Insomnia: Causes, Types, Symptoms, Treatment

The insomnia is a sleep disorder characterized by difficulty in initiating sleep, waking up frequently or too early and did not get back to sleep, or sleep a number of hours but still feel tired.

In this article I will explain your causes, symptoms, types, treatment, consequences, diagnosis, factors and some tips to improve your sleep habits.

Therefore, insomnia generally refers to sleeping problems. Not just the difficulty of falling asleep.

In fact, it is impossible not to sleep – except in some pathologies – and after about 40 hours without doing so the so-called microsueños, which last several seconds.



Types of insomnia

  • Primary insomnia: difficulty with sleep does not refer to other medical or psychiatric problems. However, insomnia can cause disorders such as anxiety; not sleeping causes anxiety, anxiety further disrupts sleep, which further increases anxiety.
  • Secondary insomnia: The person has sleep problems due to something else, such as illness (depression, asthma, arthritis, cancer, and heart disease), pain, medications or substances (alcohol, drugs).

Insomnia Symptoms

The symptoms of insomnia can be:

  • Difficulty falling asleep.
  • Waking up at night.
  • Waking up too early.
  • Not feeling well rested even though he slept at night.
  • Tired during the day.
  • Sleep during the day.
  • Irritability, depression or anxiety.
  • Difficulty paying attention, concentrating or remembering things.
  • More mistakes or accidents.
  • Tension and headaches.
  • Stomach ache.
  • Worries about sleeping.


Diagnostic criteria for primary insomnia (DSM-IV)

  1. A) The predominant symptom is difficulty initiating or maintaining sleep, or not having a restful sleep, for at least 1 month.
  2. B) Sleep disturbance (or associated daytime fatigue) causes clinically significant distress or social, occupational, or other significant impairment of the individual’s activity.
  3. C) Sleep disturbance does not appear exclusively in the course of narcolepsy, breathing-related sleep disorder, circadian rhythm disorder or a parasomnia.
  4. D) The alteration does not appear exclusively in the course of another mental disorder.
  5. E) The alteration is not due to the direct physiological effects of a substance or a medical illness.

Causes of insomnia

The common causes of insomnia can be:

  • Stress: worries about work, health, college or family that can keep the mind active at night.
  • Anxiety: Daily anxiety or serious anxiety disorders such as post-traumatic stress can disrupt sleep. Worrying about being able or not to go to sleep can make the problem worse.
  • Depression: You may sleep too much or have problems with sleep if you are depressed.
  • Other medical conditions : There are medical conditions that can worsen insomnia such as pain, difficulty breathing, need to urinate frequently, arthritis, cancer, hyperthyroidism, Parkinson’s, Alzheimer’s …
  • Changes in the environment or school schedule: travel or work late can interrupt circadian rhythms difficult sleep.
  • Poor sleep habits: Poor sleep habits include irregular schedules, doing stimulant activities before bed, uncomfortable atmosphere, using the bed for other activities other than sex or sleeping.
  • Medications: Many drugs that are prescribed may interfere with sleep, including some antidepressants, medications for hypertension, stimulants, corticosterolds…
  • Caffeine, nicotine, and alcohol: Coffee, tea, and caffeine-containing beverages are stimulants and may interfere with sleep if taken in the afternoon. Nicotine is another stimulant that can produce insomnia. Alcohol is a sedative, although it can prevent reaching deep sleep stages and often causes sleep disruption during the night.
  • Eating too much for dinner: eating too much for dinner can cause physical discomfort at bedtime, making it difficult to fall asleep.

