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| Boilerpipe Text | Insomnia
Other names
Sleeplessness, trouble sleeping
Depiction of insomnia from the 14th century medical manuscript
Tacuinum Sanitatis
Pronunciation
[
1
]
Specialty
Psychiatry
,
Clinical Psychology
,
Sleep Medicine
Symptoms
Trouble
sleeping
, daytime sleepiness, low energy, irritability,
depressed mood
[
1
]
Causes
Unknown,
psychological stress
,
chronic pain
,
heart failure
,
hyperthyroidism
,
heartburn
,
restless leg syndrome
,
autism spectrum disorder
,
obstructive sleep apnea
, others
[
2
]
Diagnostic method
Based on symptoms,
sleep study
[
3
]
Differential diagnosis
Delayed sleep phase disorder
,
restless leg syndrome
,
sleep apnea
,
psychiatric disorder
[
4
]
Treatment
Sleep hygiene
,
cognitive behavioral therapy
,
hypnotics
[
5
]
[
6
]
[
7
]
Frequency
~20%
[
8
]
[
9
]
[
10
]
Insomnia
, also known as
sleeplessness
, is a
sleep disorder
causing difficulty falling asleep or staying asleep for as long as desired.
[
1
]
[
9
]
[
11
]
Insomnia is typically followed by daytime
sleepiness
, low energy,
irritability
, and a
depressed mood
.
[
1
]
It may result in an increased risk of accidents as well as problems focusing and learning.
[
9
]
Insomnia can be short-term, lasting for days or weeks, or long-term, lasting more than a month.
[
1
]
The concept of the word
insomnia
has two distinct possibilities: insomnia disorder or insomnia symptoms.
[
12
]
Insomnia can occur independently or as a result of another problem.
[
2
]
Conditions that can result in insomnia include
psychological stress
,
chronic pain
,
heart failure
,
hyperthyroidism
,
heartburn
,
restless leg syndrome
,
menopause
, certain
medications
, and drugs such as
caffeine
,
nicotine
, and
alcohol
.
[
2
]
[
8
]
Risk factors include working
night shifts
and
sleep apnea
.
[
9
]
Diagnosis is based on sleep habits and an examination to look for underlying causes.
[
3
]
A
sleep study
may be done to look for underlying sleep disorders.
[
3
]
Screening may be done with questions like "Do you experience difficulty sleeping?" or "Do you have difficulty falling or staying asleep?"
[
9
]
Cognitive behavioral therapy
is considered the first-line treatment.
[
6
]
[
13
]
[
14
]
Sleep hygiene
and lifestyle changes are also recommended for insomnia, though their efficacy is not definitely established.
[
5
]
[
7
]
[
14
]
Sleep hygiene includes a consistent bedtime, a quiet and dark room, exposure to sunlight during the day and regular
exercise
.
[
7
]
Sleeping pills
can improve sleep, though some are associated with falls,
cognitive impairment
, and
dependence
.
[
5
]
[
6
]
These medications are not recommended for more than four or five weeks but can be used longer in certain instances.
[
6
]
[
15
]
Among these,
lemborexant
and
eszopiclone
have the most favorable efficacy and safety profiles.
[
16
]
The efficacy and safety of
alternative medicine
treatments are unclear.
[
6
]
[
15
]
Between 10% and 30% of adults have insomnia at any given point in time, and up to half of people have insomnia in a given year.
[
8
]
[
9
]
[
10
]
About 6% of people have insomnia that is not due to another problem and lasts for more than a month.
[
9
]
People over the age of 65 are affected more often than younger people.
[
7
]
Women are more often affected than men.
[
8
]
Descriptions of insomnia occur at least as far back as
ancient Greece
.
[
17
]
Potential complications of insomnia
[
18
]
Symptoms of insomnia:
[
19
]
Difficulty falling asleep, including difficulty finding a comfortable
sleeping position
Waking during the night, being unable to return to sleep
[
20
]
and waking up early
Not able to focus on daily tasks, difficulty in remembering
Daytime sleepiness
,
irritability
,
depression
or
anxiety
Feeling tired or having low energy during the day
[
21
]
Trouble concentrating
Being irritable, acting aggressive, or impulsive
Sleep onset
insomnia is difficulty falling asleep at the beginning of the night, often a symptom of
anxiety disorders
.
Delayed sleep phase disorder
can be misdiagnosed as insomnia, as sleep onset is delayed much later than normal, while awakening spills over into daylight hours.
[
22
]
It is common for patients who have difficulty falling asleep to also have nocturnal awakenings with difficulty returning to sleep.
[
23
]
Two-thirds of these patients wake up in the middle of the night, with more than half having trouble falling back to sleep after a
middle-of-the-night awakening
.
[
24
]
Early morning awakening occurs earlier (more than 30 minutes) than desired, with an inability to go back to sleep and before total sleep time reaches 6.5 hours. Early morning awakening is often a characteristic of
depression
.
[
25
]
Anxiety symptoms may well lead to insomnia. Some of these symptoms include
psychological stress
, compulsive worrying about the future, feeling overstimulated, and overanalyzing past events.
[
26
]
Chronic insomnia may take a mental toll, affecting social interactions, work, and lifestyle.
[
14
]
Poor sleep quality can occur as a result of, for example,
restless legs
,
sleep apnea
, or
major depression
. Poor sleep quality is defined as the individual not reaching
stage 3
or delta sleep, which has restorative properties.
[
27
]
Major depression leads to alterations in the function of the
hypothalamic–pituitary–adrenal axis
, causing excessive release of
cortisol
, which can lead to poor sleep quality.
Nocturnal
polyuria
, excessive night-time urination, can also result in a poor quality of sleep.
[
28
]
Sleep state misperception is a condition where patients believe that they have been awake all night even though sleep tests prove that they have slept for hours. Also called paradoxical insomnia or subjective insomnia, paradoxical insomnia may affect only about 5% of people with insomnia.
[
29
]
Despite sleeping for multiple hours each night and typically not experiencing significant daytime sleepiness or other symptoms of sleep loss, patients feel like they have not slept very much, if at all. They incorrectly believe it takes them an abnormally long
time to fall asleep
, and they underestimate how long they stay asleep.
[
30
]
Problematic digital media use
[
edit
]
Sleep quality and screen time or digital media use have been linked, including studies looking at media type, time of day, and age of person.
[
31
]
[
32
]
[
33
]
[
34
]
[
35
]
[
36
]
[
37
]
[
38
]
[
39
]
[
40
]
Various sleep challenges or outcomes have been studied including a reduction in sleep duration, increased sleep onset latency, modifications to
rapid eye movement sleep
and
slow-wave sleep
, increased sleepiness and self-perceived
fatigue
, and impaired post-sleep
attention span
and
verbal memory
.
[
41
]
While insomnia can be caused by many conditions, it can also occur without any identifiable cause. This is known as Primary Insomnia.
[
42
]
Primary Insomnia may also have an initial identifiable cause but continues after the cause is no longer present. For example, a bout of insomnia may be triggered by a stressful work or life event. However, the condition may continue after the stressful event has been resolved. In such cases, the insomnia is usually perpetuated by the anxiety or fear caused by the sleeplessness itself, rather than any external factors.
[
43
]
Symptoms of insomnia can be caused by or associated with:
Sleep breathing disorders, such as
sleep apnea
or
upper airway resistance syndrome
[
44
]
Use of
psychoactive drugs
(such as
stimulants
), including certain
medications
,
herbs
,
caffeine
,
nicotine
,
cocaine
,
amphetamines
,
methylphenidate
,
aripiprazole
,
MDMA
,
modafinil
, or excessive alcohol intake
[
45
]
Use of or withdrawal from alcohol and other
sedatives
, such as anti-anxiety and sleep drugs like
benzodiazepines
[
45
]
Use of or withdrawal from pain-relievers such as
opioids
[
45
]
Heart disease
[
46
]
Restless legs syndrome
, which can cause sleep onset insomnia due to the discomforting sensations felt and the need to move the legs or other body parts to relieve these sensations
[
47
]
Periodic limb movement disorder
(PLMD), which occurs during sleep and can cause arousals of which the sleeper is unaware
[
48
]
Pain
:
[
49
]
an injury or condition that causes pain can preclude an individual from finding a comfortable position in which to fall asleep, and can also cause awakening.
Hormone
shifts such as those that precede
menstruation
and those during
menopause
[
50
]
Life events such as
fear
,
stress
,
anxiety
, emotional or mental tension, work problems, financial stress, birth of a child, and bereavement
[
47
]
Gastrointestinal issues such as heartburn or constipation
[
51
]
Mental
,
neurobehavioral
, or
neurodevelopmental
disorders such as
bipolar disorder
,
clinical depression
,
generalized anxiety disorder
,
post traumatic stress disorder
,
schizophrenia
,
obsessive compulsive disorder
,
autism
,
dementia
,
[
52
]
: 326
ADHD
,
[
53
]
and
FASD
Disturbances of the
circadian rhythm
, such as
shift work
and
jet lag
, can cause an inability to sleep at some times of the day and excessive sleepiness at other times of the day. Chronic
circadian rhythm disorders
are characterized by similar symptoms.
[
45
]
Certain
neurological
disorders such as
brain lesions
, or a
history
of
traumatic brain injury
[
54
]
Medical conditions
such as
hyperthyroidism
[
2
]
Abuse of over-the-counter or prescription sleep aids (
sedative
or
depressant
drugs) can produce
rebound insomnia
[
45
]
Poor
sleep hygiene
, e.g.,
noise
or over-consumption of caffeine
[
45
]
A rare genetic condition can cause a
prion
-based, permanent, and eventually fatal form of insomnia called
fatal familial insomnia
[
55
]
Physical exercise
: exercise-induced insomnia is common in athletes in the form of prolonged
sleep onset latency
[
56
]
Increased exposure to the blue light from artificial sources, such as phones or computers
[
57
]
Chronic pain
[
58
]
[
59
]
Lower back pain
[
59
]
Asthma
[
59
]
Parkinson's disease
Sleep studies using
polysomnography
have suggested that people who have sleep disruption have elevated night-time levels of circulating
cortisol
and
adrenocorticotropic hormone
.
[
60
]
They also have an elevated metabolic rate, which does not occur in people who do not have insomnia but whose sleep is intentionally disrupted during a sleep study. Studies of brain metabolism using
positron emission tomography (PET) scans
indicate that people with insomnia have higher metabolic rates by night and by day. The question remains whether these changes are the causes or consequences of long-term insomnia.
[
61
]
Heritability
estimates of insomnia vary between 38% in males to 59% in females.
[
62
]
A
genome-wide association study
(GWAS) identified 3 genomic loci and 7
genes
that influence the risk of insomnia and showed that insomnia is highly polygenic.
[
63
]
In particular, a strong positive association was observed for the
MEIS1
gene in both males and females. This study showed that the genetic architecture of insomnia strongly overlaps with psychiatric disorders and metabolic traits.
It has been hypothesized that epigenetics might also influence insomnia through a controlling process of both sleep regulation and brain-stress response, having an impact as well on brain plasticity.
[
64
]
Alcohol is often used as a form of self-treatment for insomnia to induce sleep. However, alcohol use to induce sleep can be a cause of insomnia.
Long-term use of alcohol
is associated with a decrease in
NREM
stage 3 and 4 sleep as well as suppression of
REM sleep
and REM sleep fragmentation. Frequent moving between sleep stages occurs with awakenings due to headaches,
the need to urinate
,
dehydration
, and
excessive sweating
.
Glutamine
rebound also plays a role when someone is drinking; alcohol inhibits glutamine, one of the body's natural stimulants. When the person stops drinking, the body tries to make up for lost time by producing more glutamine than it needs.
The increase in glutamine levels stimulates the brain while the drinker is trying to sleep, keeping them from reaching the deepest levels of sleep.
[
65
]
Stopping chronic alcohol use can also lead to severe insomnia with vivid dreams. During withdrawal, REM sleep is typically exaggerated as part of a
rebound effect
.
[
66
]
Some people experience sleep disruption or anxiety if they consume caffeine.
[
67
]
Doses as low as 100 mg/day, such as a 6 oz (170 g) cup of coffee or two to three 12 oz (340 g) servings of caffeinated soft-drink, may continue to cause sleep disruption, among other intolerances. Non-regular caffeine users have the least caffeine tolerance for sleep disruption.
[
68
]
Some coffee drinkers develop tolerance to its undesired sleep-disrupting effects, but others apparently do not.
[
69
]
Benzodiazepine-induced
[
edit
]
Like alcohol,
benzodiazepines
, such as
alprazolam
,
clonazepam
,
lorazepam
, and
diazepam
, are commonly used to treat insomnia in the short-term (both prescribed and self-medicated), but worsen sleep in the long-term. While benzodiazepines can put people to sleep (i.e., inhibit NREM stage 1 and 2 sleep), while asleep, the drugs disrupt
sleep architecture
: decreasing sleep time, delaying time to REM sleep, and decreasing deep
slow-wave sleep
(the most restorative part of sleep for both energy and mood).
[
70
]
[
71
]
[
72
]
Opioid
medications such as
hydrocodone
,
oxycodone
, and
morphine
are used for insomnia that is associated with
pain
due to their
analgesic
properties and
hypnotic
effects. Opioids can fragment sleep and decrease
REM
and
stage 2
sleep. By producing
analgesia
and
sedation
, opioids may be appropriate in carefully selected patients with pain-associated insomnia.
[
49
]
However, dependence on opioids can lead to long-term sleep disturbances.
[
73
]
Insomnia affects people of all age groups, but people in the following groups have a higher chance of acquiring insomnia:
[
74
]
Individuals older than 60
History of mental health disorders, including depression, etc.
Emotional stress
Working late-night shifts
Traveling through different time zones
[
11
]
Having chronic diseases such as
diabetes
, kidney disease, lung disease,
Alzheimer's
, or heart disease
[
75
]
Alcohol
or drug use disorders
Gastrointestinal reflux disease
Heavy smoking
Work stress
[
76
]
Individuals of low socioeconomic status
[
77
]
Urban neighborhoods
[
77
]
Household stress
[
77
]
Two main models exist regarding the mechanism of insomnia: cognitive and physiological. The cognitive model suggests that rumination and hyperarousal contribute to preventing a person from falling asleep and might lead to an episode of insomnia.
The physiological model is based upon three major findings in people with insomnia; firstly, increased urinary
cortisol
and
catecholamines
have been found suggesting increased activity of the HPA axis and arousal; second, increased global cerebral glucose utilization during wakefulness and NREM sleep in people with insomnia; and lastly, increased full body metabolism and heart rate in those with insomnia. All these findings taken together suggest a deregulation of the arousal system, cognitive system, and
HPA axis
, all contributing to insomnia.
[
9
]
[
78
]
However, it is unknown if the hyperarousal is a result of, or cause of insomnia. Altered levels of the inhibitory
neurotransmitter
GABA
have been found, but the results have been inconsistent, and the implications of altered levels of such a ubiquitous neurotransmitter are unknown. Studies on whether insomnia is driven by circadian control over sleep or a wake-dependent process have shown inconsistent results, but some literature suggests a deregulation of the circadian rhythm based on core temperature.
[
79
]
Increased beta activity and decreased delta wave activity has been observed on
electroencephalograms
; however, the implication of this is unknown.
[
80
]
Around half of post-menopausal women experience sleep disturbances, and generally, sleep disturbance is about twice as common in women as men; this appears to be due in part, but not completely, to changes in hormone levels, especially in post-menopause.
[
50
]
[
81
]
Changes in
sex hormones
in both men and women as they age may account in part for an increased prevalence of
sleep disorders
in older people.
[
82
]
In medicine, insomnia is measured using the
Athens Insomnia Scale
(AIS).
[
83
]
It measures eight parameters related to sleep, represented as an overall scale which assesses an individual's sleep quality. It has excellent internal consistency and re-test reliability.
[
84
]
The Athens Insomnia Scale for Non-Clinical Populations (AIS-NCA) has been developed and validated in English,
[
85
]
Chinese,
[
86
]
and German
[
85
]
to identify subclinical manifestations of insomnia in a language simpler than the Athens Insomnia Scale and more suitable for self-report. It uses four items to assess sleep problems and three items to assess impaired daytime functioning.
A medical history and a physical examination can identify other conditions that could be the cause of insomnia. A comprehensive sleep history should include sleep habits and sleep environment, medications (prescription and non-prescription, including supplements), alcohol, nicotine, and caffeine intake, and co-morbid illnesses.
[
87
]
A
sleep diary
can be used to track time to bed, total sleep time, time to sleep onset, number of awakenings, use of medications, time of awakening, and subjective feelings in the morning.
[
87
]
The sleep diary can be replaced or validated by the use of out-patient
actigraphy
for a week or more, using a non-invasive device that measures movement.
[
88
]
Not everyone who suffers from insomnia should routinely have a
polysomnography
study to screen for sleep disorders,
[
89
]
but it may be indicated for those with risk factors for
sleep apnea
, including obesity, a thick neck diameter, or fullness of the flesh in the
oropharynx
.
[
89
]
For most people, the test is not needed to make a diagnosis, and insomnia can often be treated by changing their schedule to make time for sufficient sleep and by improving
sleep hygiene
.
[
89
]
Some patients may need an overnight sleep study in a sleep lab. Such a study will commonly involve assessment tools including a polysomnogram and the
multiple sleep latency test
. Specialists in
sleep medicine
are qualified to diagnose disorders according to the
ICSD
, 81 major sleep disorder diagnostic categories.
[
90
]
Patients with some disorders, including
delayed sleep phase disorder
, are often misdiagnosed with primary insomnia; when a person has trouble getting to sleep and awakening at desired times, but has a normal sleep pattern once asleep, a circadian rhythm disorder is a likely cause.
In many cases, insomnia is co-morbid with another disease, side effects from medications, or a psychological problem. Approximately half of all diagnosed insomnia is related to psychiatric disorders.
[
91
]
For those who have depression, "insomnia should be regarded as a co-morbid condition, rather than as a secondary one;" insomnia typically predates psychiatric symptoms.
[
91
]
"In fact, it is possible that insomnia represents a significant risk for the development of a subsequent psychiatric disorder."
[
9
]
Insomnia occurs in between 60% and 80% of people with depression and can be a side effect of medications that treat depression.
[
92
]
The determination of causation is not necessary for a diagnosis.
[
91
]
The
DSM-5
criteria for insomnia include the following:
[
93
]
"Predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms":
Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention.)
Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.)
Early-morning awakening with inability to return to sleep.
In addition:
The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
The sleep difficulty occurs at least three nights per week.
The sleep difficulty has been present for at least three months.
The sleep difficulty occurs despite adequate opportunity for sleep.
The insomnia is not better explained by and does not occur exclusively during another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia).
The insomnia is not attributable to the physiological effects of a substance (e.g., a
drug of abuse
, a medication)."
The
DSM-IV TR
includes insomnia but does not fully elaborate on the symptoms compared to the DSM-5. Instead of early-morning waking as a symptom, the DSM-IV-TR listed "
nonrestorative sleep
" as a primary symptom. The duration of the experience was also vague in the DSM-IV-TR. The DSM-IV-TR stated that symptoms had to be present for a month, whereas the DSM-5 states that symptoms must be present for three months and occur at least three nights a week (Gillette).
Insomnia can be classified as transient, acute, or chronic.
Transient insomnia
lasts for less than a week. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe
depression
, or by
stress
. Its consequences – sleepiness and impaired psychomotor performance – are similar to those of
sleep deprivation
.
[
94
]
Acute
insomnia
is the inability to consistently sleep well for less than a month. Insomnia is present when there is difficulty initiating or maintaining sleep or when the sleep that is obtained is
non-refreshing
or of poor quality. These problems occur despite adequate opportunity and circumstances for sleep, and they must result in problems with daytime function.
[
95
]
Hyperarousal can be linked to acute insomnia since it activates the body's fight-or-flight response. When we encounter stress or danger, our bodies naturally become more alert, which can interfere with our capacity to both fall asleep and remain asleep. This heightened state of arousal can be useful in the short term during threatening situations, but if it continues over an extended period, it can result in acute insomnia.
[
96
]
Acute insomnia is also known as
short term insomnia
or
stress related insomnia
.
[
97
]
Chronic
insomnia
lasts for longer than a month. It can be caused by another disorder, or it can be a primary disorder. Common causes of chronic insomnia include persistent stress, trauma, work schedules, poor sleep habits, medications, and other mental health disorders.
[
98
]
When an individual consistently engages in behaviors that disrupt their sleep, such as irregular sleep schedules, spending excessive time awake in bed, or engaging in stimulating activities close to bedtime, it can lead to conditioned wakefulness contributing to chronic insomnia.
[
96
]
People with high levels of stress hormones or shifts in the levels of
cytokines
are more likely than others to have chronic insomnia.
[
99
]
Its effects can vary according to its causes. They might include muscular weariness,
hallucinations
, and/or
mental fatigue
.
[
94
]
Prevention and treatment of insomnia may require a combination of
cognitive behavioral therapy
,
[
13
]
medications,
[
100
]
and lifestyle changes.
[
101
]
Among lifestyle practices, going to sleep and waking up at the same time each day can create a steady pattern which may help to prevent insomnia.
[
11
]
Avoidance of vigorous
exercise
and
caffeinated drinks
a few hours before going to sleep is recommended, while exercise earlier in the day may be beneficial.
[
101
]
Other practices to improve
sleep hygiene
may include:
[
101
]
[
102
]
Avoiding or limiting
naps
Treating pain at bedtime
Avoiding large meals, beverages,
alcohol
, and
nicotine
before bedtime
Finding soothing ways to relax into sleep, including the use of
white noise
Making the bedroom suitable for sleep by keeping it dark, cool, and free of devices, such as clocks, cell phones, or televisions
Maintain regular exercise
Try relaxing activities before sleeping
It is recommended to rule out medical and psychological causes before deciding on the treatment for insomnia.
[
103
]
Cognitive behavioral therapy
is an effective first-line treatment for chronic insomnia.
[
104
]
[
13
]
The beneficial effects, in contrast to those produced by medications, may last well beyond the stopping of therapy.
[
105
]
Medications have been used mainly to reduce symptoms in insomnia of short duration; their role in the management of chronic insomnia remains unclear.
[
8
]
Several different types of medications may be used.
[
106
]
[
107
]
[
100
]
Many doctors do not recommend relying on prescription sleeping pills for long-term use.
[
101
]
These medications are not recommended for more than four or five weeks, although they can be used longer in certain instances.
[
6
]
[
15
]
It is also important to identify and treat other medical conditions that may be contributing to insomnia, such as depression, breathing problems, and chronic pain.
[
101
]
[
108
]
As of 2022, many people with insomnia were reported as not receiving overall sufficient sleep or treatment for insomnia.
[
109
]
[
110
]
Non-medication based
[
edit
]
Non-medication-based strategies have comparable efficacy to
hypnotic
medication for insomnia, and they may have longer-lasting effects. Hypnotic medication is only recommended for short-term use because
dependence
with
rebound withdrawal effects
upon discontinuation or
tolerance
can develop.
[
111
]
Non-medication-based strategies provide long-lasting improvements to insomnia and are recommended as a first-line and long-term strategy of management. Behavioral sleep medicine offers non-medication strategies to address chronic insomnia including
sleep hygiene
,
stimulus control
, behavioral interventions,
sleep-restriction therapy
,
paradoxical intention
, patient education, and
relaxation therapy
.
[
112
]
Some examples are keeping a journal, restricting the time spent awake in bed, practicing
relaxation techniques
, and maintaining a regular sleep schedule and a wake-up time. Behavioral therapy can assist a patient in developing new sleep behaviors to improve sleep quality and consolidation. Behavioral therapy may include learning healthy sleep habits to promote sleep relaxation, undergoing light therapy to regulate the
circadian rhythm
, and regulating the circadian clock.
[
108
]
Music may improve insomnia in adults (see
music and sleep
).
[
113
]
EEG biofeedback
has demonstrated effectiveness in the treatment of insomnia with improvements in duration as well as the quality of sleep.
[
114
]
Self-help therapy (defined as a psychological therapy that can be worked through on one's own) may improve sleep quality for adults with insomnia to a small or moderate degree.
[
115
]
Stimulus control therapy is a treatment for patients who have conditioned themselves to associate the bed or sleep in general with a negative response. As stimulus control therapy involves taking steps to control the sleep environment, it is sometimes referred to interchangeably with the concept of
sleep hygiene
. Examples of such environmental modifications include using the bed for sleep and sex only, not for activities such as reading or watching television; waking up at the same time every morning, including on weekends; going to bed only when sleepy and when there is a high likelihood that sleep will occur; leaving the bed and beginning an activity in another location if sleep does not occur in a reasonably brief period after getting into bed (commonly ~20 min); reducing the subjective effort and energy expended trying to fall asleep; avoiding exposure to bright light during night-time hours, and eliminating daytime naps.
[
116
]
A component of stimulus control therapy is sleep restriction, a technique that aims to match the time spent in bed with the actual time spent asleep. This technique involves maintaining a strict sleep-wake schedule, sleeping only at certain times of the day and for specific amounts of time to induce mild sleep deprivation. Complete treatment usually lasts up to 3 weeks and involves making oneself sleep for only a minimum amount of time that they are actually capable of on average, and then, if capable (i.e. when
sleep efficiency
improves), slowly increasing this amount (~15 min) by going to bed earlier as the body attempts to reset its internal sleep clock.
Bright light therapy
may be effective for insomnia.
[
117
]
Paradoxical intention is a cognitive reframing technique where the insomniac, instead of attempting to fall asleep at night, makes every effort to stay awake (i.e., essentially stops trying to fall asleep). One theory that may explain the effectiveness of this method is that by not voluntarily making oneself go to sleep, it relieves the performance anxiety that arises from the need or requirement to fall asleep, which is meant to be a passive act. This technique has been shown to reduce sleep effort and performance anxiety and also lower subjective assessment of sleep-onset latency and overestimation of the sleep deficit (a quality found in many insomniacs).
[
118
]
Sleep hygiene
is a common term for all of the behaviors that relate to the promotion of good sleep. They include habits that provide a good foundation for sleep and help to prevent insomnia. However, sleep hygiene alone may not be adequate to address chronic insomnia. Sleep hygiene recommendations are typically included as one component of
cognitive behavioral therapy for insomnia
(CBT-I).
[
88
]
[
6
]
Recommendations include reducing caffeine, nicotine, and alcohol consumption, maximizing the regularity and efficiency of sleep episodes, minimizing medication usage and daytime napping, the promotion of regular exercise, and the facilitation of a positive sleep environment.
[
119
]
The creation of a positive sleep environment may also help reduce the symptoms of insomnia.
[
120
]
On the other hand, a systematic review by the AASM concluded that clinicians should not prescribe sleep hygiene for insomnia due to the evidence of absence of its efficacy and potential delaying of adequate treatment, recommending instead that effective therapies such as CBT-i should be preferred.
[
14
]
Cognitive behavioral therapy
[
edit
]
There is some evidence that cognitive behavioral therapy for insomnia (CBT-I) is superior not only in the long-term, but also in the short-term (2 months) to
benzodiazepines
and the
nonbenzodiazepines
in the treatment and management of insomnia.
[
121
]
[
122
]
In this therapy, patients are taught improved sleep habits and relieved of counter-productive assumptions about sleep. Common misconceptions and expectations that can be modified include:
[
citation needed
]
Unrealistic sleep expectations.
Misconceptions about insomnia causes.
Amplifying the consequences of insomnia.
Performance anxiety after trying for so long to have a good night's sleep by controlling the sleep process.
Numerous studies have reported positive outcomes of combining cognitive behavioral therapy for insomnia treatment with treatments such as stimulus control and relaxation therapies.
Hypnotic
medications are equally effective in the short-term treatment of insomnia, but their effects wear off over time due to
tolerance
. The effects of
CBT-I
have sustained and lasting effects on treating insomnia long after therapy has been discontinued.
[
123
]
[
124
]
The addition of hypnotic medications with CBT-I adds no benefit in insomnia. The long-lasting benefits of a course of CBT-I shows superiority over pharmacological hypnotic drugs. Even in the short term, when compared to short-term hypnotic medication such as zolpidem, CBT-I still shows significant superiority. Thus, CBT-I is recommended as a first-line treatment for insomnia.
[
125
]
Common forms of CBT-I treatments include stimulus control therapy, sleep restriction, sleep hygiene, improved sleeping environments, relaxation training, paradoxical intention, and biofeedback.
[
126
]
Sleep restriction (also called "time-in-bed restriction"), stimulus control and cognitive restructuring are key components.
[
127
]
CBT is a well-accepted form of therapy for insomnia since it has no known adverse effects, whereas taking medications to alleviate insomnia symptoms has been shown to have adverse side effects.
[
128
]
Nevertheless, the downside of CBT is that it may take a lot of time and motivation.
[
129
]
Acceptance and commitment therapy
[
edit
]
Treatments based on the principles of
acceptance and commitment therapy
(ACT) and
metacognition
have emerged as alternative approaches to treating insomnia.
[
130
]
ACT rejects the idea that behavioral changes can help insomniacs achieve better sleep since they require "sleep efforts" - actions which create more "struggle" and arouse the nervous system, leading to
hyperarousal
.
[
131
]
The ACT approach posits that acceptance of the negative feelings associated with insomnia can, in time, create the right conditions for sleep.
Mindfulness
practice is a key feature of this approach, although mindfulness is not practiced to induce sleep (this in itself is a
sleep effort
to be avoided) but rather as a longer-term activity to help calm the nervous system and create the internal conditions from which sleep can emerge.
A key distinction between CBT-I and ACT lies in the divergent approaches to time spent awake in bed. Proponents of CBT-i advocate minimizing time spent awake in bed, on the basis that this creates a cognitive association between being in bed and wakefulness. The ACT approach proposes that avoiding time in bed may increase the pressure to sleep and arouse the nervous system further.
[
131
]
Research has shown that "ACT has a significant effect on primary and comorbid insomnia and sleep quality, and ... can be used as an appropriate treatment method to control and improve insomnia".
[
132
]
Internet Interventions
[
edit
]
Despite the therapeutic effectiveness and proven success of CBT, treatment availability is significantly limited by a lack of trained clinicians, poor geographical distribution of knowledgeable professionals, and expense.
[
133
]
One way to potentially overcome these barriers is to use the Internet to deliver treatment, making this effective intervention more accessible and less costly. The Internet has already become a critical source of health care and medical information.
[
134
]
Although the vast majority of health websites provide general information,
[
134
]
[
135
]
there is growing research literature on the development and evaluation of Internet interventions.
[
136
]
[
137
]
These online programs are typically behaviorally based treatments that have been operationalized and transformed for delivery via the Internet. They are usually highly structured, automated, or human-supported, based on effective face-to-face treatment; personalized to the user; interactive; enhanced by graphics, animations, audio, and possibly video; and tailored to provide follow-up and feedback.
[
137
]
There is good evidence for the use of computer-based CBT for insomnia.
[
138
]
Many people with insomnia use
sleeping tablets
and other
sedatives
. In some places, medications are prescribed in over 95% of cases.
[
139
]
They, however, are a second line treatment.
[
140
]
In 2019, the US
Food and Drug Administration
stated it is going to require warnings for
eszopiclone
,
zaleplon
, and
zolpidem
, due to concerns about serious injuries resulting from abnormal sleep behaviors, including
sleepwalking
or driving a vehicle while asleep.
