Tired but Can't Sleep? What You Should Know About Insomnia

Introduction

You crawl into bed exhausted after a long day, expecting sleep to come easily. Instead, your mind refuses to switch off, and before you know it, you are staring at the ceiling while the hours tick by. If this sounds familiar, you are not alone.

Insomnia is one of the most common sleep disorders worldwide, affecting an estimated 10 to 40% of adults at some point in their lives [1]. It is characterised by difficulty falling asleep, staying asleep, or returning to sleep after waking during the night, despite having adequate time and opportunity to do so. Beyond the night itself, insomnia often spills into the day, causing fatigue, poor concentration, low mood, and a reduced ability to function.

Insomnia may be short-term, lasting less than three months, or chronic, persisting for at least three months with symptoms occurring three or more nights per week [1]. It can affect people of all ages, and understanding why it occurs is a crucial first step towards improving sleep and overall well-being.

What Causes Insomnia?

Insomnia can develop for many different reasons, and in many cases, several factors may contribute at the same time. Research suggests that insomnia develops from an interaction between brain-based arousal systems, psychological factors such as stress, and environmental or behavioural influences [2].

Some of the most common causes of insomnia include [1]:

• Stress and anxiety: Worries about work, finances, relationships, health, or major life changes can make it difficult for the mind to relax at bedtime. Stress is one of the most common triggers of short-term insomnia.
• Poor sleep habits: Irregular sleep schedules, excessive screen time before bed, daytime naps, or engaging in stimulating activities late in the evening can disrupt the body's natural sleep-wake cycle.
• Mental health conditions: Conditions such as anxiety disorders, depression, and post-traumatic stress disorder (PTSD) are frequently associated with sleep disturbances and chronic insomnia [3].
• Medical conditions: Chronic pain, asthma, gastroesophageal reflux disease (GERD), heart problems, brain and nerve conditions and other health conditions may disrupt sleep and increase the risk of insomnia [4].
• Medications: Some prescription and over-the-counter medications, such as stimulants, certain antidepressants, decongestants, and some asthma medications, can contribute to insomnia as a side effect and may make it more difficult to fall asleep or stay asleep [5].
• Caffeine and alcohol: Consuming caffeine close to bedtime can delay sleep onset, while alcohol may initially make a person feel sleepy but can disrupt sleep quality later in the night [6].
• Shift work and jet lag: Changes in work schedules, night shifts, and travel across time zones can disrupt the body's internal clock, making it difficult to maintain healthy sleep patterns.

Who Is More Likely to Develop Insomnia?

Although insomnia can affect anyone, some groups of people are more likely to experience sleep difficulties than others. Research suggests that the risk of insomnia may be influenced by factors such as age, sex, and the presence of physical or mental health conditions [7].

People at a higher risk of developing insomnia include [7]:

• Older adults: Sleep patterns naturally change with age, and insomnia becomes more common in older adulthood.
• Women: Insomnia is reported more frequently in women than in men. Hormonal changes during menstruation, pregnancy, and menopause may contribute to this increased risk.
• People with a family history of insomnia: Research suggests that genetic factors may influence a person's susceptibility to insomnia.
• Individuals with chronic health conditions: People living with long-term medical conditions often report higher rates of insomnia than the general population.
• People with mental health disorders: Insomnia is more common among individuals with anxiety, depression, and other mental health conditions.
• Shift workers: Working night shifts or rotating schedules can disrupt the body's internal clock, increasing the likelihood of sleep problems.

While belonging to one of these groups does not guarantee that a person will develop insomnia, it may increase their risk of experiencing sleep difficulties.

How Does Insomnia Affect Your Health?

Insomnia can affect more than just your sleep. Over time, persistent sleep difficulties may hurt both physical and mental health.

Some common effects of insomnia include:

• Daytime fatigue and low energy
• Difficulty concentrating and remembering information
• Irritability, mood changes, and reduced productivity
• Increased risk of anxiety and depression
• Reduced quality of life and daily functioning

The longer insomnia persists, the greater its potential impact on overall health and well-being.

How Is Insomnia Diagnosed?

Insomnia is usually diagnosed based on a person's symptoms, sleep patterns, and medical history. There is no single test that can confirm insomnia. Instead, healthcare providers assess the frequency, duration, and impact of sleep problems on daily functioning [8].

To diagnose insomnia, a healthcare provider may use:

• A detailed sleep and medical history: This includes questions about sleep habits, bedtime routines, sleep quality, daytime symptoms, medications, and any physical or mental health conditions that may be affecting sleep.
• A sleep diary: Keeping a record of sleep and wake times for several days or weeks can help identify patterns and provide a clearer picture of a person's sleep habits.
• A physical and mental health assessment: This helps identify underlying medical or psychological conditions that may be contributing to insomnia.
• Additional tests when necessary: If another sleep disorder (such as sleep apnea or restless legs syndrome) or medical condition is suspected, a healthcare provider may recommend further investigations, such as polysomnography and actigraphy [8].