On the other hand, insomnia becomes more common with age. As you grow older you can experience:

  • Changes in sleep patterns: Sleep often becomes less refreshing with age and the sounds of the environment make it easier to wake up. With age the internal clock usually advances, which is equivalent to getting tired earlier in the afternoon and getting up earlier. However, older people generally need the same hours of sleep.
  • Change in activity: with age can decrease physical or social activity. This lack of activity can interfere with a good night’s sleep. On the other hand, being less active may lead to more naps, which may interfere with nighttime sleep.
  • Change in health: Chronic pain, arthritis, stress, anxiety or depression can interfere with sleep. The Benign prostatic hyperplasia in men causes the need to urinate frequently, interrupting sleep. The hot flashes of menopause can also be the same.
  • Other sleep disorders: Sleep apnea or restless legs syndrome become more frequent with age.
  • More medications: older people often take more medications, which increases the likelihood of drug-induced insomnia.


1-Behavioral Therapies

Behavioral therapies educate on new behaviors, habits and ways that improve the quality of sleep.

These therapies are recommended as the first line of treatment and are usually just as effective as or more effective than medication.

Cognitive-behavioral therapy

The cognitive-behavioral therapy (CBT) focuses on breaking the cycle of amnesia.

Poor sleep quality leads to stress and anxiety, which makes sleep even worse and this causes more stress and more anxiety.

To try to solve the problem, the affected person can adopt poor habits like taking sleeping pills, alcohol or sleeping long naps to regain sleep. This makes everything worse.

In addition to improving habits, CBT aims to change thoughts and feelings about sleep that can cause stress and contribute to insomnia.

CBT does not have immediate results, requires patience and persistence, although it is a safer and more effective treatment than the medication.

At first, the situation may worsen if the therapist proposes sleep restriction therapy. This limits the time spent in bed and as sleep efficiency increases, you start to sleep earlier and get up later, until the ideal hours are reached.

Relaxation techniques

Progressive muscle relaxation, biofeedback, and breathing exercises can reduce bedtime anxiety.

These techniques help control breathing, heart rate, muscle tension and mood.

In this article you have several detailed relaxation techniques.

Stimulus control

It is about controlling the time you spend awake in bed and associate the bed and bedroom with sleep and sex.

Restriction of sleep

This treatment decreases the time spent in the layer, causing partial deprivation of sleep, which makes the person feel more tired the following night. When sleep improves, bed time is gradually increased.

Paradoxical Intent

It aims to reduce worries and anxiety about being able to fall asleep.

It’s about trying to stay awake – paradoxical intention – instead of worrying about the ability to sleep.

Light Therapy

If the affected person falls asleep too early and then gets up too early, he can use light therapy to delay the internal clock.


Prescription drugs such as zolpidem, eszopiclone, zaleplon or ramelteon can help you fall asleep.

It is not recommended to take sleeping pills for more than a few weeks, although some drugs are approved for long-term use.

According to the American Association of Retired Persons, the following drugs can cause insomnia:

  • Corticosterolds: used in patients with allergic reactions, gout, lupus, rheumatoid arthritis and for muscle inflammation. Examples are: prednisone, triamcinolone, methylprednisolone and cortisone.
  • Stations: medicines used to treat high cholesterol. They may be simvastatin, rosuvastatin, lovastatin and atorvastatin.
  • Alpha blockers: used to treat hypertension and benign prostatic hyperplasia. Examples are terazosin, silodosin, alfuzosin, proposing, dioxin and tamsulosin.
  • Selective serotonin reuptake inhibitors: used for depression. Examples are flux tin, paroxetine, escitalopram, sertraline and fluvoxamine.
  • Cholinesterase Inhibitors: used to treat memory loss and other symptoms in patients with dementia. Examples are rivastigmine, donezepil and glutamine.
  • Glucosamine / Chondroitin Sulfate: dietary supplements used to decrease the symptoms of joint pains to reduce inflammation.

3-Alternative medicine

Many people fail to visit a professional and manage to overcome insomnia by themselves.