[
141
]
The percentage of adults using a prescription sleep aid increases with age. During 2005–2010, about 4% of U.S. adults aged 20 and over reported that they took prescription sleep aids in the past 30 days. Rates of use were lowest among the youngest age group (those aged 20–39) at about 2%, increased to 6% among those aged 50–59, and reached 7% among those aged 80 and over. More adult women (5%) reported using prescription sleep aids than adult men (3%). Non-Hispanic white adults reported higher use of sleep aids (5%) than non-Hispanic black (3%) and Mexican-American (2%) adults. No difference was shown between non-Hispanic black adults and Mexican-American adults in use of prescription sleep aids.
[
142
]
As an alternative to taking prescription drugs, some evidence shows that an average person seeking short-term help may find relief by taking
over-the-counter
antihistamines
such as
diphenhydramine
or
doxylamine
.
[
143
]
Diphenhydramine and doxylamine are widely used in nonprescription sleep aids. They are the most effective over-the-counter sedatives currently available, at least in much of Europe, Canada, Australia, and the United States, and are more sedating than some prescription
hypnotics
.
[
144
]
Antihistamine effectiveness for sleep may decrease over time, and
anticholinergic
side-effects (such as dry mouth) may also be a drawback with these particular drugs. While addiction does not seem to be an issue with this class of drugs, they can induce dependence and rebound effects upon abrupt cessation of use.
[
145
]
However, people whose insomnia is caused by restless legs syndrome may have worsened symptoms with antihistamines.
[
146
]
While insomnia is a common symptom of depression,
antidepressants
are effective for treating sleep problems whether or not they are associated with depression. While all antidepressants help regulate sleep, some antidepressants, such as
amitriptyline
,
doxepin
,
mirtazapine
,
trazodone
, and
trimipramine
, can have an immediate sedative effect and are prescribed to treat insomnia.
[
147
]
Trazodone was at the beginning of the 2020s the most prescribed drug for sleep in the United States despite not being indicated for sleep.
[
148
]
Amitriptyline, doxepin, and trimipramine all have
antihistaminergic
,
anticholinergic
,
antiadrenergic
, and
antiserotonergic
properties, which contribute to both their therapeutic effects and side effect profiles, while mirtazapine's actions are primarily antihistaminergic and antiserotonergic and trazodone's effects are primarily antiadrenergic and antiserotonergic. Mirtazapine is known to decrease sleep latency (i.e., the time it takes to fall asleep), promoting sleep efficiency and increasing the total amount of sleeping time in people with both depression and insomnia.
[
149
]
[
150
]
Agomelatine
, a melatonergic antidepressant with claimed sleep-improving qualities that does not cause daytime drowsiness,
[
151
]
is approved for the treatment of depression though not sleep conditions in the European Union
[
152
]
and
Australia
.
[
153
]
After trials in the United States, its development for use there was discontinued in October 2011
[
154
]
by
Novartis
, who had bought the rights to market it there from the European pharmaceutical company
Servier
.
[
155
]
A 2018
Cochrane review
found the safety of taking antidepressants for insomnia to be uncertain with no evidence supporting long term use.
[
156
]
Melatonin receptor agonists
such as
melatonin
and
ramelteon
are used in the treatment of insomnia.
Prolonged-release melatonin
improves insomnia mainly in adults ≥55, and ramelteon improves sleep generally, with both effective versus placebo but less effective than most licensed insomnia drugs and showing limited long-term benefits.
[
16
]
[
157
]
[
158
]
[
159
]
The usage of melatonin as a treatment for insomnia in adults has increased from 0.4% between 1999 and 2000 to nearly 2.1% between 2017 and 2018.
[
160
]
While the use of melatonin in the short term has been proven to be generally safe and is shown not to be a dependent medication, side effects can still occur.
[
161
]
Most common side effects of melatonin include:
[
161
]
Headache
Dizziness
Nausea
Daytime drowsiness
Studies have also shown that children who have an
autism spectrum disorder
or a learning disability, such as
attention-deficit hyperactivity disorder
(ADHD) or related
neurological
diseases, can benefit from the use of melatonin. This is because they often have trouble sleeping due to their disorders. For example, children with ADHD tend to have trouble falling asleep because of their
hyperactivity
and, as a result, tend to be tired during most of the day. Another cause of insomnia in children with ADHD is the use of stimulants to treat their disorder. Children who have ADHD, as well as the other disorders mentioned, may be given melatonin before bedtime to help them sleep.
[
162
]
Normison (
temazepam
) is a
benzodiazepine
commonly prescribed for insomnia and other
sleep disorders
.
[
163
]
The most commonly used class of hypnotics for insomnia are the
benzodiazepines
.
[
52
]
: 363
Benzodiazepines are
not significantly
better for insomnia than
antidepressants
.
[
164
]
Chronic users of
hypnotic
medications for insomnia do not have better sleep than chronic insomniacs not taking medications. In fact, chronic users of hypnotic medications have more regular night-time awakenings than insomniacs not taking hypnotic medications.
[
165
]
Many have concluded that these drugs cause an unjustifiable risk to the individual and to
public health
and lack evidence of long-term effectiveness. It is preferred that hypnotics be prescribed for only a few days at the lowest effective dose and avoided altogether wherever possible, especially in the elderly.
[
166
]
Between 1993 and 2010, the prescribing of benzodiazepines to individuals with sleep disorders has decreased from 24% to 11% in the US, coinciding with the first release of
nonbenzodiazepines
.
[
167
]
The
benzodiazepine
and
nonbenzodiazepine
hypnotic
medications also have several side effects, such as daytime fatigue, motor vehicle crashes and other accidents, cognitive impairments, and falls and fractures. Elderly people are more sensitive to these side effects.
[
168
]
Some benzodiazepines have demonstrated effectiveness in sleep maintenance in the short term but in the longer term benzodiazepines can lead to
tolerance
,
physical dependence
,
benzodiazepine withdrawal syndrome
upon discontinuation, and long-term worsening of sleep, especially after consistent usage over long periods. Benzodiazepines, while inducing unconsciousness, actually worsen sleep as – like alcohol – they promote light sleep while decreasing time spent in deep sleep.
[
169
]
A further problem is, with regular use of short-acting sleep aids for insomnia, daytime
rebound anxiety
can emerge.
[
170
]
Although there is little evidence for benefit of benzodiazepines in insomnia compared to other treatments and evidence of major harm, prescriptions have continued to increase.
[
171
]
This is likely due to their addictive nature, both due to misuse and because – through their rapid action, tolerance and withdrawal they can "trick" insomniacs into thinking they are helping with sleep. There is a general awareness that long-term use of benzodiazepines for insomnia in most people is inappropriate and that a gradual withdrawal is usually beneficial due to the adverse effects associated with the
long-term use of benzodiazepines
and is recommended whenever possible.
[
172
]
[
173
]
Benzodiazepines all bind unselectively to the
GABA
A
receptor
.
[
164
]
Some theorize that certain benzodiazepines (hypnotic benzodiazepines) have significantly higher activity at the α
1
subunit of the GABA
A
receptor compared to other benzodiazepines (for example, triazolam and temazepam have significantly higher activity at the α
1
subunit compared to alprazolam and diazepam, making them superior sedative-hypnotics – alprazolam and diazepam, in turn, have higher activity at the α
2
subunit compared to triazolam and temazepam, making them superior anxiolytic agents). Modulation of the α
1
subunit is associated with sedation, motor impairment, respiratory depression, amnesia, ataxia, and reinforcing behavior (drug-seeking behavior). Modulation of the α
2
subunit is associated with anxiolytic activity and disinhibition. For this reason, certain benzodiazepines may be better suited to treat insomnia than others.
[
120
]
Nonbenzodiazepine
or
Z-drug
sedative–hypnotic drugs, such as
zolpidem
,
zaleplon
,
zopiclone
, and
eszopiclone
, are a class of hypnotic medications that are similar to benzodiazepines in their mechanism of action, and indicated for mild to moderate insomnia. Their effectiveness at improving time to sleeping is slight, and they have similar—though potentially less severe—side effect profiles compared to benzodiazepines.
[
174
]
Prescribing of nonbenzodiazepines has seen a general increase since their initial release on the US market in 1992, from 2.3% in 1993 among individuals with sleep disorders to 13.7% in 2010.
[
167
]
Orexin receptor antagonists
are a more recently introduced class of sleep medications and include
suvorexant
,
lemborexant
, and
daridorexant
, all of which are FDA-approved for treatment of insomnia characterized by difficulties with
sleep onset
and/or sleep maintenance.
[
175
]
[
176
]
They are oriented towards blocking signals in the brain that stimulate wakefulness, therefore claiming to address insomnia without creating dependence. There are three
dual orexin receptor (DORA)
drugs on the market:
Belsomra
(
Merck
),
Dayvigo
(
Eisai
) and
Quviviq
(
Idorsia
).
[
148
]
Certain
atypical antipsychotics
, particularly
quetiapine
,
olanzapine
, and
risperidone
, are used in the treatment of insomnia.
[
177
]
[
178
]
However, while common, the use of antipsychotics for this indication is not recommended as the evidence does not demonstrate a benefit, and the risk of adverse effects is significant.
[
177
]
[
179
]
[
180
]
[
181
]
A major 2022 systematic review and network meta-analysis of medications for insomnia in adults found that quetiapine did not demonstrate any short-term benefits for insomnia.
[
16
]
Some of the more serious adverse effects may also occur at the low doses used, such as
dyslipidemia
and
neutropenia
.
[
182
]
[
183
]
Such concerns of risks at low doses are supported by Danish observational studies that showed an association of use of low-dose quetiapine (excluding prescriptions filled for tablet strengths >50 mg) with an increased risk of major cardiovascular events as compared to use of
Z-drugs
, with most of the risk being driven by cardiovascular death.
[
184
]
Laboratory data from an unpublished analysis of the same cohort also support the lack of dose-dependency of metabolic side effects, as new use of low-dose quetiapine was associated with a risk of increased fasting triglycerides at one-year follow-up.
[
185
]
Concerns regarding side effects are greater in the elderly.
[
186
]
Gabapentinoids
like
gabapentin
and
pregabalin
have sleep-promoting effects, but are not commonly used for the treatment of insomnia.
[
187
]
Gabapentin is not effective in helping alcohol related insomnia.
[
188
]
[
189
]
Barbiturates
, while once used, are no longer recommended for insomnia due to the risk of addiction and other side effects.
[
190
]
Comparative effectiveness
[
edit
]
Medications for the treatment of insomnia have a wide range of
effect sizes
.
[
16
]
When comparing drugs such as
benzodiazepines
,
Z-drugs
, sedative
antidepressants
and
antihistamines
,
quetiapine
,
orexin receptor antagonists
, and
melatonin receptor agonists
, the orexin antagonist
lemborexant
and the Z-drug
eszopiclone
had the best profiles overall in terms of
efficacy
,
tolerability
, and
acceptability
.
[
16
]
Alternative medicine
[
edit
]
Herbal products
, such as
valerian
,
kava
,
chamomile
, and
lavender
, have been used to treat insomnia.
[
15
]
[
191
]
[
192
]
However, there is no
quality evidence
that they are effective and safe.
[
15
]
[
191
]
[
192
]
The same is true for
cannabis
and
cannabinoids
.
[
193
]
[
194
]
[
195
]
Acupuncture
is often promoted for insomnia, but evidence for its effectiveness is mixed. It is unclear whether acupuncture is helpful for treating insomnia in the general population.
[
196
]
In people with
cancer
, acupuncture may reduce insomnia severity and improve sleep quality, though its effects are often similar to those of sham acupuncture. While acupuncture can help alleviate insomnia and enhance sleep, it is generally less effective than
cognitive behavioural therapy for insomnia
(CBT-I).
[
197
]
Disability-adjusted life year
for insomnia per 100,000 inhabitants in 2004:
no data
less than 25
25–30.25
30.25–36
36–41.5
41.5–47
47–52.5
52.5–58
58–63.5
63.5–69
69–74.5
74.5–80
more than 80
A survey of 1.1 million residents in the United States found that those who reported sleeping about 7 hours per night had the lowest rates of mortality, whereas those who slept for fewer than 6 hours or more than 8 hours had higher mortality rates. Severe insomnia—sleeping less than 3.5 hours in women and 4.5 hours in men—is associated with a 15% increase in mortality, while getting 8.5 or more hours of sleep per night was associated with a 15% higher mortality rate.
[
198
]
With this technique, it is difficult to distinguish the lack of sleep caused by a disorder, which is also a cause of premature death, versus a disorder that causes a lack of sleep, and the lack of sleep, causing premature death. Most of the increase in mortality from severe insomnia was discounted after controlling for
associated disorders
. After controlling for sleep duration and insomnia, the use of sleeping pills was also found to be associated with an increased
mortality rate
.
[
198
]
The lowest mortality was seen in individuals who slept between six and a half and seven and a half hours nightly. Even sleeping only 4.5 hours per night is associated with a very small increase in mortality. Thus, mild to moderate insomnia for most people is associated with increased
longevity
, and severe insomnia is associated only with a very small effect on mortality.
[
198
]
It is unclear why sleeping longer than 7.5 hours is associated with excess mortality.
[
198
]
Between 10% and 30% of adults have insomnia at any given point in time and up to half of people have insomnia in a given year, making it the most common sleep disorder.
[
9
]
[
8
]
[
10
]
[
199
]
About 6% of people have insomnia that is not due to another problem and lasts for more than a month.
[
9
]
People over the age of 65 are affected more often than younger people.
[
7
]
Females are more often affected than males.
[
8
]
Insomnia is 40% more common in women than in men.
[
200
]
There are higher rates of insomnia reported
among university students
compared to the general population.
[
201
]
Society and culture
[
edit
]
The word insomnia is from
Latin
:
in
+
somnus
"without sleep" and
-ia
as a
nominalizing
suffix
.
The
popular press
have published stories about people who supposedly never sleep, such as that of
Thái Ngọc
and
Al Herpin
.
[
202
]
Horne writes "everybody sleeps and needs to do so", and generally this appears true. However, he also relates from contemporary accounts the case of Paul Kern, who was shot in 1915 fighting in
World War I
and then "never slept again" until he died in 1955.
[
203
]
Kern appears to be a completely isolated, unique case.
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.
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## Contents
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- [(Top)](https://en.wikipedia.org/wiki/Insomnia)
- [1 Signs and symptoms](https://en.wikipedia.org/wiki/Insomnia#Signs_and_symptoms)
Toggle Signs and symptoms subsection
- [1\.1 Poor sleep quality](https://en.wikipedia.org/wiki/Insomnia#Poor_sleep_quality)
- [1\.2 Subjectivity](https://en.wikipedia.org/wiki/Insomnia#Subjectivity)
- [1\.3 Problematic digital media use](https://en.wikipedia.org/wiki/Insomnia#Problematic_digital_media_use)
- [2 Causes](https://en.wikipedia.org/wiki/Insomnia#Causes)
Toggle Causes subsection
- [2\.1 Genetics](https://en.wikipedia.org/wiki/Insomnia#Genetics)
- [2\.2 Substance-induced](https://en.wikipedia.org/wiki/Insomnia#Substance-induced)
- [2\.2.1 Alcohol-induced](https://en.wikipedia.org/wiki/Insomnia#Alcohol-induced)
- [2\.2.2 Caffeine](https://en.wikipedia.org/wiki/Insomnia#Caffeine)
- [2\.2.3 Benzodiazepine-induced](https://en.wikipedia.org/wiki/Insomnia#Benzodiazepine-induced)
- [2\.2.4 Opioid-induced](https://en.wikipedia.org/wiki/Insomnia#Opioid-induced)
- [2\.3 Risk factors](https://en.wikipedia.org/wiki/Insomnia#Risk_factors)
- [3 Mechanism](https://en.wikipedia.org/wiki/Insomnia#Mechanism)
- [4 Diagnosis](https://en.wikipedia.org/wiki/Insomnia#Diagnosis)
Toggle Diagnosis subsection
- [4\.1 DSM-5 criteria](https://en.wikipedia.org/wiki/Insomnia#DSM-5_criteria)
- [4\.2 Types](https://en.wikipedia.org/wiki/Insomnia#Types)
- [5 Prevention](https://en.wikipedia.org/wiki/Insomnia#Prevention)
- [6 Management](https://en.wikipedia.org/wiki/Insomnia#Management)
Toggle Management subsection
- [6\.1 Non-medication based](https://en.wikipedia.org/wiki/Insomnia#Non-medication_based)
- [6\.1.1 Sleep Hygiene](https://en.wikipedia.org/wiki/Insomnia#Sleep_Hygiene)
- [6\.1.2 Cognitive behavioral therapy](https://en.wikipedia.org/wiki/Insomnia#Cognitive_behavioral_therapy)
- [6\.1.3 Acceptance and commitment therapy](https://en.wikipedia.org/wiki/Insomnia#Acceptance_and_commitment_therapy)
- [6\.1.4 Internet Interventions](https://en.wikipedia.org/wiki/Insomnia#Internet_Interventions)
- [6\.2 Medications](https://en.wikipedia.org/wiki/Insomnia#Medications)
- [6\.2.1 Antihistamines](https://en.wikipedia.org/wiki/Insomnia#Antihistamines)
- [6\.2.2 Antidepressants](https://en.wikipedia.org/wiki/Insomnia#Antidepressants)
- [6\.2.3 Melatonin agonists](https://en.wikipedia.org/wiki/Insomnia#Melatonin_agonists)
- [6\.2.4 Benzodiazepines](https://en.wikipedia.org/wiki/Insomnia#Benzodiazepines)
- [6\.2.5 Z-Drugs](https://en.wikipedia.org/wiki/Insomnia#Z-Drugs)
- [6\.2.6 Orexin antagonists](https://en.wikipedia.org/wiki/Insomnia#Orexin_antagonists)
- [6\.2.7 Antipsychotics](https://en.wikipedia.org/wiki/Insomnia#Antipsychotics)
- [6\.2.8 Other sedatives](https://en.wikipedia.org/wiki/Insomnia#Other_sedatives)
- [6\.2.9 Comparative effectiveness](https://en.wikipedia.org/wiki/Insomnia#Comparative_effectiveness)
- [6\.3 Alternative medicine](https://en.wikipedia.org/wiki/Insomnia#Alternative_medicine)
- [7 Prognosis](https://en.wikipedia.org/wiki/Insomnia#Prognosis)
- [8 Epidemiology](https://en.wikipedia.org/wiki/Insomnia#Epidemiology)
- [9 Society and culture](https://en.wikipedia.org/wiki/Insomnia#Society_and_culture)
- [10 References](https://en.wikipedia.org/wiki/Insomnia#References)
- [11 External links](https://en.wikipedia.org/wiki/Insomnia#External_links)
Toggle the table of contents
# Insomnia
86 languages
- [Afrikaans](https://af.wikipedia.org/wiki/Slapeloosheid "Slapeloosheid – Afrikaans")
- [العربية](https://ar.wikipedia.org/wiki/%D8%A3%D8%B1%D9%82 "أرق – Arabic")
- [Azərbaycanca](https://az.wikipedia.org/wiki/%C4%B0nsomniya "İnsomniya – Azerbaijani")
- [Беларуская (тарашкевіца)](https://be-tarask.wikipedia.org/wiki/%D0%91%D0%B5%D1%81%D1%81%D0%B0%D0%BD%D1%8C "Бессань – Belarusian (Taraškievica orthography)")
- [Беларуская](https://be.wikipedia.org/wiki/%D0%91%D1%8F%D1%81%D1%81%D0%BE%D0%BD%D1%96%D1%86%D0%B0 "Бяссоніца – Belarusian")
- [Български](https://bg.wikipedia.org/wiki/%D0%91%D0%B5%D0%B7%D1%81%D1%8A%D0%BD%D0%B8%D0%B5 "Безсъние – Bulgarian")
- [বাংলা](https://bn.wikipedia.org/wiki/%E0%A6%85%E0%A6%A8%E0%A6%BF%E0%A6%A6%E0%A7%8D%E0%A6%B0%E0%A6%BE "অনিদ্রা – Bangla")
- [Bosanski](https://bs.wikipedia.org/wiki/Nesanica "Nesanica – Bosnian")
- [Català](https://ca.wikipedia.org/wiki/Insomni "Insomni – Catalan")
- [کوردی](https://ckb.wikipedia.org/wiki/%D8%A8%DB%8E%D8%AE%DB%95%D9%88%DB%8C "بێخەوی – Central Kurdish")
- [Čeština](https://cs.wikipedia.org/wiki/Insomnie "Insomnie – Czech")
- [Cymraeg](https://cy.wikipedia.org/wiki/Anhunedd "Anhunedd – Welsh")
- [Dansk](https://da.wikipedia.org/wiki/S%C3%B8vnl%C3%B8shed "Søvnløshed – Danish")
- [Deutsch](https://de.wikipedia.org/wiki/Insomnie "Insomnie – German")
- [ދިވެހިބަސް](https://dv.wikipedia.org/wiki/%DE%82%DE%A8%DE%8B%DE%A8%DE%82%DE%A6%DE%87%DE%AA%DE%82%DE%B0 "ނިދިނައުން – Divehi")
- [Ελληνικά](https://el.wikipedia.org/wiki/%CE%91%CF%8B%CF%80%CE%BD%CE%AF%CE%B1 "Αϋπνία – Greek")
- [Esperanto](https://eo.wikipedia.org/wiki/Sendormeco "Sendormeco – Esperanto")
- [Español](https://es.wikipedia.org/wiki/Insomnio "Insomnio – Spanish")
- [Eesti](https://et.wikipedia.org/wiki/Unetus "Unetus – Estonian")
- [Euskara](https://eu.wikipedia.org/wiki/Insomnio "Insomnio – Basque")
- [فارسی](https://fa.wikipedia.org/wiki/%D8%A8%DB%8C%E2%80%8C%D8%AE%D9%88%D8%A7%D8%A8%DB%8C "بیخوابی – Persian")
- [Suomi](https://fi.wikipedia.org/wiki/Unettomuus "Unettomuus – Finnish")
- [Français](https://fr.wikipedia.org/wiki/Insomnie "Insomnie – French")
- [Gaeilge](https://ga.wikipedia.org/wiki/Easuan "Easuan – Irish")
- [Galego](https://gl.wikipedia.org/wiki/Insomnio "Insomnio – Galician")
- [Avañe'ẽ](https://gn.wikipedia.org/wiki/Kesasy "Kesasy – Guarani")
- [Ghanaian Pidgin](https://gpe.wikipedia.org/wiki/Insomnia "Insomnia – Ghanaian Pidgin")
- [ગુજરાતી](https://gu.wikipedia.org/wiki/%E0%AA%85%E0%AA%A8%E0%AA%BF%E0%AA%A6%E0%AB%8D%E0%AA%B0%E0%AA%BE "અનિદ્રા – Gujarati")
- [עברית](https://he.wikipedia.org/wiki/%D7%A0%D7%93%D7%95%D7%93%D7%99_%D7%A9%D7%99%D7%A0%D7%94 "נדודי שינה – Hebrew")
- [हिन्दी](https://hi.wikipedia.org/wiki/%E0%A4%85%E0%A4%A8%E0%A4%BF%E0%A4%A6%E0%A5%8D%E0%A4%B0%E0%A4%BE "अनिद्रा – Hindi")
- [Hrvatski](https://hr.wikipedia.org/wiki/Nesanica "Nesanica – Croatian")
- [Magyar](https://hu.wikipedia.org/wiki/Inszomnia "Inszomnia – Hungarian")
- [Հայերեն](https://hy.wikipedia.org/wiki/%D4%B1%D5%B6%D6%84%D5%B6%D5%B8%D6%82%D5%A9%D5%B5%D5%B8%D6%82%D5%B6 "Անքնություն – Armenian")
- [Արեւմտահայերէն](https://hyw.wikipedia.org/wiki/%D4%B1%D5%B6%D6%84%D5%B6%D5%B8%D6%82%D5%A9%D5%AB%D6%82%D5%B6 "Անքնութիւն – Western Armenian")
- [Bahasa Indonesia](https://id.wikipedia.org/wiki/Insomnia "Insomnia – Indonesian")
- [Italiano](https://it.wikipedia.org/wiki/Insonnia "Insonnia – Italian")
- [日本語](https://ja.wikipedia.org/wiki/%E4%B8%8D%E7%9C%A0%E7%97%87 "不眠症 – Japanese")
- [Jawa](https://jv.wikipedia.org/wiki/Insomnia "Insomnia – Javanese")
- [ქართული](https://ka.wikipedia.org/wiki/%E1%83%A3%E1%83%AB%E1%83%98%E1%83%9A%E1%83%9D%E1%83%91%E1%83%90 "უძილობა – Georgian")
- [Taqbaylit](https://kab.wikipedia.org/wiki/Awwaz "Awwaz – Kabyle")
- [Қазақша](https://kk.wikipedia.org/wiki/%D2%B0%D0%B9%D2%9B%D1%8B%D1%81%D1%8B%D0%B7%D0%B4%D1%8B%D2%9B "Ұйқысыздық – Kazakh")
- [ಕನ್ನಡ](https://kn.wikipedia.org/wiki/%E0%B2%A8%E0%B2%BF%E0%B2%A6%E0%B3%8D%E0%B2%B0%E0%B2%BE%E0%B2%B9%E0%B3%80%E0%B2%A8%E0%B2%A4%E0%B3%86 "ನಿದ್ರಾಹೀನತೆ – Kannada")
- [한국어](https://ko.wikipedia.org/wiki/%EB%B6%88%EB%A9%B4%EC%A6%9D "불면증 – Korean")
- [Кыргызча](https://ky.wikipedia.org/wiki/%D0%A3%D0%B9%D0%BA%D1%83_%D0%BA%D0%B0%D1%87%D1%83%D1%83 "Уйку качуу – Kyrgyz")
- [Latina](https://la.wikipedia.org/wiki/Insomnia "Insomnia – Latin")
- [Lietuvių](https://lt.wikipedia.org/wiki/Nemiga "Nemiga – Lithuanian")
- [Latviešu](https://lv.wikipedia.org/wiki/Bezmiegs "Bezmiegs – Latvian")
- [Македонски](https://mk.wikipedia.org/wiki/%D0%9D%D0%B5%D1%81%D0%BE%D0%BD%D0%B8%D1%86%D0%B0 "Несоница – Macedonian")
- [മലയാളം](https://ml.wikipedia.org/wiki/%E0%B4%87%E0%B5%BB%E0%B4%B8%E0%B5%8B%E0%B4%AE%E0%B5%8D%E0%B4%A8%E0%B4%BF%E0%B4%AF "ഇൻസോമ്നിയ – Malayalam")
- [मराठी](https://mr.wikipedia.org/wiki/%E0%A4%A8%E0%A4%BF%E0%A4%A6%E0%A5%8D%E0%A4%B0%E0%A4%BE%E0%A4%A8%E0%A4%BE%E0%A4%B6 "निद्रानाश – Marathi")
- [Bahasa Melayu](https://ms.wikipedia.org/wiki/Insomnia "Insomnia – Malay")
- [Nederlands](https://nl.wikipedia.org/wiki/Slapeloosheid "Slapeloosheid – Dutch")
- [Norsk nynorsk](https://nn.wikipedia.org/wiki/S%C3%B8vnl%C3%B8yse "Søvnløyse – Norwegian Nynorsk")
- [Norsk bokmål](https://no.wikipedia.org/wiki/S%C3%B8vnl%C3%B8shet "Søvnløshet – Norwegian Bokmål")
- [ଓଡ଼ିଆ](https://or.wikipedia.org/wiki/%E0%AC%A8%E0%AC%BF%E0%AC%A6%E0%AD%8D%E0%AC%B0%E0%AC%BE%E0%AC%B9%E0%AD%80%E0%AC%A8%E0%AC%A4%E0%AC%BE "ନିଦ୍ରାହୀନତା – Odia")
- [ਪੰਜਾਬੀ](https://pa.wikipedia.org/wiki/%E0%A8%85%E0%A8%A8%E0%A9%80%E0%A8%82%E0%A8%A6%E0%A8%B0%E0%A8%BE "ਅਨੀਂਦਰਾ – Punjabi")
- [Polski](https://pl.wikipedia.org/wiki/Bezsenno%C5%9B%C4%87 "Bezsenność – Polish")
- [پنجابی](https://pnb.wikipedia.org/wiki/%D8%A7%D9%86%DB%8C%D9%86%D8%AF%D8%B1%D8%A7 "انیندرا – Western Punjabi")
- [Português](https://pt.wikipedia.org/wiki/Ins%C3%B4nia "Insônia – Portuguese")
- [Română](https://ro.wikipedia.org/wiki/Insomnie "Insomnie – Romanian")
- [Русский](https://ru.wikipedia.org/wiki/%D0%91%D0%B5%D1%81%D1%81%D0%BE%D0%BD%D0%BD%D0%B8%D1%86%D0%B0 "Бессонница – Russian")
- [Scots](https://sco.wikipedia.org/wiki/Insomnia "Insomnia – Scots")
- [Srpskohrvatski / српскохрватски](https://sh.wikipedia.org/wiki/Nesanica "Nesanica – Serbo-Croatian")
- [Simple English](https://simple.wikipedia.org/wiki/Insomnia "Insomnia – Simple English")
- [Slovenčina](https://sk.wikipedia.org/wiki/Nespavos%C5%A5 "Nespavosť – Slovak")
- [Slovenščina](https://sl.wikipedia.org/wiki/Nespe%C4%8Dnost "Nespečnost – Slovenian")
- [Shqip](https://sq.wikipedia.org/wiki/Insomnia "Insomnia – Albanian")
- [Српски / srpski](https://sr.wikipedia.org/wiki/%D0%9D%D0%B5%D1%81%D0%B0%D0%BD%D0%B8%D1%86%D0%B0 "Несаница – Serbian")
- [Sunda](https://su.wikipedia.org/wiki/Insomnia "Insomnia – Sundanese")
- [Svenska](https://sv.wikipedia.org/wiki/S%C3%B6mnl%C3%B6shet "Sömnlöshet – Swedish")
- [Kiswahili](https://sw.wikipedia.org/wiki/Kukosa_usingizi "Kukosa usingizi – Swahili")
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From Wikipedia, the free encyclopedia
Disorder causing trouble with sleeping
This article is about the sleeping disorder. For other uses, see [Insomnia (disambiguation)](https://en.wikipedia.org/wiki/Insomnia_\(disambiguation\) "Insomnia (disambiguation)").
"Trouble sleeping" redirects here. For other uses, see [Trouble sleeping (disambiguation)](https://en.wikipedia.org/wiki/Trouble_sleeping_\(disambiguation\) "Trouble sleeping (disambiguation)").
