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Insomnia: The Silent Struggle for Rest

Insomnia is one of the most common sleep disorders, affecting up to one-third of adults at some point in their lives. It can take the form of difficulty falling asleep, staying asleep, or waking too early and not being able to return to sleep. While it may seem like a personal or temporary issue, chronic insomnia can lead to serious physical, emotional, and cognitive health consequences. It also disproportionately affects underserved communities, making it a key issue in the conversation about sleep health equity.

Types of Insomnia

  • Acute Insomnia: Short-term sleep difficulty, often caused by stress, life events, or changes in schedule or environment.

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  • Chronic Insomnia: Trouble sleeping at least three nights a week for three months or more. Often linked to mental health issues, chronic illness, or environmental stressors.

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  • Sleep-Onset Insomnia: Difficulty falling asleep at the beginning of the night.

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  • Sleep-Maintenance Insomnia: Trouble staying asleep through the night or waking up too early.

Key Symptoms 

  • Lying awake for long periods

  • Waking up frequently during the night

  • Feeling tired despite spending enough time in bed

  • Trouble concentrating or remembering things

  • Increased irritability or mood changes

  • Daytime fatigue, clumsiness, or low motivation

Causes/Risk Factors

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Biological & Psychological Factors 

  • Anxiety, depression, PTSD

  • Chronic pain or illness

  • Hormonal changes (e.g., menopause)

  • Neurodivergent conditions (e.g., ADHD)

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Environment& Lifestyle 
Factors 

  • Poor sleep hygiene (screen time before bed, inconsistent schedule)

  • Stressful living conditions or unsafe housing

  • Shift work or irregular job hours

  • Noise, light, or shared living spaces

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Societal & Structural  
Factors 

  • Discrimination, racism, and chronic stress

  • Lack of access to healthcare or mental health support

  • Housing instability and neighborhood violence

  • Cultural stigma around mental health or rest

Diagnosis and Assessment

If you’re experiencing symptoms of insomnia, a healthcare provider may ask questions about:

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  • Sleep patterns and routines

  • Daytime functioning

  • Medical and mental health history

  • Lifestyle, stress levels, and environment

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You may be asked to complete a sleep diary, insomnia severity index (ISI), or even undergo a sleep study if another disorder like sleep apnea is suspected.

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Health Consequences

  • Increased risk of heart disease, hypertension, and stroke

  • Higher likelihood of depression, anxiety, and suicidal ideation

  • Impaired cognitive performance and memory

  • Weakened immune system and frequent illness

  • Greater risk of substance use or dependency

  • Lost productivity, increased work absences, and financial stress

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Treatment Options

Managing sleep disorders and hypertension can bith significantly improve blood pressure and your overall health. Strategies include:

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Cognitive Behavioral Therapy

CBT is the single most effective treatment for chronic insomnia:

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  • Focuses on replacing unhelpful thoughts and behaviors around sleep

  • Involves sleep restriction, stimulus control, relaxation techniques

  • May be offered in-person, online, or through apps

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Lifestyle Changes

Sleep Hygeine Changes:

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  • Consistent bedtime/wake time

  • Limiting screen time before bed

  • Avoiding caffeine, alcohol, or heavy meals in the evening

  • Creating a comfortable sleep environment

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Holisitic approaches:

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  • Meditation, yoga, breathing exercises

  • Physical activity (earlier in the day)

  • Herbal remedies

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Medication

Medication for insomnia should be used in the short term only.

 

Options inlcude:

  • Melatonin

  • Melatonin receptor agonists

  • Sedative-hypnotics

  • Others​

Sources

1.American Academy of Sleep Medicine (AASM). (2021). Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults. https://aasm.org/clinical-resources/practice-standards/insomnia/ 2.National Heart, Lung, and Blood Institute (NHLBI). (2020). What Is Insomnia? https://www.nhlbi.nih.gov/health/insomnia 3.Centers for Disease Control and Prevention (CDC). (2022). Insomnia and Sleep Health. https://www.cdc.gov/sleep/data_statistics.html 4.Morin, C. M., & Benca, R. (2012). “Chronic insomnia.” The Lancet, 379(9821), 1129–1141. https://doi.org/10.1016/S0140-6736(11)60750-2 5.Ong, J. C., & Manber, R. (2011). Cognitive Behavioral Therapy for Insomnia in Those with Depression. Behavioral Sleep Medicine. https://doi.org/10.1080/15402002.2011.533987 6.Grandner, M. A., & Patel, N. P. (2020). “Sleep-related disparities: A focus on insufficient sleep and insomnia.” Sleep Health, 6(5), 430–441. https://doi.org/10.1016/j.sleh.2020.04.002 7.Hale, L., & Troxel, W. (2020). “Sleep health as a public health issue: Promoting health equity through better sleep.” Sleep Health, 6(4), 365–367. https://doi.org/10.1016/j.sleh.2020.05.004 8.National Institutes of Health (NIH). (2019). Insomnia: Causes, Diagnosis, and Treatments. https://www.ninds.nih.gov/health-information/disorders/insomnia

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