What are the Main Causes of Insomnia?

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May 8, 2025
Insomnia
Neha
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- Dr. Gundu Reddy

What is Insomnia?

Insomnia is among the most common sleep-wake disorders. This disorder occurs when a person’s sleeping patterns are disrupted, resulting in difficulty falling, staying, or getting any type of restorative sleep. Moreover, a person with this problem may not be able to sleep even with enough time and space.

Some of the signs of insomnia are:

Not being able to fall asleep at night
Being conscious for long periods during the night
Waking up at night and having difficulty falling asleep again
Waking up in the morning (before the alarm) and then not being able to fall back asleep
Not feeling well-rested despite sleeping throughout the night
Extreme drowsiness and fatigue during the day
Having feelings of discomfort and pain, such as headaches and stomachaches, after sleep
Inadequate output at work and school
Difficulty concentrating on work and a hobby
Mood fluctuations and depression
Refusing to sleep even when asked to (in children and teens)
Not being able to fall asleep without help (in children and teens)
Despite being tired, you can’t nap during the day
Making mistakes and increased injury/accidents
Irritability and obsession over not getting enough sleep

Individuals with insomnia often feel sleepy during the day due to poor sleep quality.

Insomnia has numerous causes that can lower the quality of life. These include stress, anxiety, sadness, and physical disorders that impair sleep. Even your daily choices can cause insomnia if they disrupt your normal sleep patterns, which everyone needs to function well.

The American Sleep Association reports that about 70 million Americans suffer from some type of sleep disorder, such as insomnia, and that nearly 40% of individuals doze off while at work, and 5% doze off while driving. Trouble sleeping is a common issue among those with insomnia.

Types of Insomnia

The different types of insomnia that can be differentiated based on their duration, cause, or intensity include the following:

Acute insomnia:

Acute insomnia, often known as short-term insomnia, usually lasts a few days or weeks. This type of insomnia is usually caused by stressful life events, including the death of a loved one, major medical issues, or major employment or relationship changes. It can also occur when traveling or other major lifestyle changes disrupt sleep routines.

The symptoms of acute insomnia usually fade away when the sufferers cope with the underlying cause. Additionally, acute insomnia can become chronic if people don’t obtain timely treatment.

Primary insomnia:

Primary insomnia is a type of sleep issue that is not directly related to any recognized medical problems or environmental stimuli. This is caused by the sleeper’s physiology (e.g., poor sleep habits, stress).

People with primary insomnia may feel fatigued during the day, become irritable, or impair cognitive abilities for no apparent reason, and may experience mood swings and trouble paying attention due to the lack of energy after sleeping less.

Chronic insomnia:

People who suffer from chronic insomnia have long-term problems falling or staying asleep. Chronic insomnia is defined as a persistent sleep disorder that occurs at least three times per week for three months or longer. This also leads to many severe health issues, such as:

Diabetes
Obesity
Depression and anxiety
Heart disease
Stroke
Alzheimer’s disease
High blood pressure/hypertension
Certain cancers

The cause of chronic insomnia is often a combination of medical issues (eg, chronic pain, diabetes, thyroid condition), mental issues (e.g., bipolar disorder, schizophrenia, major depressive disorder, and anxiety), poor sleep hygiene, and lifestyle choices that interfere with sleep.

This chronic disorder can cause brain fog, emotional instability, and daytime impairment. Furthermore, chronic insomnia may negatively impact everyone, but women are at more risk.

Sleep-onset Insomnia:

The inability to fall asleep in the early hours of the night is known as sleep-onset insomnia. This kind of insomnia causes a person to stay awake for at least 20 to 30 minutes before sleep, making it hard to fall asleep.

Sleep-onset insomnia is caused by factors such as sudden lifestyle changes, extreme physical pain, overuse of brain stimulants, and stress/anxiety.

Sleep-onset insomnia often leaves sufferers in a state of consciousness halfway between sleep and wakefulness, knowing they should be asleep but being too restless to just let go and fall asleep. Not getting enough sleep, especially for two nights, promotes daytime fatigue and cognitive impairment.

