Insomnia is a common sleep disorder. You have trouble falling asleep, staying asleep or getting good-quality sleep, even with time and a suitable place to sleep. It affects how you feel and function during the day.
Short-term insomnia lasts days or weeks and is often triggered by stress or a change in routine. Chronic insomnia happens 3 or more nights a week, lasts more than 3 months and cannot be fully explained by another health problem (NHLBI).
The usual first treatment for chronic insomnia is cognitive behavioral therapy for insomnia (CBT-I), not sleeping pills. Our CBT-I guide explains how it works. The sleep efficiency calculator shows how much of your time in bed is spent asleep.
For quick help tonight, compare techniques in how to fall asleep fast. Or read why you keep waking up at night.
Not a diagnosis. This page explains insomnia in general terms. Other conditions can cause the same nights and days, from sleep apnea to depression and thyroid problems. Only a doctor can tell what is behind your sleep problem.
What Is Insomnia?
Insomnia is the most common sleep complaint. It has a night side and a day side. You sleep badly at night, and you feel the effects during the day. It happens even when you have the chance to get a full night of sleep (AASM Sleep Education).
That last point matters. Say you go to bed at 1 AM and your alarm rings at 6 AM. Five hours of sleep is not enough time in bed. It is not insomnia.
An occasional bad night is not insomnia either. Staying up late, getting up early and stress all cause a poor night now and then.
As many as 35 percent of adults complain of insomnia, and about 10 percent have the chronic form. It is more common in older adults, women and people under stress. It is also more common in people with certain medical and mental health problems, such as depression (AASM).
The NHS gives a practical test. You may have insomnia if you regularly:
- find it hard to go to sleep;
- wake several times in the night, or lie awake;
- wake early and cannot get back to sleep;
- still feel tired after waking, with irritability or poor concentration during the day (NHS).
The chart below turns these definitions into three quick checks.
Short-Term vs Chronic Insomnia
Doctors sort insomnia first by how often it happens and how long it has lasted.
| Short-term (acute) insomnia | Chronic insomnia | |
|---|---|---|
| How long | Up to 3 months; often days or weeks | 3 months or longer |
| How often | Varies | At least 3 nights a week |
| How common | 15 to 20 percent of people at any given time | About 10 percent of people |
| Typical triggers | Stress, a life event, a change in schedule or surroundings | Often linked to another condition, habits, or the way the brain has learned to stay awake in bed |
| Usual first step | Good sleep habits; it often settles once the trigger passes | See a doctor; CBT-I is the recommended first treatment |
The 3-nights, 3-months rule is often called the 3×3 rule. Short-term insomnia does not always fade on its own. It can persist and become chronic (Sleep Foundation).
That is why it pays to act early. Do it before habits such as lying in bed for hours or napping to catch up become fixed.
Types Of Insomnia By When You Are Awake
Insomnia is also described by which part of the night goes wrong. These are descriptive terms, not separate diagnoses. Many people have more than one, and the pattern can shift over time (Sleep Foundation).
| Pattern | What it looks like | Read more |
|---|---|---|
| Sleep-onset insomnia | Lying awake a long time before you first fall asleep. More common in younger adults (NHLBI). | Why you cannot fall asleep |
| Sleep-maintenance insomnia | Waking often during the night or being awake for much of it. This is the most common symptom and mostly affects older adults (NHLBI). | Why you keep waking up at 3 AM |
| Early-morning waking | Waking too early and not getting back to sleep (NHLBI). Sometimes called late or terminal insomnia. | Same guide as above |
| Mixed | A combination of the three, which is common (Sleep Foundation). | Start with the action plan below |
You may also see the terms primary and secondary (or comorbid) insomnia. Sleep medicine has moved away from them. Insomnia and other conditions often feed each other in both directions. Anxiety, depression and sleep apnea are examples.
Insomnia also does not always go away once the other problem is treated (Sleep Foundation).
Symptoms At Night And During The Day
At night, the symptoms are the patterns above. You may take a long time to fall asleep, sleep in pieces or wake early. Your sleep may feel light and unrefreshing. During the day, insomnia can cause:
- fatigue, low energy or low motivation;
- problems with attention, concentration or memory, and poorer performance at school or work;
- moodiness or irritability, and sometimes rash actions;
- daytime sleepiness, errors and accidents;
- concern or frustration about your sleep (AASM).
Insomnia can also make you feel anxious, depressed or easily annoyed (NHLBI). If worry is part of the picture and you are not sure which came first, see our guide to insomnia vs anxiety.
