What Is Insomnia?

Key takeaways

• Insomnia is a common sleep disorder that involves trouble falling asleep or staying asleep. 
• An estimated 75% of older U.S. adults experience the effects of poor sleep. 
• Common symptoms of insomnia are daytime drowsiness, trouble focusing, irritability, anxiety, and depression.
• Age, stress, and certain health conditions are common causes of insomnia, but there are many other causes, including genetics. 
• Negative health effects of insomnia include fatigue, increased risk of obesity, high blood pressure, and depression. 
• Nearly 72% of people experiencing short-term insomnia recover without developing chronic, long-term insomnia.

Lori B., age 63, lay in bed, ready to go to sleep. It was 10:30 p.m., her regular bedtime, but she couldn’t relax. The Metairie, Louisiana, resident tossed and turned for hours but didn’t fall asleep until almost 3 a.m. “I was exhausted, but I couldn’t sleep,” she said. “I would lie there thinking, ‘Should I do something? Should I get up?’ But I didn’t have the energy. It was very aggravating.” 

Lori explained that she began experiencing insomnia episodes in her 50s, and the episodes had always been the same. “Whenever I have insomnia, I can’t fall asleep,” she said. “I know some people wake up in the middle of the night and can’t go back to sleep, but for me, I can’t fall asleep.” 

Insomnia is a common sleep disorder, affecting nearly 30% ^[1] Roth T. Insomnia: Definition, Prevalence, Etiology, and Consequences. Journal of Clinical Sleep Medicine. Nov. 14, 2019. Found on the internet at https://jcsm.aasm.org/doi/10.5664/jcsm.26929 of the world’s population and up to an estimated 75% of older adults ^[2] Nguyen V., et al. Insomnia in Older Adults. Current Geriatrics Reports. Oct. 22, 2019. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731454/ in the United States. Because sleep significantly impacts our health, sleep disruptions can put us at risk for a number of health issues. 

“Sleep accomplishes many essential biological functions in the brain and body that do not occur effectively while we’re awake,” said Chelsie Rohrscheib, a neuroscientist and head sleep expert with the sleep testing platform Wesper. 

“The damage from sleep loss compounds over time and impacts health,” said Rohrscheib. “Sleep loss is associated with increased stress and directly impacts the areas of the brain that control emotion, making us prone to depression and anxiety.”. 

What is insomnia?

Insomnia is a broad term that refers to trouble falling asleep, staying asleep, or waking up too early and being unable to get back to sleep. Insomnia doesn’t have one main cause. Instead, many health and lifestyle factors can cause insomnia. 

Insomnia is common, with multiple studies showing 10–30% of people worldwide experiencing the sleep disorder ^[3] Bhaskar S., et al. Prevalence of Chronic Insomnia in Adult Patients and Its Correlation with Medical Comorbidities. Journal of Family Medicine and Primary Care. Oct.-Dec. 2016. Found on the internet at https://journals.lww.com/jfmpc/fulltext/2016/050 . And older adults have even higher rates of insomnia. If we have occasional sleepless nights, it doesn’t automatically mean we have insomnia. Having trouble falling or staying asleep is classified as insomnia when it occurs consecutively, whether it’s occasional short-term insomnia or chronic insomnia. The National Institute of Health defines short-term and chronic insomnia as the following ^[4] What Is Insomnia? National Heart, Lung, and Blood Institute. March 2022. Found on the internet www.nhlbi.nih.gov/health/insomnia : 

• People with short-term insomnia have difficulty sleeping about three nights a week for at least two weeks in a row. Insomnia is considered short-term if it only lasts up to three months at a time. It’s also known as acute (sudden) insomnia.

• People experiencing chronic insomnia have trouble sleeping at least three times per week for more than three months.

Fortunately, nearly 72% of people who experience short-term insomnia recover without developing long-term insomnia ^[5] Vargas I., et al. Acute and Chronic Insomnia: What Has Time and/or Hyperarousal Got to Do With It? Brain Sciences. Jan. 29, 2020. Found on the internet at https://www.mdpi.com/2076-3425/10/2/71 , but without treatment, it can worsen ^[6] Yale Medicine. Insomnia. Found on the internet at https://www.yalemedicine.org/conditions/insomnia . Early treatment is the key to preventing it from becoming a chronic condition.

What are the causes of insomnia? 

Insomnia can be triggered by our health, environment, and lifestyle—there isn’t one specific cause.

Health risks for insomnia

Certain health characteristics can increase your risk of insomnia. Some causes can’t be prevented, such as age and genetics, but that doesn’t mean you’re guaranteed to develop insomnia.