Maintenance Insomnia:

Having difficulty falling asleep, which often leads to many awakenings and attempts to get back asleep, is known as maintaining insomnia. This type of sleep disorder, sometimes called “nighttime insomnia,” is characterized by the inability to fall or stay asleep at any time during the night. Individuals often wake up too early and struggle to return to sleep.

Frequent awakening that lasts 30 to 40 minutes is a symptom of maintenance insomnia. The most common causes of this insomnia are environmental illness, underlying medical conditions, or severe stress.

Secondary Insomnia:

Secondary insomnia can occur as a side effect of medication or as a symptom of another illness. This type of insomnia is caused by various conditions, such as substance misuse, mental health issues, or chronic pain.

Unlike primary insomnia, secondary insomnia requires complete therapy. The underlying medical conditions that cause secondary insomnia are the focus of beneficial therapies.

Furthermore, secondary insomnia can be as severe as other types, although it can improve after serious medical issues or pharmaceutical side effects are treated.

What are the Causes of Insomnia?

Insomnia can develop temporarily or chronically as a single problem or in conjunction with other health issues. Underlying health conditions can contribute to insomnia. Like many health issues, insomnia is also considered to be caused by many factors. Sleep disturbances are a common issue associated with insomnia. Among the causes of insomnia are:

Causes of Acute Insomnia:

Different situational factors can develop acute insomnia (>3–14 days), which is often a temporary condition. Some of these causes are:

Poor Sleep Practices:

Not having a consistent sleep routine and partaking in exciting and energizing activities in the hours just prior to sleeping may lead to an acute case of insomnia. Irregular sleep schedules can affect when individuals go to bed, making it harder to establish a healthy sleep pattern.

Stress:

Persisting stress from health issues, work, family, or money often causes short-term insomnia. Dramatic life events, such as the death of a loved one, divorce, or relocation, can also cause significant changes. Typically, when you are stressed or have recently experienced a significant life change, you may have difficulty falling and staying asleep.

Big Dinner or Midnight Munchies:

Occasionally, consuming food late at night can lead to sleeping difficulties and cause individuals to feel drowsy during the day. Sometimes, it also causes acid reflux and other symptoms.

Stimulant consumption:

When ingested late in the day (like caffeine from coffee, tea, or soft drinks) can stimulate the body, which is one of the leading causes of temporary insomnia. Additionally, individuals who drink alcohol late in the day may experience acute insomnia.

Medication use:

Several drugs (such as over-the-counter drugs for colds, allergies, and pain) can cause insomnia until the body adjusts to them. When the medications are stopped, sleep returns to normal.

Causes of Chronic Insomnia:

Chronic insomnia is a longer-lasting condition (1–3 months) that can be associated with many different health problems or lifestyle factors. Some of the following causes of chronic insomnia are:

Medical and Mental issues:

Chronic medical conditions (e.g., arthritis, cardiovascular disease, diabetes, and blood pressure) as well as mental health issues (e.g, depression and anxiety) are often associated with insomnia symptoms. These health conditions may cause an individual to wake up several times during the night. Mental health problems can exacerbate chronic insomnia, making it more difficult to achieve restful sleep.

Age:

Sleep patterns naturally change with aging. This produces more persistent nocturnal awake and less restorative deep sleep. Older individuals are also likely to have changes in their circadian rhythms, which regulate sleep onset and maintenance.

Genetic factors:

Genetic factors affecting sleep regulation and circadian rhythms can cause insomnia. Individuals with chronic insomnia are more likely to have genetic abnormalities in neurotransmitter systems like serotonin and dopamine, which are essential for sleep. Research also demonstrates that genes can influence insomnia risk.

Biological Factors:

Sleep disruption interferes with the production of growth hormone, which also negatively affects sleep quality, leading to the development of chronic insomnia symptoms, such as short sleep duration and restless sleep. Disruptions in these biological processes can prevent quality sleep, further contributing to insomnia.

Sedentary Lifestyles:

Not enough exercise can disrupt the body’s internal clock and push it toward long-term insomnia. Moreover, being stationary may cause restlessness and joint pain, causing more stress and affecting sleep quality. According to research, 80% of the US workforce has sedentary jobs, and insomnia is more common among them.