What Causes Insomnia?
Insomnia is most often tied to another problem that drives it (AASM). The main groups of causes are:
- Stress from work, relationships, money, divorce, job loss or the death of a loved one.
- Other sleep disorders. Restless legs syndrome, for example, can make it hard to fall asleep.
- Medical conditions that cause pain, discomfort or limited mobility, plus pregnancy (especially the third trimester) and menopause.
- Mental health conditions. Depression is a frequent cause. Trouble falling asleep is common with anxiety disorders.
- Medicines and substances. Some cold and allergy medicines, antidepressants and medicines for ADHD, high blood pressure or Parkinson’s disease can cause insomnia. So can caffeine, alcohol near bedtime and withdrawal from some drugs.
- Your sleep setting: noise, light, temperature or a bed partner who snores.
- Schedule and habits: shift work, a very late or irregular bedtime (AASM).
Risk Factors
Your chances of insomnia rise with age, and it sometimes runs in families. It is more common in women than in men, partly because of hormone changes during pregnancy and menopause.
Other risks include shift work, frequent travel across time zones, long daytime naps and little physical activity. Screens close to bedtime also raise the risk (NHLBI).
Why Insomnia Can Outlast Its Cause
The body’s physical response to stress can lead to hyperarousal. This is a state of being too alert to sleep. Mental stress can have the same effect (Sleep Foundation).
Over time, the worry shifts to sleep itself. Worrying about whether you will get enough sleep and watching the clock can raise your risk of insomnia or make it worse (NHLBI).
This learned link between bed and being awake is one reason chronic insomnia often continues after the trigger has gone. It is what CBT-I is designed to undo.
Is It Insomnia Or Something Else?
Before calling it insomnia, rule out the common look-alikes:
- Not enough time in bed. AASM’s self-check asks two questions. Do you give yourself enough time in bed for at least 7 hours of sleep? Is your bedroom safe, dark and quiet? If not, fix that first (AASM).
- Sleep apnea. A doctor will ask about loud, frequent snoring or waking up gasping or out of breath (NHLBI).
- A late body clock, restless legs syndrome or another sleep disorder.
Our guide to the signs of a sleep disorder sets out the warning signs for each one. It also says which specialist to see.
How Insomnia Is Diagnosed
There is no single test for insomnia. Diagnosis rests mostly on your sleep history.
- Sleep history. Your provider will ask how often and for how long you have trouble sleeping. They will ask about bed and wake times on work days and days off. They will ask how long you take to fall asleep, how often you wake and how long it takes to get back to sleep. Daytime feelings, screen use and snoring or waking gasping come up too (NHLBI).
- Sleep diary. Keeping one for 1 to 2 weeks before the visit helps. Note when you go to sleep, wake up and nap. Note how sleepy you feel in the day. Also note when you have caffeine or alcohol and exercise (NHLBI).
- Health review and physical exam. This covers new or long-standing health problems, medicines, pregnancy or menopause, and caffeine, nicotine, alcohol or drug use (NHLBI). You may be asked about major life events. You may also have a test of your mental and emotional wellbeing (AASM).
- Other tests only if needed. You will not need a sleep study unless the doctor suspects sleep apnea or another sleep disorder (AASM). Actigraphy uses a small wrist motion sensor worn for 3 to 14 days. Blood tests can check for thyroid or other problems (NHLBI).
A consumer sleep tracker is not a diagnostic test. For some people with insomnia, nightly scores become one more source of worry. Our guide to sleep tracking and insomnia explains how to use one without making things worse.
Want a starting point for that conversation? The insomnia severity calculator rates how much your sleep problems affect your nights and days. You can then track change over time.
How Insomnia Is Treated
Treatment depends on the cause. If a medical condition is driving the insomnia, treating that condition comes first (AASM). For insomnia itself, the main options are:
| Option | What it is | Where it fits |
|---|---|---|
| Healthy sleep habits | A regular schedule, a cool, dark, quiet bedroom, caffeine, alcohol and screen cut-offs | Often enough for short-term insomnia; a base for everyone, but not recommended as the only treatment for chronic insomnia |
| CBT-I | A structured 6- to 8-week program that changes the thoughts and habits that keep you awake | The recommended first treatment for chronic insomnia in adults |
| Medicines | Prescription sleep medicines, some medicines for other conditions, and over-the-counter sleep aids | Discussed with a doctor, usually when CBT-I alone has not been enough |
| Treating the cause | Managing pain, depression, sleep apnea, menopause symptoms or a medicine side effect | Whenever another condition is involved |
Sources: NHLBI, AASM, AASM guideline 2021.