What Lifestyle Changes Can Help You Sleep Better?

While lifestyle changes may not completely resolve chronic insomnia, they are often an important part of managing sleep difficulties.

Some strategies that may help include [8]:

• Maintain a consistent sleep schedule: Try to go to bed and wake up at the same time every day, including weekends.
• Create a comfortable sleep environment: Keep your bedroom quiet, dark, and at a comfortable temperature.
• Limit screen time before bed: The light from phones, tablets, and other electronic devices can interfere with the body's natural sleep-wake cycle.
• Avoid caffeine, nicotine, and alcohol close to bedtime: These substances can affect sleep quality and make it harder to achieve restful sleep.
• Stay physically active: Regular physical activity may promote better sleep, although vigorous exercise should be avoided close to bedtime.
• Develop a relaxing bedtime routine: Activities such as reading, meditation, or taking a warm bath may help prepare the body for sleep.
• Avoid long daytime naps: Excessive napping can make it more difficult to fall asleep at night.

What Treatments Are Available for Insomnia?

The treatment of insomnia depends on its cause, severity, and how long the symptoms have been present. In many cases, treatment focuses on improving sleep habits, addressing underlying conditions, and using evidence-based therapies to promote healthy sleep.

Common treatment options include:

• Cognitive behavioural therapy for insomnia (CBT-I): CBT-I is considered the first-line treatment for chronic insomnia. It helps people identify and change thoughts and behaviours that interfere with sleep and teaches strategies to develop healthier sleep patterns [9].
• Treatment of underlying conditions: When insomnia is linked to a medical condition, mental health disorder, or another sleep disorder, managing the underlying condition may help improve sleep.
• Sleep medications: In some cases, healthcare providers may prescribe medications such as zolpidem, zopiclone, melatonin, or other sedative medicines to help manage insomnia symptoms. These medications are generally used under medical supervision and may be recommended for short-term use or in specific situations.
• Relaxation techniques: Techniques such as mindfulness, meditation, and relaxation exercises may help reduce stress and promote better sleep [10].

When Should You See a Doctor for Insomnia?

Occasional sleepless nights are common and are not usually a cause for concern. However, it may be time to seek medical advice if sleep difficulties occur regularly, persist for several weeks, or begin to affect daily life [9].

You should consider seeing a healthcare provider if [9]:

• Insomnia occurs at least a few times a week or lasts for several weeks.
• Sleep problems affect your work, studies, relationships, or daily activities.
• You experience excessive daytime sleepiness, difficulty concentrating, or mood changes.
• You suspect that an underlying medical or mental health condition may be contributing to your sleep difficulties.
• Lifestyle changes and self-help strategies have not improved your sleep.

Can Insomnia Be Prevented?

Insomnia cannot always be prevented, but certain habits may help reduce the risk of developing sleep difficulties [8].

• Maintaining a consistent sleep schedule
• Creating a comfortable sleep environment
• Managing stress, staying physically active
• Limiting caffeine, nicotine and alcohol close to bedtime can support healthy sleep

It is also important to address physical and mental health concerns early, as many medical and psychological conditions can contribute to sleep problems.

While these measures may lower the risk of insomnia, they may not prevent all cases. Individuals who continue to experience persistent sleep difficulties should seek medical advice.

Conclusion

Insomnia is one of the most common sleep disorders worldwide, yet it remains largely manageable with the right knowledge and support. While occasional sleep difficulties are a normal part of life, persistent insomnia can significantly interfere with daily functioning, mental health, and overall quality of life.

Understanding the potential causes and recognising the symptoms early are important first steps. Both non-pharmacological approaches, such as cognitive behavioural therapy, and pharmacological treatments are effective, and many people experience significant improvements with the right support.

If sleep problems persist despite lifestyle changes, seeking medical advice is strongly encouraged. With appropriate treatment and guidance, better sleep and better health are achievable.

References

1. Naha S, Sivaraman M, Sahota P. — Missouri Medicine
2. Van Someren EJW. — Physiological Reviews
3. Lancel M, Boersma GJ, Kamphuis J. — Current Opinion in Psychology
4. Mayer G, Happe S, Evers S, et al. — Neurological Research and Practice
5. Do D. — Journal of Sleep Research
6. Chaput JP. — Nutrients
7. Bjorvatn B, Jernelöv S, Pallesen S. — Frontiers in Psychology
8. Riemann D, Baglioni C, Bassetti C, et al. — Journal of Sleep Research
9. Edinger JD, Arnedt JT, Bertisch SM, et al. — Journal of Clinical Sleep Medicine
10. Rusch HL, Rosario M, Levison LM, et al. — Annals of the New York Academy of Sciences