How to figure out the cause of your insomnia and resolve your sleep troubles

Kelly BurchMay 29, 2020, 04:00 IST

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Looking at your phone screen before bed may contribute to insomnia.WeAre/Shutterstock

There are many potential causes of insomnia, or trouble sleeping.
Poor sleep habits — such as an irregular schedule or using screens before bed — often cause insomnia.
Insomnia can also be caused by stress, mental health conditions, sleep disorders like sleep apnea, hormonal changes like pregnancy, physical ailments or illnesses, and medication side effects.
This article was medically reviewed by Alex Dimitriu, MD, psychiatrist and founder of Menlo Park Psychiatry and Sleep Medicine.

If you have trouble falling asleep, staying asleep, or both, you may have insomnia. It's a common condition, but comes with a wide range of possible causes.

For example, if you suffer from occasional bouts of sleeplessness, it's probably due to stress, an irregular sleep schedule, or unhealthy habits before bed.

But if you're suffering from insomnia more frequently, over a few months, the cause could be an underlying physical condition, mental health issue, or side effect from medication.

Here's what you need to know to get to the root of your sleeping troubles.

Poor sleeping habits

An irregular sleep schedule is one of the main causes of sleep troubles.

For example, irregular sleep caused by abnormal shift work has been linked to higher rates of insomnia. Though it may be more difficult for night shift workers, people should try to go to bed and wake up at the same time every day, even on the weekends.

This can help your body establish a sleep routine by regulating your circadian rhythm, the internal clock that makes your body feel sleepy or awake at certain times. Having a predictable schedule helps your body prepare for sleep at the right time.

In addition, any stimulation before bed, such as working or doing a stressful activity like paying the bills, can make it difficult to fall asleep. Using screens at night will also harm sleep, since the blue light in tablets and smartphone screens inhibits the production of melatonin, the hormone that makes us sleepy.

Instead, it's better to establish relaxing habits before bedtime. "Take a hot bath or drink a cup of chamomile tea, which can be helpful in slowing your mind and body down," says Nate Favini, MD, medical lead of Forward, a preventive care practice.

Unhealthy diet or substances

There are also certain foods and substances that can make it more difficult for you to sleep:

Nutrition. A 2019 study found that eating lots of refined carbohydrates — for example, white bread instead of whole grains — and products with added sugar can make insomnia worse.
Alcohol. Though it may seem like having a drink makes it easier to fall asleep, alcohol actually reduces the quality of sleep and can leave you feeling drowsy. It also disrupts your circadian rhythm, which can contribute to insomnia, according to a 2019 study.
Caffeine. Many people turn to caffeine to stay awake, so it's no surprise that it interrupts sleep. One study found that 400 mg — that's about four 8-ounce cups of coffee — as much as six hours before bed can contribute to poor sleep.
Nicotine. A 2019 survey of more than 26,000 people found that smokers reported more disturbed sleep than non-smokers, which can contribute to insomnia.

Stress

Acute insomnia, which usually only lasts for days or weeks, is closely associated with high levels of stress.

Insomnia can be caused by hyperarousal, or when your brain has trouble turning off. Stress is an aroused state, in which your hormones and thoughts are flowing at high speed, so it can interfere with the calm mental state needed for sleep.

A big project at work, financial troubles, or a nasty argument are all examples of stressful life events that can keep you up at night. For example, a 2018 scientific review found that having a high-stress job was associated with higher likelihood of insomnia.

Another 2017 study of nearly 25,000 workers found that those with more job strain — defined as having lots of stress and low levels of control — were more likely to experience insomnia.

Depression or anxiety

About 50% to 80% of people that visit a psychiatrist report trouble sleeping, compared with 10% to 18% of the general population.

While not everyone who visits a psychiatrist has a mental illness, about 40% of people with chronic insomnia — sleep troubles occurring at least three times a week for three months — will have a mental health condition, such as depression.

For example, depression can cause insomnia, and both conditions can exacerbate symptoms of the other, leading to a vicious cycle. Anxiety can also cause insomnia. In fact, trouble sleeping is one of the most common symptoms of anxiety.

A 2016 study of college students found that people with anxiety were more likely to have insomnia and poor sleep quality. As a result, more than half of people with anxiety reported excessive daytime sleepiness, compared to 30% of people without anxiety, the study found.

Pregnancy

Insomnia during pregnancy is common.

In fact, up to 78% of pregnant women experience insomnia, and it occurs most often during the third trimester.

Many factors contribute to trouble falling asleep and staying asleep during pregnancy, including:

Hormonal changes
Physical discomfort
Frequent need to use the bathroom
Anxiety about labor or life changes

Although insomnia during pregnancy is common, the condition usually resolves after delivery. Having a good sleep hygiene routine, and increasing physical comfort by using extra pillows or lying in a different position can help pregnant women sleep better.

Overall, women are 40% more likely to suffer from insomnia than men. They're especially at risk during times when their hormones are changing, as in pregnancy, and menopause or menstruation may also affect sleep.

Medical conditions

There are many health conditions that can cause insomnia — especially sleep disorders.

Sleep apnea is a condition that causes a person to suddenly stop breathing during sleep. According to a 2019 scientific review, 38% of people with sleep apnea have insomnia.

A 2019 study found that treating both conditions together — beginning with cognitive behavioral therapy and then introducing a CPAP machine to address breathing troubles — can lead to a reduction in insomnia symptoms.

In addition, restless leg syndrome causes twitching in the legs, and since movement in the legs is often worse at night, it is a common sleep disorder.

Roughly 48% to 60% of people with restless leg syndrome have insomnia. Cognitive behavioral therapy can also help treat insomnia that occurs with restless leg syndrome.

Other physical ailments that can cause insomnia include:

Hormone and thyroid disorders, such as hyperthyroidism
Neurological disorders, including Parkinson's disease
Acid reflux, or indigestion
Chronic pain
Asthma

Medications

The side effects of many common medications can also contribute to insomnia.

Medications that may cause sleep trouble include:

SSRIs: Selective Serotonin Reuptake Inhibitors (SSRIs), commonly used to treat anxiety and depression, can cause new insomnia in 17% of users, according to a 2017 study.
Blood-pressure medications: Alpha-blockers and beta-blockers are common types of medications used to treat high blood pressure. Alpha-blockers are thought to reduce REM sleep, while beta-blockers reduce the secretion of melatonin, a hormone that makes you sleepy.
Steroids: Steroids, including those used to treat arthritis, can make it difficult to fall asleep, so it's recommended that people take these medications in the morning.

The bottom line

Although some occasional sleep troubles are normal, Favini says you should talk to your doctor if your inability to fall asleep or stay asleep starts interfering with the ability to live your life, and impacts your work or relationships.

Together, you and your doctor can figure out what exactly is causing your insomnia, and the best way to help you get better sleep.

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