Insomnia and sleep problems: why you can't sleep, and what helps

Signs at a glance

• Lying awake a long time before you fall asleep
• Waking up often during the night and struggling to get back to sleep
• Waking too early and not being able to fall back asleep
• Feeling as though you barely slept, even after a night in bed
• Daytime sleepiness, tiredness or low energy
• Trouble concentrating or remembering things
• Irritability, anxiety or low mood during the day
• Worrying about sleep as bedtime gets closer

Everyone has some of these sometimes. What matters is how long they last, how strong they are, and whether they get in the way of daily life. Only a doctor or licensed counselor can diagnose. If you're worried, that's reason enough to ask.

Jordan Snook described insomnia in 2020 as a sleeping disorder that makes it hard to fall asleep or stay asleep, leaving people unsatisfied with their sleep and dealing with fatigue, low energy, trouble concentrating, mood changes and slipping performance at work or school. That description still holds. Sleep and mental health are tightly woven together, and a long run of bad nights can make everything else harder. The good news: insomnia is very treatable, often without medicine.

What is insomnia?

The National Heart, Lung, and Blood Institute (NHLBI) defines insomnia as a common sleep disorder in which you have trouble falling asleep, staying asleep or getting good-quality sleep, even when you have the time and a good environment for sleep.

There are two broad kinds:

• Short-term (acute) insomnia lasts days or weeks. It usually follows stress, a loss, a move, travel or a change in schedule, and it often eases when life settles.
• Chronic insomnia happens three or more nights a week, lasts more than three months, and isn’t fully explained by another health problem.

Insomnia is different from simply not giving yourself enough time to sleep, though both leave you tired.

What does insomnia feel like?

Lying in the dark while the clock creeps forward. Waking at 3 a.m. with your mind already racing. Getting up feeling like you never slept. Then dragging through the day with a foggy head, a short fuse, and dread about whether tonight will be the same.

MedlinePlus lists the common signs: taking a long time to fall asleep, sleeping in short stretches, being awake much of the night, waking too early, feeling as if you haven’t slept at all, and daytime sleepiness, low energy, irritability, anxiety and trouble concentrating or remembering. Many people start to fear bedtime itself, and that worry keeps the cycle going.

How common are sleep problems?

• The American Academy of Sleep Medicine (AASM) says chronic insomnia disorder affects about 10% of adults. In a 2024 AASM survey of 2,006 U.S. adults, 12% said they had been diagnosed with chronic insomnia.
• Not getting enough sleep is even more common. In 2022, the share of adults getting less than 7 hours a day ranged from 30% in Vermont to 46% in Hawaii, according to CDC survey data.
• Insomnia is more common in women than men, and the chance of having it rises with age (NHLBI).

What causes insomnia?

Often several things stack up. NHLBI and MedlinePlus list:

• Stress and worry about school, work, money, relationships, or the death of someone you love, and worry about sleep itself
• Mental health conditions such as depression, anxiety and PTSD
• Health problems and medicines, including pain, other sleep disorders, and some cold, allergy or other medicines
• Caffeine, nicotine, alcohol and drugs. Alcohol may help you fall asleep but makes sleep lighter and more broken
• Schedules and surroundings: night or shift work, travel across time zones, noise, light or an uncomfortable temperature
• Habits: irregular bedtimes, long daytime naps, little physical activity, and screens before bed
• Life stage: pregnancy, menopause, caring for a baby, and getting older
• Family history, since insomnia can run in families

How is insomnia treated?

• CBT-I first. Cognitive behavioral therapy for insomnia is a 6- to 8-week program that NHLBI calls the usual first treatment for long-term insomnia. In 2020 the AASM issued a strong recommendation for it. It includes learning about sleep, sleep restriction (a set window in bed that grows as sleep improves), stimulus control (bed is for sleep; get up if you can’t sleep), relaxation, and working through anxious thoughts about sleep. It is offered by trained therapists, and some programs are online.
• Treat what’s underneath. If depression, anxiety, pain or a medicine is driving the insomnia, treating that cause matters.
• Medicine, carefully. Some prescription medicines can help for a time, but some are habit-forming and meant only for short-term use. NHLBI says research has not proven melatonin effective for insomnia, and over-the-counter sleep aids and supplements should be discussed with a doctor first.

Good sleep habits support treatment, though the AASM notes that sleep hygiene alone is not enough for chronic insomnia:

• Go to bed and get up at the same time every day, weekends included.
• Keep the bedroom cool, quiet and dark.
• Turn off screens at least 30 minutes before bed (CDC).
• Avoid caffeine in the afternoon and evening, and alcohol and big meals near bedtime.
• Exercise regularly, but finish at least 5 to 6 hours before bed (NHLBI).
• Skip or limit naps, and build a calm wind-down routine.

How can I help someone who can’t sleep?

• Take it seriously. Ongoing insomnia is exhausting, and chronic insomnia is linked with higher risk of high blood pressure, heart disease and diabetes (NHLBI).
• Protect their routine. Help keep evenings calm and screens out of the bedroom, especially for teens.
• Encourage a doctor’s visit, and ask about CBT-I.
• Look for what’s underneath. Sleep trouble can be an early sign of depression, anxiety or trauma. Ask gently how they are really doing.

When should I get help right away?

See a doctor soon if sleeplessness lasts more than a few weeks, if you are so sleepy it’s unsafe to drive, or if someone notices you stop breathing or gasp in your sleep. Get help right away if sleepless nights come with hopelessness, thoughts of death or suicide, or if you are using alcohol or drugs to get through the night. Call or text 988, text HOME to 741741, or call 911 in an emergency. Every option is on Get help now.

Faith and sleep

Lying awake can feel lonely, as though everyone else in the world is resting except you. The psalms were often written for exactly those hours. David wrote while surrounded by people who doubted him:

“In peace I will both lay myself down and sleep, for you alone, LORD, make me live in safety.” — Psalm 4:8 (WEB)

“It is vain for you to rise up early, to stay up late, eating the bread of toil, for he gives sleep to his loved ones.” — Psalm 127:2 (WEB)

Psalm 127 speaks first to anxious overwork, the habit of grinding late into the night as if everything depends on us. It is a reminder that sleep is a gift, and that resting is an act of trust. It is not a promise that a believer will never have insomnia, and bad nights are not a sign that God has withdrawn his love. You can pray in the dark and also call your doctor in the morning, try CBT-I, and put the phone in another room. Read more about faith and healing.