Although in some cases there is no research on safety and effectiveness, there are options such as:

  • Melatonin: The body naturally produces melatonin, releasing it into the bloodstream. The release increases during the evening and decreases during the morning. Older people appear to have greater benefits with melatonin, although there is no evidence to prove it is effective. It is generally considered safe for a few weeks, but its long-term safety is not known.
  • Valerian: this is a supplement that is sold as a help to sleep better. It has a moderate sedative effect, although it has not been studied well. It is advisable to consult with your doctor before taking it.
  • Acupuncture: this is the placement of small needles at specific points in your body. There is evidence that this practice may benefit some people with insomnia, although more research is needed.
  • Yoga: Some studies suggest that regular yoga practice can improve sleep quality.
  • Meditation: Some studies suggest that meditation along with conventional treatment can improve the quality of sleep. It also has benefits like reducing stress or blood pressure.

4-Lifestyle and habits

Often the best solution for insomnia is to change the routines you have during the day and before going to sleep.

Good sleep habits promote a good quality of sleep and energy and alertness during the day.

Basic tips are:

  • Check Medications: If you take drugs regularly check with your doctor what may be affecting your sleep
  • Exercise and stay active: physical exercise promotes sleep quality. Do 30 minutes of physical exercise daily at least 4 or 5 hours before bed?
  • Avoid or limit naps: Naps can make it more difficult to sleep at night. If you need them, try not to spend more than 30 minutes in the siesta and not later than 15:00.
  • Avoid or limit caffeine, alcohol and nicotine: Coffee, tea and beverages containing caffeine are stimulants and can interfere with sleep if taken in the afternoon. Nicotine is another stimulant that can produce insomnia. Alcohol is a sedative, although it can prevent reaching deep sleep stages and often causes sleep disruption during the night.
  • Establish a schedule: Make the hours you get up and wake up stay consistent, including weekends.

Before sleep:

  • Avoid long meals and beverages before bedtime: Avoid eating too much before bed to reduce the likelihood of gastro esophageal reflux and improve sleep quality.
  • Use bed or room only for sleeping or sex: avoid reading, working or eating in bed. Also watch the TV, use the Smartphone or laptop, play video games or any kind of screen.
  • Make your room comfortable for sleeping: close your room and keep it quiet. Make the temperature pleasant, usually cooler than during the day, and dark.
  • Turn off clocks: Set your alarm to wake up, but turn off the other clocks, including your Smartphone, so you do not worry about what time it is.
  • Relax: you can relax before bed with relaxation techniques, relaxing music, massages or baths.
  • Get out of bed if you do not sleep: sleep as you need to rest and then get out of bed. If you cannot sleep, get out of bed for 20 minutes, do something relaxing and then try to sleep again.
  • Do not try too much sleep: the more you try to fall asleep, the more awake you will be. Do something in another room until you are sleepy and then try to sleep again.

When to seek professional help?

If you have tried the treatments described above and you still have problems with sleep, a specialist can help you.

Seek professional help if:

  • Your insomnia does not respond to your strategies.
  • Your insomnia causes major problems in your home, work or school.
  • You experience symptoms such as chest pain or shortness of breath.
  • Insomnia occurs every night and is getting worse.

Risk factors

The risk of insomnia is greater if:

  • Being a woman: Women are more likely to experience insomnia. Hormonal changes in the menstrual cycle and menopause play a role.
  • Be over 60 years: due to changes in sleep patterns.
  • Having a mental disorder: disorders such as depression, bipolar disorder, anxiety or post-traumatic stress disorder can disrupt sleep. Waking up early in the morning is a classic symptom of depression.
  • Stress: Having stressful events can lead to insomnia. Examples are family deaths, couple breaks, job loss…
  • Change schedules or work at night.
  • Travel long distances (jet lag).


Sleeping is as important to health as having an adequate diet and exercise.

Also Read: Bipolar Disorder (Type 1 and 2): Symptoms, Causes, Treatments

Whatever the cause, it can have negative consequences in all areas of life and in mental and physical health.

Complications can be:

  • Lower productivity at work or school.
  • Less reaction time when driving.
  • Psychiatric problems such as anxiety or depression.
  • Irritability.
  • Higher odds of getting diseases or conditions such as hypertension, diabetes or heart disease.
  • Substance abuse.
  • Overweight or obsessive.