Medical condition
| Insomnia | |
|---|---|
| Other names | Sleeplessness, trouble sleeping |
| [](https://en.wikipedia.org/wiki/File:53-aspetti_di_vita_quotidiana,_insonnia,_Taccuino_Sanitatis,.jpg) | |
| Depiction of insomnia from the 14th century medical manuscript *[Tacuinum Sanitatis](https://en.wikipedia.org/wiki/Tacuinum_Sanitatis "Tacuinum Sanitatis")* | |
| Pronunciation | [/ɪnˈsɒmniə/](https://en.wikipedia.org/wiki/Help:IPA/English "Help:IPA/English")[\[1\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Ov-1) |
| [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") | [Psychiatry](https://en.wikipedia.org/wiki/Psychiatry "Psychiatry"), [Clinical Psychology](https://en.wikipedia.org/wiki/Clinical_Psychology "Clinical Psychology"), [Sleep Medicine](https://en.wikipedia.org/wiki/Sleep_Medicine "Sleep Medicine") |
| [Symptoms](https://en.wikipedia.org/wiki/Signs_and_symptoms "Signs and symptoms") | Trouble [sleeping](https://en.wikipedia.org/wiki/Sleeping "Sleeping"), daytime sleepiness, low energy, irritability, [depressed mood](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)")[\[1\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Ov-1) |
| [Causes](https://en.wikipedia.org/wiki/Cause_\(medicine\) "Cause (medicine)") | Unknown, [psychological stress](https://en.wikipedia.org/wiki/Psychological_stress "Psychological stress"), [chronic pain](https://en.wikipedia.org/wiki/Chronic_pain "Chronic pain"), [heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure"), [hyperthyroidism](https://en.wikipedia.org/wiki/Hyperthyroidism "Hyperthyroidism"), [heartburn](https://en.wikipedia.org/wiki/Heartburn "Heartburn"), [restless leg syndrome](https://en.wikipedia.org/wiki/Restless_leg_syndrome "Restless leg syndrome"), [autism spectrum disorder](https://en.wikipedia.org/wiki/Autism_spectrum_disorder "Autism spectrum disorder"), [obstructive sleep apnea](https://en.wikipedia.org/wiki/Obstructive_sleep_apnea "Obstructive sleep apnea"), others[\[2\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Ca-2) |
| [Diagnostic method](https://en.wikipedia.org/wiki/Medical_diagnosis "Medical diagnosis") | Based on symptoms, [sleep study](https://en.wikipedia.org/wiki/Sleep_study "Sleep study")[\[3\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Diag-3) |
| [Differential diagnosis](https://en.wikipedia.org/wiki/Differential_diagnosis "Differential diagnosis") | [Delayed sleep phase disorder](https://en.wikipedia.org/wiki/Delayed_sleep_phase_disorder "Delayed sleep phase disorder"), [restless leg syndrome](https://en.wikipedia.org/wiki/Restless_leg_syndrome "Restless leg syndrome"), [sleep apnea](https://en.wikipedia.org/wiki/Sleep_apnea "Sleep apnea"), [psychiatric disorder](https://en.wikipedia.org/wiki/Psychiatric_disorder "Psychiatric disorder")[\[4\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-4) |
| Treatment | [Sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene"), [cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_for_insomnia "Cognitive behavioral therapy for insomnia"), [hypnotics](https://en.wikipedia.org/wiki/Hypnotics "Hypnotics")[\[5\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Tx-5)[\[6\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-AC2016-6)[\[7\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Wil2008-7) |
| Frequency | ~20%[\[8\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-WHO2009-8)[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9)[\[10\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Tas2015-10) |
**Insomnia**, also known as **sleeplessness**, is a [sleep disorder](https://en.wikipedia.org/wiki/Sleep_disorder "Sleep disorder") causing difficulty falling asleep or staying asleep for as long as desired.[\[1\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Ov-1)[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9)[\[11\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Pun2012-11) Insomnia is typically followed by daytime [sleepiness](https://en.wikipedia.org/wiki/Sleepiness "Sleepiness"), low energy, [irritability](https://en.wikipedia.org/wiki/Irritability "Irritability"), and a [depressed mood](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)").[\[1\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Ov-1) It may result in an increased risk of accidents as well as problems focusing and learning.[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9) Insomnia can be short-term, lasting for days or weeks, or long-term, lasting more than a month.[\[1\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Ov-1) The concept of the word *insomnia* has two distinct possibilities: insomnia disorder or insomnia symptoms.[\[12\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Banno2022-12)
Insomnia can occur independently or as a result of another problem.[\[2\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Ca-2) Conditions that can result in insomnia include [psychological stress](https://en.wikipedia.org/wiki/Psychological_stress "Psychological stress"), [chronic pain](https://en.wikipedia.org/wiki/Chronic_pain "Chronic pain"), [heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure"), [hyperthyroidism](https://en.wikipedia.org/wiki/Hyperthyroidism "Hyperthyroidism"), [heartburn](https://en.wikipedia.org/wiki/Heartburn "Heartburn"), [restless leg syndrome](https://en.wikipedia.org/wiki/Restless_leg_syndrome "Restless leg syndrome"), [menopause](https://en.wikipedia.org/wiki/Menopause "Menopause"), certain [medications](https://en.wikipedia.org/wiki/Medication "Medication"), and drugs such as [caffeine](https://en.wikipedia.org/wiki/Caffeine "Caffeine"), [nicotine](https://en.wikipedia.org/wiki/Nicotine "Nicotine"), and [alcohol](https://en.wikipedia.org/wiki/Alcohol_\(drug\) "Alcohol (drug)").[\[2\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Ca-2)[\[8\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-WHO2009-8) Risk factors include working [night shifts](https://en.wikipedia.org/wiki/Night_shifts "Night shifts") and [sleep apnea](https://en.wikipedia.org/wiki/Sleep_apnea "Sleep apnea").[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9) Diagnosis is based on sleep habits and an examination to look for underlying causes.[\[3\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Diag-3) A [sleep study](https://en.wikipedia.org/wiki/Sleep_study "Sleep study") may be done to look for underlying sleep disorders.[\[3\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Diag-3) Screening may be done with questions like "Do you experience difficulty sleeping?" or "Do you have difficulty falling or staying asleep?"[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9)
[Cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_for_insomnia "Cognitive behavioral therapy for insomnia") is considered the first-line treatment.[\[6\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-AC2016-6)[\[13\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Tra2015-13)[\[14\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Behavioral_and_psychological_treatm-14) [Sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene") and lifestyle changes are also recommended for insomnia, though their efficacy is not definitely established.[\[5\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Tx-5)[\[7\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Wil2008-7)[\[14\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Behavioral_and_psychological_treatm-14) Sleep hygiene includes a consistent bedtime, a quiet and dark room, exposure to sunlight during the day and regular [exercise](https://en.wikipedia.org/wiki/Exercise "Exercise").[\[7\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Wil2008-7) [Sleeping pills](https://en.wikipedia.org/wiki/Sleeping_pill "Sleeping pill") can improve sleep, though some are associated with falls, [cognitive impairment](https://en.wikipedia.org/wiki/Cognitive_impairment "Cognitive impairment"), and [dependence](https://en.wikipedia.org/wiki/Substance_dependence "Substance dependence").[\[5\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Tx-5)[\[6\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-AC2016-6) These medications are not recommended for more than four or five weeks but can be used longer in certain instances.[\[6\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-AC2016-6)[\[15\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-riemann-23-15) Among these, [lemborexant](https://en.wikipedia.org/wiki/Lemborexant "Lemborexant") and [eszopiclone](https://en.wikipedia.org/wiki/Eszopiclone "Eszopiclone") have the most favorable efficacy and safety profiles.[\[16\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid35843245-16) The efficacy and safety of [alternative medicine](https://en.wikipedia.org/wiki/Insomnia#Alternative_medicine) treatments are unclear.[\[6\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-AC2016-6)[\[15\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-riemann-23-15)
Between 10% and 30% of adults have insomnia at any given point in time, and up to half of people have insomnia in a given year.[\[8\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-WHO2009-8)[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9)[\[10\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Tas2015-10) About 6% of people have insomnia that is not due to another problem and lasts for more than a month.[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9) People over the age of 65 are affected more often than younger people.[\[7\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Wil2008-7) Women are more often affected than men.[\[8\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-WHO2009-8) Descriptions of insomnia occur at least as far back as [ancient Greece](https://en.wikipedia.org/wiki/Ancient_Greece "Ancient Greece").[\[17\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-17)
## Signs and symptoms
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=1 "Edit section: Signs and symptoms")\]
[](https://en.wikipedia.org/wiki/File:Complications_of_insomnia.svg)
Potential complications of insomnia[\[18\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-18)
Symptoms of insomnia:[\[19\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-BBDinsomnia-19)
- Difficulty falling asleep, including difficulty finding a comfortable [sleeping position](https://en.wikipedia.org/wiki/Sleeping_position "Sleeping position")
- Waking during the night, being unable to return to sleep[\[20\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-20) and waking up early
- Not able to focus on daily tasks, difficulty in remembering
- [Daytime sleepiness](https://en.wikipedia.org/wiki/Excessive_daytime_sleepiness "Excessive daytime sleepiness"), [irritability](https://en.wikipedia.org/wiki/Irritability "Irritability"), [depression](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)") or [anxiety](https://en.wikipedia.org/wiki/Anxiety "Anxiety")
- Feeling tired or having low energy during the day[\[21\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-21)
- Trouble concentrating
- Being irritable, acting aggressive, or impulsive
[Sleep onset](https://en.wikipedia.org/wiki/Sleep_onset "Sleep onset") insomnia is difficulty falling asleep at the beginning of the night, often a symptom of [anxiety disorders](https://en.wikipedia.org/wiki/Anxiety_disorder "Anxiety disorder"). [Delayed sleep phase disorder](https://en.wikipedia.org/wiki/Delayed_sleep_phase_disorder "Delayed sleep phase disorder") can be misdiagnosed as insomnia, as sleep onset is delayed much later than normal, while awakening spills over into daylight hours.[\[22\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-22)
It is common for patients who have difficulty falling asleep to also have nocturnal awakenings with difficulty returning to sleep.[\[23\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-23) Two-thirds of these patients wake up in the middle of the night, with more than half having trouble falling back to sleep after a [middle-of-the-night awakening](https://en.wikipedia.org/wiki/Middle-of-the-night_insomnia "Middle-of-the-night insomnia").[\[24\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-24)
Early morning awakening occurs earlier (more than 30 minutes) than desired, with an inability to go back to sleep and before total sleep time reaches 6.5 hours. Early morning awakening is often a characteristic of [depression](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder").[\[25\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-25) Anxiety symptoms may well lead to insomnia. Some of these symptoms include [psychological stress](https://en.wikipedia.org/wiki/Psychological_stress "Psychological stress"), compulsive worrying about the future, feeling overstimulated, and overanalyzing past events.[\[26\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-26)
Chronic insomnia may take a mental toll, affecting social interactions, work, and lifestyle.[\[14\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Behavioral_and_psychological_treatm-14)
### Poor sleep quality
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=2 "Edit section: Poor sleep quality")\]
Poor sleep quality can occur as a result of, for example, [restless legs](https://en.wikipedia.org/wiki/Restless_legs "Restless legs"), [sleep apnea](https://en.wikipedia.org/wiki/Sleep_apnea "Sleep apnea"), or [major depression](https://en.wikipedia.org/wiki/Major_depression "Major depression"). Poor sleep quality is defined as the individual not reaching [stage 3](https://en.wikipedia.org/wiki/Slow-wave_sleep "Slow-wave sleep") or delta sleep, which has restorative properties.[\[27\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-27)
Major depression leads to alterations in the function of the [hypothalamic–pituitary–adrenal axis](https://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary%E2%80%93adrenal_axis "Hypothalamic–pituitary–adrenal axis"), causing excessive release of [cortisol](https://en.wikipedia.org/wiki/Cortisol "Cortisol"), which can lead to poor sleep quality.
Nocturnal [polyuria](https://en.wikipedia.org/wiki/Polyuria "Polyuria"), excessive night-time urination, can also result in a poor quality of sleep.[\[28\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-28)
### Subjectivity
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=3 "Edit section: Subjectivity")\]
Main article: [Sleep state misperception](https://en.wikipedia.org/wiki/Sleep_state_misperception "Sleep state misperception")
Sleep state misperception is a condition where patients believe that they have been awake all night even though sleep tests prove that they have slept for hours. Also called paradoxical insomnia or subjective insomnia, paradoxical insomnia may affect only about 5% of people with insomnia.[\[29\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-29)
Despite sleeping for multiple hours each night and typically not experiencing significant daytime sleepiness or other symptoms of sleep loss, patients feel like they have not slept very much, if at all. They incorrectly believe it takes them an abnormally long [time to fall asleep](https://en.wikipedia.org/wiki/Sleep_onset_latency "Sleep onset latency"), and they underestimate how long they stay asleep.[\[30\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Harvey_2012-30)
### Problematic digital media use
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=4 "Edit section: Problematic digital media use")\]
See also: [Screen time](https://en.wikipedia.org/wiki/Screen_time "Screen time"), [Binge-watching](https://en.wikipedia.org/wiki/Binge-watching "Binge-watching"), [Internet addiction disorder](https://en.wikipedia.org/wiki/Internet_addiction_disorder "Internet addiction disorder"), [Nomophobia](https://en.wikipedia.org/wiki/Nomophobia "Nomophobia"), [Problematic smartphone use](https://en.wikipedia.org/wiki/Problematic_smartphone_use "Problematic smartphone use"), [Problematic social media use](https://en.wikipedia.org/wiki/Problematic_social_media_use "Problematic social media use"), [Television addiction](https://en.wikipedia.org/wiki/Television_addiction "Television addiction"), and [Video game addiction](https://en.wikipedia.org/wiki/Video_game_addiction "Video game addiction")
This section is an excerpt from [Digital media use and mental health § Sleep](https://en.wikipedia.org/wiki/Digital_media_use_and_mental_health#Sleep "Digital media use and mental health").\[[edit](https://en.wikipedia.org/w/index.php?title=Digital_media_use_and_mental_health&action=edit)\]
Sleep quality and screen time or digital media use have been linked, including studies looking at media type, time of day, and age of person.[\[31\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-31)[\[32\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-32)[\[33\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Digital_media_use_and_mental_health_Psychiatry_Research_2020-33)[\[34\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Digital_media_use_and_mental_health_JBA_2020-34)[\[35\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-35)[\[36\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-36)[\[37\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-37)[\[38\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-38)[\[39\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-39)[\[40\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-40) Various sleep challenges or outcomes have been studied including a reduction in sleep duration, increased sleep onset latency, modifications to [rapid eye movement sleep](https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep "Rapid eye movement sleep") and [slow-wave sleep](https://en.wikipedia.org/wiki/Slow-wave_sleep "Slow-wave sleep"), increased sleepiness and self-perceived [fatigue](https://en.wikipedia.org/wiki/Fatigue "Fatigue"), and impaired post-sleep [attention span](https://en.wikipedia.org/wiki/Attention_span "Attention span") and [verbal memory](https://en.wikipedia.org/wiki/Verbal_memory "Verbal memory").[\[41\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-41)
## Causes
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=5 "Edit section: Causes")\]
While insomnia can be caused by many conditions, it can also occur without any identifiable cause. This is known as Primary Insomnia.[\[42\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-42) Primary Insomnia may also have an initial identifiable cause but continues after the cause is no longer present. For example, a bout of insomnia may be triggered by a stressful work or life event. However, the condition may continue after the stressful event has been resolved. In such cases, the insomnia is usually perpetuated by the anxiety or fear caused by the sleeplessness itself, rather than any external factors.[\[43\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-43)
Symptoms of insomnia can be caused by or associated with:
- Sleep breathing disorders, such as [sleep apnea](https://en.wikipedia.org/wiki/Sleep_apnea "Sleep apnea") or [upper airway resistance syndrome](https://en.wikipedia.org/wiki/Upper_airway_resistance_syndrome "Upper airway resistance syndrome")[\[44\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-44)
- Use of [psychoactive drugs](https://en.wikipedia.org/wiki/Psychoactive_drug "Psychoactive drug") (such as [stimulants](https://en.wikipedia.org/wiki/Stimulant "Stimulant")), including certain [medications](https://en.wikipedia.org/wiki/Medication "Medication"), [herbs](https://en.wikipedia.org/wiki/Herb "Herb"), [caffeine](https://en.wikipedia.org/wiki/Caffeine "Caffeine"), [nicotine](https://en.wikipedia.org/wiki/Nicotine "Nicotine"), [cocaine](https://en.wikipedia.org/wiki/Cocaine "Cocaine"), [amphetamines](https://en.wikipedia.org/wiki/Amphetamine "Amphetamine"), [methylphenidate](https://en.wikipedia.org/wiki/Methylphenidate "Methylphenidate"), [aripiprazole](https://en.wikipedia.org/wiki/Aripiprazole "Aripiprazole"), [MDMA](https://en.wikipedia.org/wiki/MDMA "MDMA"), [modafinil](https://en.wikipedia.org/wiki/Modafinil "Modafinil"), or excessive alcohol intake[\[45\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-umm_causes-45)
- Use of or withdrawal from alcohol and other [sedatives](https://en.wikipedia.org/wiki/Sedative "Sedative"), such as anti-anxiety and sleep drugs like [benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepine_withdrawal "Benzodiazepine withdrawal")[\[45\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-umm_causes-45)
- Use of or withdrawal from pain-relievers such as [opioids](https://en.wikipedia.org/wiki/Opioid_withdrawal "Opioid withdrawal")[\[45\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-umm_causes-45)
- [Heart disease](https://en.wikipedia.org/wiki/Heart_disease "Heart disease")[\[46\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-comorbidity-46)
- [Restless legs syndrome](https://en.wikipedia.org/wiki/Restless_legs_syndrome "Restless legs syndrome"), which can cause sleep onset insomnia due to the discomforting sensations felt and the need to move the legs or other body parts to relieve these sensations[\[47\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-mayo_insomnia_causes-47)
- [Periodic limb movement disorder](https://en.wikipedia.org/wiki/Periodic_limb_movement_disorder "Periodic limb movement disorder") (PLMD), which occurs during sleep and can cause arousals of which the sleeper is unaware[\[48\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-48)
- [Pain](https://en.wikipedia.org/wiki/Pain "Pain"):[\[49\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Ramakrishnan-2007-49) an injury or condition that causes pain can preclude an individual from finding a comfortable position in which to fall asleep, and can also cause awakening.
- [Hormone](https://en.wikipedia.org/wiki/Hormone "Hormone") shifts such as those that precede [menstruation](https://en.wikipedia.org/wiki/Menstruation "Menstruation") and those during [menopause](https://en.wikipedia.org/wiki/Menopause "Menopause")[\[50\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Santoro2015rev-50)
- Life events such as [fear](https://en.wikipedia.org/wiki/Fear "Fear"), [stress](https://en.wikipedia.org/wiki/Stress_\(psychology\) "Stress (psychology)"), [anxiety](https://en.wikipedia.org/wiki/Anxiety "Anxiety"), emotional or mental tension, work problems, financial stress, birth of a child, and bereavement[\[47\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-mayo_insomnia_causes-47)
- Gastrointestinal issues such as heartburn or constipation[\[51\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-nhlbi_causes-51)
- [Mental](https://en.wikipedia.org/wiki/Mental_disorder "Mental disorder"), [neurobehavioral](https://en.wikipedia.org/wiki/Learning_Disability "Learning Disability"), or [neurodevelopmental](https://en.wikipedia.org/wiki/Neurodevelopmental_disorder "Neurodevelopmental disorder") disorders such as [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder"), [clinical depression](https://en.wikipedia.org/wiki/Clinical_depression "Clinical depression"), [generalized anxiety disorder](https://en.wikipedia.org/wiki/Generalized_anxiety_disorder "Generalized anxiety disorder"), [post traumatic stress disorder](https://en.wikipedia.org/wiki/Post_traumatic_stress_disorder "Post traumatic stress disorder"), [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia"), [obsessive compulsive disorder](https://en.wikipedia.org/wiki/Obsessive_compulsive_disorder "Obsessive compulsive disorder"), [autism](https://en.wikipedia.org/wiki/Autism "Autism"), [dementia](https://en.wikipedia.org/wiki/Dementia "Dementia"),[\[52\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Psych4th-52): 326 [ADHD](https://en.wikipedia.org/wiki/ADHD "ADHD"),[\[53\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-53) and [FASD](https://en.wikipedia.org/wiki/Fetal_Alcohol_Spectrum_Disorder "Fetal Alcohol Spectrum Disorder")
- Disturbances of the [circadian rhythm](https://en.wikipedia.org/wiki/Circadian_rhythm "Circadian rhythm"), such as [shift work](https://en.wikipedia.org/wiki/Shift_work "Shift work") and [jet lag](https://en.wikipedia.org/wiki/Jet_lag "Jet lag"), can cause an inability to sleep at some times of the day and excessive sleepiness at other times of the day. Chronic [circadian rhythm disorders](https://en.wikipedia.org/wiki/Circadian_rhythm_sleep_disorder "Circadian rhythm sleep disorder") are characterized by similar symptoms.[\[45\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-umm_causes-45)
- Certain [neurological](https://en.wikipedia.org/wiki/Neurology "Neurology") disorders such as [brain lesions](https://en.wikipedia.org/wiki/Brain_damage "Brain damage"), or a [history](https://en.wikipedia.org/wiki/Medical_history "Medical history") of [traumatic brain injury](https://en.wikipedia.org/wiki/Traumatic_brain_injury "Traumatic brain injury")[\[54\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-54)
- [Medical conditions](https://en.wikipedia.org/wiki/Disease "Disease") such as [hyperthyroidism](https://en.wikipedia.org/wiki/Hyperthyroidism "Hyperthyroidism")[\[2\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Ca-2)
- Abuse of over-the-counter or prescription sleep aids ([sedative](https://en.wikipedia.org/wiki/Sedative "Sedative") or [depressant](https://en.wikipedia.org/wiki/Depressant "Depressant") drugs) can produce [rebound insomnia](https://en.wikipedia.org/wiki/Rebound_insomnia "Rebound insomnia")[\[45\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-umm_causes-45)
- Poor [sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene"), e.g., [noise](https://en.wikipedia.org/wiki/Noise_health_effects "Noise health effects") or over-consumption of caffeine[\[45\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-umm_causes-45)
- A rare genetic condition can cause a [prion](https://en.wikipedia.org/wiki/Prion "Prion")\-based, permanent, and eventually fatal form of insomnia called [fatal familial insomnia](https://en.wikipedia.org/wiki/Fatal_familial_insomnia "Fatal familial insomnia")[\[55\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid17406188-55)
- [Physical exercise](https://en.wikipedia.org/wiki/Physical_exercise "Physical exercise"): exercise-induced insomnia is common in athletes in the form of prolonged [sleep onset latency](https://en.wikipedia.org/wiki/Sleep_onset_latency "Sleep onset latency")[\[56\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-56)
- Increased exposure to the blue light from artificial sources, such as phones or computers[\[57\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-57)
- Chronic pain[\[58\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-58)[\[59\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-nsf-59)
- [Lower back pain](https://en.wikipedia.org/wiki/Lower_back_pain "Lower back pain")[\[59\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-nsf-59)
- [Asthma](https://en.wikipedia.org/wiki/Asthma "Asthma")[\[59\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-nsf-59)
- [Parkinson's disease](https://en.wikipedia.org/wiki/Parkinson%27s_disease "Parkinson's disease")
Sleep studies using [polysomnography](https://en.wikipedia.org/wiki/Polysomnography "Polysomnography") have suggested that people who have sleep disruption have elevated night-time levels of circulating [cortisol](https://en.wikipedia.org/wiki/Cortisol "Cortisol") and [adrenocorticotropic hormone](https://en.wikipedia.org/wiki/Adrenocorticotropic_hormone "Adrenocorticotropic hormone").[\[60\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-60) They also have an elevated metabolic rate, which does not occur in people who do not have insomnia but whose sleep is intentionally disrupted during a sleep study. Studies of brain metabolism using [positron emission tomography (PET) scans](https://en.wikipedia.org/wiki/Positron_emission_tomography "Positron emission tomography") indicate that people with insomnia have higher metabolic rates by night and by day. The question remains whether these changes are the causes or consequences of long-term insomnia.[\[61\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Mendelson-61)
### Genetics
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=6 "Edit section: Genetics")\]
[Heritability](https://en.wikipedia.org/wiki/Heritability "Heritability") estimates of insomnia vary between 38% in males to 59% in females.[\[62\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Lind-62) A [genome-wide association study](https://en.wikipedia.org/wiki/Genome-wide_association_study "Genome-wide association study") (GWAS) identified 3 genomic loci and 7 [genes](https://en.wikipedia.org/wiki/Genes "Genes") that influence the risk of insomnia and showed that insomnia is highly polygenic.[\[63\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Hammerschlag-63) In particular, a strong positive association was observed for the [MEIS1](https://en.wikipedia.org/wiki/MEIS1 "MEIS1") gene in both males and females. This study showed that the genetic architecture of insomnia strongly overlaps with psychiatric disorders and metabolic traits.
It has been hypothesized that epigenetics might also influence insomnia through a controlling process of both sleep regulation and brain-stress response, having an impact as well on brain plasticity.[\[64\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-palagini-64)
### Substance-induced
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=7 "Edit section: Substance-induced")\]
#### Alcohol-induced
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=8 "Edit section: Alcohol-induced")\]
Main article: [Alcohol use and sleep](https://en.wikipedia.org/wiki/Alcohol_use_and_sleep "Alcohol use and sleep")
Alcohol is often used as a form of self-treatment for insomnia to induce sleep. However, alcohol use to induce sleep can be a cause of insomnia. [Long-term use of alcohol](https://en.wikipedia.org/wiki/Long-term_use_of_alcohol "Long-term use of alcohol") is associated with a decrease in [NREM](https://en.wikipedia.org/wiki/NREM "NREM") stage 3 and 4 sleep as well as suppression of [REM sleep](https://en.wikipedia.org/wiki/REM_sleep "REM sleep") and REM sleep fragmentation. Frequent moving between sleep stages occurs with awakenings due to headaches, [the need to urinate](https://en.wikipedia.org/wiki/Polyuria "Polyuria"), [dehydration](https://en.wikipedia.org/wiki/Dehydration "Dehydration"), and [excessive sweating](https://en.wikipedia.org/wiki/Diaphoresis "Diaphoresis"). [Glutamine](https://en.wikipedia.org/wiki/Glutamine "Glutamine") rebound also plays a role when someone is drinking; alcohol inhibits glutamine, one of the body's natural stimulants. When the person stops drinking, the body tries to make up for lost time by producing more glutamine than it needs.
The increase in glutamine levels stimulates the brain while the drinker is trying to sleep, keeping them from reaching the deepest levels of sleep.[\[65\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-65) Stopping chronic alcohol use can also lead to severe insomnia with vivid dreams. During withdrawal, REM sleep is typically exaggerated as part of a [rebound effect](https://en.wikipedia.org/wiki/Rebound_effect "Rebound effect").[\[66\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-sleep_medicine_a04-66)
#### Caffeine
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=9 "Edit section: Caffeine")\]
Some people experience sleep disruption or anxiety if they consume caffeine.[\[67\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-67) Doses as low as 100 mg/day, such as a 6 oz (170 g) cup of coffee or two to three 12 oz (340 g) servings of caffeinated soft-drink, may continue to cause sleep disruption, among other intolerances. Non-regular caffeine users have the least caffeine tolerance for sleep disruption.[\[68\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Caffeinedependence_JohnHopkins-68) Some coffee drinkers develop tolerance to its undesired sleep-disrupting effects, but others apparently do not.[\[69\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Fredholm-69)
#### Benzodiazepine-induced
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=10 "Edit section: Benzodiazepine-induced")\]
Like alcohol, [benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepine "Benzodiazepine"), such as [alprazolam](https://en.wikipedia.org/wiki/Alprazolam "Alprazolam"), [clonazepam](https://en.wikipedia.org/wiki/Clonazepam "Clonazepam"), [lorazepam](https://en.wikipedia.org/wiki/Lorazepam "Lorazepam"), and [diazepam](https://en.wikipedia.org/wiki/Diazepam "Diazepam"), are commonly used to treat insomnia in the short-term (both prescribed and self-medicated), but worsen sleep in the long-term. While benzodiazepines can put people to sleep (i.e., inhibit NREM stage 1 and 2 sleep), while asleep, the drugs disrupt [sleep architecture](https://en.wikipedia.org/wiki/Sleep_architecture "Sleep architecture"): decreasing sleep time, delaying time to REM sleep, and decreasing deep [slow-wave sleep](https://en.wikipedia.org/wiki/Slow-wave_sleep "Slow-wave sleep") (the most restorative part of sleep for both energy and mood).[\[70\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-70)[\[71\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-71)[\[72\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-72)
#### Opioid-induced
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=11 "Edit section: Opioid-induced")\]
[Opioid](https://en.wikipedia.org/wiki/Opioid "Opioid") medications such as [hydrocodone](https://en.wikipedia.org/wiki/Hydrocodone "Hydrocodone"), [oxycodone](https://en.wikipedia.org/wiki/Oxycodone "Oxycodone"), and [morphine](https://en.wikipedia.org/wiki/Morphine "Morphine") are used for insomnia that is associated with [pain](https://en.wikipedia.org/wiki/Pain "Pain") due to their [analgesic](https://en.wikipedia.org/wiki/Analgesic "Analgesic") properties and [hypnotic](https://en.wikipedia.org/wiki/Hypnotic "Hypnotic") effects. Opioids can fragment sleep and decrease [REM](https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep "Rapid eye movement sleep") and [stage 2](https://en.wikipedia.org/wiki/Non-rapid_eye_movement_sleep "Non-rapid eye movement sleep") sleep. By producing [analgesia](https://en.wikipedia.org/wiki/Analgesia "Analgesia") and [sedation](https://en.wikipedia.org/wiki/Sedation "Sedation"), opioids may be appropriate in carefully selected patients with pain-associated insomnia.[\[49\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Ramakrishnan-2007-49) However, dependence on opioids can lead to long-term sleep disturbances.[\[73\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-73)
### Risk factors
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=12 "Edit section: Risk factors")\]
Insomnia affects people of all age groups, but people in the following groups have a higher chance of acquiring insomnia:[\[74\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-74)
- Individuals older than 60
- History of mental health disorders, including depression, etc.
- Emotional stress
- Working late-night shifts
- Traveling through different time zones[\[11\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Pun2012-11)
- Having chronic diseases such as [diabetes](https://en.wikipedia.org/wiki/Diabetes "Diabetes"), kidney disease, lung disease, [Alzheimer's](https://en.wikipedia.org/wiki/Alzheimer%27s "Alzheimer's"), or heart disease[\[75\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-75)
- [Alcohol](https://en.wikipedia.org/wiki/Alcohol_\(drug\) "Alcohol (drug)") or drug use disorders
- Gastrointestinal reflux disease
- Heavy smoking
- Work stress[\[76\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-76)
- Individuals of low socioeconomic status[\[77\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Billings_2021-77)
- Urban neighborhoods[\[77\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Billings_2021-77)
- Household stress[\[77\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Billings_2021-77)
## Mechanism
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=13 "Edit section: Mechanism")\]
Two main models exist regarding the mechanism of insomnia: cognitive and physiological. The cognitive model suggests that rumination and hyperarousal contribute to preventing a person from falling asleep and might lead to an episode of insomnia.