Here are common physical conditions that may increase your risk of insomnia: 

• Age: Insomnia can happen at any age, but you’re more likely to experience it as you get older. About 50% of older adults report experiencing insomnia with some groups reporting higher rates than others ^[7] Brewster G., et al. Insomnia in the Older Adult. Sleep Medicine Clinics. Nov. 22, 2017. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847293/ .

• Family history: You may develop insomnia if it runs in your family. Many genes influence our sleep habits ^[8] Parish J.M. Genetic and Immunologic Aspects of Sleep and Sleep Disorders. Chest. May 2013. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734884/ , including our circadian sleep-wake cyclesⓘ Circadian rhythms are 24-hour cycles running the body’s internal clock allowing you to carry out important functions. The most well-known circadian rhythm is the sleep-wake cycle. 1, which can be influenced by both genetic and environmental factors, and which can lead to an inability to get the amount of sleep we need to function at our best. Insomnia has also been linked to psychological health, which is heavily influenced by family, and presumably, the genetics we share with family. In one study, 35% of people with insomnia had a family history of sleep disturbances ^[9] Bastien C.H., and Morin C.M. Familial Incidence of Insomnia. Journal of Sleep Research. Dec. 24, 2001. Found on the internet at https://onlinelibrary.wiley.com/doi/10.1046/j.1365-2869.2000.00182.x . 

• Sex assigned at birth: Women are more likely to have insomnia compared to men due to the hormonal changes and side effects ^[10] Chen J. Women, Are Your Hormones Keeping You up at Night? Yale Medicine. July 10, 2017. Found on the internet www.yalemedicine.org/news/women-are-your-hormones-keeping-you-up-at-night of pregnancy and menopause.

• Health conditions: Restless leg syndrome (RLS), circadian rhythm disorder, untreated obstructive sleep apnea (OSA), arthritis, and other conditions with chronic pain may keep you up at night. Consider a mattress to address your chronic pain, such as the best mattresses for back pain.

• Mental health: Depression, anxiety, and other mental health issues can influence insomnia ^[11] Oh C.M., et al. The Effect of Anxiety and Depression on Sleep Quality of Individuals With High Risk for Insomnia: A Population-Based Study. Frontiers in Neurology. Aug. 13, 2019. Found on the internet at https://www.frontiersin.org/journals/neurology .  

Lifestyle risks for insomnia 

Your daily choices and experiences can also disrupt your sleep at night. The following lifestyle and environmental factors may result in insomnia: 

• Stress: Major life events such as death, illness, or significant life changes can make it difficult to fall asleep or stay asleep. Our body releases more cortisolⓘ Cortisol is a hormone produced and released by the adrenal glands. Commonly known as the “stress hormone,” cortisol also plays an important role in regulating the sleep-wake cycle when we’re stressed, which can disrupt our sleep-wake cycle.

• Work schedule: Adjusting your sleep schedule to accommodate shift work, or alternating between day and night shifts, goes against your body’s natural circadian rhythm ^[12] Wickwire E.M., et al. Shift Work and Shift Work Sleep Disorder. Chest. Dec. 21, 2016. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6859247/ .

• Physical activity level: Regular exercise benefits us in ways that enhance our sleep quality, such as increased melatonin production, stress reduction, mood improvement, and body temperature regulation ^[13] Alnawwar M.A., et al. The Effect of Physical Activity on Sleep Quality and Sleep Disorder: A Systematic Review. Cureus. Aug. 16, 2023. Found on the internet at https://www.cureus.com/articles/178269-the-effect-of-physical-activity-on-sleep-quality-an . When we don’t regularly exercise, we miss out on these benefits and risk developing insomnia. 

• Diet: Consuming caffeine after 12 p.m. or eating a heavy meal less than three hours before going to bed may cause disrupted sleep. 

• Alcohol use: Although alcohol is a depressant and makes us tired, it actually lowers our sleep quality ^[14] Colrain I.M., et al. Alcohol and the Sleeping Brain. Handbook of Clinical Neurology. 2014. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821259/ . We’re less likely to enter the deep, restorative stages of the sleep cycle and are more likely to wake up in the middle of the night when drinking alcohol before bed. 

• Medications: Some medications may increase your risk of insomnia. Antidepressants, corticosteroids, decongestants, statins, cholinesterase inhibitors, and heart medications (alpha and beta blockers) are common medications that may disrupt sleep. 

What are the symptoms of insomnia? 