Nutritional Deficiency:

Minerals, especially iron, are essential for the proper functioning of the human brain and sleep regulation. A lack of these nutrients can lead to chronic insomnia. Iron is crucial for many brain functions, including the synthesis of neurotransmitters, which help regulate sleep and wakefulness. Iron helps distribute oxygen to the body’s cells, therefore, a lack can cause restless sleep, fatigue, and difficulty maintaining a sleep routine.

Substance abuse:

Excessive nicotine and alcohol use can disrupt sleep patterns, resulting in persistent fragmented sleep or difficulty falling deeply asleep.

Most Common Causes of Insomnia by Age Group

Although insomnia affects every age group, some evidence indicates that different age groups have different causes. Biological, psychological, and social differences may cause these differences in group age. Daytime sleepiness is a common issue across all age groups. The following causes of insomnia in different age groups are:

Causes of Insomnia in Men:

Pressure and worry: Work (or work deadline), personal life, and financial matters often cause stress in men, which often leads to anxiety and sleep disorders like insomnia.
Health issues: Certain health problems, such as sleep apnea, chronic pain, and heart disease, which are associated with insomnia, are more common in men than women.
Lifestyle choices: Men who consume high amounts of alcohol, smoke, and have irregular sleep routines may struggle to fall asleep.
Melatonin deficiency: Insomnia is often caused by excessive exposure to artificial light, which results in decreased melatonin levels.
Sweating at night: This issue is often caused by low testosterone levels. As a result, men often suffer from restless and uncomfortable sleep, which can contribute to insomnia.
Sleep disorder: Sleep disorders such as sleep apnea are also linked to low testosterone levels in men, resulting in frequent arousals due to blocked airflow, leading to poor restorative sleep.
Serotonin deficiency: Low testosterone levels also cause insomnia in men due to a decline in serotonin levels. When serotonin levels are normal, people feel happier, attentive, and emotionally stable.
Adrenal fatigue: Chronic stress causes the adrenal glands to overproduce cortisol (which is a harmful hormone), causing insomnia and fatigue in men.

Causes of Insomnia in Women:

Hormonal changes: In many women, hormonal changes cause insomnia. Several crucial processes in female biology can cause increases and drops in hormone levels, disrupting sleep:
- Periods: Women are more likely to experience insomnia during menstruation and the premenstrual phase.
- Pregnancy: Sleep disorders are common among expectant moms and are linked to a hormone called human chorionic gonadotropin (hCG).
- Menopause: Many women suffer from insomnia both during and after menopause.
Urinary incontinence: During menstruation, pregnancy, delivery (or labor), and menopause, the reproductive system changes, causing the need to go to the washroom multiple times at night or fear urine leakage, terror at night, which also contributes to insomnia in women.
Prolonged sleep disorders: Sleep disorders like apnea are linked to hormonal disruption in women, resulting in frequent awakenings and poor sleep quality.
Responsibilities of caregiving: Often, women are homemakers or caretakers. Balancing that with the other multiple roles can lead to stress and sleeping problems for them.
Melatonin deficiency: Like men, exposure to artificial light diminishes melatonin, which in turn makes women sleep more difficult.
Adrenal fatigue: Prolonged stress results in an imbalance of cortisol, which contributes to insomnia in women.

Causes of Insomnia in Teenagers:

Hormonal changes: During adolescence, a young person’s body undergoes significant hormonal changes (changes in puberty). These changes can affect their sleep patterns, causing them to wake up more often at night.
Academic pressure: Pressure from academic work and activities beyond school can be a source of stress that leads to anxiety and insomnia in teenagers.
Disruptive sleep patterns from social media and technology: Excessive use of phones and social media right before bedtime can cause insomnia in teens.

Causes of Insomnia in Kids:

Nightmares: Children may have nightmares or night terrors, which can make it challenging for them to fall back asleep, contributing to insomnia.
Too much screen time: Engaging with screens and other stimulating activities before bedtime disrupts the circadian rhythm, fooling the brain that it is still daytime, resulting in the onset of insomnia in children.
Disrupting sleep: An unfamiliar environment or changes in daily routines, such as school time or an examination, can disrupt many children’s sleep, which contributes to insomnia. Additionally, sleeping in an uncomfortable or noisy environment can also disrupt sleep quality in children.

