What it is
Insomnia Disorder involves trouble falling asleep, staying asleep, or waking too early—at least 3 nights per week for 3+ months—with daytime impact (fatigue, irritability, brain fog, reduced performance). Short-term insomnia is common; when it persists, targeted treatment helps.
Insomnia is not just “bad sleep hygiene.” It’s a conditioned arousal problem that responds well to structured therapy.
Common signs and symptoms
- Lying awake for 30+ minutes at bedtime or after awakenings
- Fragmented sleep, early morning awakenings, nonrestorative sleep
- Daytime sleepiness or fatigue, low mood, anxiety about sleep
- “Tired but wired” feeling; clock-watching at night
- Reliance on naps, caffeine, alcohol, or sedatives to cope
Why it happens
- Hyperarousal: stress, worry, and conditioned bed–wakefulness association
- Irregular schedules, caffeine/alcohol, evening light/screen exposure
- Co-occurring conditions: anxiety, depression, pain, sleep apnea, restless legs, medications
What helps
- Gold standard: CBT-I (Cognitive Behavioral Therapy for Insomnia)
- Sleep restriction/compression: match time in bed to actual sleep, then expand
- Stimulus control: bed only for sleep/sex; get up if awake >15–20 min; consistent wake time
- Cognitive tools: reduce sleep catastrophizing and clock-watching
- Relaxation: breathing, progressive muscle relaxation, wind-down routine
- Circadian and lifestyle supports
- Fixed wake time, morning light exposure, daytime activity
- Limit caffeine after midday; avoid alcohol as a “sleep aid”
- Dim lights/screens 1–2 hours before bed; use night mode or blue-light filters
- Medications and supplements
- Short-term options: doxepin low-dose, zolpidem/zopiclone, eszopiclone, suvorexant/lemorexant, ramelteon—best paired with CBT-I
- Melatonin: small dose (0.5–1 mg) 3–5 hours before desired bedtime for circadian shifting; 1–3 mg at bedtime in older adults
- Evaluate for sleep apnea or restless legs if snoring, witnessed apneas, or urge to move legs
CBT-I often improves sleep within 4–8 weeks and has longer-lasting benefits than meds.
When to seek help now
- Insomnia 3+ nights/week for 3 months with daytime impairment
- Loud snoring, apneas, gasping, or severe leg discomfort at night
- Thoughts of self-harm or not wanting to live (seek urgent help)
How to talk to a clinician
- “I’ve had chronic insomnia with difficulty [falling/staying asleep]. I’d like referral to CBT-I and to screen for sleep apnea/restless legs.”
Outlook
Most people sleep better with CBT-I, consistent routines, and addressing co-occurring conditions. Expect gradual wins: faster sleep onset, fewer awakenings, better energy.
Resources for readers in the USA
- Immediate help: 988 Suicide & Crisis Lifeline; Crisis Text Line (text HOME to 741741)
- Find care: Psychology Today (filter for CBT-I); FindTreatment.gov; AASM Sleep Center locator (aasm.org)
- Self-guided CBT-I: VA CBT-I Coach app; online programs (e.g., sleepio.com, cbtforinsomnia.com)
- Low-cost/community: Community Health Centers (findahealthcenter.hrsa.gov); 211
- Insurance tips: Ask about in-network CBT-I, sleep study coverage (home vs lab), device coverage for sleep apnea; copay/coinsurance, deductible, out-of-pocket max
- Work/school supports: ADA accommodations (flexible start time temporarily), EAP; campus counseling
Disclaimer: Educational information, not a diagnosis. If in crisis, use the resources above.