The physiological model is based upon three major findings in people with insomnia; firstly, increased urinary [cortisol](https://en.wikipedia.org/wiki/Cortisol "Cortisol") and [catecholamines](https://en.wikipedia.org/wiki/Catecholamines "Catecholamines") have been found suggesting increased activity of the HPA axis and arousal; second, increased global cerebral glucose utilization during wakefulness and NREM sleep in people with insomnia; and lastly, increased full body metabolism and heart rate in those with insomnia. All these findings taken together suggest a deregulation of the arousal system, cognitive system, and [HPA axis](https://en.wikipedia.org/wiki/HPA_axis "HPA axis"), all contributing to insomnia.[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9)[\[78\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-78) However, it is unknown if the hyperarousal is a result of, or cause of insomnia. Altered levels of the inhibitory [neurotransmitter](https://en.wikipedia.org/wiki/Neurotransmitter "Neurotransmitter") [GABA](https://en.wikipedia.org/wiki/GABA "GABA") have been found, but the results have been inconsistent, and the implications of altered levels of such a ubiquitous neurotransmitter are unknown. Studies on whether insomnia is driven by circadian control over sleep or a wake-dependent process have shown inconsistent results, but some literature suggests a deregulation of the circadian rhythm based on core temperature.[\[79\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-79) Increased beta activity and decreased delta wave activity has been observed on [electroencephalograms](https://en.wikipedia.org/wiki/Electroencephalogram "Electroencephalogram"); however, the implication of this is unknown.[\[80\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-80)
Around half of post-menopausal women experience sleep disturbances, and generally, sleep disturbance is about twice as common in women as men; this appears to be due in part, but not completely, to changes in hormone levels, especially in post-menopause.[\[50\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Santoro2015rev-50)[\[81\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-81)
Changes in [sex hormones](https://en.wikipedia.org/wiki/Sex_hormone "Sex hormone") in both men and women as they age may account in part for an increased prevalence of [sleep disorders](https://en.wikipedia.org/wiki/Sleep_disorder "Sleep disorder") in older people.[\[82\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-82)
## Diagnosis
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=14 "Edit section: Diagnosis")\]
Further information: [Ford Insomnia Response to Stress Test](https://en.wikipedia.org/wiki/Ford_Insomnia_Response_to_Stress_Test "Ford Insomnia Response to Stress Test")
In medicine, insomnia is measured using the [Athens Insomnia Scale](https://en.wikipedia.org/wiki/Athens_Insomnia_Scale "Athens Insomnia Scale") (AIS).[\[83\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-83) It measures eight parameters related to sleep, represented as an overall scale which assesses an individual's sleep quality. It has excellent internal consistency and re-test reliability.[\[84\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-84) The Athens Insomnia Scale for Non-Clinical Populations (AIS-NCA) has been developed and validated in English,[\[85\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Sattler-2023-85) Chinese,[\[86\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-86) and German[\[85\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Sattler-2023-85) to identify subclinical manifestations of insomnia in a language simpler than the Athens Insomnia Scale and more suitable for self-report. It uses four items to assess sleep problems and three items to assess impaired daytime functioning.
A medical history and a physical examination can identify other conditions that could be the cause of insomnia. A comprehensive sleep history should include sleep habits and sleep environment, medications (prescription and non-prescription, including supplements), alcohol, nicotine, and caffeine intake, and co-morbid illnesses.[\[87\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Passarella,_S_2008-87) A [sleep diary](https://en.wikipedia.org/wiki/Sleep_diary "Sleep diary") can be used to track time to bed, total sleep time, time to sleep onset, number of awakenings, use of medications, time of awakening, and subjective feelings in the morning.[\[87\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Passarella,_S_2008-87) The sleep diary can be replaced or validated by the use of out-patient [actigraphy](https://en.wikipedia.org/wiki/Actigraphy "Actigraphy") for a week or more, using a non-invasive device that measures movement.[\[88\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Schutte-Rodin-88)
Not everyone who suffers from insomnia should routinely have a [polysomnography](https://en.wikipedia.org/wiki/Polysomnography "Polysomnography") study to screen for sleep disorders,[\[89\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-ACOEMfive-89) but it may be indicated for those with risk factors for [sleep apnea](https://en.wikipedia.org/wiki/Sleep_apnea "Sleep apnea"), including obesity, a thick neck diameter, or fullness of the flesh in the [oropharynx](https://en.wikipedia.org/wiki/Oropharynx "Oropharynx").[\[89\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-ACOEMfive-89) For most people, the test is not needed to make a diagnosis, and insomnia can often be treated by changing their schedule to make time for sufficient sleep and by improving [sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene").[\[89\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-ACOEMfive-89)
Some patients may need an overnight sleep study in a sleep lab. Such a study will commonly involve assessment tools including a polysomnogram and the [multiple sleep latency test](https://en.wikipedia.org/wiki/Multiple_sleep_latency_test "Multiple sleep latency test"). Specialists in [sleep medicine](https://en.wikipedia.org/wiki/Sleep_medicine "Sleep medicine") are qualified to diagnose disorders according to the [ICSD](https://en.wikipedia.org/wiki/International_Classification_of_Sleep_Disorders "International Classification of Sleep Disorders"), 81 major sleep disorder diagnostic categories.[\[90\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-90) Patients with some disorders, including [delayed sleep phase disorder](https://en.wikipedia.org/wiki/Delayed_sleep_phase_disorder "Delayed sleep phase disorder"), are often misdiagnosed with primary insomnia; when a person has trouble getting to sleep and awakening at desired times, but has a normal sleep pattern once asleep, a circadian rhythm disorder is a likely cause.
In many cases, insomnia is co-morbid with another disease, side effects from medications, or a psychological problem. Approximately half of all diagnosed insomnia is related to psychiatric disorders.[\[91\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Wilson-91) For those who have depression, "insomnia should be regarded as a co-morbid condition, rather than as a secondary one;" insomnia typically predates psychiatric symptoms.[\[91\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Wilson-91) "In fact, it is possible that insomnia represents a significant risk for the development of a subsequent psychiatric disorder."[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9) Insomnia occurs in between 60% and 80% of people with depression and can be a side effect of medications that treat depression.[\[92\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Luca2013-92)
The determination of causation is not necessary for a diagnosis.[\[91\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Wilson-91)
### DSM-5 criteria
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=15 "Edit section: DSM-5 criteria")\]
The [DSM-5](https://en.wikipedia.org/wiki/DSM-5 "DSM-5") criteria for insomnia include the following:[\[93\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-93)
"Predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms":
- Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention.)
- Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.)
- Early-morning awakening with inability to return to sleep.
In addition:
- The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
- The sleep difficulty occurs at least three nights per week.
- The sleep difficulty has been present for at least three months.
- The sleep difficulty occurs despite adequate opportunity for sleep.
- The insomnia is not better explained by and does not occur exclusively during another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia).
- The insomnia is not attributable to the physiological effects of a substance (e.g., a [drug of abuse](https://en.wikipedia.org/wiki/Drug_of_abuse "Drug of abuse"), a medication)."
The [DSM-IV TR](https://en.wikipedia.org/wiki/DSM-IV_TR "DSM-IV TR") includes insomnia but does not fully elaborate on the symptoms compared to the DSM-5. Instead of early-morning waking as a symptom, the DSM-IV-TR listed "[nonrestorative sleep](https://en.wikipedia.org/wiki/Nonrestorative_sleep "Nonrestorative sleep")" as a primary symptom. The duration of the experience was also vague in the DSM-IV-TR. The DSM-IV-TR stated that symptoms had to be present for a month, whereas the DSM-5 states that symptoms must be present for three months and occur at least three nights a week (Gillette).
### Types
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=16 "Edit section: Types")\]
Insomnia can be classified as transient, acute, or chronic.
- *Transient insomnia* lasts for less than a week. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe [depression](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder"), or by [stress](https://en.wikipedia.org/wiki/Stress_\(biology\) "Stress (biology)"). Its consequences – sleepiness and impaired psychomotor performance – are similar to those of [sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation").[\[94\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Roth-94)
- *[Acute](https://en.wikipedia.org/wiki/Acute_\(medicine\) "Acute (medicine)") insomnia* is the inability to consistently sleep well for less than a month. Insomnia is present when there is difficulty initiating or maintaining sleep or when the sleep that is obtained is [non-refreshing](https://en.wikipedia.org/wiki/Non-restorative_sleep "Non-restorative sleep") or of poor quality. These problems occur despite adequate opportunity and circumstances for sleep, and they must result in problems with daytime function.[\[95\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-95) Hyperarousal can be linked to acute insomnia since it activates the body's fight-or-flight response. When we encounter stress or danger, our bodies naturally become more alert, which can interfere with our capacity to both fall asleep and remain asleep. This heightened state of arousal can be useful in the short term during threatening situations, but if it continues over an extended period, it can result in acute insomnia.[\[96\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Acute_and_Chronic_Insomnia:_What_Ha-96) Acute insomnia is also known as *short term insomnia* or *stress related insomnia*.[\[97\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-r1-97)
- *[Chronic](https://en.wikipedia.org/wiki/Chronic_\(medical\) "Chronic (medical)") insomnia* lasts for longer than a month. It can be caused by another disorder, or it can be a primary disorder. Common causes of chronic insomnia include persistent stress, trauma, work schedules, poor sleep habits, medications, and other mental health disorders.[\[98\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-98) When an individual consistently engages in behaviors that disrupt their sleep, such as irregular sleep schedules, spending excessive time awake in bed, or engaging in stimulating activities close to bedtime, it can lead to conditioned wakefulness contributing to chronic insomnia.[\[96\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Acute_and_Chronic_Insomnia:_What_Ha-96) People with high levels of stress hormones or shifts in the levels of [cytokines](https://en.wikipedia.org/wiki/Cytokine "Cytokine") are more likely than others to have chronic insomnia.[\[99\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-99) Its effects can vary according to its causes. They might include muscular weariness, [hallucinations](https://en.wikipedia.org/wiki/Hallucination "Hallucination"), and/or [mental fatigue](https://en.wikipedia.org/wiki/Mental_fatigue "Mental fatigue").[\[94\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Roth-94)
## Prevention
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=17 "Edit section: Prevention")\]
Prevention and treatment of insomnia may require a combination of [cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy"),[\[13\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Tra2015-13) medications,[\[100\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-abad-100) and lifestyle changes.[\[101\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-mayo-101)
Among lifestyle practices, going to sleep and waking up at the same time each day can create a steady pattern which may help to prevent insomnia.[\[11\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Pun2012-11) Avoidance of vigorous [exercise](https://en.wikipedia.org/wiki/Physical_exercise "Physical exercise") and [caffeinated drinks](https://en.wikipedia.org/wiki/Caffeine "Caffeine") a few hours before going to sleep is recommended, while exercise earlier in the day may be beneficial.[\[101\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-mayo-101) Other practices to improve [sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene") may include:[\[101\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-mayo-101)[\[102\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-102)
- Avoiding or limiting [naps](https://en.wikipedia.org/wiki/Nap "Nap")
- Treating pain at bedtime
- Avoiding large meals, beverages, [alcohol](https://en.wikipedia.org/wiki/Alcohol_\(drug\) "Alcohol (drug)"), and [nicotine](https://en.wikipedia.org/wiki/Nicotine "Nicotine") before bedtime
- Finding soothing ways to relax into sleep, including the use of [white noise](https://en.wikipedia.org/wiki/White_noise "White noise")
- Making the bedroom suitable for sleep by keeping it dark, cool, and free of devices, such as clocks, cell phones, or televisions
- Maintain regular exercise
- Try relaxing activities before sleeping
## Management
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=18 "Edit section: Management")\]
It is recommended to rule out medical and psychological causes before deciding on the treatment for insomnia.[\[103\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-103) [Cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") is an effective first-line treatment for chronic insomnia.[\[104\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-104)[\[13\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Tra2015-13) The beneficial effects, in contrast to those produced by medications, may last well beyond the stopping of therapy.[\[105\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-105)
Medications have been used mainly to reduce symptoms in insomnia of short duration; their role in the management of chronic insomnia remains unclear.[\[8\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-WHO2009-8) Several different types of medications may be used.[\[106\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-106)[\[107\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-107)[\[100\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-abad-100) Many doctors do not recommend relying on prescription sleeping pills for long-term use.[\[101\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-mayo-101) These medications are not recommended for more than four or five weeks, although they can be used longer in certain instances.[\[6\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-AC2016-6)[\[15\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-riemann-23-15) It is also important to identify and treat other medical conditions that may be contributing to insomnia, such as depression, breathing problems, and chronic pain.[\[101\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-mayo-101)[\[108\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-insomnia_JAMA-108) As of 2022, many people with insomnia were reported as not receiving overall sufficient sleep or treatment for insomnia.[\[109\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-109)[\[110\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-110)
### Non-medication based
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=19 "Edit section: Non-medication based")\]
Non-medication-based strategies have comparable efficacy to [hypnotic](https://en.wikipedia.org/wiki/Hypnotic "Hypnotic") medication for insomnia, and they may have longer-lasting effects. Hypnotic medication is only recommended for short-term use because [dependence](https://en.wikipedia.org/wiki/Substance_dependence "Substance dependence") with [rebound withdrawal effects](https://en.wikipedia.org/wiki/Rebound_withdrawal_effects "Rebound withdrawal effects") upon discontinuation or [tolerance](https://en.wikipedia.org/wiki/Drug_tolerance "Drug tolerance") can develop.[\[111\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-111)
Non-medication-based strategies provide long-lasting improvements to insomnia and are recommended as a first-line and long-term strategy of management. Behavioral sleep medicine offers non-medication strategies to address chronic insomnia including [sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene"), [stimulus control](https://en.wikipedia.org/wiki/Stimulus_control "Stimulus control"), behavioral interventions, [sleep-restriction therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_for_insomnia#Sleep_restriction_therapy "Cognitive behavioral therapy for insomnia"), [paradoxical intention](https://en.wikipedia.org/wiki/Paradoxical_intention "Paradoxical intention"), patient education, and [relaxation therapy](https://en.wikipedia.org/wiki/Relaxation_technique "Relaxation technique").[\[112\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-112) Some examples are keeping a journal, restricting the time spent awake in bed, practicing [relaxation techniques](https://en.wikipedia.org/wiki/Relaxation_technique "Relaxation technique"), and maintaining a regular sleep schedule and a wake-up time. Behavioral therapy can assist a patient in developing new sleep behaviors to improve sleep quality and consolidation. Behavioral therapy may include learning healthy sleep habits to promote sleep relaxation, undergoing light therapy to regulate the [circadian rhythm](https://en.wikipedia.org/wiki/Circadian_rhythm "Circadian rhythm"), and regulating the circadian clock.[\[108\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-insomnia_JAMA-108)
Music may improve insomnia in adults (see [music and sleep](https://en.wikipedia.org/wiki/Music_and_sleep "Music and sleep")).[\[113\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-113) [EEG biofeedback](https://en.wikipedia.org/wiki/EEG_biofeedback "EEG biofeedback") has demonstrated effectiveness in the treatment of insomnia with improvements in duration as well as the quality of sleep.[\[114\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-114) Self-help therapy (defined as a psychological therapy that can be worked through on one's own) may improve sleep quality for adults with insomnia to a small or moderate degree.[\[115\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-115)
Stimulus control therapy is a treatment for patients who have conditioned themselves to associate the bed or sleep in general with a negative response. As stimulus control therapy involves taking steps to control the sleep environment, it is sometimes referred to interchangeably with the concept of [sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene"). Examples of such environmental modifications include using the bed for sleep and sex only, not for activities such as reading or watching television; waking up at the same time every morning, including on weekends; going to bed only when sleepy and when there is a high likelihood that sleep will occur; leaving the bed and beginning an activity in another location if sleep does not occur in a reasonably brief period after getting into bed (commonly ~20 min); reducing the subjective effort and energy expended trying to fall asleep; avoiding exposure to bright light during night-time hours, and eliminating daytime naps.[\[116\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-116)
A component of stimulus control therapy is sleep restriction, a technique that aims to match the time spent in bed with the actual time spent asleep. This technique involves maintaining a strict sleep-wake schedule, sleeping only at certain times of the day and for specific amounts of time to induce mild sleep deprivation. Complete treatment usually lasts up to 3 weeks and involves making oneself sleep for only a minimum amount of time that they are actually capable of on average, and then, if capable (i.e. when [sleep efficiency](https://en.wikipedia.org/wiki/Polysomnography#Interpretation "Polysomnography") improves), slowly increasing this amount (~15 min) by going to bed earlier as the body attempts to reset its internal sleep clock. [Bright light therapy](https://en.wikipedia.org/wiki/Bright_light_therapy "Bright light therapy") may be effective for insomnia.[\[117\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-117)
Paradoxical intention is a cognitive reframing technique where the insomniac, instead of attempting to fall asleep at night, makes every effort to stay awake (i.e., essentially stops trying to fall asleep). One theory that may explain the effectiveness of this method is that by not voluntarily making oneself go to sleep, it relieves the performance anxiety that arises from the need or requirement to fall asleep, which is meant to be a passive act. This technique has been shown to reduce sleep effort and performance anxiety and also lower subjective assessment of sleep-onset latency and overestimation of the sleep deficit (a quality found in many insomniacs).[\[118\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-118)
#### Sleep Hygiene
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=20 "Edit section: Sleep Hygiene")\]
[Sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene") is a common term for all of the behaviors that relate to the promotion of good sleep. They include habits that provide a good foundation for sleep and help to prevent insomnia. However, sleep hygiene alone may not be adequate to address chronic insomnia. Sleep hygiene recommendations are typically included as one component of [cognitive behavioral therapy for insomnia](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_for_insomnia "Cognitive behavioral therapy for insomnia") (CBT-I).[\[88\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Schutte-Rodin-88)[\[6\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-AC2016-6) Recommendations include reducing caffeine, nicotine, and alcohol consumption, maximizing the regularity and efficiency of sleep episodes, minimizing medication usage and daytime napping, the promotion of regular exercise, and the facilitation of a positive sleep environment.[\[119\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Ellis_2002-119) The creation of a positive sleep environment may also help reduce the symptoms of insomnia.[\[120\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Insomnia-120) On the other hand, a systematic review by the AASM concluded that clinicians should not prescribe sleep hygiene for insomnia due to the evidence of absence of its efficacy and potential delaying of adequate treatment, recommending instead that effective therapies such as CBT-i should be preferred.[\[14\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Behavioral_and_psychological_treatm-14)
#### Cognitive behavioral therapy
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=21 "Edit section: Cognitive behavioral therapy")\]
Main article: [Cognitive behavioral therapy for insomnia](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_for_insomnia "Cognitive behavioral therapy for insomnia")
There is some evidence that cognitive behavioral therapy for insomnia (CBT-I) is superior not only in the long-term, but also in the short-term (2 months) to [benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepine "Benzodiazepine") and the [nonbenzodiazepines](https://en.wikipedia.org/wiki/Nonbenzodiazepine "Nonbenzodiazepine") in the treatment and management of insomnia.[\[121\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-121)[\[122\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Mitchell-2012-122) In this therapy, patients are taught improved sleep habits and relieved of counter-productive assumptions about sleep. Common misconceptions and expectations that can be modified include:\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
- Unrealistic sleep expectations.
- Misconceptions about insomnia causes.
- Amplifying the consequences of insomnia.
- Performance anxiety after trying for so long to have a good night's sleep by controlling the sleep process.
Numerous studies have reported positive outcomes of combining cognitive behavioral therapy for insomnia treatment with treatments such as stimulus control and relaxation therapies. [Hypnotic](https://en.wikipedia.org/wiki/Hypnotic "Hypnotic") medications are equally effective in the short-term treatment of insomnia, but their effects wear off over time due to [tolerance](https://en.wikipedia.org/wiki/Drug_tolerance "Drug tolerance"). The effects of [CBT-I](https://en.wikipedia.org/wiki/CBT-I "CBT-I") have sustained and lasting effects on treating insomnia long after therapy has been discontinued.[\[123\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-JacobsG2004Cognitive-123)[\[124\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-124) The addition of hypnotic medications with CBT-I adds no benefit in insomnia. The long-lasting benefits of a course of CBT-I shows superiority over pharmacological hypnotic drugs. Even in the short term, when compared to short-term hypnotic medication such as zolpidem, CBT-I still shows significant superiority. Thus, CBT-I is recommended as a first-line treatment for insomnia.[\[125\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-125)
Common forms of CBT-I treatments include stimulus control therapy, sleep restriction, sleep hygiene, improved sleeping environments, relaxation training, paradoxical intention, and biofeedback.[\[126\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-126) Sleep restriction (also called "time-in-bed restriction"), stimulus control and cognitive restructuring are key components.[\[127\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-127)
CBT is a well-accepted form of therapy for insomnia since it has no known adverse effects, whereas taking medications to alleviate insomnia symptoms has been shown to have adverse side effects.[\[128\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-128) Nevertheless, the downside of CBT is that it may take a lot of time and motivation.[\[129\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-129)
#### Acceptance and commitment therapy
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=22 "Edit section: Acceptance and commitment therapy")\]
Treatments based on the principles of [acceptance and commitment therapy](https://en.wikipedia.org/wiki/Acceptance_and_commitment_therapy "Acceptance and commitment therapy") (ACT) and [metacognition](https://en.wikipedia.org/wiki/Metacognition "Metacognition") have emerged as alternative approaches to treating insomnia.[\[130\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-130) ACT rejects the idea that behavioral changes can help insomniacs achieve better sleep since they require "sleep efforts" - actions which create more "struggle" and arouse the nervous system, leading to [hyperarousal](https://en.wikipedia.org/wiki/Hyperarousal "Hyperarousal").[\[131\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-meadows-131) The ACT approach posits that acceptance of the negative feelings associated with insomnia can, in time, create the right conditions for sleep. [Mindfulness](https://en.wikipedia.org/wiki/Mindfulness "Mindfulness") practice is a key feature of this approach, although mindfulness is not practiced to induce sleep (this in itself is a *sleep effort* to be avoided) but rather as a longer-term activity to help calm the nervous system and create the internal conditions from which sleep can emerge.
A key distinction between CBT-I and ACT lies in the divergent approaches to time spent awake in bed. Proponents of CBT-i advocate minimizing time spent awake in bed, on the basis that this creates a cognitive association between being in bed and wakefulness. The ACT approach proposes that avoiding time in bed may increase the pressure to sleep and arouse the nervous system further.[\[131\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-meadows-131)
Research has shown that "ACT has a significant effect on primary and comorbid insomnia and sleep quality, and ... can be used as an appropriate treatment method to control and improve insomnia".[\[132\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Salari_2020-132)
#### Internet Interventions
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=23 "Edit section: Internet Interventions")\]
Despite the therapeutic effectiveness and proven success of CBT, treatment availability is significantly limited by a lack of trained clinicians, poor geographical distribution of knowledgeable professionals, and expense.[\[133\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-133) One way to potentially overcome these barriers is to use the Internet to deliver treatment, making this effective intervention more accessible and less costly. The Internet has already become a critical source of health care and medical information.[\[134\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pewinternet.org-134) Although the vast majority of health websites provide general information,[\[134\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pewinternet.org-134)[\[135\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-135) there is growing research literature on the development and evaluation of Internet interventions.[\[136\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-136)[\[137\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-ritter-137)
These online programs are typically behaviorally based treatments that have been operationalized and transformed for delivery via the Internet. They are usually highly structured, automated, or human-supported, based on effective face-to-face treatment; personalized to the user; interactive; enhanced by graphics, animations, audio, and possibly video; and tailored to provide follow-up and feedback.[\[137\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-ritter-137)
There is good evidence for the use of computer-based CBT for insomnia.[\[138\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-138)
### Medications
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=24 "Edit section: Medications")\]
See also: [Hypnotic](https://en.wikipedia.org/wiki/Hypnotic "Hypnotic") and [List of investigational insomnia drugs](https://en.wikipedia.org/wiki/List_of_investigational_insomnia_drugs "List of investigational insomnia drugs")
Many people with insomnia use [sleeping tablets](https://en.wikipedia.org/wiki/Sleeping_tablet "Sleeping tablet") and other [sedatives](https://en.wikipedia.org/wiki/Sedative "Sedative"). In some places, medications are prescribed in over 95% of cases.[\[139\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-139) They, however, are a second line treatment.[\[140\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-140) In 2019, the US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") stated it is going to require warnings for [eszopiclone](https://en.wikipedia.org/wiki/Eszopiclone "Eszopiclone"), [zaleplon](https://en.wikipedia.org/wiki/Zaleplon "Zaleplon"), and [zolpidem](https://en.wikipedia.org/wiki/Zolpidem "Zolpidem"), due to concerns about serious injuries resulting from abnormal sleep behaviors, including [sleepwalking](https://en.wikipedia.org/wiki/Sleepwalking "Sleepwalking") or driving a vehicle while asleep.[\[141\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-141)
The percentage of adults using a prescription sleep aid increases with age. During 2005–2010, about 4% of U.S. adults aged 20 and over reported that they took prescription sleep aids in the past 30 days. Rates of use were lowest among the youngest age group (those aged 20–39) at about 2%, increased to 6% among those aged 50–59, and reached 7% among those aged 80 and over. More adult women (5%) reported using prescription sleep aids than adult men (3%). Non-Hispanic white adults reported higher use of sleep aids (5%) than non-Hispanic black (3%) and Mexican-American (2%) adults. No difference was shown between non-Hispanic black adults and Mexican-American adults in use of prescription sleep aids.[\[142\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid24152538-142)
#### Antihistamines
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=25 "Edit section: Antihistamines")\]