Causes of Insomnia in the Elderly:

Change sleep cycle: Changes in sleep structure can lead to lighter sleep and more frequent awakenings in older adults. Furthermore, age might cause some disorders in the elderly, such as sleep apnea and prostate difficulties, which impair sleep.
Chronic health conditions: Arthritis, diabetes, and heart disease are more common in older adults. These conditions can often lead to insomnia.
Medications: Older persons who use many medications are more likely to experience medication-related insomnia. Disrupted sleep can occur when drugs interact or are taken at the wrong time of day.

Medical Conditions That Can Cause Insomnia

Insomnia is also recognized as a symptom of many medical disorders, rather than a major sleep disorder. Clinical sleep medicine plays a crucial role in diagnosing and treating insomnia caused by these medical conditions. The following disorders and conditions may cause insomnia:

Diabetes: Diabetic complications can cause blood sugar changes, frequent bathroom visits, and hand and foot nerve problems. These factors can all cause them to have insomnia symptoms, such as waking up in the middle of the night and having trouble falling back asleep.
Cancer: Many cancer patients suffer from insomnia, which is frequently linked to the disease’s clinical symptoms and associated suffering. After surgery, chemotherapy, and radiation, people may have problems sleeping even in remission. Moreover, many cancer patients report struggling to get restorative sleep.
Alzheimer’s Disease: Alzheimer’s can cause “sundowning,” when confusion and restlessness peak at night, causing midnight wandering and insomnia. This is a major cause of insomnia for around half of the people with mild to moderate Alzheimer’s disease.
Asthma: Asthma sufferers may have midnight episodes that cause respiratory problems that interfere with sleep. Anyone with asthma can have a bedtime asthma attack, and the worry of the illness can cause insomnia-causing anxiety.
Chronic Obstructive Pulmonary Disease (COPD): Like asthma, COPD can impair breathing and oxygen levels during sleep. Consequently, this medical condition may result in frequent episodes of awakenings as well as poor sleep quality.
Fibromyalgia: Fibromyalgia is a clinical syndrome that affects the sleep cycle, resulting in nonrestorative sleep. Many fibromyalgia patients suffer from insomnia, which is commonly caused by pain and neurological problems.
Thyroid Disease: Insomnia can be caused by either hyperthyroidism or hypothyroidism, as both conditions cause hormonal imbalances that impact sleep and energy levels.
Arthritis: Rheumatoid arthritis and osteoarthritis can cause chronic joint pain and inflammation, making it difficult to sleep. Finding a comfortable sleeping position is difficult when you’re in pain. People in this condition can’t find a pain-free, comfortable resting position. Consequently, they may not be able to fall asleep easily and end up staying awake for hours on end (insomnia symptoms).
Kidney Disease: Impaired kidney function can cause insomnia when the body experiences chemical imbalances. Restless legs syndrome, which is frequently associated with kidney failure, may also affect sleep.
Epilepsy: Seizures can disrupt the sleep cycle and cause insomnia. When this happens, the body may react with stress hormones, which can cause irregular or even parasomniac sleep patterns.
Multiple Sclerosis (MS): MS is a chronic, autoimmune disorder of the central nervous system in which the body’s immune system mistakenly attacks itself. This central nervous system condition can interrupt sleep and cause insomnia by damaging the neuronal connections that control the time and pattern of sleep.
Gastroesophageal Reflux Disorder (GERD): Heartburn and reflux from Gastroesophageal Reflux Disease (GERD) can cause insomnia. Patients with reflux often report that it affects their sleep and makes them feel like they’re daydreaming. Naturally, GERD makes sleep quality even more difficult by increasing the risk of snoring, insomnia, and sleep apnea.
Parkinson’s Disease: Individuals with tremors or stiffness may experience disruptive sleeplessness (i.e., insomnia). These symptoms relate to two key sleep deprivation factors—physical discomfort and the inability to keep a particular posture.
Nasal/sinus Allergies: Nasal allergies can cause congestion and pain, making it difficult to breathe at night and leading to insomnia from disrupted sleep.
Traumatic Brain Injury & Concussion: A traumatic brain injury can affect the brain’s ability to regulate sleep, making insomnia a common side effect.
Angina (Chest Pain): People who suffer from chest pain throughout the night may find it difficult to get back to sleep and may wake up multiple times during the night, which leads to insomnia.
Cardiovascular Disease: Heart patients may experience insomnia due to concern and physical distress, due to fluid buildup in the lungs when they lie down.
Stroke: A stroke can affect brain areas that control sleep, resulting in insomnia symptoms and difficulty maintaining a regular sleep schedule.
Undiagnosed Sleep Disorders: Insomnia-causing diseases include obstructive sleep apnea, narcolepsy, and restless leg syndrome. They frequently go unreported and misdiagnosed until they have severely affected your sleep pattern for an extended period.
Attention Deficit Hyperactivity Disorder (ADHD): According to a study, 66.8% of adults with ADHD suffer from insomnia symptoms. In children with ADHD, behavioral insomnia (pediatric insomnia) is a common cause.