Insomnia episodes can vary for each person, but the effects of poor, disrupted sleep generally look the same for everyone. Typical symptoms include: 

• Frequent difficulty falling or staying asleep 
• Daytime sleepiness
• Irritability, depression, or anxiety
• Craving sugary foods ^[15] Greer S.M., et al. The Impact of Sleep Deprivation on Food Desire in the Human Brain. Nature Communications. Aug. 6, 2013. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763921/
• Trouble concentrating 

• Increased errors or accidents
• Long-term health issues
  

“Chronic insomnia causes chronic sleep deprivation,” said Rohrscheib. “This has many negative effects on health, including an increased risk for many dangerous diseases, such as cardiovascular disease, stroke, diabetes, dementia, cancer, and mental health disorders.” 

 Insomnia in older adults

We’re more likely to develop insomnia as we age, but why is that? A strong relationship can be seen between sleep and aging, with biological and lifestyle changes influencing our sleep patterns. 

“The area of the brain that controls sleep declines as we age, which affects our ability to fall asleep and stay asleep,” Rohrscheib explained. “It also impacts our circadian rhythm, our 24-hour internal biological clock that controls the time of day you are awake and asleep.” 

According to Rohrscheib, other reasons insomnia is more prominent in older adults include:

• Reduced sex hormones, which makes it more difficult for the brain to regulate sleep.  
• Sleep disorders older adults are more prone to, such as sleep apnea and RLS, and painful health conditions like arthritis. 
• Multiple prescription medicines, some of which can disrupt sleep. 

“Frequent nighttime urination is another common sleep disruptor for older adults,” said Suzanne Gorovoy, PhD, EdM, clinical psychologist and behavioral sleep medicine specialist with the University of Arizona College of Medicine. “This is especially prevalent in older adult males due to prostate enlargement.”

Warning

Retirement is a celebratory milestone for many older adults, but this major lifestyle change may come with schedule and sleep disruptions. Research shows that no longer having a set work schedule can lead to insomnia for some people ^[16] Patel D., et al. Insomnia in the Elderly: A Review. Journal of Clinical Sleep Medicine. June 15, 2018. Found on the internet at https://jcsm.aasm.org/doi/10.5664/jcsm.7172 . An unstructured day may throw off mealtime and bedtime routines, which help regulate our circadian rhythm.

Although we’re more likely to develop insomnia with age, it isn’t an inevitable part of aging. Treatment options are available to manage symptoms and help support restorative, healthy sleep. 

 Insomnia treatment options

Possible insomnia treatment options include lifestyle changes, talk therapy, and medication. Not sure where to begin? Start small by establishing healthy sleep habits with these sleep hygiene tips.  

• Have a consistent sleep schedule: Go to bed and wake up at the same time each day. 

• Create a relaxing bedroom environment: Make sure your bedroom is completely dark, quiet, and at a comfortable, cool temperature (68–77 degrees Fahrenheit for older adults) ^[17] Baniassadi A, et al. Nighttime Ambient Temperature and Sleep in Community-Dwelling Older Adults. Science of the Total Environment. Nov. 15, 2023. Found on the internet at https://www.sciencedirect.com/science/article/abs/pii/S0048969723042468 . Consider upgrading to a better mattress if your mattress is old or uncomfortable.  

• Refrain from caffeine, alcohol, or heavy meals before bed: Make a habit of cutting out these sleep disruptors earlier in your day. 

• Don’t use electronic devices before bed: TV and smartphones give off a blue light, which tricks our bodies into thinking it’s daytime. Too much blue light exposure suppresses our melatonin production ^[18] Harvard Medical School. Blue Light Has a Dark Side. July 7, 2020. Found on the internet at https://www.health.harvard.edu/staying-healthy/blue-light-has-a-dark-side . 

• Make time for exercise during the day: Stay physically active to help regulate your mood and stress levels, but don’t do any rigorous exercise close to bedtime

• Take time to meditate: Meditation has benefits that go beyond lowering stress and creating a sense of well-being ^[19] U.S. Department for Health and Human Services National Center for Complimentary and Integrative Health. Meditation and Mindfulness: What You Need To Know. June 2022. Found on the internet at https://www.nccih.nih.gov/health/meditation-and-mindfulness ; it has also been found to be beneficial for a large number of physical conditions, including insomnia and sleep apnea. 

On top of adopting healthy sleep habits, upgrading to an adjustable bed may help promote better sleep. Adjustable beds can help reduce pain and snoring, as well as relieve symptoms of conditions like acid reflux.