As an alternative to taking prescription drugs, some evidence shows that an average person seeking short-term help may find relief by taking [over-the-counter](https://en.wikipedia.org/wiki/Over-the-counter "Over-the-counter") [antihistamines](https://en.wikipedia.org/wiki/Antihistamines "Antihistamines") such as [diphenhydramine](https://en.wikipedia.org/wiki/Diphenhydramine "Diphenhydramine") or [doxylamine](https://en.wikipedia.org/wiki/Doxylamine "Doxylamine").[\[143\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-BBDinsomnia-2-143) Diphenhydramine and doxylamine are widely used in nonprescription sleep aids. They are the most effective over-the-counter sedatives currently available, at least in much of Europe, Canada, Australia, and the United States, and are more sedating than some prescription [hypnotics](https://en.wikipedia.org/wiki/Hypnotic "Hypnotic").[\[144\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-drugbankDB00366-144) Antihistamine effectiveness for sleep may decrease over time, and [anticholinergic](https://en.wikipedia.org/wiki/Anticholinergic "Anticholinergic") side-effects (such as dry mouth) may also be a drawback with these particular drugs. While addiction does not seem to be an issue with this class of drugs, they can induce dependence and rebound effects upon abrupt cessation of use.[\[145\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-145) However, people whose insomnia is caused by restless legs syndrome may have worsened symptoms with antihistamines.[\[146\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-146)
#### Antidepressants
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=26 "Edit section: Antidepressants")\]
While insomnia is a common symptom of depression, [antidepressants](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant") are effective for treating sleep problems whether or not they are associated with depression. While all antidepressants help regulate sleep, some antidepressants, such as [amitriptyline](https://en.wikipedia.org/wiki/Amitriptyline "Amitriptyline"), [doxepin](https://en.wikipedia.org/wiki/Doxepin "Doxepin"), [mirtazapine](https://en.wikipedia.org/wiki/Mirtazapine "Mirtazapine"), [trazodone](https://en.wikipedia.org/wiki/Trazodone "Trazodone"), and [trimipramine](https://en.wikipedia.org/wiki/Trimipramine "Trimipramine"), can have an immediate sedative effect and are prescribed to treat insomnia.[\[147\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-147) Trazodone was at the beginning of the 2020s the most prescribed drug for sleep in the United States despite not being indicated for sleep.[\[148\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Dunleavy-148)
Amitriptyline, doxepin, and trimipramine all have [antihistaminergic](https://en.wikipedia.org/wiki/Antihistaminergic "Antihistaminergic"), [anticholinergic](https://en.wikipedia.org/wiki/Anticholinergic "Anticholinergic"), [antiadrenergic](https://en.wikipedia.org/wiki/Antiadrenergic "Antiadrenergic"), and [antiserotonergic](https://en.wikipedia.org/wiki/Antiserotonergic "Antiserotonergic") properties, which contribute to both their therapeutic effects and side effect profiles, while mirtazapine's actions are primarily antihistaminergic and antiserotonergic and trazodone's effects are primarily antiadrenergic and antiserotonergic. Mirtazapine is known to decrease sleep latency (i.e., the time it takes to fall asleep), promoting sleep efficiency and increasing the total amount of sleeping time in people with both depression and insomnia.[\[149\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-149)[\[150\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-150)
[Agomelatine](https://en.wikipedia.org/wiki/Agomelatine "Agomelatine"), a melatonergic antidepressant with claimed sleep-improving qualities that does not cause daytime drowsiness,[\[151\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-151) is approved for the treatment of depression though not sleep conditions in the European Union[\[152\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-emea-152) and [Australia](https://en.wikipedia.org/wiki/Australia "Australia").[\[153\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-PI-153) After trials in the United States, its development for use there was discontinued in October 2011[\[154\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-154) by [Novartis](https://en.wikipedia.org/wiki/Novartis "Novartis"), who had bought the rights to market it there from the European pharmaceutical company [Servier](https://en.wikipedia.org/wiki/Servier "Servier").[\[155\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Bentham-155)
A 2018 [Cochrane review](https://en.wikipedia.org/wiki/Cochrane_review "Cochrane review") found the safety of taking antidepressants for insomnia to be uncertain with no evidence supporting long term use.[\[156\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-156)
#### Melatonin agonists
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=27 "Edit section: Melatonin agonists")\]
[Melatonin receptor agonists](https://en.wikipedia.org/wiki/Melatonin_receptor_agonist "Melatonin receptor agonist") such as [melatonin](https://en.wikipedia.org/wiki/Melatonin_\(medication\) "Melatonin (medication)") and [ramelteon](https://en.wikipedia.org/wiki/Ramelteon "Ramelteon") are used in the treatment of insomnia. [Prolonged-release melatonin](https://en.wikipedia.org/wiki/Melatonin_as_a_medication_and_supplement "Melatonin as a medication and supplement") improves insomnia mainly in adults ≥55, and ramelteon improves sleep generally, with both effective versus placebo but less effective than most licensed insomnia drugs and showing limited long-term benefits.[\[16\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid35843245-16)[\[157\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-157)[\[158\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-158)[\[159\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-159)
The usage of melatonin as a treatment for insomnia in adults has increased from 0.4% between 1999 and 2000 to nearly 2.1% between 2017 and 2018.[\[160\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-160)
While the use of melatonin in the short term has been proven to be generally safe and is shown not to be a dependent medication, side effects can still occur.[\[161\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Pros_and_cons_of_melatonin-161)
Most common side effects of melatonin include:[\[161\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Pros_and_cons_of_melatonin-161)
- Headache
- Dizziness
- Nausea
- Daytime drowsiness
Studies have also shown that children who have an [autism spectrum disorder](https://en.wikipedia.org/wiki/Autism_spectrum_disorder "Autism spectrum disorder") or a learning disability, such as [attention-deficit hyperactivity disorder](https://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorder "Attention-deficit hyperactivity disorder") (ADHD) or related [neurological](https://en.wikipedia.org/wiki/Neurological "Neurological") diseases, can benefit from the use of melatonin. This is because they often have trouble sleeping due to their disorders. For example, children with ADHD tend to have trouble falling asleep because of their [hyperactivity](https://en.wikipedia.org/wiki/Hyperactivity "Hyperactivity") and, as a result, tend to be tired during most of the day. Another cause of insomnia in children with ADHD is the use of stimulants to treat their disorder. Children who have ADHD, as well as the other disorders mentioned, may be given melatonin before bedtime to help them sleep.[\[162\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-162)
#### Benzodiazepines
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=28 "Edit section: Benzodiazepines")\]
[](https://en.wikipedia.org/wiki/File:Normison.jpg)
Normison ([temazepam](https://en.wikipedia.org/wiki/Temazepam "Temazepam")) is a [benzodiazepine](https://en.wikipedia.org/wiki/Benzodiazepine "Benzodiazepine") commonly prescribed for insomnia and other [sleep disorders](https://en.wikipedia.org/wiki/Sleep_disorders "Sleep disorders").[\[163\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-163)
The most commonly used class of hypnotics for insomnia are the [benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepine "Benzodiazepine").[\[52\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Psych4th-52): 363 Benzodiazepines are [not significantly](https://en.wikipedia.org/wiki/Statistical_significance "Statistical significance") better for insomnia than [antidepressants](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant").[\[164\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid17619935-164) Chronic users of [hypnotic](https://en.wikipedia.org/wiki/Hypnotic "Hypnotic") medications for insomnia do not have better sleep than chronic insomniacs not taking medications. In fact, chronic users of hypnotic medications have more regular night-time awakenings than insomniacs not taking hypnotic medications.[\[165\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-165) Many have concluded that these drugs cause an unjustifiable risk to the individual and to [public health](https://en.wikipedia.org/wiki/Public_health "Public health") and lack evidence of long-term effectiveness. It is preferred that hypnotics be prescribed for only a few days at the lowest effective dose and avoided altogether wherever possible, especially in the elderly.[\[166\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-166) Between 1993 and 2010, the prescribing of benzodiazepines to individuals with sleep disorders has decreased from 24% to 11% in the US, coinciding with the first release of [nonbenzodiazepines](https://en.wikipedia.org/wiki/Nonbenzodiazepine "Nonbenzodiazepine").[\[167\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Kaufmann-167)
The [benzodiazepine](https://en.wikipedia.org/wiki/Benzodiazepine "Benzodiazepine") and [nonbenzodiazepine](https://en.wikipedia.org/wiki/Nonbenzodiazepine "Nonbenzodiazepine") [hypnotic](https://en.wikipedia.org/wiki/Hypnotic "Hypnotic") medications also have several side effects, such as daytime fatigue, motor vehicle crashes and other accidents, cognitive impairments, and falls and fractures. Elderly people are more sensitive to these side effects.[\[168\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-168) Some benzodiazepines have demonstrated effectiveness in sleep maintenance in the short term but in the longer term benzodiazepines can lead to [tolerance](https://en.wikipedia.org/wiki/Drug_tolerance "Drug tolerance"), [physical dependence](https://en.wikipedia.org/wiki/Physical_dependence "Physical dependence"), [benzodiazepine withdrawal syndrome](https://en.wikipedia.org/wiki/Benzodiazepine_withdrawal_syndrome "Benzodiazepine withdrawal syndrome") upon discontinuation, and long-term worsening of sleep, especially after consistent usage over long periods. Benzodiazepines, while inducing unconsciousness, actually worsen sleep as – like alcohol – they promote light sleep while decreasing time spent in deep sleep.[\[169\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-169) A further problem is, with regular use of short-acting sleep aids for insomnia, daytime [rebound anxiety](https://en.wikipedia.org/wiki/Rebound_anxiety "Rebound anxiety") can emerge.[\[170\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-170) Although there is little evidence for benefit of benzodiazepines in insomnia compared to other treatments and evidence of major harm, prescriptions have continued to increase.[\[171\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-handbook_of_integrative-171) This is likely due to their addictive nature, both due to misuse and because – through their rapid action, tolerance and withdrawal they can "trick" insomniacs into thinking they are helping with sleep. There is a general awareness that long-term use of benzodiazepines for insomnia in most people is inappropriate and that a gradual withdrawal is usually beneficial due to the adverse effects associated with the [long-term use of benzodiazepines](https://en.wikipedia.org/wiki/Long-term_use_of_benzodiazepines "Long-term use of benzodiazepines") and is recommended whenever possible.[\[172\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-172)[\[173\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Authier--173)
Benzodiazepines all bind unselectively to the [GABAA receptor](https://en.wikipedia.org/wiki/GABAA_receptor "GABAA receptor").[\[164\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid17619935-164) Some theorize that certain benzodiazepines (hypnotic benzodiazepines) have significantly higher activity at the α1 subunit of the GABAA receptor compared to other benzodiazepines (for example, triazolam and temazepam have significantly higher activity at the α1 subunit compared to alprazolam and diazepam, making them superior sedative-hypnotics – alprazolam and diazepam, in turn, have higher activity at the α2 subunit compared to triazolam and temazepam, making them superior anxiolytic agents). Modulation of the α1 subunit is associated with sedation, motor impairment, respiratory depression, amnesia, ataxia, and reinforcing behavior (drug-seeking behavior). Modulation of the α2 subunit is associated with anxiolytic activity and disinhibition. For this reason, certain benzodiazepines may be better suited to treat insomnia than others.[\[120\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Insomnia-120)
#### Z-Drugs
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=29 "Edit section: Z-Drugs")\]
[Nonbenzodiazepine](https://en.wikipedia.org/wiki/Nonbenzodiazepine "Nonbenzodiazepine") or [Z-drug](https://en.wikipedia.org/wiki/Z-drug "Z-drug") sedative–hypnotic drugs, such as [zolpidem](https://en.wikipedia.org/wiki/Zolpidem "Zolpidem"), [zaleplon](https://en.wikipedia.org/wiki/Zaleplon "Zaleplon"), [zopiclone](https://en.wikipedia.org/wiki/Zopiclone "Zopiclone"), and [eszopiclone](https://en.wikipedia.org/wiki/Eszopiclone "Eszopiclone"), are a class of hypnotic medications that are similar to benzodiazepines in their mechanism of action, and indicated for mild to moderate insomnia. Their effectiveness at improving time to sleeping is slight, and they have similar—though potentially less severe—side effect profiles compared to benzodiazepines.[\[174\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-174) Prescribing of nonbenzodiazepines has seen a general increase since their initial release on the US market in 1992, from 2.3% in 1993 among individuals with sleep disorders to 13.7% in 2010.[\[167\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Kaufmann-167)
#### Orexin antagonists
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=30 "Edit section: Orexin antagonists")\]
[Orexin receptor antagonists](https://en.wikipedia.org/wiki/Orexin_receptor_antagonist "Orexin receptor antagonist") are a more recently introduced class of sleep medications and include [suvorexant](https://en.wikipedia.org/wiki/Suvorexant "Suvorexant"), [lemborexant](https://en.wikipedia.org/wiki/Lemborexant "Lemborexant"), and [daridorexant](https://en.wikipedia.org/wiki/Daridorexant "Daridorexant"), all of which are FDA-approved for treatment of insomnia characterized by difficulties with [sleep onset](https://en.wikipedia.org/wiki/Sleep_onset "Sleep onset") and/or sleep maintenance.[\[175\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid35043499-175)[\[176\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-prescribing_info-176) They are oriented towards blocking signals in the brain that stimulate wakefulness, therefore claiming to address insomnia without creating dependence. There are three [dual orexin receptor (DORA)](https://en.wikipedia.org/wiki/Orexin_antagonist "Orexin antagonist") drugs on the market: [Belsomra](https://en.wikipedia.org/wiki/Suvorexant "Suvorexant") ([Merck](https://en.wikipedia.org/wiki/Merck_%26_Co. "Merck & Co.")), [Dayvigo](https://en.wikipedia.org/wiki/Lemborexant "Lemborexant") ([Eisai](https://en.wikipedia.org/wiki/Eisai_\(company\) "Eisai (company)")) and [Quviviq](https://en.wikipedia.org/wiki/Daridorexant "Daridorexant") ([Idorsia](https://en.wikipedia.org/wiki/Idorsia "Idorsia")).[\[148\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Dunleavy-148)
#### Antipsychotics
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=31 "Edit section: Antipsychotics")\]
Certain [atypical antipsychotics](https://en.wikipedia.org/wiki/Atypical_antipsychotic "Atypical antipsychotic"), particularly [quetiapine](https://en.wikipedia.org/wiki/Quetiapine "Quetiapine"), [olanzapine](https://en.wikipedia.org/wiki/Olanzapine "Olanzapine"), and [risperidone](https://en.wikipedia.org/wiki/Risperidone "Risperidone"), are used in the treatment of insomnia.[\[177\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid27544830-177)[\[178\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Morin2014-178) However, while common, the use of antipsychotics for this indication is not recommended as the evidence does not demonstrate a benefit, and the risk of adverse effects is significant.[\[177\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid27544830-177)[\[179\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-179)[\[180\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-180)[\[181\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Off-Label_Use-181) A major 2022 systematic review and network meta-analysis of medications for insomnia in adults found that quetiapine did not demonstrate any short-term benefits for insomnia.[\[16\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid35843245-16) Some of the more serious adverse effects may also occur at the low doses used, such as [dyslipidemia](https://en.wikipedia.org/wiki/Dyslipidemia "Dyslipidemia") and [neutropenia](https://en.wikipedia.org/wiki/Neutropenia "Neutropenia").[\[182\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-182)[\[183\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-183) Such concerns of risks at low doses are supported by Danish observational studies that showed an association of use of low-dose quetiapine (excluding prescriptions filled for tablet strengths \>50 mg) with an increased risk of major cardiovascular events as compared to use of [Z-drugs](https://en.wikipedia.org/wiki/Z-drugs "Z-drugs"), with most of the risk being driven by cardiovascular death.[\[184\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-184) Laboratory data from an unpublished analysis of the same cohort also support the lack of dose-dependency of metabolic side effects, as new use of low-dose quetiapine was associated with a risk of increased fasting triglycerides at one-year follow-up.[\[185\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-185) Concerns regarding side effects are greater in the elderly.[\[186\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Conn_271%E2%80%93287-186)
#### Other sedatives
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=32 "Edit section: Other sedatives")\]
[Gabapentinoids](https://en.wikipedia.org/wiki/Gabapentinoid "Gabapentinoid") like [gabapentin](https://en.wikipedia.org/wiki/Gabapentin "Gabapentin") and [pregabalin](https://en.wikipedia.org/wiki/Pregabalin "Pregabalin") have sleep-promoting effects, but are not commonly used for the treatment of insomnia.[\[187\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid29487083-187) Gabapentin is not effective in helping alcohol related insomnia.[\[188\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIHR_Evidence_2022-188)[\[189\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Hong_2022-189)
[Barbiturates](https://en.wikipedia.org/wiki/Barbiturate "Barbiturate"), while once used, are no longer recommended for insomnia due to the risk of addiction and other side effects.[\[190\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-190)
#### Comparative effectiveness
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=33 "Edit section: Comparative effectiveness")\]
Medications for the treatment of insomnia have a wide range of [effect sizes](https://en.wikipedia.org/wiki/Effect_size "Effect size").[\[16\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid35843245-16) When comparing drugs such as [benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepine "Benzodiazepine"), [Z-drugs](https://en.wikipedia.org/wiki/Z-drug "Z-drug"), sedative [antidepressants](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant") and [antihistamines](https://en.wikipedia.org/wiki/Antihistamine "Antihistamine"), [quetiapine](https://en.wikipedia.org/wiki/Quetiapine "Quetiapine"), [orexin receptor antagonists](https://en.wikipedia.org/wiki/Orexin_receptor_antagonist "Orexin receptor antagonist"), and [melatonin receptor agonists](https://en.wikipedia.org/wiki/Melatonin_receptor_agonist "Melatonin receptor agonist"), the orexin antagonist [lemborexant](https://en.wikipedia.org/wiki/Lemborexant "Lemborexant") and the Z-drug [eszopiclone](https://en.wikipedia.org/wiki/Eszopiclone "Eszopiclone") had the best profiles overall in terms of [efficacy](https://en.wikipedia.org/wiki/Efficacy "Efficacy"), [tolerability](https://en.wikipedia.org/wiki/Tolerability "Tolerability"), and [acceptability](https://en.wikipedia.org/wiki/Acceptability "Acceptability").[\[16\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid35843245-16)
### Alternative medicine
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=34 "Edit section: Alternative medicine")\]
[Herbal products](https://en.wikipedia.org/wiki/Herbal_product "Herbal product"), such as [valerian](https://en.wikipedia.org/wiki/Valerian_\(herb\) "Valerian (herb)"), [kava](https://en.wikipedia.org/wiki/Kava "Kava"), [chamomile](https://en.wikipedia.org/wiki/Chamomile "Chamomile"), and [lavender](https://en.wikipedia.org/wiki/Lavender "Lavender"), have been used to treat insomnia.[\[15\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-riemann-23-15)[\[191\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid25644982-191)[\[192\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid29356580-192) However, there is no [quality evidence](https://en.wikipedia.org/wiki/Quality_evidence "Quality evidence") that they are effective and safe.[\[15\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-riemann-23-15)[\[191\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid25644982-191)[\[192\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid29356580-192) The same is true for [cannabis](https://en.wikipedia.org/wiki/Cannabis_\(drug\) "Cannabis (drug)") and [cannabinoids](https://en.wikipedia.org/wiki/Cannabinoid "Cannabinoid").[\[193\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid33244728-193)[\[194\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid32603954-194)[\[195\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid24726015-195)
[Acupuncture](https://en.wikipedia.org/wiki/Acupuncture "Acupuncture") is often promoted for insomnia, but evidence for its effectiveness is mixed. It is unclear whether acupuncture is helpful for treating insomnia in the general population.[\[196\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-196) In people with [cancer](https://en.wikipedia.org/wiki/Cancer "Cancer"), acupuncture may reduce insomnia severity and improve sleep quality, though its effects are often similar to those of sham acupuncture. While acupuncture can help alleviate insomnia and enhance sleep, it is generally less effective than [cognitive behavioural therapy for insomnia](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_for_insomnia "Cognitive behavioral therapy for insomnia") (CBT-I).[\[197\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-197)
## Prognosis
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=35 "Edit section: Prognosis")\]
[](https://en.wikipedia.org/wiki/File:Insomnia_world_map_-_DALY_-_WHO2004.svg)
[Disability-adjusted life year](https://en.wikipedia.org/wiki/Disability-adjusted_life_year "Disability-adjusted life year") for insomnia per 100,000 inhabitants in 2004:
no data
less than 25
25–30.25
30\.25–36
36–41.5
41\.5–47
47–52.5
52\.5–58
58–63.5
63\.5–69
69–74.5
74\.5–80
more than 80
A survey of 1.1 million residents in the United States found that those who reported sleeping about 7 hours per night had the lowest rates of mortality, whereas those who slept for fewer than 6 hours or more than 8 hours had higher mortality rates. Severe insomnia—sleeping less than 3.5 hours in women and 4.5 hours in men—is associated with a 15% increase in mortality, while getting 8.5 or more hours of sleep per night was associated with a 15% higher mortality rate.[\[198\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Kripke-2002-198)
With this technique, it is difficult to distinguish the lack of sleep caused by a disorder, which is also a cause of premature death, versus a disorder that causes a lack of sleep, and the lack of sleep, causing premature death. Most of the increase in mortality from severe insomnia was discounted after controlling for [associated disorders](https://en.wikipedia.org/wiki/Comorbidity "Comorbidity"). After controlling for sleep duration and insomnia, the use of sleeping pills was also found to be associated with an increased [mortality rate](https://en.wikipedia.org/wiki/Mortality_rate "Mortality rate").[\[198\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Kripke-2002-198)
The lowest mortality was seen in individuals who slept between six and a half and seven and a half hours nightly. Even sleeping only 4.5 hours per night is associated with a very small increase in mortality. Thus, mild to moderate insomnia for most people is associated with increased [longevity](https://en.wikipedia.org/wiki/Longevity "Longevity"), and severe insomnia is associated only with a very small effect on mortality.[\[198\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Kripke-2002-198) It is unclear why sleeping longer than 7.5 hours is associated with excess mortality.[\[198\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Kripke-2002-198)
## Epidemiology
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=36 "Edit section: Epidemiology")\]
Between 10% and 30% of adults have insomnia at any given point in time and up to half of people have insomnia in a given year, making it the most common sleep disorder.[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9)[\[8\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-WHO2009-8)[\[10\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Tas2015-10)[\[199\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-199) About 6% of people have insomnia that is not due to another problem and lasts for more than a month.[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9) People over the age of 65 are affected more often than younger people.[\[7\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Wil2008-7) Females are more often affected than males.[\[8\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-WHO2009-8) Insomnia is 40% more common in women than in men.[\[200\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-200)
There are higher rates of insomnia reported [among university students](https://en.wikipedia.org/wiki/Sleep_deprivation_in_higher_education "Sleep deprivation in higher education") compared to the general population.[\[201\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-201)
## Society and culture
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=37 "Edit section: Society and culture")\]
The word insomnia is from [Latin](https://en.wikipedia.org/wiki/Latin_language "Latin language"): *in* + *[somnus](https://en.wiktionary.org/wiki/somnus#Latin "wiktionary:somnus")* "without sleep" and *\-ia* as a [nominalizing](https://en.wikipedia.org/wiki/Nominalization "Nominalization") [suffix](https://en.wikipedia.org/wiki/Suffix "Suffix").
The [popular press](https://en.wikipedia.org/wiki/Popular_press "Popular press") have published stories about people who supposedly never sleep, such as that of [Thái Ngọc](https://en.wikipedia.org/w/index.php?title=Th%C3%A1i_Ng%E1%BB%8Dc&action=edit&redlink=1 "Thái Ngọc (page does not exist)") and [Al Herpin](https://en.wikipedia.org/wiki/Al_Herpin "Al Herpin").[\[202\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-202) Horne writes "everybody sleeps and needs to do so", and generally this appears true. However, he also relates from contemporary accounts the case of Paul Kern, who was shot in 1915 fighting in [World War I](https://en.wikipedia.org/wiki/World_War_I "World War I") and then "never slept again" until he died in 1955.[\[203\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-203) Kern appears to be a completely isolated, unique case.
## References
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=38 "Edit section: References")\]
1. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Ov_1-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Ov_1-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Ov_1-2) [***d***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Ov_1-3) [***e***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Ov_1-4)
["What Is Insomnia?"](https://www.nhlbi.nih.gov/health/insomnia). *Health Topics*. [NHLBI](https://en.wikipedia.org/wiki/NHLBI "NHLBI"). 24 March 2022. [Archived](https://web.archive.org/web/20160728012148/http://www.nhlbi.nih.gov/health/health-topics/topics/inso) from the original on 28 July 2016. Retrieved 26 November 2023.
2. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Ca_2-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Ca_2-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Ca_2-2) [***d***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Ca_2-3)
["What Causes Insomnia?"](https://www.nhlbi.nih.gov/health/insomnia/causes). *NHLBI*. 13 December 2011. [Archived](https://web.archive.org/web/20160728012201/http://www.nhlbi.nih.gov/health/health-topics/topics/inso/causes) from the original on 28 July 2016. Retrieved 9 August 2016.
3. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Diag_3-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Diag_3-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Diag_3-2)
["How Is Insomnia Diagnosed?"](https://www.nhlbi.nih.gov/health/insomnia). *NHLBI*. 13 December 2011. [Archived](https://web.archive.org/web/20160811091424/http://www.nhlbi.nih.gov/health/health-topics/topics/inso/diagnosis) from the original on 11 August 2016. Retrieved 9 August 2016.
4. **[^](https://en.wikipedia.org/wiki/Insomnia#cite_ref-4)**
Watson NF, Vaughn BV (2006). [*Clinician's Guide to Sleep Disorders*](https://books.google.com/books?id=M9zKBQAAQBAJ&pg=PA10). CRC Press. p. 10. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-8493-7449-4](https://en.wikipedia.org/wiki/Special:BookSources/978-0-8493-7449-4 "Special:BookSources/978-0-8493-7449-4")
.
5. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Tx_5-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Tx_5-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Tx_5-2)
["How Is Insomnia Treated?"](https://web.archive.org/web/20160728012302/http://www.nhlbi.nih.gov/health/health-topics/topics/inso/treatment). *NHLBI*. 13 December 2011. Archived from [the original](https://www.nhlbi.nih.gov/health/health-topics/topics/inso/treatment) on 28 July 2016. Retrieved 9 August 2016.
6. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-AC2016_6-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-AC2016_6-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-AC2016_6-2) [***d***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-AC2016_6-3) [***e***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-AC2016_6-4) [***f***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-AC2016_6-5) [***g***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-AC2016_6-6)
Qaseem A, Kansagara D, Forciea MA, et al. (July 2016). ["Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians"](https://doi.org/10.7326%2FM15-2175). *Annals of Internal Medicine*. **165** (2): 125–133\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.7326/M15-2175](https://doi.org/10.7326%2FM15-2175). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27136449](https://pubmed.ncbi.nlm.nih.gov/27136449).
7. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Wil2008_7-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Wil2008_7-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Wil2008_7-2) [***d***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Wil2008_7-3) [***e***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Wil2008_7-4)
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8. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-WHO2009_8-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-WHO2009_8-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-WHO2009_8-2) [***d***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-WHO2009_8-3) [***e***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-WHO2009_8-4) [***f***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-WHO2009_8-5) [***g***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-WHO2009_8-6)
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9. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-2) [***d***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-3) [***e***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-4) [***f***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-5) [***g***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-6) [***h***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-7) [***i***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-8) [***j***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-9) [***k***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-10)
Roth T (August 2007). ["Insomnia: definition, prevalence, etiology, and consequences"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978319). *[Journal of Clinical Sleep Medicine](https://en.wikipedia.org/wiki/Journal_of_Clinical_Sleep_Medicine "Journal of Clinical Sleep Medicine")* (Supplement). **3** (5 Suppl): S7–10. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.5664/jcsm.26929](https://doi.org/10.5664%2Fjcsm.26929). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [1978319](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978319). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [17824495](https://pubmed.ncbi.nlm.nih.gov/17824495).
10. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Tas2015_10-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Tas2015_10-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Tas2015_10-2)
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## External links
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Wikimedia Commons has media related to [Insomnia](https://commons.wikimedia.org/wiki/Special:Search/Insomnia "commons:Special:Search/Insomnia").
