Insomnia risk factors: who is more likely to have it

What insomnia is

Insomnia is a common sleep disorder. With insomnia, you may have trouble falling asleep, staying asleep or getting good quality sleep, even when you have the time and the right setting to sleep well. It can get in the way of daily activities and make you feel sleepy during the day (NHLBI).

Short-term insomnia may be caused by stress or by changes in your schedule or environment, and it can last for a few days or weeks. Chronic (long-term) insomnia happens 3 or more nights a week, lasts more than 3 months, and cannot be fully explained by another health problem (NHLBI).

MedlinePlus adds that most cases of chronic insomnia are secondary: they are a symptom or side effect of another problem, such as certain medical conditions, medicines or other sleep disorders. Caffeine, tobacco and alcohol can also be a cause (MedlinePlus).

Risk factors

NHLBI says changes in your schedule or environment can cause or raise your risk of insomnia. Some risk factors, such as your job or lifestyle, can be changed, while your age and family history cannot. It lists (NHLBI):

• Age: insomnia can start at any age, but your chances of having it go up as you get older.
• Family history and genetics: insomnia sometimes runs in families, and your genes may also affect whether you are a deep or light sleeper.
• Environment or job: shift or night work, noise or light during the night, temperatures that are too hot or too cold, and traveling often across time zones can disturb your sleep-wake cycle.
• Lifestyle: changing your routine or sleep schedule often, sleep that is often interrupted (for example, to care for a baby), long daytime naps, too little physical activity, using caffeine, nicotine, alcohol or recreational drugs, and watching TV or using electronic devices close to bedtime.
• Stress: worry about school or work, relationships, money or the death of a loved one. Worrying about whether you will sleep enough and watching the clock can also raise the risk or make insomnia worse.
• Sex: insomnia is more common in women than in men. Hormone changes during pregnancy and menopause can cause sleep problems.

MedlinePlus also says older adults are more likely to have insomnia, and that you are at higher risk if you (MedlinePlus):

• have a lot of stress
• are depressed or have other emotional distress, such as divorce or the death of a spouse
• have a lower income
• work at night or have frequent major shifts in your work hours
• travel long distances with time changes
• have an inactive lifestyle
• are African American. MedlinePlus says research shows African Americans take longer to fall asleep, do not sleep as well and have more sleep-related breathing problems than White people.

Some prescription medicines used for other health conditions can also raise the risk of insomnia (NHLBI), and NHLBI names some cold and allergy medicines as examples of medicines that can disrupt sleep (NHLBI).

Symptoms

NHLBI describes these symptoms (NHLBI):

• lying awake for a long time before you fall asleep, which is more common in younger adults
• sleeping for only short amounts of time
• waking up often during the night or being awake for most of the night, the most common symptom, which mostly affects older adults
• waking up too early in the morning and not getting back to sleep
• poor quality sleep, so you wake up unrested and feel sleepy during the day

You may also have trouble focusing on daily tasks, and insomnia can make you feel anxious, depressed or easily annoyed (NHLBI). MedlinePlus notes that it can make you drowsy while driving, which could lead to a car accident (MedlinePlus).

Health problems linked to chronic insomnia

In the short term, insomnia can make it hard to concentrate or think clearly, and it raises the risk of falling, having a road accident or missing work (NHLBI). See fall risk factors.

NHLBI says chronic insomnia raises your risk of high blood pressure, coronary heart disease, diabetes and cancer (NHLBI). It also lists breathing problems such as asthma, heart problems such as arrhythmia and heart failure, pregnancy complications, effects on the immune system, and changes in hormones that control hunger, which can raise the risk of overweight and obesity, metabolic syndrome and diabetes (NHLBI).

Mental health conditions such as anxiety, depression and thoughts of suicide may occur with chronic insomnia (NHLBI). See depression risk factors and anxiety risk factors.

Restless legs syndrome causes an urge to move the legs that can make it hard to fall asleep and stay asleep (MedlinePlus). See restless legs syndrome risk factors.

The 988 Lifeline is free and confidential and available 24/7 (988 Lifeline).

How insomnia is found

If not getting enough sleep is affecting your daily activities, NHLBI says to talk to your doctor. You may be diagnosed with insomnia if you have trouble falling or staying asleep at least 3 nights a week (NHLBI). Keeping a sleep diary for 1 to 2 weeks before your visit can help: write down when you go to sleep, wake up and nap, how sleepy you feel during the day, when you have caffeine or alcohol, and when you exercise (NHLBI).

Your provider will ask about your sleep habits, health problems, medicines, pregnancy or menopause, and use of caffeine, nicotine, alcohol or drugs, and will do a physical exam. They will also look for signs of sleep apnea, such as loud, frequent snoring or waking up gasping (NHLBI); see sleep apnea symptoms. Tests may include a sleep study, actigraphy (a small wrist motion sensor worn for 3 to 14 days) and blood tests for thyroid problems or other conditions that affect sleep (NHLBI).

Treatment and lowering your risk

NHLBI suggests healthy sleep habits (NHLBI):

• sleep in a cool, quiet, dark place and avoid TV or electronic devices before bed
• go to sleep and wake up around the same time each day, even on weekends
• avoid caffeine, nicotine and alcohol close to bedtime
• get regular physical activity during the day, at least 5 to 6 hours before bed
• avoid naps, especially in the afternoon
• eat meals on a regular schedule, avoid late dinners and limit drinks close to bedtime
• find ways to manage stress and wind down before bed

Cognitive behavioral therapy for insomnia (CBT-I) is a 6 to 8 week treatment plan that is usually recommended as the first treatment for long-term insomnia and can be very effective (NHLBI). Some prescription medicines are meant for short-term use and others for longer-term use, so talk to your doctor about benefits and side effects (NHLBI). NHLBI says to talk to your doctor before taking over-the-counter sleep aids that contain antihistamines, and that research has not proven melatonin is an effective treatment for insomnia (NHLBI). If insomnia is a symptom or side effect of another problem, MedlinePlus says it is important to treat that problem if possible (MedlinePlus).

Common questions

Who is most likely to have insomnia?

Insomnia is more common in women than in men, and the chance of having it goes up as you get older (NHLBI). Stress, shift work, frequent travel across time zones and some lifestyle habits also raise the risk (NHLBI).

When does insomnia become chronic?

NHLBI calls insomnia chronic when it happens 3 or more nights a week and lasts for 3 months or longer (NHLBI).

Is insomnia the same as sleep apnea?

No. They are different sleep disorders. During an insomnia visit, NHLBI says your provider may look for signs of sleep apnea, and a sleep study can check for other sleep problems such as sleep apnea and narcolepsy (NHLBI). The STOP-Bang sleep apnea check can help you decide whether to raise sleep apnea with your provider.