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Insomnia Causes, Symptoms, and Treatment Options

Everyone has a poor night of sleep now and then. But if you have trouble falling or staying asleep on a regular basis, you may have insomnia.

At the UPMC Sleep Medicine Center, we offer the latest insomnia treatments so you can get a good night's sleep.

Find a UPMC Sleep Medicine doctor near you to make an appointment.

What Is Insomnia?

Insomnia is a condition where people have trouble getting to sleep or staying asleep. You can suffer from this sleep disorder on a short- or long-term basis.

Chronic insomnia is when you have trouble sleeping at least three days per week for more than three months. About 10% of adults have chronic insomnia.

It causes daytime fatigue, attention issues, and other health problems.

People with short-term insomnia have similar symptoms but for less than three months, and often less than three times a week. Between 15% and 20% of adults have short-term insomnia in any given year.

What Causes Insomnia?

Short-term insomnia causes

Stressful life events that may trigger a bout of short-term insomnia include:

  • A divorce.
  • The death of a loved one.
  • An illness.
  • The loss of a job.

Chronic insomnia causes

Stress and anxiety about not sleeping can further create a cycle of being unable to sleep, leading to chronic insomnia.

Other common causes of chronic insomnia include:

  • An irregular sleep schedule, such as from shift work or travel.
  • Poor sleep habits, like using electronics or drinking alcohol before bedtime.
  • Mental health issues, like anxiety, depression, and bipolar disorder.
  • Physical illness and pain, which can disrupt sleep.
  • Side effects from medicine, such as blood pressure drugs, antidepressants, and stimulants.
  • Neurological problems, like Alzheimer's disease, which throw off the body's wake-sleep cycle.
  • Other sleep disorders, such as obstructive sleep apnea (OSA) and restless legs syndrome (RLS).

What Are Risk Factors and Complications of Insomnia?

Certain factors make insomnia more likely, such as:

  • Age. The risk of insomnia rises with age.
  • Genetics. If you have a family history of insomnia, you're more likely to have it.
  • Sex. Women are more at risk than men.
  • Lifestyle. Shift work, drinking caffeine or alcohol near bedtime, or using electronics at night.
  • Stress or worry.
  • Medical and mental health disorders. Heart disease, asthma, depression, and anxiety raise the risk.

Complications of insomnia

Chronic insomnia can cause other health problems.

It can affect your:

  • Memory.
  • Mood.
  • Productivity.
  • Motivation.
  • Ability to concentrate.

Lack of sleep can also lead to accidents.

Insomnia Symptoms and Diagnosis

People with insomnia may have different degrees of symptoms. But if sleepless nights are causing problems in your daily life, you should call your doctor.

What are the symptoms of insomnia?

Insomnia symptoms and signs include:

  • Lying awake for a long time before you fall asleep.
  • Waking up often or being awake for much of the night.
  • Waking up too early in the morning, and not being able to get back to sleep.
  • Feeling grouchy or sleepy during the day.
  • Having trouble focusing or paying attention during the day.
  • Memory lapses.
  • Lacking energy throughout the day.
  • Lack of motivation or initiative.
  • Feeling irritable or depressed.
  • Worrying about not being able to sleep.

How do you diagnose insomnia?

Your doctor may ask you to keep a sleep log for a week or two before your appointment.

You'll need to keep track of what times you:

  • Go to sleep and wake up.
  • Drink caffeine or alcohol.
  • Work out.

During your appointment, your doctor will:

  • Ask about your insomnia symptoms and how long you've had them.
  • Talk about your sleep habits and lifestyle.
  • Do a physical exam.

There are no special tests to diagnose chronic insomnia.

Your doctor may order blood tests to rule out health issues that could affect your sleep.

They may also order a sleep study to make sure you don't have another sleep disorder like:

  • Sleep apnea.
  • Leg movements.
  • Rare behaviors while asleep.

How Do You Treat Insomnia?

The experts at the UPMC Sleep Medicine Center treat people with insomnia every day. We use the latest techniques and therapies to help you get good, solid sleep.

Your doctor will likely start with the most conservative treatment.

Treatment options include therapy and medications. At times, lifestyle changes can help treat sleep problems like insomnia.

Cognitive behavior therapy (CBT) for insomnia

Your doctor may suggest a six- to eight-week CBT plan to address unwarranted thoughts and beliefs about your sleep.

CBT teaches you ways to:

  • Build sleep pressure.
  • Adjust your sleep timing to your body's clock.
  • Cope with stress about not being able to sleep.

Your CBT sessions may involve:

  • Sleep restriction and compression. You and your doctor will figure out how much sleep you need and the best time to sleep. Then you work to reduce the time you spend in bed. The goal is not to restrict sleep, but to lessen the time you lie in bed awake.
  • Sleep education and sleep hygiene. Your doctor may talk to you about how lifestyle choices affect sleep.
  • Stimulus control. You may learn steps you can take to reduce anxiety about sleep. For instance, if you don't fall asleep after 20 minutes in bed, get up. Go read, meditate, or do another quiet activity. This will decrease your thoughts about not being able to sleep while in bed.
  • Relaxation therapy. This can also help decrease anxiety surrounding sleep. You may learn breathing techniques, muscle relaxation, or meditation.
  • Relapse prevention. Learning about trigger points for recurrence of insomnia and how to cope/address such trigger points.

The UPMC Sleep Medicine Center is the only adult sleep center in western Pennsylvania that offers CBT for insomnia. It's a novel alternative to sleeping pills with fewer side effects.

Medicine to treat insomnia

Your doctor might prescribe medicines in addition to or as an alternative to CBT.

Drugs that may help your insomnia include:

  • Benzodiazepines (BZDs). Five different FDA-approved psychoactive drugs for insomnia. Doctors usually don't prescribe BZDs long-term because they have a high potential for abuse.
  • Nonbenzodiazepines. These drugs (Zolpidem is one) have less abuse potential than BZDs, but still need a prescription.
  • Melatonin agonists. These medicines stimulate melatonin production, which helps you feel sleepy at night.
  • Orexin receptor antagonists. These drugs help manage feelings of sleepiness and wakefulness.
  • Antidepressants. Low doses of sedatives like trazodone and doxepin can be helpful.

Your UPMC sleep doctor will tailor your medication for your sleep problem based on:

  • The cause of your insomnia.
  • Your medical history.
  • Drug costs.
  • Potential side effects.
  • What you prefer.

With the right treatment, you can start getting restful sleep and feel like yourself again.

Contact the UPMC Sleep Medicine Center

To make an appointment, find a UPMC Sleep Medicine specialist close to you.