Establishing healthy sleep habits may help curb disruptions for some sleepers, but others may need more guided, structured treatment for insomnia.

 Cognitive behavior therapy for insomnia 

Cognitive behavior therapy for insomnia (CBT-I) is a popular treatment. CBT-I involves both behavioral and cognitive therapy centered on positive changes in both thinking and behavior and is recommended as the first treatment option for sleep disruptions before medical interventions like drugs and sleep aids are prescribed.  

Research shows that older adults with insomnia and depression benefitted from CBT-I and had significantly fewer symptoms at a 20-week follow-up visit ^[20] Sadler P., et al. Cognitive Behavior Therapy for Older Adults with Insomnia and Depression: A Randomized Controlled Trial in Community Mental Health Services. Sleep. August 2018. Found on the internet at https://academic.oup.com/sleep/article/41/8/zs . 

CBT-I aims to help patients recognize the root causes of their insomnia. Patients work with a licensed provider who has completed formal training in CBT-I to implement behavioral changes and habits to support better sleep. 

“Cognitive behavioral therapy for insomnia includes psychoeducation on sleep, sleep restriction, stimulus control, and helping people manage their anxiety relating to sleep,” said Shmaya Krinsky, doctor of psychology and founder of Anxiety and Behavioral Health Psychotherapy in New York. “Sleep restriction is a tool that helps increase the client’s sleep efficiency by helping them stay in bed for only times that they can actually sleep, rather than lying in bed for hours not sleeping.”

“Stimulus control is reducing all of the negative behaviors around sleep, such as screen time, exercise, using their bedroom for other activities that may distract from sleep, caffeine in the evening, and others,” said Krinsky.

“Finally, we treat the client’s negative associations related to sleep so that they can become more confident in their ability to sleep and reduce their negative thoughts and emotions that may have developed relating to sleep.”

 Insomnia medication and supplements

Behavioral changes and sleep modifications are popular first-round treatment options for insomnia, but some health care providers may recommend medication or supplements to help manage the problem. Medications and supplements should always be paired with healthy sleep habits—they aren’t a substitution for good sleep practices. While supplements can be helpful for some people, they are not intended to treat long-term sleep problems.

• Prescription medication: Your health care provider may prescribe medication to help you sleep. It’s important to note that sleep medications aren’t intended for long-term use. 

• Over-the-counter (OTC) medications: You can find sleeping aids that don’t require a prescription, but always speak with your health care provider before using an OTC insomnia medication ^[21] Mayo Clinic. Prescription Sleeping Pills: What’s Right For You? Sept. 16, 2022. Found on the internet at https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/sleeping-pills/art-20043959 . OTC medications aren’t intended to be used long-term, and some OTC medications and supplements can interact negatively with some prescription medications. 

• Supplements: Melatonin supplements can help promote better sleep by raising melatonin levels. Always speak with your health care provider before taking any supplements. “If adding melatonin to your nightly routine for sleep doesn’t produce improvements in about one to two weeks, it’s important to stop taking it and speak with your health care provider,” said Gorovoy, a clinical psychologist and behavioral sleep medicine specialist.

Bottom line

Insomnia can happen to anyone at any stage of life. Still, the typical biological and lifestyle changes associated with aging make it more likely for older adults to develop this sleep disorder. If you experience insomnia for more than three months, it’s considered chronic. 

Because high-quality sleep is crucial for our physical and mental health, we recommend speaking with your health care provider if you have insomnia. Your provider will discuss the best treatment options according to your lifestyle, current health conditions, and preferences. 

Have questions about this article? Email us at reviewsteam@ncoa.org.

Sources

1. Roth T. Insomnia: Definition, Prevalence, Etiology, and Consequences. Journal of Clinical Sleep Medicine. Nov. 14, 2019. Found on the internet at https://jcsm.aasm.org/doi/10.5664/jcsm.26929

2. Nguyen V., et al. Insomnia in Older Adults. Current Geriatrics Reports. Oct. 22, 2019. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731454/

3. Bhaskar S., et al. Prevalence of Chronic Insomnia in Adult Patients and Its Correlation with Medical Comorbidities. Journal of Family Medicine and Primary Care. October-December 2016. Found on the internet at https://journals.lww.com/jfmpc/fulltext/2016/05040/prevalence_of_chronic_insomnia_in_adult_patients.8.aspx

4. What Is Insomnia? National Heart, Lung, and Blood Institute. March 2022. Found on the internet www.nhlbi.nih.gov/health/insomnia