| | |
|---|---|
| Classification | [D](https://www.wikidata.org/wiki/Q1869874 "d:Q1869874") **[ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[11](https://en.wikipedia.org/wiki/ICD-11 "ICD-11")**: [7A00](https://icd.who.int/browse/latest-release/mms/en#323148092), [7A01](https://icd.who.int/browse/latest-release/mms/en#1832877760), [7A0Z](https://icd.who.int/browse/latest-release/mms/en#1038292737%2Funspecified), [8E02.2](https://icd.who.int/browse/latest-release/mms/en#669154658), [SD84](https://icd.who.int/browse/latest-release/mms/en#607986723) **[ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[10](https://en.wikipedia.org/wiki/ICD-10 "ICD-10")**: [F51](https://icd.who.int/browse10/2019/en#/F51), [G47.0](https://icd.who.int/browse10/2019/en#/G47.0) **[ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[9-CM](https://en.wikipedia.org/wiki/List_of_ICD-9_codes "List of ICD-9 codes")**: [307\.42](http://www.icd9data.com/getICD9Code.ashx?icd9=307.42), [307\.41](http://www.icd9data.com/getICD9Code.ashx?icd9=307.41), [327\.0](http://www.icd9data.com/getICD9Code.ashx?icd9=327.0), [780\.51](http://www.icd9data.com/getICD9Code.ashx?icd9=780.51), [780\.52](http://www.icd9data.com/getICD9Code.ashx?icd9=780.52) **[MeSH](https://en.wikipedia.org/wiki/Medical_Subject_Headings "Medical Subject Headings")**: [D007319](https://meshb.nlm.nih.gov/record/ui?ui=D007319) **[DiseasesDB](https://en.wikipedia.org/wiki/Diseases_Database "Diseases Database")**: [26877](http://www.diseasesdatabase.com/ddb26877.htm) **[SNOMED CT](https://en.wikipedia.org/wiki/SNOMED_CT "SNOMED CT")**: [193462001](https://browser.ihtsdotools.org/?perspective=full&conceptId1=193462001&languages=en) |
| External resources | **[MedlinePlus](https://en.wikipedia.org/wiki/MedlinePlus "MedlinePlus")**: [000805](https://www.nlm.nih.gov/medlineplus/ency/article/000805.htm) **[eMedicine](https://en.wikipedia.org/wiki/EMedicine "EMedicine")**: [med/2698](https://emedicine.medscape.com/med/2698-overview) **[Patient UK](https://en.wikipedia.org/wiki/Patient_UK "Patient UK")**: [Insomnia](https://patient.info/doctor/insomnia) |
| [v](https://en.wikipedia.org/wiki/Template:Sleep "Template:Sleep") [t](https://en.wikipedia.org/wiki/Template_talk:Sleep "Template talk:Sleep") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Sleep "Special:EditPage/Template:Sleep")[Sleep](https://en.wikipedia.org/wiki/Sleep "Sleep") and [sleep disorders](https://en.wikipedia.org/wiki/Sleep_disorder "Sleep disorder") | |
|---|---|
| Stages of [sleep cycles](https://en.wikipedia.org/wiki/Sleep_cycle "Sleep cycle") | [Rapid eye movement (REM)](https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep "Rapid eye movement sleep") [Quiescent sleep](https://en.wikipedia.org/wiki/Non-rapid_eye_movement_sleep "Non-rapid eye movement sleep") [Slow-wave](https://en.wikipedia.org/wiki/Slow-wave_sleep "Slow-wave sleep") |
| [Brain waves](https://en.wikipedia.org/wiki/Electroencephalography "Electroencephalography") | [Alpha wave](https://en.wikipedia.org/wiki/Alpha_wave "Alpha wave") [Beta wave](https://en.wikipedia.org/wiki/Beta_wave "Beta wave") [Delta wave](https://en.wikipedia.org/wiki/Delta_wave "Delta wave") [Gamma wave](https://en.wikipedia.org/wiki/Gamma_wave "Gamma wave") [K-complex](https://en.wikipedia.org/wiki/K-complex "K-complex") [Mu rhythm](https://en.wikipedia.org/wiki/Mu_wave "Mu wave") [PGO waves](https://en.wikipedia.org/wiki/PGO_waves "PGO waves") [Sensorimotor rhythm](https://en.wikipedia.org/wiki/Sensorimotor_rhythm "Sensorimotor rhythm") [Sleep spindle](https://en.wikipedia.org/wiki/Sleep_spindle "Sleep spindle") [Theta wave](https://en.wikipedia.org/wiki/Theta_wave "Theta wave") |
| [Sleep disorders](https://en.wikipedia.org/wiki/Sleep_disorder "Sleep disorder") | |
| | |
| [Anatomical](https://en.wikipedia.org/wiki/Oral_and_maxillofacial_pathology "Oral and maxillofacial pathology") | [Mouth breathing](https://en.wikipedia.org/wiki/Mouth_breathing "Mouth breathing") [SRBD](https://en.wikipedia.org/wiki/Sleep-related_breathing_disorder "Sleep-related breathing disorder") [Sleep apnea](https://en.wikipedia.org/wiki/Sleep_apnea "Sleep apnea") [Catathrenia](https://en.wikipedia.org/wiki/Catathrenia "Catathrenia") [Central hypoventilation syndrome](https://en.wikipedia.org/wiki/Central_hypoventilation_syndrome "Central hypoventilation syndrome") [Obesity hypoventilation syndrome](https://en.wikipedia.org/wiki/Obesity_hypoventilation_syndrome "Obesity hypoventilation syndrome") [Obstructive sleep apnea](https://en.wikipedia.org/wiki/Obstructive_sleep_apnea "Obstructive sleep apnea") [Periodic breathing](https://en.wikipedia.org/wiki/Periodic_breathing "Periodic breathing") [Snoring](https://en.wikipedia.org/wiki/Snoring "Snoring") |
| [Dyssomnia](https://en.wikipedia.org/wiki/Dyssomnia "Dyssomnia") | [Excessive daytime sleepiness](https://en.wikipedia.org/wiki/Excessive_daytime_sleepiness "Excessive daytime sleepiness") [Hypersomnia](https://en.wikipedia.org/wiki/Hypersomnia "Hypersomnia") [Insomnia]() [Kleine–Levin syndrome](https://en.wikipedia.org/wiki/Kleine%E2%80%93Levin_syndrome "Kleine–Levin syndrome") [Narcolepsy](https://en.wikipedia.org/wiki/Narcolepsy "Narcolepsy") [Idiopathic hypersomnia](https://en.wikipedia.org/wiki/Idiopathic_hypersomnia "Idiopathic hypersomnia") [Night eating syndrome](https://en.wikipedia.org/wiki/Night_eating_syndrome "Night eating syndrome") [Nocturia](https://en.wikipedia.org/wiki/Nocturia "Nocturia") [Non-restorative sleep](https://en.wikipedia.org/wiki/Non-restorative_sleep "Non-restorative sleep") [Sleep state misperception](https://en.wikipedia.org/wiki/Sleep_state_misperception "Sleep state misperception") |
| [Circadian rhythm disorders](https://en.wikipedia.org/wiki/Circadian_rhythm_sleep_disorder "Circadian rhythm sleep disorder") | [Advanced sleep phase disorder](https://en.wikipedia.org/wiki/Advanced_sleep_phase_disorder "Advanced sleep phase disorder") [Cyclic alternating pattern](https://en.wikipedia.org/wiki/Cyclic_alternating_pattern "Cyclic alternating pattern") [Delayed sleep phase disorder](https://en.wikipedia.org/wiki/Delayed_sleep_phase_disorder "Delayed sleep phase disorder") [Irregular sleep–wake rhythm](https://en.wikipedia.org/wiki/Irregular_sleep%E2%80%93wake_rhythm "Irregular sleep–wake rhythm") [Jet lag](https://en.wikipedia.org/wiki/Jet_lag "Jet lag") [Non-24-hour sleep–wake disorder](https://en.wikipedia.org/wiki/Non-24-hour_sleep%E2%80%93wake_disorder "Non-24-hour sleep–wake disorder") [Shift work sleep disorder](https://en.wikipedia.org/wiki/Shift_work_sleep_disorder "Shift work sleep disorder") |
| [Parasomnia](https://en.wikipedia.org/wiki/Parasomnia "Parasomnia") | [Bruxism](https://en.wikipedia.org/wiki/Bruxism "Bruxism") [Nightmare disorder](https://en.wikipedia.org/wiki/Nightmare_disorder "Nightmare disorder") [Night terror](https://en.wikipedia.org/wiki/Night_terror "Night terror") [Periodic limb movement disorder](https://en.wikipedia.org/wiki/Periodic_limb_movement_disorder "Periodic limb movement disorder") [Rapid eye movement sleep behavior disorder](https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep_behavior_disorder "Rapid eye movement sleep behavior disorder") [Sleepwalking](https://en.wikipedia.org/wiki/Sleepwalking "Sleepwalking") [Sleep driving](https://en.wikipedia.org/wiki/Sleep_driving "Sleep driving") [Sleep-talking](https://en.wikipedia.org/wiki/Sleep-talking "Sleep-talking") |
| Benign phenomena | [Dreams](https://en.wikipedia.org/wiki/Dream "Dream") [Lucid dreams](https://en.wikipedia.org/wiki/Lucid_dream "Lucid dream") [Exploding head syndrome](https://en.wikipedia.org/wiki/Exploding_head_syndrome "Exploding head syndrome") [Hypnic jerk](https://en.wikipedia.org/wiki/Hypnic_jerk "Hypnic jerk") [Hypnagogia](https://en.wikipedia.org/wiki/Hypnagogia "Hypnagogia") / [Sleep onset](https://en.wikipedia.org/wiki/Sleep_onset "Sleep onset") [Hypnopompia](https://en.wikipedia.org/wiki/Hypnopompia "Hypnopompia") [Sleep paralysis](https://en.wikipedia.org/wiki/Sleep_paralysis "Sleep paralysis") [Sleep inertia](https://en.wikipedia.org/wiki/Sleep_inertia "Sleep inertia") [Somnolence](https://en.wikipedia.org/wiki/Somnolence "Somnolence") [Nocturnal clitoral tumescence](https://en.wikipedia.org/wiki/Nocturnal_clitoral_tumescence "Nocturnal clitoral tumescence") [Nocturnal penile tumescence](https://en.wikipedia.org/wiki/Nocturnal_penile_tumescence "Nocturnal penile tumescence") [Nocturnal emission](https://en.wikipedia.org/wiki/Nocturnal_emission "Nocturnal emission") |
| [Treatment](https://en.wikipedia.org/wiki/Sleep_medicine "Sleep medicine") | [Sleep diary](https://en.wikipedia.org/wiki/Sleep_diary "Sleep diary") [Sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene") [Sleep induction](https://en.wikipedia.org/wiki/Sleep_induction "Sleep induction") [Hypnosis](https://en.wikipedia.org/wiki/Hypnosis "Hypnosis") [Lullaby](https://en.wikipedia.org/wiki/Lullaby "Lullaby") [Somnology](https://en.wikipedia.org/wiki/Somnology "Somnology") [Polysomnography](https://en.wikipedia.org/wiki/Polysomnography "Polysomnography") [Sleep surgery](https://en.wikipedia.org/wiki/Sleep_surgery "Sleep surgery") |
| Other | [Sleep medicine](https://en.wikipedia.org/wiki/Sleep_medicine "Sleep medicine") [Behavioral sleep medicine](https://en.wikipedia.org/wiki/Behavioral_sleep_medicine "Behavioral sleep medicine") [Sleep study](https://en.wikipedia.org/wiki/Sleep_study "Sleep study") [Melatonin](https://en.wikipedia.org/wiki/Melatonin "Melatonin") [Neuroscience of sleep](https://en.wikipedia.org/wiki/Neuroscience_of_sleep "Neuroscience of sleep") |
| Daily life | [Bed](https://en.wikipedia.org/wiki/Bed "Bed") [Bunk bed](https://en.wikipedia.org/wiki/Bunk_bed "Bunk bed") [Daybed](https://en.wikipedia.org/wiki/Daybed "Daybed") [Four-poster bed](https://en.wikipedia.org/wiki/Four-poster_bed "Four-poster bed") [Futon](https://en.wikipedia.org/wiki/Futon "Futon") [Hammock](https://en.wikipedia.org/wiki/Hammock "Hammock") [Mattress](https://en.wikipedia.org/wiki/Mattress "Mattress") [Sleeping bag](https://en.wikipedia.org/wiki/Sleeping_bag "Sleeping bag") [Bed bug](https://en.wikipedia.org/wiki/Bed_bug "Bed bug") [Bedding](https://en.wikipedia.org/wiki/Bedding "Bedding") [Bedroom](https://en.wikipedia.org/wiki/Bedroom "Bedroom") [Bedtime](https://en.wikipedia.org/wiki/Bedtime "Bedtime") [Procrastination](https://en.wikipedia.org/wiki/Bedtime_procrastination "Bedtime procrastination") [Story](https://en.wikipedia.org/wiki/Bedtime_story "Bedtime story") [Biphasic and polyphasic sleep](https://en.wikipedia.org/wiki/Biphasic_and_polyphasic_sleep "Biphasic and polyphasic sleep") [Chronotype](https://en.wikipedia.org/wiki/Chronotype "Chronotype") [Circadian rhythm](https://en.wikipedia.org/wiki/Circadian_rhythm "Circadian rhythm") [Comfort object](https://en.wikipedia.org/wiki/Comfort_object "Comfort object") [Dream diary](https://en.wikipedia.org/wiki/Dream_diary "Dream diary") [Microarousal](https://en.wikipedia.org/wiki/Microarousal "Microarousal") [Microsleep](https://en.wikipedia.org/wiki/Microsleep "Microsleep") [Nap](https://en.wikipedia.org/wiki/Nap "Nap") [Nightwear](https://en.wikipedia.org/wiki/Nightwear "Nightwear") [Power nap](https://en.wikipedia.org/wiki/Power_nap "Power nap") [Second wind](https://en.wikipedia.org/wiki/Second_wind_\(sleep\) "Second wind (sleep)") [Siesta](https://en.wikipedia.org/wiki/Siesta "Siesta") [Sleep and breathing](https://en.wikipedia.org/wiki/Sleep_and_breathing "Sleep and breathing") [Sleep and creativity](https://en.wikipedia.org/wiki/Sleep_and_creativity "Sleep and creativity") [Sleep and learning](https://en.wikipedia.org/wiki/Sleep_and_learning "Sleep and learning") [Sleep and memory](https://en.wikipedia.org/wiki/Sleep_and_memory "Sleep and memory") [Sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation") / [Sleep debt](https://en.wikipedia.org/wiki/Sleep_debt "Sleep debt") [Sleeping while on duty](https://en.wikipedia.org/wiki/Sleeping_while_on_duty "Sleeping while on duty") [Sleepover](https://en.wikipedia.org/wiki/Sleepover "Sleepover") |
| [v](https://en.wikipedia.org/wiki/Template:Hypnotics_and_sedatives "Template:Hypnotics and sedatives") [t](https://en.wikipedia.org/wiki/Template_talk:Hypnotics_and_sedatives "Template talk:Hypnotics and sedatives") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Hypnotics_and_sedatives "Special:EditPage/Template:Hypnotics and sedatives")[Hypnotics](https://en.wikipedia.org/wiki/Hypnotic "Hypnotic")/[sedatives](https://en.wikipedia.org/wiki/Sedative "Sedative") ([N05C](https://en.wikipedia.org/wiki/ATC_code_N05#N05C "ATC code N05")) | |
|---|---|
| [GABAA](https://en.wikipedia.org/wiki/GABAA_receptor "GABAA receptor") | |
| | |
| [Alcohols](https://en.wikipedia.org/wiki/Alcohol_\(chemistry\) "Alcohol (chemistry)") | [2M2B](https://en.wikipedia.org/wiki/2M2B "2M2B") [Chloralodol](https://en.wikipedia.org/wiki/Chloralodol "Chloralodol") [Ethanol (alcohol)](https://en.wikipedia.org/wiki/Alcohol_\(drug\) "Alcohol (drug)") [Diethylpropanediol](https://en.wikipedia.org/wiki/Diethylpropanediol "Diethylpropanediol") [Ethchlorvynol](https://en.wikipedia.org/wiki/Ethchlorvynol "Ethchlorvynol") [Methylpentynol](https://en.wikipedia.org/wiki/Methylpentynol "Methylpentynol") [Trichloroethanol](https://en.wikipedia.org/wiki/2,2,2-Trichloroethanol "2,2,2-Trichloroethanol") |
| [Barbiturates](https://en.wikipedia.org/wiki/Barbiturate "Barbiturate") | [Allobarbital](https://en.wikipedia.org/wiki/Allobarbital "Allobarbital") [Amobarbital](https://en.wikipedia.org/wiki/Amobarbital "Amobarbital") [Aprobarbital](https://en.wikipedia.org/wiki/Aprobarbital "Aprobarbital") [Barbital](https://en.wikipedia.org/wiki/Barbital "Barbital") [Butabarbital](https://en.wikipedia.org/wiki/Butabarbital "Butabarbital") [Butobarbital](https://en.wikipedia.org/wiki/Butobarbital "Butobarbital") [Cyclobarbital](https://en.wikipedia.org/wiki/Cyclobarbital "Cyclobarbital") [Ethallobarbital](https://en.wikipedia.org/wiki/Ethallobarbital "Ethallobarbital") [Heptabarb](https://en.wikipedia.org/wiki/Heptabarb "Heptabarb") [Hexobarbital](https://en.wikipedia.org/wiki/Hexobarbital "Hexobarbital") [Mephobarbital](https://en.wikipedia.org/wiki/Mephobarbital "Mephobarbital") [Methohexital](https://en.wikipedia.org/wiki/Methohexital "Methohexital") [Narcobarbital](https://en.wikipedia.org/wiki/Narcobarbital "Narcobarbital") [Pentobarbital](https://en.wikipedia.org/wiki/Pentobarbital "Pentobarbital") [Phenallymal](https://en.wikipedia.org/wiki/Phenallymal "Phenallymal") [Phenobarbital](https://en.wikipedia.org/wiki/Phenobarbital "Phenobarbital") [Propylbarbital](https://en.wikipedia.org/wiki/Propylbarbital "Propylbarbital") [Proxibarbal](https://en.wikipedia.org/wiki/Proxibarbal "Proxibarbal") [Reposal](https://en.wikipedia.org/wiki/Reposal "Reposal") [Secobarbital](https://en.wikipedia.org/wiki/Secobarbital "Secobarbital") [Talbutal](https://en.wikipedia.org/wiki/Talbutal "Talbutal") [Thiamylal](https://en.wikipedia.org/wiki/Thiamylal "Thiamylal") [Thiopental](https://en.wikipedia.org/wiki/Sodium_thiopental "Sodium thiopental") [Thiotetrabarbital](https://en.wikipedia.org/wiki/Thiotetrabarbital "Thiotetrabarbital") [Vinbarbital](https://en.wikipedia.org/wiki/Vinbarbital "Vinbarbital") [Vinylbital](https://en.wikipedia.org/wiki/Vinylbital "Vinylbital") |
| [Benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepine "Benzodiazepine") | [Brotizolam](https://en.wikipedia.org/wiki/Brotizolam "Brotizolam") [Cinolazepam](https://en.wikipedia.org/wiki/Cinolazepam "Cinolazepam") [Climazolam](https://en.wikipedia.org/wiki/Climazolam "Climazolam") [Clobazam](https://en.wikipedia.org/wiki/Clobazam "Clobazam") [Clonazolam](https://en.wikipedia.org/wiki/Clonazolam "Clonazolam") [Doxefazepam](https://en.wikipedia.org/wiki/Doxefazepam "Doxefazepam") [Estazolam](https://en.wikipedia.org/wiki/Estazolam "Estazolam") [Flubromazolam](https://en.wikipedia.org/wiki/Flubromazolam "Flubromazolam") [Flunitrazolam](https://en.wikipedia.org/wiki/Flunitrazolam "Flunitrazolam") [Flunitrazepam](https://en.wikipedia.org/wiki/Flunitrazepam "Flunitrazepam") [Flurazepam](https://en.wikipedia.org/wiki/Flurazepam "Flurazepam") [Flutemazepam](https://en.wikipedia.org/wiki/Flutemazepam "Flutemazepam") [Flutoprazepam](https://en.wikipedia.org/wiki/Flutoprazepam "Flutoprazepam") [Loprazolam](https://en.wikipedia.org/wiki/Loprazolam "Loprazolam") [Lormetazepam](https://en.wikipedia.org/wiki/Lormetazepam "Lormetazepam") [Midazolam](https://en.wikipedia.org/wiki/Midazolam "Midazolam") [Nimetazepam](https://en.wikipedia.org/wiki/Nimetazepam "Nimetazepam") [Nitemazepam](https://en.wikipedia.org/wiki/Nitemazepam "Nitemazepam") [Nitrazepam](https://en.wikipedia.org/wiki/Nitrazepam "Nitrazepam") [Nitrazolam](https://en.wikipedia.org/wiki/Nitrazolam "Nitrazolam") [Quazepam](https://en.wikipedia.org/wiki/Quazepam "Quazepam") [Temazepam](https://en.wikipedia.org/wiki/Temazepam "Temazepam") [Triazolam](https://en.wikipedia.org/wiki/Triazolam "Triazolam") |
| [Carbamates](https://en.wikipedia.org/wiki/Carbamate "Carbamate") | [Carisoprodol](https://en.wikipedia.org/wiki/Carisoprodol "Carisoprodol") [Emylcamate](https://en.wikipedia.org/wiki/Emylcamate "Emylcamate") [Ethinamate](https://en.wikipedia.org/wiki/Ethinamate "Ethinamate") [Hexapropymate](https://en.wikipedia.org/wiki/Hexapropymate "Hexapropymate") [Meprobamate](https://en.wikipedia.org/wiki/Meprobamate "Meprobamate") [Methocarbamol](https://en.wikipedia.org/wiki/Methocarbamol "Methocarbamol") [Phenprobamate](https://en.wikipedia.org/wiki/Phenprobamate "Phenprobamate") [Procymate](https://en.wikipedia.org/wiki/Procymate "Procymate") [Tybamate](https://en.wikipedia.org/wiki/Tybamate "Tybamate") |
| [Imidazoles](https://en.wikipedia.org/wiki/Imidazole "Imidazole") | [Etomidate](https://en.wikipedia.org/wiki/Etomidate "Etomidate") [Metomidate](https://en.wikipedia.org/wiki/Metomidate "Metomidate") [Propoxate](https://en.wikipedia.org/wiki/Propoxate "Propoxate") |
| [Monoureides](https://en.wikipedia.org/wiki/Monoureide "Monoureide") | [Acecarbromal](https://en.wikipedia.org/wiki/Acecarbromal "Acecarbromal") [Apronal (apronalide)](https://en.wikipedia.org/wiki/Apronal "Apronal") [Bromisoval](https://en.wikipedia.org/wiki/Bromisoval "Bromisoval") [Capuride](https://en.wikipedia.org/wiki/Capuride "Capuride") [Carbromal](https://en.wikipedia.org/wiki/Carbromal "Carbromal") [Ectylurea](https://en.wikipedia.org/w/index.php?title=Ectylurea&action=edit&redlink=1 "Ectylurea (page does not exist)") |
| [Neurosteroids](https://en.wikipedia.org/wiki/Neurosteroid "Neurosteroid") | [Acebrochol](https://en.wikipedia.org/wiki/Acebrochol "Acebrochol") [Alfadolone](https://en.wikipedia.org/wiki/Alfadolone "Alfadolone") [Alfaxolone](https://en.wikipedia.org/wiki/Alfaxolone "Alfaxolone") [Brexanolone (allopregnanolone)](https://en.wikipedia.org/wiki/Brexanolone "Brexanolone") [Eltanolone (pregnanolone)](https://en.wikipedia.org/wiki/Eltanolone "Eltanolone") [Ganaxolone](https://en.wikipedia.org/wiki/Ganaxolone "Ganaxolone") [Hydroxydione](https://en.wikipedia.org/wiki/Hydroxydione "Hydroxydione") [Minaxolone](https://en.wikipedia.org/wiki/Minaxolone "Minaxolone") [Progesterone](https://en.wikipedia.org/wiki/Progesterone_\(medication\) "Progesterone (medication)") [Renanolone](https://en.wikipedia.org/wiki/Renanolone "Renanolone") [Zuranolone](https://en.wikipedia.org/wiki/Zuranolone "Zuranolone") |
| [Nonbenzodiazepines](https://en.wikipedia.org/wiki/Nonbenzodiazepine "Nonbenzodiazepine") | [Eszopiclone](https://en.wikipedia.org/wiki/Eszopiclone "Eszopiclone") [Indiplon](https://en.wikipedia.org/wiki/Indiplon "Indiplon") [Lirequinil](https://en.wikipedia.org/wiki/Lirequinil "Lirequinil") [Necopidem](https://en.wikipedia.org/wiki/Necopidem "Necopidem") [Pagoclone](https://en.wikipedia.org/wiki/Pagoclone "Pagoclone") [Pazinaclone](https://en.wikipedia.org/wiki/Pazinaclone "Pazinaclone") [Saripidem](https://en.wikipedia.org/wiki/Saripidem "Saripidem") [Suproclone](https://en.wikipedia.org/wiki/Suproclone "Suproclone") [Suriclone](https://en.wikipedia.org/wiki/Suriclone "Suriclone") [Zaleplon](https://en.wikipedia.org/wiki/Zaleplon "Zaleplon") [Zolpidem](https://en.wikipedia.org/wiki/Zolpidem "Zolpidem") [Zopiclone](https://en.wikipedia.org/wiki/Zopiclone "Zopiclone") |
| [Phenols](https://en.wikipedia.org/wiki/Phenol "Phenol") | [Cipepofol (ciprofol)](https://en.wikipedia.org/wiki/Cipepofol "Cipepofol") [Fospropofol](https://en.wikipedia.org/wiki/Fospropofol "Fospropofol") [Propofol](https://en.wikipedia.org/wiki/Propofol "Propofol") [Propofol hemisuccinate](https://en.wikipedia.org/wiki/Propofol_hemisuccinate "Propofol hemisuccinate") |
| [Piperidinediones](https://en.wikipedia.org/wiki/Piperidinedione "Piperidinedione") | [Glutethimide](https://en.wikipedia.org/wiki/Glutethimide "Glutethimide") [Methyprylon](https://en.wikipedia.org/wiki/Methyprylon "Methyprylon") [Piperidione](https://en.wikipedia.org/wiki/Piperidione "Piperidione") [Pyrithyldione](https://en.wikipedia.org/wiki/Pyrithyldione "Pyrithyldione") |
| [Quinazolinones](https://en.wikipedia.org/wiki/Quinazolinone "Quinazolinone") | [Afloqualone](https://en.wikipedia.org/wiki/Afloqualone "Afloqualone") [Cloroqualone](https://en.wikipedia.org/wiki/Cloroqualone "Cloroqualone") [Diproqualone](https://en.wikipedia.org/wiki/Diproqualone "Diproqualone") [Etaqualone](https://en.wikipedia.org/wiki/Etaqualone "Etaqualone") [Mebroqualone](https://en.wikipedia.org/wiki/Mebroqualone "Mebroqualone") [Mecloqualone](https://en.wikipedia.org/wiki/Mecloqualone "Mecloqualone") [Methaqualone](https://en.wikipedia.org/wiki/Methaqualone "Methaqualone") [Methylmethaqualone](https://en.wikipedia.org/wiki/Methylmethaqualone "Methylmethaqualone") [Nitromethaqualone](https://en.wikipedia.org/wiki/Nitromethaqualone "Nitromethaqualone") [SL-164](https://en.wikipedia.org/wiki/SL-164 "SL-164") |
| Others | [Acetophenone](https://en.wikipedia.org/wiki/Acetophenone "Acetophenone") [Acetylglycinamide chloral hydrate](https://en.wikipedia.org/wiki/Acetylglycinamide_chloral_hydrate "Acetylglycinamide chloral hydrate") [Bromide](https://en.wikipedia.org/wiki/Bromide "Bromide") compounds [Lithium bromide](https://en.wikipedia.org/wiki/Lithium_bromide "Lithium bromide") [Potassium bromide](https://en.wikipedia.org/wiki/Potassium_bromide "Potassium bromide") [Sodium bromide](https://en.wikipedia.org/wiki/Sodium_bromide "Sodium bromide") [Centalun](https://en.wikipedia.org/wiki/Centalun "Centalun") [Chloral betaine](https://en.wikipedia.org/wiki/Chloral_betaine "Chloral betaine") [Chloral hydrate](https://en.wikipedia.org/wiki/Chloral_hydrate "Chloral hydrate") [Chloralose](https://en.wikipedia.org/wiki/Chloralose "Chloralose") [Clomethiazole](https://en.wikipedia.org/wiki/Clomethiazole "Clomethiazole") [Dichloralphenazone](https://en.wikipedia.org/wiki/Dichloralphenazone "Dichloralphenazone") [Gaboxadol (THIP)](https://en.wikipedia.org/wiki/Gaboxadol "Gaboxadol") [Ibotenic acid](https://en.wikipedia.org/wiki/Ibotenic_acid "Ibotenic acid") (*[Amanita muscaria](https://en.wikipedia.org/wiki/Amanita_muscaria "Amanita muscaria")*) [Kavalactones](https://en.wikipedia.org/wiki/Kavalactone "Kavalactone") [Loreclezole](https://en.wikipedia.org/wiki/Loreclezole "Loreclezole") [Muscimol](https://en.wikipedia.org/wiki/Muscimol "Muscimol") (*[Amanita muscaria](https://en.wikipedia.org/wiki/Amanita_muscaria "Amanita muscaria")*) [Paraldehyde](https://en.wikipedia.org/wiki/Paraldehyde "Paraldehyde") [Petrichloral](https://en.wikipedia.org/wiki/Petrichloral "Petrichloral") [Sesquiterpene](https://en.wikipedia.org/wiki/Sesquiterpene "Sesquiterpene") [Isovaleramide](https://en.wikipedia.org/wiki/Isovaleramide "Isovaleramide") [Isovaleric acid](https://en.wikipedia.org/wiki/Isovaleric_acid "Isovaleric acid") [Valerenic acid](https://en.wikipedia.org/wiki/Valerenic_acid "Valerenic acid") [Sulfonylalkanes](https://en.wikipedia.org/w/index.php?title=Sulfonylalkane&action=edit&redlink=1 "Sulfonylalkane (page does not exist)") [Sulfonmethane (sulfonal)](https://en.wikipedia.org/wiki/Sulfonmethane "Sulfonmethane") [Tetronal](https://en.wikipedia.org/wiki/Tetronal "Tetronal") [Trional](https://en.wikipedia.org/wiki/Trional "Trional") [Triclofos](https://en.wikipedia.org/wiki/Triclofos "Triclofos") |
| [GABAB](https://en.wikipedia.org/wiki/GABAB_receptor "GABAB receptor") | [1,4-Butanediol](https://en.wikipedia.org/wiki/1,4-Butanediol "1,4-Butanediol") [4-Fluorophenibut](https://en.wikipedia.org/wiki/4-Fluorophenibut "4-Fluorophenibut") [Aceburic acid](https://en.wikipedia.org/wiki/Aceburic_acid "Aceburic acid") [Baclofen](https://en.wikipedia.org/wiki/Baclofen "Baclofen") [GABOB](https://en.wikipedia.org/wiki/GABOB "GABOB") [GHB](https://en.wikipedia.org/wiki/Gamma-Hydroxybutyric_acid "Gamma-Hydroxybutyric acid") ([sodium oxybate](https://en.wikipedia.org/wiki/Sodium_oxybate "Sodium oxybate")) [GBL](https://en.wikipedia.org/wiki/Gamma-Butyrolactone "Gamma-Butyrolactone") [GVL](https://en.wikipedia.org/wiki/Gamma-Valerolactone "Gamma-Valerolactone") [JZP-386](https://en.wikipedia.org/wiki/JZP-386 "JZP-386") [Phenibut](https://en.wikipedia.org/wiki/Phenibut "Phenibut") [Tolibut](https://en.wikipedia.org/wiki/Tolibut "Tolibut") [Valiloxybate (XW-10172)](https://en.wikipedia.org/wiki/Valiloxybate "Valiloxybate") |
| [H1](https://en.wikipedia.org/wiki/H1_receptor "H1 receptor") | |
| | |
| [Antihistamines](https://en.wikipedia.org/wiki/Histamine_antagonist "Histamine antagonist") | [Captodiame](https://en.wikipedia.org/wiki/Captodiame "Captodiame") [Cyproheptadine](https://en.wikipedia.org/wiki/Cyproheptadine "Cyproheptadine") [Diphenhydramine](https://en.wikipedia.org/wiki/Diphenhydramine "Diphenhydramine") [Doxylamine](https://en.wikipedia.org/wiki/Doxylamine "Doxylamine") [Hydroxyzine](https://en.wikipedia.org/wiki/Hydroxyzine "Hydroxyzine") [Methapyrilene](https://en.wikipedia.org/wiki/Methapyrilene "Methapyrilene") [Perlapine](https://en.wikipedia.org/wiki/Perlapine "Perlapine") [Pheniramine](https://en.wikipedia.org/wiki/Pheniramine "Pheniramine") [Promethazine](https://en.wikipedia.org/wiki/Promethazine "Promethazine") [Propiomazine](https://en.wikipedia.org/wiki/Propiomazine "Propiomazine") |
| [Antidepressants](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant") | [Serotonin antagonists and reuptake inhibitors](https://en.wikipedia.org/wiki/Serotonin_antagonists_and_reuptake_inhibitors "Serotonin antagonists and reuptake inhibitors") [Etoperidone](https://en.wikipedia.org/wiki/Etoperidone "Etoperidone") [Nefazodone](https://en.wikipedia.org/wiki/Nefazodone "Nefazodone") [Trazodone](https://en.wikipedia.org/wiki/Trazodone "Trazodone") [Tricyclic antidepressants](https://en.wikipedia.org/wiki/Tricyclic_antidepressant "Tricyclic antidepressant") [Amitriptyline](https://en.wikipedia.org/wiki/Amitriptyline "Amitriptyline") [Doxepin](https://en.wikipedia.org/wiki/Doxepin "Doxepin") [Trimipramine](https://en.wikipedia.org/wiki/Trimipramine "Trimipramine"), etc. [Tetracyclic antidepressants](https://en.wikipedia.org/wiki/Tetracyclic_antidepressant "Tetracyclic antidepressant") [Mianserin](https://en.wikipedia.org/wiki/Mianserin "Mianserin") [Mirtazapine](https://en.wikipedia.org/wiki/Mirtazapine "Mirtazapine"), etc. |
| [Antipsychotics](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic") | [Typical antipsychotics](https://en.wikipedia.org/wiki/Typical_antipsychotic "Typical antipsychotic") [Chlorpromazine](https://en.wikipedia.org/wiki/Chlorpromazine "Chlorpromazine") [Thioridazine](https://en.wikipedia.org/wiki/Thioridazine "Thioridazine"), etc. [Atypical antipsychotics](https://en.wikipedia.org/wiki/Atypical_antipsychotic "Atypical antipsychotic") [Olanzapine](https://en.wikipedia.org/wiki/Olanzapine "Olanzapine") [Quetiapine](https://en.wikipedia.org/wiki/Quetiapine "Quetiapine") [Risperidone](https://en.wikipedia.org/wiki/Risperidone "Risperidone"), etc. |
| [α2\-Adrenergic](https://en.wikipedia.org/wiki/Alpha-2_adrenergic_receptor "Alpha-2 adrenergic receptor") | [Clonidine](https://en.wikipedia.org/wiki/Clonidine "Clonidine") [Detomidine](https://en.wikipedia.org/wiki/Detomidine "Detomidine") [Dexmedetomidine](https://en.wikipedia.org/wiki/Dexmedetomidine "Dexmedetomidine") [Lofexidine](https://en.wikipedia.org/wiki/Lofexidine "Lofexidine") [Medetomidine](https://en.wikipedia.org/wiki/Medetomidine "Medetomidine") [Romifidine](https://en.wikipedia.org/wiki/Romifidine "Romifidine") [Tasipimidine](https://en.wikipedia.org/wiki/Tasipimidine "Tasipimidine") [Tizanidine](https://en.wikipedia.org/wiki/Tizanidine "Tizanidine") [Xylazine](https://en.wikipedia.org/wiki/Xylazine "Xylazine") |
| [5-HT2A](https://en.wikipedia.org/wiki/5-HT2A_receptor "5-HT2A receptor") | |
| | |
| [Antidepressants](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant") | [Trazodone](https://en.wikipedia.org/wiki/Trazodone "Trazodone") [Tricyclic antidepressants](https://en.wikipedia.org/wiki/Tricyclic_antidepressant "Tricyclic antidepressant") [Amitriptyline](https://en.wikipedia.org/wiki/Amitriptyline "Amitriptyline") [Doxepin](https://en.wikipedia.org/wiki/Doxepin "Doxepin") [Trimipramine](https://en.wikipedia.org/wiki/Trimipramine "Trimipramine"), etc. [Tetracyclic antidepressants](https://en.wikipedia.org/wiki/Tetracyclic_antidepressant "Tetracyclic antidepressant") [Mianserin](https://en.wikipedia.org/wiki/Mianserin "Mianserin") [Mirtazapine](https://en.wikipedia.org/wiki/Mirtazapine "Mirtazapine"), etc. |
| [Antipsychotics](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic") | [Typical antipsychotics](https://en.wikipedia.org/wiki/Typical_antipsychotic "Typical antipsychotic") [Chlorpromazine](https://en.wikipedia.org/wiki/Chlorpromazine "Chlorpromazine") [Thioridazine](https://en.wikipedia.org/wiki/Thioridazine "Thioridazine"), etc. [Atypical antipsychotics](https://en.wikipedia.org/wiki/Atypical_antipsychotic "Atypical antipsychotic") [Olanzapine](https://en.wikipedia.org/wiki/Olanzapine "Olanzapine") [Quetiapine](https://en.wikipedia.org/wiki/Quetiapine "Quetiapine") [Risperidone](https://en.wikipedia.org/wiki/Risperidone "Risperidone"), etc. |
| Others | [Niaprazine](https://en.wikipedia.org/wiki/Niaprazine "Niaprazine") |
| [Melatonin](https://en.wikipedia.org/wiki/Melatonin_receptor "Melatonin receptor") | [Agomelatine](https://en.wikipedia.org/wiki/Agomelatine "Agomelatine") [Melatonin](https://en.wikipedia.org/wiki/Melatonin_\(medication\) "Melatonin (medication)") [Ramelteon](https://en.wikipedia.org/wiki/Ramelteon "Ramelteon") [Tasimelteon](https://en.wikipedia.org/wiki/Tasimelteon "Tasimelteon") |
| [Orexin](https://en.wikipedia.org/wiki/Orexin_receptor "Orexin receptor") | [Daridorexant](https://en.wikipedia.org/wiki/Daridorexant "Daridorexant") [Lemborexant](https://en.wikipedia.org/wiki/Lemborexant "Lemborexant") [Suvorexant](https://en.wikipedia.org/wiki/Suvorexant "Suvorexant") |
| [α2δ VDCC](https://en.wikipedia.org/wiki/Gabapentinoid "Gabapentinoid") | [Atagabalin](https://en.wikipedia.org/wiki/Atagabalin "Atagabalin") [Baclofen](https://en.wikipedia.org/wiki/Baclofen "Baclofen") [Gabapentin](https://en.wikipedia.org/wiki/Gabapentin "Gabapentin") [Gabapentin enacarbil](https://en.wikipedia.org/wiki/Gabapentin_enacarbil "Gabapentin enacarbil") [Mirogabalin](https://en.wikipedia.org/wiki/Mirogabalin "Mirogabalin") [Phenibut](https://en.wikipedia.org/wiki/Phenibut "Phenibut") [Pregabalin](https://en.wikipedia.org/wiki/Pregabalin "Pregabalin") |
| Others | [Cannabinoids](https://en.wikipedia.org/wiki/Cannabinoid "Cannabinoid") (e.g., [cannabis](https://en.wikipedia.org/wiki/Cannabis_\(drug\) "Cannabis (drug)"), [tetrahydrocannabinol](https://en.wikipedia.org/wiki/Tetrahydrocannabinol "Tetrahydrocannabinol")/[dronabinol](https://en.wikipedia.org/wiki/Dronabinol "Dronabinol"), [nabilone](https://en.wikipedia.org/wiki/Nabilone "Nabilone"), [cannabidiol](https://en.wikipedia.org/wiki/Cannabidiol "Cannabidiol"), [Zenivol](https://en.wikipedia.org/wiki/Zenivol "Zenivol")) [Chlorophenylalkyldiols](https://en.wikipedia.org/w/index.php?title=Chlorophenylalkyldiol&action=edit&redlink=1 "Chlorophenylalkyldiol (page does not exist)") [Fenpentadiol](https://en.wikipedia.org/wiki/Fenpentadiol "Fenpentadiol") [Metaglycodol](https://en.wikipedia.org/wiki/Metaglycodol "Metaglycodol") [Phenaglycodol](https://en.wikipedia.org/wiki/Phenaglycodol "Phenaglycodol") [Diethylpropanediol](https://en.wikipedia.org/wiki/2,2-Diethyl-1,3-propanediol "2,2-Diethyl-1,3-propanediol") [Evoxine](https://en.wikipedia.org/wiki/Evoxine "Evoxine") [Fenadiazole](https://en.wikipedia.org/wiki/Fenadiazole "Fenadiazole") [GABA reuptake inhibitors](https://en.wikipedia.org/wiki/GABA_reuptake_inhibitor "GABA reuptake inhibitor") (e.g., [tiagabine](https://en.wikipedia.org/wiki/Tiagabine "Tiagabine")) [Guaifenesin](https://en.wikipedia.org/wiki/Guaifenesin "Guaifenesin")\-related [muscle relaxants](https://en.wikipedia.org/wiki/Muscle_relaxant "Muscle relaxant") [Chlorphenesin](https://en.wikipedia.org/wiki/Chlorphenesin "Chlorphenesin") [Mephenesin](https://en.wikipedia.org/wiki/Mephenesin "Mephenesin") [Mephenoxalone](https://en.wikipedia.org/wiki/Mephenoxalone "Mephenoxalone") [Metaxalone](https://en.wikipedia.org/wiki/Metaxalone "Metaxalone") [Methocarbamol](https://en.wikipedia.org/wiki/Methocarbamol "Methocarbamol") [Midaflur](https://en.wikipedia.org/wiki/Midaflur "Midaflur") [Opioids](https://en.wikipedia.org/wiki/Opioid "Opioid") (e.g., [morphine](https://en.wikipedia.org/wiki/Morphine "Morphine")) [Passion flower](https://en.wikipedia.org/wiki/Passiflora "Passiflora") [Phemerazole](https://en.wikipedia.org/wiki/Phemerazole "Phemerazole") [Scopolamine](https://en.wikipedia.org/wiki/Scopolamine "Scopolamine") [Serotonin precursors](https://en.wikipedia.org/wiki/Serotonin_precursor "Serotonin precursor") (e.g., [tryptophan](https://en.wikipedia.org/wiki/Tryptophan "Tryptophan"), [5-hydroxytryptophan](https://en.wikipedia.org/wiki/5-hydroxytryptophan "5-hydroxytryptophan") (5-HTP; [oxitriptan](https://en.wikipedia.org/wiki/Oxitriptan "Oxitriptan"))) [Trazodone](https://en.wikipedia.org/wiki/Trazodone "Trazodone") [UMB68](https://en.wikipedia.org/wiki/UMB68 "UMB68") [Valnoctamide](https://en.wikipedia.org/wiki/Valnoctamide "Valnoctamide") |
