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Medical Author:

Siamak T. Nabili, MD, MPH

Siamak T. Nabili, MD, MPH

Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Insomnia may be caused by a host of different reasons. These causes may be divided into situational factors, medical or psychiatric conditions, or primary sleep problems. Insomnia could also be classified by the duration of the symptoms into transient, short-term, or chronic. Transient insomnia generally last less than seven days; short-term insomnia usually lasts for about one to three weeks, and chronic insomnia lasts for more than three weeks.

Many of the causes of transient and short-term insomnia are similar and they include:

• Jet lag
  
  
• Changes in shift work
  
  
• Excessive or unpleasant noise
  
  
• Uncomfortable room temperature (too hot or too cold)
  
  
• Stressful situations in life (exam preparation, loss of a loved one, unemployment, divorce, or separation)
  
  
• Presence of an acute medical or surgical illness or hospitalization
  
  
• Withdrawal from drug, alcohol, sedative, or stimulant medications
  
  
• Insomnia related to high altitude (mountains)

Uncontrolled physical symptoms (pain, fever, breathing problems, nasal congestion, cough, diarrhea, etc.) can also cause someone to have insomnia. Controlling these symptoms and their underlying causes may lead to resolution of insomnia.

Causes of Chronic or Long-Term Insomnia

The majority of causes of chronic or long-term insomnia are usually linked to an underlying psychiatric or physiologic (medical) condition.

Psychological Causes of Insomnia

The most common psychological problems that may lead to insomnia include:

• anxiety,
  
  
• depression
  
  
• stress (mental, emotional, situational, etc),
  
  
• schizophrenia, and/or
  
  
• mania (bipolar disorder)

Insomnia may be an indicator of depression. Many people will have insomnia during the acute phases of a mental illness. As mentioned earlier, depression and anxiety are strongly associated with insomnia. Out of the all the other secondary medical and psychological causes of insomnia, anxiety and depression are the most common.

Physiological Causes of Insomnia

Physiological causes span from circadian rhythm disorders (disturbance of the biological clock), sleep-wake imbalance, to a variety of medical conditions. The following are the most common medical conditions that trigger insomnia:

• Chronic pain syndromes
  
  
• Chronic fatigue syndrome
  
  
• Congestive heart failure
  
  
• Night time angina (chest pain) from heart disease
  
  
• Acid reflux disease (GERD)
  
  
• Chronic obstructive pulmonary disease (COPD)
  
  
• Nocturnal asthma (asthma with night time breathing symptoms)
  
  
• Obstructive sleep apnea
  
  
• Degenerative diseases, such as Parkinson's disease and Alzheimer's disease (Often insomnia is the deciding factor for nursing home placement.)
  
  
• Brain tumors, strokes, or trauma to the brain

High Risk Groups for Insomnia

In addition to people with the above medical conditions, certain groups may be at higher risk for developing insomnia:

• Travelers
  
  
• Shift workers with frequent changing of shifts
  
  
• Seniors
  
  
• Adolescents or young adult students
  
  
• Pregnant women
  
  
• Women in menopause
  
  
• People who use abuse drugs
  
  
• Alcoholics

Medication Related Insomnia

Certain medications have also been associated with insomnia. Among them are:

• Certain over-the-counter cold and asthma preparations.
  
  
• The prescription varieties of these medications may also contain stimulants and thus produce similar effects on sleep.
  
  
• Some medications used to treat high blood pressure have also been associated with poor sleep.
  
  
• Some medications used to treat depression, anxiety, and schizophrenia.

Other Causes of Insomnia

• Common stimulants associated with poor sleep include caffeine and nicotine. You should consider not only restricting caffeine and nicotine use in the hours immediately before bedtime but also limiting your total daily intake.
  
  
• People often use alcohol to help induce sleep, as a nightcap. However, it is a poor choice. Alcohol is associated with sleep disruption and creates a sense of non-refreshed sleep in the morning.
  
  
• A disruptive bed partner with loud snoring or periodic leg movements also may impair your ability to get a good night's sleep.

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