CBT-I Comes First
CBT-I is usually recommended as the first treatment for long-term insomnia. It can be very effective. A doctor, nurse or therapist can deliver it in person, by phone or online. It combines cognitive therapy, relaxation, sleep education, sleep restriction and stimulus control (NHLBI).
The American Academy of Sleep Medicine strongly recommends multicomponent CBT-I for chronic insomnia in adults. It suggests that sleep hygiene not be used on its own as a treatment (AASM 2021 guideline).
The American College of Physicians says all adults with chronic insomnia should receive CBT-I as the initial treatment (ACP 2016 guideline).
Where Sleep Medicines Fit
Some prescription insomnia medicines are meant for short-term use and others for longer use. Talk to your doctor about their benefits and side effects (NHLBI).
Sleeping pills can cause complex sleep behaviors such as sleepwalking or sleep driving. They can raise the risk of falls and affect memory. Take them only under medical supervision (AASM).
Over-the-counter sleep aids may help for 1 to 2 weeks but cannot cure insomnia (NHS). Research has not proven that melatonin is an effective treatment for insomnia (NHLBI).
If CBT-I alone has not worked, adding a medicine should be a shared decision. You and your doctor weigh short-term benefits, harms and costs (ACP). Never start, stop or change a medicine without your doctor.
Where To Start: Your Next Step
This page is the overview. These guides go deeper on each part of the problem:
- You want a practical plan to start tonight: follow our 7-step plan to beat insomnia. It turns the habits and CBT-I principles into a daily routine.
- Your habits need work: use the sleep hygiene checklist to find the gaps in your schedule, bedroom and evening routine.
- You mostly cannot fall asleep: read why you cannot fall asleep fast.
- You mostly wake in the night: read why you keep waking up at 3 AM.
- Worry or a racing mind keeps you up: see insomnia vs anxiety.
- You want to measure where you stand: try the insomnia severity calculator.
Whatever the pattern, the AASM’s healthy sleep habits are a sensible base. Get up at the same time every day. Do not go to bed unless you are sleepy. If you do not fall asleep after 20 minutes, get up and do something quiet in low light (AASM).
Why Chronic Insomnia Is Worth Treating
In the short term, insomnia can make it hard to concentrate or think clearly. It raises the risk of falls, road accidents and missed work.
Chronic insomnia can raise the risk of high blood pressure and heart problems. It can raise the risk of mental health conditions such as anxiety and depression. It can also make chronic pain feel worse (NHLBI).
After treatment, a few habits help stop insomnia coming back. Keep a regular sleep schedule and stay active. Avoid caffeine, nicotine and alcohol near bedtime (NHLBI).
When To See A Doctor
- Changing your sleep habits has not helped, you have had trouble sleeping for months, or insomnia makes it hard to cope with daily life (NHS).
- Your sleep problem has lasted 3 months or more. AASM suggests seeing a sleep doctor at an accredited sleep center for chronic insomnia. If it has lasted less than 3 months, work on sleep habits. Talk to your provider if it does not go away (AASM).
- You snore loudly, stop breathing or wake gasping, which may point to sleep apnea (NHLBI).
- You feel very sleepy while driving. Do not drive when you feel sleepy (NHS).
- You feel low, hopeless or very anxious, or you are relying on alcohol or sleep aids to get to sleep.
If you are in crisis: if you or someone you know is having thoughts of suicide, in the U.S. call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org. In a life-threatening situation call 911 (NIMH). Outside the U.S., contact your local emergency number.
Insomnia FAQs
How Many Nights A Week Counts As Insomnia?
Chronic insomnia means trouble sleeping at least 3 nights a week for 3 months or more. Shorter spells are short-term insomnia.
What Is The Most Common Type Of Insomnia?
Waking often during the night is the most common symptom, especially in older adults. Many people have a mix of patterns.
Can Insomnia Go Away On Its Own?
Short-term insomnia often settles once the trigger passes. It can also turn chronic, which usually needs treatment such as CBT-I.
Do I Need A Sleep Study For Insomnia?
Usually not. A sleep study is used when a doctor suspects another disorder such as sleep apnea.
What Is The Best Treatment For Chronic Insomnia?
Guidelines from the AASM and the American College of Physicians recommend CBT-I as the first treatment for adults.
Is Good Sleep Hygiene Enough To Fix Insomnia?
It can be enough for short-term insomnia. On its own, it is not recommended as a treatment for chronic insomnia.