| [v](https://en.wikipedia.org/wiki/Template:Insomnia_medications "Template:Insomnia medications") [t](https://en.wikipedia.org/wiki/Template_talk:Insomnia_medications "Template talk:Insomnia medications") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Insomnia_medications "Special:EditPage/Template:Insomnia medications")[Insomnia medications](https://en.wikipedia.org/wiki/Hypnotic "Hypnotic") | |
|---|---|
| [GABAA receptor positive modulators](https://en.wikipedia.org/wiki/GABAA_receptor_positive_allosteric_modulator "GABAA receptor positive allosteric modulator") | *[Benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepine "Benzodiazepine"):* [Brotizolam](https://en.wikipedia.org/wiki/Brotizolam "Brotizolam") [Cinolazepam](https://en.wikipedia.org/wiki/Cinolazepam "Cinolazepam") [Climazolam](https://en.wikipedia.org/wiki/Climazolam "Climazolam") [Clorazepate](https://en.wikipedia.org/wiki/Clorazepate "Clorazepate") [Doxefazepam](https://en.wikipedia.org/wiki/Doxefazepam "Doxefazepam") [Estazolam](https://en.wikipedia.org/wiki/Estazolam "Estazolam") [Etizolam](https://en.wikipedia.org/wiki/Etizolam "Etizolam") [Flunitrazepam](https://en.wikipedia.org/wiki/Flunitrazepam "Flunitrazepam") [Flurazepam](https://en.wikipedia.org/wiki/Flurazepam "Flurazepam") [Flutoprazepam](https://en.wikipedia.org/wiki/Flutoprazepam "Flutoprazepam") [Haloxazolam](https://en.wikipedia.org/wiki/Haloxazolam "Haloxazolam") [Loprazolam](https://en.wikipedia.org/wiki/Loprazolam "Loprazolam") [Lormetazepam](https://en.wikipedia.org/wiki/Lormetazepam "Lormetazepam") [Midazolam](https://en.wikipedia.org/wiki/Midazolam "Midazolam") [Nimetazepam](https://en.wikipedia.org/wiki/Nimetazepam "Nimetazepam") [Nitrazepam](https://en.wikipedia.org/wiki/Nitrazepam "Nitrazepam") [Quazepam](https://en.wikipedia.org/wiki/Quazepam "Quazepam") [Temazepam](https://en.wikipedia.org/wiki/Temazepam "Temazepam") [Triazolam](https://en.wikipedia.org/wiki/Triazolam "Triazolam") *[Nonbenzodiazepines](https://en.wikipedia.org/wiki/Nonbenzodiazepine "Nonbenzodiazepine")/[Z-drugs](https://en.wikipedia.org/wiki/Z-drug "Z-drug"):* [Eszopiclone](https://en.wikipedia.org/wiki/Eszopiclone "Eszopiclone") [Zaleplon](https://en.wikipedia.org/wiki/Zaleplon "Zaleplon") [Zolpidem](https://en.wikipedia.org/wiki/Zolpidem "Zolpidem") [Zopiclone](https://en.wikipedia.org/wiki/Zopiclone "Zopiclone") *Others:* [Alcohols](https://en.wikipedia.org/wiki/Alcohol_\(chemistry\) "Alcohol (chemistry)") (e.g., [ethchlorvynol](https://en.wikipedia.org/wiki/Ethchlorvynol "Ethchlorvynol"), [amylene hydrate](https://en.wikipedia.org/wiki/Tert-Amyl_alcohol "Tert-Amyl alcohol"), [ethanol](https://en.wikipedia.org/wiki/Ethanol "Ethanol")) [Barbiturates](https://en.wikipedia.org/wiki/Barbiturate "Barbiturate") (e.g., [amobarbital](https://en.wikipedia.org/wiki/Amobarbital "Amobarbital"), [pentobarbital](https://en.wikipedia.org/wiki/Pentobarbital "Pentobarbital"), [phenobarbital](https://en.wikipedia.org/wiki/Phenobarbital "Phenobarbital"), [secobarbital](https://en.wikipedia.org/wiki/Secobarbital "Secobarbital")) [Bromides](https://en.wikipedia.org/wiki/Bromide "Bromide") (e.g., [potassium bromide](https://en.wikipedia.org/wiki/Potassium_bromide "Potassium bromide"), [sodium bromide](https://en.wikipedia.org/wiki/Sodium_bromide "Sodium bromide")) [Carbamates](https://en.wikipedia.org/wiki/Carbamate "Carbamate") (e.g., [meprobamate](https://en.wikipedia.org/wiki/Meprobamate "Meprobamate")) [Chloral hydrate](https://en.wikipedia.org/wiki/Chloral_hydrate "Chloral hydrate") [Clomethiazole](https://en.wikipedia.org/wiki/Clomethiazole "Clomethiazole") [Kava](https://en.wikipedia.org/wiki/Kava "Kava") [Neurosteroids](https://en.wikipedia.org/wiki/Neurosteroid "Neurosteroid") (e.g., [progesterone](https://en.wikipedia.org/wiki/Progesterone_\(medication\) "Progesterone (medication)"), [zuranolone](https://en.wikipedia.org/wiki/Zuranolone "Zuranolone")†) [Paraldehyde](https://en.wikipedia.org/wiki/Paraldehyde "Paraldehyde") [Piperidinediones](https://en.wikipedia.org/wiki/Piperidinedione "Piperidinedione") (e.g., [glutethimide](https://en.wikipedia.org/wiki/Glutethimide "Glutethimide")) [Quinazolinones](https://en.wikipedia.org/wiki/Quinazolinone "Quinazolinone") (e.g., [methaqualone](https://en.wikipedia.org/wiki/Methaqualone "Methaqualone")) [Sulfonmethane](https://en.wikipedia.org/wiki/Sulfonmethane "Sulfonmethane") [Valerian](https://en.wikipedia.org/wiki/Valerian_\(herb\) "Valerian (herb)") |
| [Antihistamines](https://en.wikipedia.org/wiki/H1_antagonist "H1 antagonist") ([H1 receptor](https://en.wikipedia.org/wiki/H1_receptor "H1 receptor") [inverse agonists](https://en.wikipedia.org/wiki/Inverse_agonist "Inverse agonist")) | [Alimemazine](https://en.wikipedia.org/wiki/Alimemazine "Alimemazine") [Captodiame](https://en.wikipedia.org/wiki/Captodiame "Captodiame") [Cyproheptadine](https://en.wikipedia.org/wiki/Cyproheptadine "Cyproheptadine") [Dimenhydrinate](https://en.wikipedia.org/wiki/Dimenhydrinate "Dimenhydrinate") [Diphenhydramine](https://en.wikipedia.org/wiki/Diphenhydramine "Diphenhydramine") [Doxylamine](https://en.wikipedia.org/wiki/Doxylamine "Doxylamine") [Etodroxizine](https://en.wikipedia.org/wiki/Etodroxizine "Etodroxizine") [Hydroxyzine](https://en.wikipedia.org/wiki/Hydroxyzine "Hydroxyzine") [Meclizine](https://en.wikipedia.org/wiki/Meclizine "Meclizine") [Methapyrilene](https://en.wikipedia.org/wiki/Methapyrilene "Methapyrilene") [Pheniramine](https://en.wikipedia.org/wiki/Pheniramine "Pheniramine") [Phenyltoloxamine](https://en.wikipedia.org/wiki/Phenyltoloxamine "Phenyltoloxamine") [Pimethixene](https://en.wikipedia.org/wiki/Pimethixene "Pimethixene") [Promethazine](https://en.wikipedia.org/wiki/Promethazine "Promethazine") [Propiomazine](https://en.wikipedia.org/wiki/Propiomazine "Propiomazine") [Pyrilamine](https://en.wikipedia.org/wiki/Pyrilamine "Pyrilamine") [Tricyclic antidepressants](https://en.wikipedia.org/wiki/Tricyclic_antidepressant "Tricyclic antidepressant") (e.g., [amitriptyline](https://en.wikipedia.org/wiki/Amitriptyline "Amitriptyline"), [doxepin](https://en.wikipedia.org/wiki/Doxepin "Doxepin"), [trimipramine](https://en.wikipedia.org/wiki/Trimipramine "Trimipramine")) [Tetracyclic antidepressants](https://en.wikipedia.org/wiki/Tetracyclic_antidepressant "Tetracyclic antidepressant") (e.g., [mirtazapine](https://en.wikipedia.org/wiki/Mirtazapine "Mirtazapine")) [Triprolidine](https://en.wikipedia.org/wiki/Triprolidine "Triprolidine") |
| [Orexin receptor antagonists](https://en.wikipedia.org/wiki/Orexin_receptor_antagonist "Orexin receptor antagonist") | [Daridorexant](https://en.wikipedia.org/wiki/Daridorexant "Daridorexant") [Fazamorexant](https://en.wikipedia.org/wiki/Fazamorexant "Fazamorexant")† [Lemborexant](https://en.wikipedia.org/wiki/Lemborexant "Lemborexant") [Seltorexant](https://en.wikipedia.org/wiki/Seltorexant "Seltorexant")† [Suvorexant](https://en.wikipedia.org/wiki/Suvorexant "Suvorexant") [Vornorexant](https://en.wikipedia.org/wiki/Vornorexant "Vornorexant")† |
| [Melatonin receptor agonists](https://en.wikipedia.org/wiki/Melatonin_receptor_agonist "Melatonin receptor agonist") | [Melatonin](https://en.wikipedia.org/wiki/Melatonin_\(medication\) "Melatonin (medication)") [Ramelteon](https://en.wikipedia.org/wiki/Ramelteon "Ramelteon") [Tasimelteon](https://en.wikipedia.org/wiki/Tasimelteon "Tasimelteon") |
| Others | [α1\-Adrenergic receptor](https://en.wikipedia.org/wiki/Alpha-1_adrenergic_receptor "Alpha-1 adrenergic receptor") [antagonists](https://en.wikipedia.org/wiki/Receptor_antagonist "Receptor antagonist") (e.g., [prazosin](https://en.wikipedia.org/wiki/Prazosin "Prazosin")) [α2\-Adrenergic receptor](https://en.wikipedia.org/wiki/Alpha-2_adrenergic_receptor "Alpha-2 adrenergic receptor") [agonists](https://en.wikipedia.org/wiki/Agonist "Agonist") (e.g., [clonidine](https://en.wikipedia.org/wiki/Clonidine "Clonidine")) [Antipsychotics](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic") (e.g., [quetiapine](https://en.wikipedia.org/wiki/Quetiapine "Quetiapine"), [olanzapine](https://en.wikipedia.org/wiki/Olanzapine "Olanzapine"), [risperidone](https://en.wikipedia.org/wiki/Risperidone "Risperidone"), [chlorpromazine](https://en.wikipedia.org/wiki/Chlorpromazine "Chlorpromazine")) [Ashwagandha](https://en.wikipedia.org/wiki/Withania_somnifera "Withania somnifera") [Benzoctamine](https://en.wikipedia.org/wiki/Benzoctamine "Benzoctamine") [Cannabinoids](https://en.wikipedia.org/wiki/Cannabinoid "Cannabinoid") (e.g., [cannabis](https://en.wikipedia.org/wiki/Cannabis_\(drug\) "Cannabis (drug)"), [dronabinol (THC)](https://en.wikipedia.org/wiki/Dronabinol "Dronabinol") , [nabilone](https://en.wikipedia.org/wiki/Nabilone "Nabilone"), [Zenivol](https://en.wikipedia.org/wiki/Zenivol "Zenivol")) [Chamomile](https://en.wikipedia.org/wiki/Chamomile "Chamomile") [Fenadiazole](https://en.wikipedia.org/wiki/Fenadiazole "Fenadiazole") [GABAA receptor](https://en.wikipedia.org/wiki/GABAA_receptor "GABAA receptor") [agonists](https://en.wikipedia.org/wiki/Agonist "Agonist") (e.g., [gaboxadol](https://en.wikipedia.org/wiki/Gaboxadol "Gaboxadol") (THIP)†, [muscimol](https://en.wikipedia.org/wiki/Muscimol "Muscimol"), *[Amanita muscaria](https://en.wikipedia.org/wiki/Amanita_muscaria "Amanita muscaria")*) [GABAB receptor](https://en.wikipedia.org/wiki/GABAB_receptor "GABAB receptor") [agonists](https://en.wikipedia.org/wiki/Agonist "Agonist") (e.g., [sodium oxybate](https://en.wikipedia.org/wiki/Sodium_oxybate "Sodium oxybate") ([γ-hydroxybutyrate](https://en.wikipedia.org/wiki/%CE%93-hydroxybutyrate "Γ-hydroxybutyrate") (GHB)), [baclofen](https://en.wikipedia.org/wiki/Baclofen "Baclofen"), [phenibut](https://en.wikipedia.org/wiki/Phenibut "Phenibut")) [GABA reuptake inhibitors](https://en.wikipedia.org/wiki/GABA_reuptake_inhibitor "GABA reuptake inhibitor") (e.g., [tiagabine](https://en.wikipedia.org/wiki/Tiagabine "Tiagabine")) [Gabapentinoids](https://en.wikipedia.org/wiki/Gabapentinoid "Gabapentinoid") (e.g., [gabapentin](https://en.wikipedia.org/wiki/Gabapentin "Gabapentin"), [gabapentin enacarbil](https://en.wikipedia.org/wiki/Gabapentin_enacarbil "Gabapentin enacarbil"), [pregabalin](https://en.wikipedia.org/wiki/Pregabalin "Pregabalin")) [Hops](https://en.wikipedia.org/wiki/Hops "Hops") [Lavender](https://en.wikipedia.org/wiki/Lavandula "Lavandula") [Menthyl isovalerate](https://en.wikipedia.org/wiki/Menthyl_isovalerate "Menthyl isovalerate") [Opioids](https://en.wikipedia.org/wiki/Opioid "Opioid") (e.g., [hydrocodone](https://en.wikipedia.org/wiki/Hydrocodone "Hydrocodone"), [oxycodone](https://en.wikipedia.org/wiki/Oxycodone "Oxycodone"), [morphine](https://en.wikipedia.org/wiki/Morphine "Morphine")) [Passion flower](https://en.wikipedia.org/wiki/Passiflora "Passiflora") [Scopolamine](https://en.wikipedia.org/wiki/Scopolamine "Scopolamine") [Serotonin precursors](https://en.wikipedia.org/wiki/Neurotransmitter#Serotonin_precursors "Neurotransmitter") ([tryptophan](https://en.wikipedia.org/wiki/Tryptophan "Tryptophan"), [5-hydroxytryptophan](https://en.wikipedia.org/wiki/5-hydroxytryptophan "5-hydroxytryptophan") (5-HTP; [oxitriptan](https://en.wikipedia.org/wiki/Oxitriptan "Oxitriptan"))) [Phenylpiperazines](https://en.wikipedia.org/wiki/Substituted_phenylpiperazine "Substituted phenylpiperazine") (e.g., [trazodone](https://en.wikipedia.org/wiki/Trazodone "Trazodone"), [niaprazine](https://en.wikipedia.org/wiki/Niaprazine "Niaprazine")) [Theanine](https://en.wikipedia.org/wiki/Theanine "Theanine") [Tricyclic antidepressants](https://en.wikipedia.org/wiki/Tricyclic_antidepressant "Tricyclic antidepressant") (e.g., [amitriptyline](https://en.wikipedia.org/wiki/Amitriptyline "Amitriptyline"), [doxepin](https://en.wikipedia.org/wiki/Doxepin "Doxepin"), [trimipramine](https://en.wikipedia.org/wiki/Trimipramine "Trimipramine")) [Tetracyclic antidepressants](https://en.wikipedia.org/wiki/Tetracyclic_antidepressant "Tetracyclic antidepressant") (e.g., [mirtazapine](https://en.wikipedia.org/wiki/Mirtazapine "Mirtazapine")) [Valnoctamide](https://en.wikipedia.org/wiki/Valnoctamide "Valnoctamide") |
| \#[WHO-EM](https://en.wikipedia.org/wiki/WHO_Model_List_of_Essential_Medicines "WHO Model List of Essential Medicines") ‡[Withdrawn](https://en.wikipedia.org/wiki/List_of_withdrawn_drugs "List of withdrawn drugs") from market [Clinical trials](https://en.wikipedia.org/wiki/Clinical_trial "Clinical trial"): †[Phase III](https://en.wikipedia.org/wiki/Phases_of_clinical_research#Phase_III "Phases of clinical research") §Never to phase III | |
| [v](https://en.wikipedia.org/wiki/Template:Digital_media_use_and_mental_health "Template:Digital media use and mental health") [t](https://en.wikipedia.org/wiki/Template_talk:Digital_media_use_and_mental_health "Template talk:Digital media use and mental health") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Digital_media_use_and_mental_health "Special:EditPage/Template:Digital media use and mental health")[Digital media use and mental health](https://en.wikipedia.org/wiki/Digital_media_use_and_mental_health "Digital media use and mental health") | |
|---|---|
| Proposed or recognised diagnostic categories | [Computer addiction](https://en.wikipedia.org/wiki/Computer_addiction "Computer addiction") [Internet addiction disorder](https://en.wikipedia.org/wiki/Internet_addiction_disorder "Internet addiction disorder") [Internet sex addiction](https://en.wikipedia.org/wiki/Internet_sex_addiction "Internet sex addiction") [Online gambling](https://en.wikipedia.org/wiki/Online_gambling "Online gambling") [Problematic smartphone use](https://en.wikipedia.org/wiki/Problematic_smartphone_use "Problematic smartphone use") [Nomophobia](https://en.wikipedia.org/wiki/Nomophobia "Nomophobia") [Problematic social media use](https://en.wikipedia.org/wiki/Problematic_social_media_use "Problematic social media use") [Television addiction](https://en.wikipedia.org/wiki/Television_addiction "Television addiction") [Video game addiction](https://en.wikipedia.org/wiki/Video_game_addiction "Video game addiction") |
| Disciplines involved | [Digital anthropology](https://en.wikipedia.org/wiki/Digital_anthropology "Digital anthropology") [Digital sociology](https://en.wikipedia.org/wiki/Digital_sociology "Digital sociology") [Ergonomics](https://en.wikipedia.org/wiki/Ergonomics "Ergonomics") [Cognitive ergonomics](https://en.wikipedia.org/wiki/Cognitive_ergonomics "Cognitive ergonomics") [Computer-mediated communication](https://en.wikipedia.org/wiki/Computer-mediated_communication "Computer-mediated communication") [Cyberpsychology](https://en.wikipedia.org/wiki/Cyberpsychology "Cyberpsychology") [Engineering psychology](https://en.wikipedia.org/wiki/Engineering_psychology "Engineering psychology") [Human–computer interaction](https://en.wikipedia.org/wiki/Human%E2%80%93computer_interaction "Human–computer interaction") [Media naturalness theory](https://en.wikipedia.org/wiki/Media_naturalness_theory "Media naturalness theory") [Neuroergonomics](https://en.wikipedia.org/wiki/Neuroergonomics "Neuroergonomics") [Neuroscience](https://en.wikipedia.org/wiki/Neuroscience "Neuroscience") [Psychiatry](https://en.wikipedia.org/wiki/Psychiatry "Psychiatry") [Evolutionary](https://en.wikipedia.org/wiki/Evolutionary_psychiatry "Evolutionary psychiatry") [Psychology](https://en.wikipedia.org/wiki/Psychology "Psychology") [Clinical](https://en.wikipedia.org/wiki/Clinical_psychology "Clinical psychology") [Cognitive](https://en.wikipedia.org/wiki/Cognitive_psychology "Cognitive psychology") [Evolutionary](https://en.wikipedia.org/wiki/Evolutionary_psychology "Evolutionary psychology") [Social](https://en.wikipedia.org/wiki/Social_psychology "Social psychology") |
| Associated psychiatric conditions | [Anxiety disorder](https://en.wikipedia.org/wiki/Anxiety_disorder "Anxiety disorder") [Generalized anxiety disorder](https://en.wikipedia.org/wiki/Generalized_anxiety_disorder "Generalized anxiety disorder") [Obsessive–compulsive disorder](https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_disorder "Obsessive–compulsive disorder") [Social anxiety disorder](https://en.wikipedia.org/wiki/Social_anxiety_disorder "Social anxiety disorder") [Attention deficit hyperactivity disorder](https://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder "Attention deficit hyperactivity disorder") [Autism](https://en.wikipedia.org/wiki/Autism "Autism") [Bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder") [Depression](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder") [Eating disorder](https://en.wikipedia.org/wiki/Eating_disorder "Eating disorder") [Anorexia nervosa](https://en.wikipedia.org/wiki/Anorexia_nervosa "Anorexia nervosa") [Body image disturbance](https://en.wikipedia.org/wiki/Body_image_disturbance "Body image disturbance") [Insomnia]() [Narcissistic personality disorder](https://en.wikipedia.org/wiki/Narcissistic_personality_disorder "Narcissistic personality disorder") |
| Related topics | [Behavioral addiction](https://en.wikipedia.org/wiki/Behavioral_addiction "Behavioral addiction") [Behavioral modernity](https://en.wikipedia.org/wiki/Behavioral_modernity "Behavioral modernity") [Body image](https://en.wikipedia.org/wiki/Body_image "Body image") [Criticism of Facebook](https://en.wikipedia.org/wiki/Criticism_of_Facebook "Criticism of Facebook") [2021 Facebook company files leak](https://en.wikipedia.org/wiki/2021_Facebook_leak "2021 Facebook leak") [Cyberbullying](https://en.wikipedia.org/wiki/Cyberbullying "Cyberbullying") [Cyberpathology](https://en.wikipedia.org/wiki/Cyberpathology "Cyberpathology") [Digital detox](https://en.wikipedia.org/wiki/Digital_detox "Digital detox") [Digital zombie](https://en.wikipedia.org/wiki/Digital_zombie "Digital zombie") [Evolution of cognition](https://en.wikipedia.org/wiki/Evolution_of_cognition "Evolution of cognition") [Evolutionary mismatch](https://en.wikipedia.org/wiki/Evolutionary_mismatch "Evolutionary mismatch") [Fear of missing out](https://en.wikipedia.org/wiki/Fear_of_missing_out "Fear of missing out") [Mobile phones and driving safety](https://en.wikipedia.org/wiki/Mobile_phones_and_driving_safety "Mobile phones and driving safety") [Promotion of anorexia](https://en.wikipedia.org/wiki/Pro-ana "Pro-ana") [Psychological effects of Internet use](https://en.wikipedia.org/wiki/Psychological_effects_of_Internet_use "Psychological effects of Internet use") [Screen time](https://en.wikipedia.org/wiki/Screen_time "Screen time") [Binge-watching](https://en.wikipedia.org/wiki/Binge-watching "Binge-watching") [Social aspects of television](https://en.wikipedia.org/wiki/Social_aspects_of_television "Social aspects of television") [Television consumption](https://en.wikipedia.org/wiki/Television_consumption "Television consumption") [Smartphones and pedestrian safety](https://en.wikipedia.org/wiki/Smartphones_and_pedestrian_safety "Smartphones and pedestrian safety") [Social media addiction trials](https://en.wikipedia.org/wiki/Social_media_addiction_trials "Social media addiction trials") [Social media and suicide](https://en.wikipedia.org/wiki/Social_media_and_suicide "Social media and suicide") [Social media restrictions on children in Australia](https://en.wikipedia.org/wiki/Online_Safety_Amendment "Online Safety Amendment") [Spaving](https://en.wikipedia.org/wiki/Spaving "Spaving") [Suicide and the Internet](https://en.wikipedia.org/wiki/Suicide_and_the_Internet "Suicide and the Internet") [Technophilia](https://en.wikipedia.org/wiki/Technophilia "Technophilia") [Technophobia](https://en.wikipedia.org/wiki/Technophobia "Technophobia") [Technostress](https://en.wikipedia.org/wiki/Technostress "Technostress") [Texting while driving](https://en.wikipedia.org/wiki/Texting_while_driving "Texting while driving") |
| [Authority control databases](https://en.wikipedia.org/wiki/Help:Authority_control "Help:Authority control") [](https://www.wikidata.org/wiki/Q1869874#identifiers "Edit this at Wikidata") | |
|---|---|
| International | [GND](https://d-nb.info/gnd/4052584-3) [FAST](https://id.worldcat.org/fast/974221) |
| National | [United States](https://id.loc.gov/authorities/sh85066717) [France](https://catalogue.bnf.fr/ark:/12148/cb119320824) [BnF data](https://data.bnf.fr/ark:/12148/cb119320824) [Japan](https://id.ndl.go.jp/auth/ndlna/00563661) [Czech Republic](https://aleph.nkp.cz/F/?func=find-c&local_base=aut&ccl_term=ica=ph124705&CON_LNG=ENG) [Spain](https://datos.bne.es/resource/XX527001) [Israel](https://www.nli.org.il/en/authorities/987007553259405171) |
| Other | [Yale LUX](https://lux.collections.yale.edu/view/concept/b78be39b-e266-43ec-bcf7-6a2ac94f883e) |
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Insomnia
86 languages
[Add topic](https://en.wikipedia.org/wiki/Insomnia) |
| Readable Markdown | | Insomnia | |
|---|---|
| Other names | Sleeplessness, trouble sleeping |
| [](https://en.wikipedia.org/wiki/File:53-aspetti_di_vita_quotidiana,_insonnia,_Taccuino_Sanitatis,.jpg) | |
| Depiction of insomnia from the 14th century medical manuscript *[Tacuinum Sanitatis](https://en.wikipedia.org/wiki/Tacuinum_Sanitatis "Tacuinum Sanitatis")* | |
| Pronunciation | [\[1\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Ov-1) |
| [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") | [Psychiatry](https://en.wikipedia.org/wiki/Psychiatry "Psychiatry"), [Clinical Psychology](https://en.wikipedia.org/wiki/Clinical_Psychology "Clinical Psychology"), [Sleep Medicine](https://en.wikipedia.org/wiki/Sleep_Medicine "Sleep Medicine") |
| [Symptoms](https://en.wikipedia.org/wiki/Signs_and_symptoms "Signs and symptoms") | Trouble [sleeping](https://en.wikipedia.org/wiki/Sleeping "Sleeping"), daytime sleepiness, low energy, irritability, [depressed mood](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)")[\[1\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Ov-1) |
| [Causes](https://en.wikipedia.org/wiki/Cause_\(medicine\) "Cause (medicine)") | Unknown, [psychological stress](https://en.wikipedia.org/wiki/Psychological_stress "Psychological stress"), [chronic pain](https://en.wikipedia.org/wiki/Chronic_pain "Chronic pain"), [heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure"), [hyperthyroidism](https://en.wikipedia.org/wiki/Hyperthyroidism "Hyperthyroidism"), [heartburn](https://en.wikipedia.org/wiki/Heartburn "Heartburn"), [restless leg syndrome](https://en.wikipedia.org/wiki/Restless_leg_syndrome "Restless leg syndrome"), [autism spectrum disorder](https://en.wikipedia.org/wiki/Autism_spectrum_disorder "Autism spectrum disorder"), [obstructive sleep apnea](https://en.wikipedia.org/wiki/Obstructive_sleep_apnea "Obstructive sleep apnea"), others[\[2\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Ca-2) |
| [Diagnostic method](https://en.wikipedia.org/wiki/Medical_diagnosis "Medical diagnosis") | Based on symptoms, [sleep study](https://en.wikipedia.org/wiki/Sleep_study "Sleep study")[\[3\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Diag-3) |
| [Differential diagnosis](https://en.wikipedia.org/wiki/Differential_diagnosis "Differential diagnosis") | [Delayed sleep phase disorder](https://en.wikipedia.org/wiki/Delayed_sleep_phase_disorder "Delayed sleep phase disorder"), [restless leg syndrome](https://en.wikipedia.org/wiki/Restless_leg_syndrome "Restless leg syndrome"), [sleep apnea](https://en.wikipedia.org/wiki/Sleep_apnea "Sleep apnea"), [psychiatric disorder](https://en.wikipedia.org/wiki/Psychiatric_disorder "Psychiatric disorder")[\[4\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-4) |
| Treatment | [Sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene"), [cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_for_insomnia "Cognitive behavioral therapy for insomnia"), [hypnotics](https://en.wikipedia.org/wiki/Hypnotics "Hypnotics")[\[5\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Tx-5)[\[6\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-AC2016-6)[\[7\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Wil2008-7) |
| Frequency | ~20%[\[8\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-WHO2009-8)[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9)[\[10\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Tas2015-10) |
**Insomnia**, also known as **sleeplessness**, is a [sleep disorder](https://en.wikipedia.org/wiki/Sleep_disorder "Sleep disorder") causing difficulty falling asleep or staying asleep for as long as desired.[\[1\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Ov-1)[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9)[\[11\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Pun2012-11) Insomnia is typically followed by daytime [sleepiness](https://en.wikipedia.org/wiki/Sleepiness "Sleepiness"), low energy, [irritability](https://en.wikipedia.org/wiki/Irritability "Irritability"), and a [depressed mood](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)").[\[1\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Ov-1) It may result in an increased risk of accidents as well as problems focusing and learning.[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9) Insomnia can be short-term, lasting for days or weeks, or long-term, lasting more than a month.[\[1\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Ov-1) The concept of the word *insomnia* has two distinct possibilities: insomnia disorder or insomnia symptoms.[\[12\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Banno2022-12)
Insomnia can occur independently or as a result of another problem.[\[2\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Ca-2) Conditions that can result in insomnia include [psychological stress](https://en.wikipedia.org/wiki/Psychological_stress "Psychological stress"), [chronic pain](https://en.wikipedia.org/wiki/Chronic_pain "Chronic pain"), [heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure"), [hyperthyroidism](https://en.wikipedia.org/wiki/Hyperthyroidism "Hyperthyroidism"), [heartburn](https://en.wikipedia.org/wiki/Heartburn "Heartburn"), [restless leg syndrome](https://en.wikipedia.org/wiki/Restless_leg_syndrome "Restless leg syndrome"), [menopause](https://en.wikipedia.org/wiki/Menopause "Menopause"), certain [medications](https://en.wikipedia.org/wiki/Medication "Medication"), and drugs such as [caffeine](https://en.wikipedia.org/wiki/Caffeine "Caffeine"), [nicotine](https://en.wikipedia.org/wiki/Nicotine "Nicotine"), and [alcohol](https://en.wikipedia.org/wiki/Alcohol_\(drug\) "Alcohol (drug)").[\[2\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Ca-2)[\[8\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-WHO2009-8) Risk factors include working [night shifts](https://en.wikipedia.org/wiki/Night_shifts "Night shifts") and [sleep apnea](https://en.wikipedia.org/wiki/Sleep_apnea "Sleep apnea").[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9) Diagnosis is based on sleep habits and an examination to look for underlying causes.[\[3\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Diag-3) A [sleep study](https://en.wikipedia.org/wiki/Sleep_study "Sleep study") may be done to look for underlying sleep disorders.[\[3\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Diag-3) Screening may be done with questions like "Do you experience difficulty sleeping?" or "Do you have difficulty falling or staying asleep?"[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9)
[Cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_for_insomnia "Cognitive behavioral therapy for insomnia") is considered the first-line treatment.[\[6\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-AC2016-6)[\[13\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Tra2015-13)[\[14\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Behavioral_and_psychological_treatm-14) [Sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene") and lifestyle changes are also recommended for insomnia, though their efficacy is not definitely established.[\[5\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Tx-5)[\[7\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Wil2008-7)[\[14\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Behavioral_and_psychological_treatm-14) Sleep hygiene includes a consistent bedtime, a quiet and dark room, exposure to sunlight during the day and regular [exercise](https://en.wikipedia.org/wiki/Exercise "Exercise").[\[7\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Wil2008-7) [Sleeping pills](https://en.wikipedia.org/wiki/Sleeping_pill "Sleeping pill") can improve sleep, though some are associated with falls, [cognitive impairment](https://en.wikipedia.org/wiki/Cognitive_impairment "Cognitive impairment"), and [dependence](https://en.wikipedia.org/wiki/Substance_dependence "Substance dependence").[\[5\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Tx-5)[\[6\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-AC2016-6) These medications are not recommended for more than four or five weeks but can be used longer in certain instances.[\[6\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-AC2016-6)[\[15\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-riemann-23-15) Among these, [lemborexant](https://en.wikipedia.org/wiki/Lemborexant "Lemborexant") and [eszopiclone](https://en.wikipedia.org/wiki/Eszopiclone "Eszopiclone") have the most favorable efficacy and safety profiles.[\[16\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid35843245-16) The efficacy and safety of [alternative medicine](https://en.wikipedia.org/wiki/Insomnia#Alternative_medicine) treatments are unclear.[\[6\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-AC2016-6)[\[15\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-riemann-23-15)
Between 10% and 30% of adults have insomnia at any given point in time, and up to half of people have insomnia in a given year.[\[8\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-WHO2009-8)[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9)[\[10\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Tas2015-10) About 6% of people have insomnia that is not due to another problem and lasts for more than a month.[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9) People over the age of 65 are affected more often than younger people.[\[7\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Wil2008-7) Women are more often affected than men.[\[8\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-WHO2009-8) Descriptions of insomnia occur at least as far back as [ancient Greece](https://en.wikipedia.org/wiki/Ancient_Greece "Ancient Greece").[\[17\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-17)
[](https://en.wikipedia.org/wiki/File:Complications_of_insomnia.svg)
Potential complications of insomnia[\[18\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-18)
Symptoms of insomnia:[\[19\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-BBDinsomnia-19)
- Difficulty falling asleep, including difficulty finding a comfortable [sleeping position](https://en.wikipedia.org/wiki/Sleeping_position "Sleeping position")
- Waking during the night, being unable to return to sleep[\[20\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-20) and waking up early
- Not able to focus on daily tasks, difficulty in remembering
- [Daytime sleepiness](https://en.wikipedia.org/wiki/Excessive_daytime_sleepiness "Excessive daytime sleepiness"), [irritability](https://en.wikipedia.org/wiki/Irritability "Irritability"), [depression](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)") or [anxiety](https://en.wikipedia.org/wiki/Anxiety "Anxiety")
- Feeling tired or having low energy during the day[\[21\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-21)
- Trouble concentrating
- Being irritable, acting aggressive, or impulsive
[Sleep onset](https://en.wikipedia.org/wiki/Sleep_onset "Sleep onset") insomnia is difficulty falling asleep at the beginning of the night, often a symptom of [anxiety disorders](https://en.wikipedia.org/wiki/Anxiety_disorder "Anxiety disorder"). [Delayed sleep phase disorder](https://en.wikipedia.org/wiki/Delayed_sleep_phase_disorder "Delayed sleep phase disorder") can be misdiagnosed as insomnia, as sleep onset is delayed much later than normal, while awakening spills over into daylight hours.[\[22\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-22)
It is common for patients who have difficulty falling asleep to also have nocturnal awakenings with difficulty returning to sleep.[\[23\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-23) Two-thirds of these patients wake up in the middle of the night, with more than half having trouble falling back to sleep after a [middle-of-the-night awakening](https://en.wikipedia.org/wiki/Middle-of-the-night_insomnia "Middle-of-the-night insomnia").[\[24\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-24)
Early morning awakening occurs earlier (more than 30 minutes) than desired, with an inability to go back to sleep and before total sleep time reaches 6.5 hours. Early morning awakening is often a characteristic of [depression](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder").[\[25\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-25) Anxiety symptoms may well lead to insomnia. Some of these symptoms include [psychological stress](https://en.wikipedia.org/wiki/Psychological_stress "Psychological stress"), compulsive worrying about the future, feeling overstimulated, and overanalyzing past events.[\[26\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-26)
Chronic insomnia may take a mental toll, affecting social interactions, work, and lifestyle.[\[14\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Behavioral_and_psychological_treatm-14)
Poor sleep quality can occur as a result of, for example, [restless legs](https://en.wikipedia.org/wiki/Restless_legs "Restless legs"), [sleep apnea](https://en.wikipedia.org/wiki/Sleep_apnea "Sleep apnea"), or [major depression](https://en.wikipedia.org/wiki/Major_depression "Major depression"). Poor sleep quality is defined as the individual not reaching [stage 3](https://en.wikipedia.org/wiki/Slow-wave_sleep "Slow-wave sleep") or delta sleep, which has restorative properties.[\[27\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-27)
Major depression leads to alterations in the function of the [hypothalamic–pituitary–adrenal axis](https://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary%E2%80%93adrenal_axis "Hypothalamic–pituitary–adrenal axis"), causing excessive release of [cortisol](https://en.wikipedia.org/wiki/Cortisol "Cortisol"), which can lead to poor sleep quality.