5. Vargas I., et al. Acute and Chronic Insomnia: What Has Time and/or Hyperarousal Got to Do With It? Brain Sciences. Jan. 29, 2020. Found on the internet at https://www.mdpi.com/2076-3425/10/2/71

6. Yale Medicine. Insomnia. Found on the internet at https://www.yalemedicine.org/conditions/insomnia

7. Brewster G., et al. Insomnia in the Older Adult. Sleep Medicine Clinics. Nov. 22, 2017. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847293/

8. Parish J.M. Genetic and Immunologic Aspects of Sleep and Sleep Disorders. Chest. May 2013. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734884/

9. Bastien C.H. and Morin C.M. Familial Incidence of Insomnia. Journal of Sleep Research. Dec. 24, 2001. Found on the internet at https://onlinelibrary.wiley.com/doi/10.1046/j.1365-2869.2000.00182.x

10. Chen J. Women, Are Your Hormones Keeping You Up at Night? Yale Medicine. July 10, 2017. Found on the internet at www.yalemedicine.org/news/women-are-your-hormones-keeping-you-up-at-night

11. Oh C.M., et al. The Effect of Anxiety and Depression on Sleep Quality of Individuals With High Risk for Insomnia: A Population-Based Study. Frontiers in Neurology. Aug. 13, 2019. Found on the internet at https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2019.00849/full

12. Wickwire E.M., et al. Shift Work and Shift Work Sleep Disorder. Chest. Dec. 21, 2016. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6859247/

13. Alnawwar M.A., et al. The Effect of Physical Activity on Sleep Quality and Sleep Disorder: A Systematic Review. Cureus. Aug. 16, 2023. Found on the internet at https://www.cureus.com/articles/178269-the-effect-of-physical-activity-on-sleep-quality-and-sleep-disorder-a-systematic-review#!/

14. Colrain I.M., et al. Alcohol and the Sleeping Brain. Handbook of Clinical Neurology. 2014. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821259/

15. Greer S.M., et al. The Impact of Sleep Deprivation on Food Desire in the Human Brain. Nature Communications. Aug. 6, 2013. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3763921/

16. Patel D., et al. Insomnia in the Elderly: A Review. Journal of Clinical Sleep Medicine. June 15, 2018. Found on the internet at https://jcsm.aasm.org/doi/10.5664/jcsm.7172

17. Baniassadi A, et al. Nighttime Ambient Temperature and Sleep in Community-Dwelling Older Adults. Science of the Total Environment. Nov. 15, 2023. Found on the internet at https://www.sciencedirect.com/science/article/abs/pii/S0048969723042468

18. Harvard Medical School. Blue Light Has a Dark Side. July 7, 2020. Found on the internet at https://www.health.harvard.edu/staying-healthy/blue-light-has-a-dark-side

19. U.S. Department for Health and Human Services National Center for Complementary and Integrative Health. Meditation and Mindfulness: What You Need To Know. June 2022. Found on the internet at https://www.nccih.nih.gov/health/meditation-and-mindfulness-what-you-need-to-know

20. Sadler P., et al. Cognitive Behavior Therapy for Older Adults with Insomnia and Depression: A Randomized Controlled Trial in Community Mental Health Services. Sleep. August 2018. Found on the internet at https://academic.oup.com/sleep/article/41/8/zsy104/5003056

21. Mayo Clinic. Prescription Sleeping Pills: What’s Right For You? Sept. 16, 2022. Found on the internet at https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/sleeping-pills/art-20043959

Emily Breaux Author

Emily Breaux is a writer with a background in education. She has written on multiple health care and technology topics, as well as for the higher education and hospitality industries. She specializes in medical alert systems and enjoys writing about hearing aids, health insurance, and wellness topics specifically for older adults.

Suzanne Gorovoy Medical Reviewer

Suzanne Gorovoy is a clinical psychologist, behavioral sleep medicine specialist, and member of the Sleep and Health Research Program at the University of Arizona College of Medicine. She received her graduate degree in School Psychology from Teachers College at Columbia University, her PhD in Clinical Psychology from Case Western Reserve University, and completed a postdoctoral fellowship in Behavioral Sleep Medicine at the University of Arizona College of Medicine.

Susan Stiles Reviewer

Susan Stiles, PhD, provides leadership in the design and development of consumer products that inspire, educate, and activate older adults. She’s been instrumental in bringing the Aging Mastery Program® to market and scaling it nationwide via strategic alliances and business partnerships. Stiles has 20+ years of experience in design thinking, multimedia, strategic communications, and management consulting.