Medications

Certain prescription drugs can contribute to insomnia. Medications for conditions such as asthma, depression, and high blood pressure may have side effects that disrupt sleep. It is important to consult a healthcare provider about these medications, as they can provide guidance on managing side effects and suggest alternatives if necessary.

Is Insomnia Genetic?

The condition of insomnia is complex and affected by both genetic and environmental factors. According to research, genetics can play major roles in an individual’s chances of suffering from insomnia, with heritability estimates ranging from 22% to 59% and an average of 39%. Understanding how much sleep is needed can help manage genetic predispositions to insomnia.

A study (2019) also found gene regions connected to insomnia symptoms, demonstrating that genetics causes certain sleep disorders. However, genes are not the only cause of insomnia, our lifestyle choices also have an impact. Poor lifestyle choices, like drinking too much coffee, can also affect sleep.

As an example, consider caffeine. Coffee and energy supplement consumers often consume 1,000 mg of caffeine per day, which could cause disruption in sleep latency and quality.
Therefore, even with many sleep-hindering genes, insomnia is preventable. Adopting healthy sleep practices, known as sleep hygiene, can help prevent insomnia and foster quality sleep. Good sleep is achievable through a healthy lifestyle regardless of deprived genetics.

Is Insomnia in the DSM5?

Insomnia is most specifically called “insomnia disorder” in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The DSM-5 classifies “insomnia disorder” as a “sleep-wake disorder,” a subset of sleep disorders. Insomnia is a transition from “primary insomnia.” This modifies “primary insomnia,” noting that insomnia may have other causes. Understanding and diagnosing insomnia as described in the DSM-5 is essential in the field of sleep medicine.

Additionally, DSM-5 criteria must be met to diagnose insomnia disorder. First, the person must complain about their sleep quality and quantity. The following are symptoms of insomnia as categorized in the DSM-5:

Difficulty initiating sleep
Difficulty maintaining sleep
Unrefreshing sleep that causes early morning awakenings (non-restorative sleep)

Experts categorize insomnia as episodic, chronic, or recurring based on frequency and duration:

Episodic insomnia lasts 1–3 weeks
Chronic insomnia lasts over 3 weeks
Unlike chronic insomnia, recurring insomnia lasts longer than three months and includes episodes of poor sleep.

To be defined as a disorder, the condition must cause a form of impairment. Insomnia is recognized as a disorder rather than an imbalance in typical sleep patterns due to the impairment symptoms that occur during the day.

According to the DSM-5, insomnia disorder affects everyone, not only those with previous mental or medical issues. Although insomniacs have a wide range of symptoms, there are a few that are common. These include drowsiness during the day, irritability and/or mood swings, poor performance at work or school, trouble focusing, and a temptation to fall asleep that borders on obsessive (addictive drowsiness).

Sleep deprivation VS Insomnia

Sleep is essential to human health. The most essential impacts of sleep are on our emotional, mental, and physical health. Lost sleep can have significant impacts on health and well-being. The most common sleep-related health problems are sleep deprivation and insomnia. These two conditions are often confused. However, each condition is highly different, with its own causes, mechanisms, and effects.

A person with sleep deprivation doesn’t receive enough sleep to function properly. In contrast, insomnia is a sleep disorder.

