diagnosis in adults.

Short duration sleep and sleep deprivation — Insomnia is frequently confused with a short sleep requirement or sleep restriction, but these mean slightly different things:

Short sleep requirement – Sleeping for only a short period of time is common among people who have insomnia. However, some people require less sleep than others and can function without difficulty after sleeping for only a few hours. People who sleep less but have no subsequent daytime sleepiness or other daytime symptoms are sometimes called "short sleepers" and do not have insomnia. In addition, you may find that you need less sleep as you get older. Needing less sleep does not necessarily mean that you have insomnia unless you also have daytime symptoms, such as sleepiness or difficulty functioning.

Sleep restriction – People who have a reduced time in bed (sleep restriction), as well as those with insomnia, sleep for a short time and have difficulty functioning during the daytime. People with insomnia are unable to sleep normally when they have the time and opportunity to sleep. However, people who are sleep restricted will fall asleep quickly and sleep normally if given the opportunity. Chronic loss of sleep, caused by spending fewer than eight hours in bed on most nights, is probably the most common cause of sleepiness.

INSOMNIA DIAGNOSIS — If you seek help for insomnia, your health care provider will start by asking you how many hours you sleep and what problems you have had with sleep over a typical 24-hour period. If you share your bed or room with another person, they may be able to help to answer these questions since you may not be aware of what happens while you sleep.

You may be asked to keep a daily sleep diary, which is a record of sleep times (including time spent in bed and time spent actually sleeping) for one to two weeks.

Your provider may ask other questions to figure out the cause of your insomnia. A physical examination can help determine if there are medical or neurologic conditions causing or worsening your sleep problems.

In some cases, laboratory tests may be recommended to help identify underlying medical or sleep disorders; however, these are not required for most people with insomnia. Laboratory tests may include polysomnography, actigraphy, or a home sleep apnea testing:

Polysomnography – Polysomnography is a formal sleep study done in a sleep laboratory. It is a painless test that uses sensors that are attached to your body to record movement, brain activity, breathing, and other physiologic functions. This test may be used when an underlying sleep disorder is suspected or if your insomnia has not responded to treatment.

Actigraphy – Actigraphy records activity and movement with a monitor or motion detector, using a watch-like device worn on the wrist throughout the day and night. The recording is conducted over one to two weeks at home to gather estimates about how much and at what times you are sleeping.

Home sleep apnea testing – Home sleep apnea testing is commonly available and allows patients to sleep at home with a portable recording device. Sensors are attached to the face and a finger, and a belt is placed around the chest to determine whether changes in breathing and oxygen levels during the night are related to the patient's poor sleep.

INSOMNIA TREATMENT — If your insomnia is related to another problem such as abnormal breathing during sleep, treating the associated problem may help to improve sleep. However, both the insomnia and the associated problem may need to be treated.

The treatment of insomnia is discussed in detail separately. (See "Patient education: Insomnia treatments (Beyond the Basics)".)

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site ( Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Insomnia (The Basics)
Patient education: Nocturnal (nighttime) leg cramps (The Basics)
Patient education: Restless legs syndrome (The Basics)
Patient education: Daytime sleepiness (The Basics)
Patient education: Sjögren's syndrome (The Basics)
Patient education: Jet lag (The Basics)
Patient education: What is a sleep study? (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Insomnia treatments (Beyond the Basics)
Patient education: Sleep apnea in adults (Beyond the Basics)
Patient education: Sleep insufficiency (The Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Classification of sleep disorders
Risk factors, comorbidities, and consequences of insomnia in adults
Evaluation and diagnosis of insomnia in adults
Overview of the treatment of insomnia in adults
Cognitive behavioral therapy for insomnia in adults
Pharmacotherapy for insomnia in adults

The following organizations also provide reliable health information.

National Library of Medicine


American Academy of Sleep Medicine


National Heart, Lung, and Blood Institute


This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at ©2023 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
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