Sleep Deprivation:

Sleep deprivation is a common issue among individuals due to their busy lifestyles, employment, and social activities. These individuals are part of a culture that increasingly expects “always on.” Research also suggests that sleep deprivation may raise brain orexin levels to unacceptable levels. When the brain is saturated with orexin, cognitive function is severely hindered.

Insomnia:

Insomnia, on the other hand, causes people to wake up early and have trouble falling or staying asleep. Stress from work and major life changes that evoke strong emotions or require a lot of time and attention may cause insomnia. Additionally, some mental health issues, drugs, and medical conditions can cause insomnia. In short, insomnia is serious and demands specific therapies.

Accordingly, insomnia is a persistent sleep disorder that prevents some people from falling asleep, while sleep deprivation is mostly caused by not receiving enough sleep. This contrast between deprivation and disorder reveals that the two conditions have different causes and must be treated differently. Both sleep deprivation and insomnia contribute to various sleep problems, affecting individuals across different age groups and leading to significant daytime consequences.

Treatment of Insomnia

It is crucial to examine a patient’s sleep habits, lifestyle, risk factors, and mental health issues before treating insomnia. Effective treatment can help get insomnia treated and improve overall health. Insomnia and any comorbid conditions can both be alleviated with effective therapy. The techniques of insomnia treatment are as follows:

Visiting a sleep center can be part of the treatment process. If a sleep problem is suspected to be a disorder, a doctor may recommend a visit to a sleep center for specialized testing, including overnight monitoring to assess conditions like sleep apnea or restless leg syndrome.

CBT-I for Treating Insomnia:

Psychiatrists usually recommend cognitive behavioral therapy as the primary treatment for insomnia. CBT is a simple psychotherapy that targets negative thought patterns and behaviors that disrupt sleep. It has been the most successful non-drug insomnia treatment for years. Additionally, CBT-I can help prevent insomnia by addressing these negative thought patterns and behaviors.

Medications for Treating Insomnia:

In certain cases, psychiatrists may recommend medications to treat insomnia. Commonly prescribed medications include sedatives and sleep aids, which are tailored to each person’s particular health profile and conditions. Additionally, sleeping pills can be prescribed to help individuals fall asleep and stay asleep, though it is important to be aware of the potential risks and side effects associated with long-term use.

Lifestyle Changes for Insomnia:

Lifestyle changes can improve the quality of sleep. Improving sleeping habits, such as maintaining a regular sleep schedule and adopting healthy lifestyle choices, can significantly enhance sleep quality. Caffeine is a stimulant, so avoiding consuming it within six to eight hours of intended sleep is recommended. Additionally, regular exercise, eating nutritional food (as well as prescribed supplements for insomnia), helps improve sleep quality.

Sleep Hygiene Techniques for Insomnia:

With proper sleep hygiene, insomnia can be efficiently treated. Proper sleep hygiene is essential for achieving quality sleep. This necessitates an appropriate sleep environment, which includes a dark, quiet, cool room and a pre-sleep routine that reinforces the brain’s signals to the body that it is time to relax and prepare for sleep.

Relaxing Techniques for Insomnia:

Relaxing techniques like breathing exercises are beneficial for calming the mind and preparing the body for sleep. Deep breathing and progressive muscle relaxation techniques help to reduce stress and anxiety, promoting a more comfortable sleep environment.

How I Cured My Insomnia

No matter how hard you try, insomnia always seems to dominate, and you wake up every night feeling fatigued and longing for the peaceful sleep you once had. Even when you don’t know how it started, you risk your insomnia by ignoring its causes. Understanding the risk of insomnia can help individuals take proactive steps to manage their sleep health. If you’re still unsure, our board-certified psychiatrists can help you find the causes and co-create a set of customized treatments that work for you. At GABA Telepsychiatry, our psychiatrists review various root causes to treat your insomnia. These include:

Sleep hygiene
Nutritional deficiency
Psychological factors
Medical conditions
Lifestyle choices
Environmental influences
and more

With these factors in mind, our psychiatrists help treat insomnia and other mental health issues. To learn more about insomnia treatment, visit our website or call +1(833)312-4222

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