Nocturnal [polyuria](https://en.wikipedia.org/wiki/Polyuria "Polyuria"), excessive night-time urination, can also result in a poor quality of sleep.[\[28\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-28)
Sleep state misperception is a condition where patients believe that they have been awake all night even though sleep tests prove that they have slept for hours. Also called paradoxical insomnia or subjective insomnia, paradoxical insomnia may affect only about 5% of people with insomnia.[\[29\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-29)
Despite sleeping for multiple hours each night and typically not experiencing significant daytime sleepiness or other symptoms of sleep loss, patients feel like they have not slept very much, if at all. They incorrectly believe it takes them an abnormally long [time to fall asleep](https://en.wikipedia.org/wiki/Sleep_onset_latency "Sleep onset latency"), and they underestimate how long they stay asleep.[\[30\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Harvey_2012-30)
### Problematic digital media use
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=4 "Edit section: Problematic digital media use")\]
Sleep quality and screen time or digital media use have been linked, including studies looking at media type, time of day, and age of person.[\[31\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-31)[\[32\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-32)[\[33\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Digital_media_use_and_mental_health_Psychiatry_Research_2020-33)[\[34\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Digital_media_use_and_mental_health_JBA_2020-34)[\[35\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-35)[\[36\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-36)[\[37\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-37)[\[38\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-38)[\[39\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-39)[\[40\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-40) Various sleep challenges or outcomes have been studied including a reduction in sleep duration, increased sleep onset latency, modifications to [rapid eye movement sleep](https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep "Rapid eye movement sleep") and [slow-wave sleep](https://en.wikipedia.org/wiki/Slow-wave_sleep "Slow-wave sleep"), increased sleepiness and self-perceived [fatigue](https://en.wikipedia.org/wiki/Fatigue "Fatigue"), and impaired post-sleep [attention span](https://en.wikipedia.org/wiki/Attention_span "Attention span") and [verbal memory](https://en.wikipedia.org/wiki/Verbal_memory "Verbal memory").[\[41\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-41)
While insomnia can be caused by many conditions, it can also occur without any identifiable cause. This is known as Primary Insomnia.[\[42\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-42) Primary Insomnia may also have an initial identifiable cause but continues after the cause is no longer present. For example, a bout of insomnia may be triggered by a stressful work or life event. However, the condition may continue after the stressful event has been resolved. In such cases, the insomnia is usually perpetuated by the anxiety or fear caused by the sleeplessness itself, rather than any external factors.[\[43\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-43)
Symptoms of insomnia can be caused by or associated with:
- Sleep breathing disorders, such as [sleep apnea](https://en.wikipedia.org/wiki/Sleep_apnea "Sleep apnea") or [upper airway resistance syndrome](https://en.wikipedia.org/wiki/Upper_airway_resistance_syndrome "Upper airway resistance syndrome")[\[44\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-44)
- Use of [psychoactive drugs](https://en.wikipedia.org/wiki/Psychoactive_drug "Psychoactive drug") (such as [stimulants](https://en.wikipedia.org/wiki/Stimulant "Stimulant")), including certain [medications](https://en.wikipedia.org/wiki/Medication "Medication"), [herbs](https://en.wikipedia.org/wiki/Herb "Herb"), [caffeine](https://en.wikipedia.org/wiki/Caffeine "Caffeine"), [nicotine](https://en.wikipedia.org/wiki/Nicotine "Nicotine"), [cocaine](https://en.wikipedia.org/wiki/Cocaine "Cocaine"), [amphetamines](https://en.wikipedia.org/wiki/Amphetamine "Amphetamine"), [methylphenidate](https://en.wikipedia.org/wiki/Methylphenidate "Methylphenidate"), [aripiprazole](https://en.wikipedia.org/wiki/Aripiprazole "Aripiprazole"), [MDMA](https://en.wikipedia.org/wiki/MDMA "MDMA"), [modafinil](https://en.wikipedia.org/wiki/Modafinil "Modafinil"), or excessive alcohol intake[\[45\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-umm_causes-45)
- Use of or withdrawal from alcohol and other [sedatives](https://en.wikipedia.org/wiki/Sedative "Sedative"), such as anti-anxiety and sleep drugs like [benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepine_withdrawal "Benzodiazepine withdrawal")[\[45\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-umm_causes-45)
- Use of or withdrawal from pain-relievers such as [opioids](https://en.wikipedia.org/wiki/Opioid_withdrawal "Opioid withdrawal")[\[45\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-umm_causes-45)
- [Heart disease](https://en.wikipedia.org/wiki/Heart_disease "Heart disease")[\[46\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-comorbidity-46)
- [Restless legs syndrome](https://en.wikipedia.org/wiki/Restless_legs_syndrome "Restless legs syndrome"), which can cause sleep onset insomnia due to the discomforting sensations felt and the need to move the legs or other body parts to relieve these sensations[\[47\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-mayo_insomnia_causes-47)
- [Periodic limb movement disorder](https://en.wikipedia.org/wiki/Periodic_limb_movement_disorder "Periodic limb movement disorder") (PLMD), which occurs during sleep and can cause arousals of which the sleeper is unaware[\[48\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-48)
- [Pain](https://en.wikipedia.org/wiki/Pain "Pain"):[\[49\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Ramakrishnan-2007-49) an injury or condition that causes pain can preclude an individual from finding a comfortable position in which to fall asleep, and can also cause awakening.
- [Hormone](https://en.wikipedia.org/wiki/Hormone "Hormone") shifts such as those that precede [menstruation](https://en.wikipedia.org/wiki/Menstruation "Menstruation") and those during [menopause](https://en.wikipedia.org/wiki/Menopause "Menopause")[\[50\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Santoro2015rev-50)
- Life events such as [fear](https://en.wikipedia.org/wiki/Fear "Fear"), [stress](https://en.wikipedia.org/wiki/Stress_\(psychology\) "Stress (psychology)"), [anxiety](https://en.wikipedia.org/wiki/Anxiety "Anxiety"), emotional or mental tension, work problems, financial stress, birth of a child, and bereavement[\[47\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-mayo_insomnia_causes-47)
- Gastrointestinal issues such as heartburn or constipation[\[51\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-nhlbi_causes-51)
- [Mental](https://en.wikipedia.org/wiki/Mental_disorder "Mental disorder"), [neurobehavioral](https://en.wikipedia.org/wiki/Learning_Disability "Learning Disability"), or [neurodevelopmental](https://en.wikipedia.org/wiki/Neurodevelopmental_disorder "Neurodevelopmental disorder") disorders such as [bipolar disorder](https://en.wikipedia.org/wiki/Bipolar_disorder "Bipolar disorder"), [clinical depression](https://en.wikipedia.org/wiki/Clinical_depression "Clinical depression"), [generalized anxiety disorder](https://en.wikipedia.org/wiki/Generalized_anxiety_disorder "Generalized anxiety disorder"), [post traumatic stress disorder](https://en.wikipedia.org/wiki/Post_traumatic_stress_disorder "Post traumatic stress disorder"), [schizophrenia](https://en.wikipedia.org/wiki/Schizophrenia "Schizophrenia"), [obsessive compulsive disorder](https://en.wikipedia.org/wiki/Obsessive_compulsive_disorder "Obsessive compulsive disorder"), [autism](https://en.wikipedia.org/wiki/Autism "Autism"), [dementia](https://en.wikipedia.org/wiki/Dementia "Dementia"),[\[52\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Psych4th-52): 326 [ADHD](https://en.wikipedia.org/wiki/ADHD "ADHD"),[\[53\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-53) and [FASD](https://en.wikipedia.org/wiki/Fetal_Alcohol_Spectrum_Disorder "Fetal Alcohol Spectrum Disorder")
- Disturbances of the [circadian rhythm](https://en.wikipedia.org/wiki/Circadian_rhythm "Circadian rhythm"), such as [shift work](https://en.wikipedia.org/wiki/Shift_work "Shift work") and [jet lag](https://en.wikipedia.org/wiki/Jet_lag "Jet lag"), can cause an inability to sleep at some times of the day and excessive sleepiness at other times of the day. Chronic [circadian rhythm disorders](https://en.wikipedia.org/wiki/Circadian_rhythm_sleep_disorder "Circadian rhythm sleep disorder") are characterized by similar symptoms.[\[45\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-umm_causes-45)
- Certain [neurological](https://en.wikipedia.org/wiki/Neurology "Neurology") disorders such as [brain lesions](https://en.wikipedia.org/wiki/Brain_damage "Brain damage"), or a [history](https://en.wikipedia.org/wiki/Medical_history "Medical history") of [traumatic brain injury](https://en.wikipedia.org/wiki/Traumatic_brain_injury "Traumatic brain injury")[\[54\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-54)
- [Medical conditions](https://en.wikipedia.org/wiki/Disease "Disease") such as [hyperthyroidism](https://en.wikipedia.org/wiki/Hyperthyroidism "Hyperthyroidism")[\[2\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIH2011Ca-2)
- Abuse of over-the-counter or prescription sleep aids ([sedative](https://en.wikipedia.org/wiki/Sedative "Sedative") or [depressant](https://en.wikipedia.org/wiki/Depressant "Depressant") drugs) can produce [rebound insomnia](https://en.wikipedia.org/wiki/Rebound_insomnia "Rebound insomnia")[\[45\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-umm_causes-45)
- Poor [sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene"), e.g., [noise](https://en.wikipedia.org/wiki/Noise_health_effects "Noise health effects") or over-consumption of caffeine[\[45\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-umm_causes-45)
- A rare genetic condition can cause a [prion](https://en.wikipedia.org/wiki/Prion "Prion")\-based, permanent, and eventually fatal form of insomnia called [fatal familial insomnia](https://en.wikipedia.org/wiki/Fatal_familial_insomnia "Fatal familial insomnia")[\[55\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid17406188-55)
- [Physical exercise](https://en.wikipedia.org/wiki/Physical_exercise "Physical exercise"): exercise-induced insomnia is common in athletes in the form of prolonged [sleep onset latency](https://en.wikipedia.org/wiki/Sleep_onset_latency "Sleep onset latency")[\[56\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-56)
- Increased exposure to the blue light from artificial sources, such as phones or computers[\[57\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-57)
- Chronic pain[\[58\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-58)[\[59\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-nsf-59)
- [Lower back pain](https://en.wikipedia.org/wiki/Lower_back_pain "Lower back pain")[\[59\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-nsf-59)
- [Asthma](https://en.wikipedia.org/wiki/Asthma "Asthma")[\[59\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-nsf-59)
- [Parkinson's disease](https://en.wikipedia.org/wiki/Parkinson%27s_disease "Parkinson's disease")
Sleep studies using [polysomnography](https://en.wikipedia.org/wiki/Polysomnography "Polysomnography") have suggested that people who have sleep disruption have elevated night-time levels of circulating [cortisol](https://en.wikipedia.org/wiki/Cortisol "Cortisol") and [adrenocorticotropic hormone](https://en.wikipedia.org/wiki/Adrenocorticotropic_hormone "Adrenocorticotropic hormone").[\[60\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-60) They also have an elevated metabolic rate, which does not occur in people who do not have insomnia but whose sleep is intentionally disrupted during a sleep study. Studies of brain metabolism using [positron emission tomography (PET) scans](https://en.wikipedia.org/wiki/Positron_emission_tomography "Positron emission tomography") indicate that people with insomnia have higher metabolic rates by night and by day. The question remains whether these changes are the causes or consequences of long-term insomnia.[\[61\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Mendelson-61)
[Heritability](https://en.wikipedia.org/wiki/Heritability "Heritability") estimates of insomnia vary between 38% in males to 59% in females.[\[62\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Lind-62) A [genome-wide association study](https://en.wikipedia.org/wiki/Genome-wide_association_study "Genome-wide association study") (GWAS) identified 3 genomic loci and 7 [genes](https://en.wikipedia.org/wiki/Genes "Genes") that influence the risk of insomnia and showed that insomnia is highly polygenic.[\[63\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Hammerschlag-63) In particular, a strong positive association was observed for the [MEIS1](https://en.wikipedia.org/wiki/MEIS1 "MEIS1") gene in both males and females. This study showed that the genetic architecture of insomnia strongly overlaps with psychiatric disorders and metabolic traits.
It has been hypothesized that epigenetics might also influence insomnia through a controlling process of both sleep regulation and brain-stress response, having an impact as well on brain plasticity.[\[64\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-palagini-64)
Alcohol is often used as a form of self-treatment for insomnia to induce sleep. However, alcohol use to induce sleep can be a cause of insomnia. [Long-term use of alcohol](https://en.wikipedia.org/wiki/Long-term_use_of_alcohol "Long-term use of alcohol") is associated with a decrease in [NREM](https://en.wikipedia.org/wiki/NREM "NREM") stage 3 and 4 sleep as well as suppression of [REM sleep](https://en.wikipedia.org/wiki/REM_sleep "REM sleep") and REM sleep fragmentation. Frequent moving between sleep stages occurs with awakenings due to headaches, [the need to urinate](https://en.wikipedia.org/wiki/Polyuria "Polyuria"), [dehydration](https://en.wikipedia.org/wiki/Dehydration "Dehydration"), and [excessive sweating](https://en.wikipedia.org/wiki/Diaphoresis "Diaphoresis"). [Glutamine](https://en.wikipedia.org/wiki/Glutamine "Glutamine") rebound also plays a role when someone is drinking; alcohol inhibits glutamine, one of the body's natural stimulants. When the person stops drinking, the body tries to make up for lost time by producing more glutamine than it needs.
The increase in glutamine levels stimulates the brain while the drinker is trying to sleep, keeping them from reaching the deepest levels of sleep.[\[65\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-65) Stopping chronic alcohol use can also lead to severe insomnia with vivid dreams. During withdrawal, REM sleep is typically exaggerated as part of a [rebound effect](https://en.wikipedia.org/wiki/Rebound_effect "Rebound effect").[\[66\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-sleep_medicine_a04-66)
Some people experience sleep disruption or anxiety if they consume caffeine.[\[67\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-67) Doses as low as 100 mg/day, such as a 6 oz (170 g) cup of coffee or two to three 12 oz (340 g) servings of caffeinated soft-drink, may continue to cause sleep disruption, among other intolerances. Non-regular caffeine users have the least caffeine tolerance for sleep disruption.[\[68\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Caffeinedependence_JohnHopkins-68) Some coffee drinkers develop tolerance to its undesired sleep-disrupting effects, but others apparently do not.[\[69\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Fredholm-69)
#### Benzodiazepine-induced
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=10 "Edit section: Benzodiazepine-induced")\]
Like alcohol, [benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepine "Benzodiazepine"), such as [alprazolam](https://en.wikipedia.org/wiki/Alprazolam "Alprazolam"), [clonazepam](https://en.wikipedia.org/wiki/Clonazepam "Clonazepam"), [lorazepam](https://en.wikipedia.org/wiki/Lorazepam "Lorazepam"), and [diazepam](https://en.wikipedia.org/wiki/Diazepam "Diazepam"), are commonly used to treat insomnia in the short-term (both prescribed and self-medicated), but worsen sleep in the long-term. While benzodiazepines can put people to sleep (i.e., inhibit NREM stage 1 and 2 sleep), while asleep, the drugs disrupt [sleep architecture](https://en.wikipedia.org/wiki/Sleep_architecture "Sleep architecture"): decreasing sleep time, delaying time to REM sleep, and decreasing deep [slow-wave sleep](https://en.wikipedia.org/wiki/Slow-wave_sleep "Slow-wave sleep") (the most restorative part of sleep for both energy and mood).[\[70\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-70)[\[71\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-71)[\[72\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-72)
[Opioid](https://en.wikipedia.org/wiki/Opioid "Opioid") medications such as [hydrocodone](https://en.wikipedia.org/wiki/Hydrocodone "Hydrocodone"), [oxycodone](https://en.wikipedia.org/wiki/Oxycodone "Oxycodone"), and [morphine](https://en.wikipedia.org/wiki/Morphine "Morphine") are used for insomnia that is associated with [pain](https://en.wikipedia.org/wiki/Pain "Pain") due to their [analgesic](https://en.wikipedia.org/wiki/Analgesic "Analgesic") properties and [hypnotic](https://en.wikipedia.org/wiki/Hypnotic "Hypnotic") effects. Opioids can fragment sleep and decrease [REM](https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep "Rapid eye movement sleep") and [stage 2](https://en.wikipedia.org/wiki/Non-rapid_eye_movement_sleep "Non-rapid eye movement sleep") sleep. By producing [analgesia](https://en.wikipedia.org/wiki/Analgesia "Analgesia") and [sedation](https://en.wikipedia.org/wiki/Sedation "Sedation"), opioids may be appropriate in carefully selected patients with pain-associated insomnia.[\[49\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Ramakrishnan-2007-49) However, dependence on opioids can lead to long-term sleep disturbances.[\[73\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-73)
Insomnia affects people of all age groups, but people in the following groups have a higher chance of acquiring insomnia:[\[74\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-74)
- Individuals older than 60
- History of mental health disorders, including depression, etc.
- Emotional stress
- Working late-night shifts
- Traveling through different time zones[\[11\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Pun2012-11)
- Having chronic diseases such as [diabetes](https://en.wikipedia.org/wiki/Diabetes "Diabetes"), kidney disease, lung disease, [Alzheimer's](https://en.wikipedia.org/wiki/Alzheimer%27s "Alzheimer's"), or heart disease[\[75\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-75)
- [Alcohol](https://en.wikipedia.org/wiki/Alcohol_\(drug\) "Alcohol (drug)") or drug use disorders
- Gastrointestinal reflux disease
- Heavy smoking
- Work stress[\[76\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-76)
- Individuals of low socioeconomic status[\[77\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Billings_2021-77)
- Urban neighborhoods[\[77\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Billings_2021-77)
- Household stress[\[77\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Billings_2021-77)
Two main models exist regarding the mechanism of insomnia: cognitive and physiological. The cognitive model suggests that rumination and hyperarousal contribute to preventing a person from falling asleep and might lead to an episode of insomnia.
The physiological model is based upon three major findings in people with insomnia; firstly, increased urinary [cortisol](https://en.wikipedia.org/wiki/Cortisol "Cortisol") and [catecholamines](https://en.wikipedia.org/wiki/Catecholamines "Catecholamines") have been found suggesting increased activity of the HPA axis and arousal; second, increased global cerebral glucose utilization during wakefulness and NREM sleep in people with insomnia; and lastly, increased full body metabolism and heart rate in those with insomnia. All these findings taken together suggest a deregulation of the arousal system, cognitive system, and [HPA axis](https://en.wikipedia.org/wiki/HPA_axis "HPA axis"), all contributing to insomnia.[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9)[\[78\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-78) However, it is unknown if the hyperarousal is a result of, or cause of insomnia. Altered levels of the inhibitory [neurotransmitter](https://en.wikipedia.org/wiki/Neurotransmitter "Neurotransmitter") [GABA](https://en.wikipedia.org/wiki/GABA "GABA") have been found, but the results have been inconsistent, and the implications of altered levels of such a ubiquitous neurotransmitter are unknown. Studies on whether insomnia is driven by circadian control over sleep or a wake-dependent process have shown inconsistent results, but some literature suggests a deregulation of the circadian rhythm based on core temperature.[\[79\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-79) Increased beta activity and decreased delta wave activity has been observed on [electroencephalograms](https://en.wikipedia.org/wiki/Electroencephalogram "Electroencephalogram"); however, the implication of this is unknown.[\[80\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-80)
Around half of post-menopausal women experience sleep disturbances, and generally, sleep disturbance is about twice as common in women as men; this appears to be due in part, but not completely, to changes in hormone levels, especially in post-menopause.[\[50\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Santoro2015rev-50)[\[81\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-81)
Changes in [sex hormones](https://en.wikipedia.org/wiki/Sex_hormone "Sex hormone") in both men and women as they age may account in part for an increased prevalence of [sleep disorders](https://en.wikipedia.org/wiki/Sleep_disorder "Sleep disorder") in older people.[\[82\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-82)
In medicine, insomnia is measured using the [Athens Insomnia Scale](https://en.wikipedia.org/wiki/Athens_Insomnia_Scale "Athens Insomnia Scale") (AIS).[\[83\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-83) It measures eight parameters related to sleep, represented as an overall scale which assesses an individual's sleep quality. It has excellent internal consistency and re-test reliability.[\[84\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-84) The Athens Insomnia Scale for Non-Clinical Populations (AIS-NCA) has been developed and validated in English,[\[85\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Sattler-2023-85) Chinese,[\[86\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-86) and German[\[85\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Sattler-2023-85) to identify subclinical manifestations of insomnia in a language simpler than the Athens Insomnia Scale and more suitable for self-report. It uses four items to assess sleep problems and three items to assess impaired daytime functioning.
A medical history and a physical examination can identify other conditions that could be the cause of insomnia. A comprehensive sleep history should include sleep habits and sleep environment, medications (prescription and non-prescription, including supplements), alcohol, nicotine, and caffeine intake, and co-morbid illnesses.[\[87\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Passarella,_S_2008-87) A [sleep diary](https://en.wikipedia.org/wiki/Sleep_diary "Sleep diary") can be used to track time to bed, total sleep time, time to sleep onset, number of awakenings, use of medications, time of awakening, and subjective feelings in the morning.[\[87\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Passarella,_S_2008-87) The sleep diary can be replaced or validated by the use of out-patient [actigraphy](https://en.wikipedia.org/wiki/Actigraphy "Actigraphy") for a week or more, using a non-invasive device that measures movement.[\[88\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Schutte-Rodin-88)
Not everyone who suffers from insomnia should routinely have a [polysomnography](https://en.wikipedia.org/wiki/Polysomnography "Polysomnography") study to screen for sleep disorders,[\[89\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-ACOEMfive-89) but it may be indicated for those with risk factors for [sleep apnea](https://en.wikipedia.org/wiki/Sleep_apnea "Sleep apnea"), including obesity, a thick neck diameter, or fullness of the flesh in the [oropharynx](https://en.wikipedia.org/wiki/Oropharynx "Oropharynx").[\[89\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-ACOEMfive-89) For most people, the test is not needed to make a diagnosis, and insomnia can often be treated by changing their schedule to make time for sufficient sleep and by improving [sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene").[\[89\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-ACOEMfive-89)
Some patients may need an overnight sleep study in a sleep lab. Such a study will commonly involve assessment tools including a polysomnogram and the [multiple sleep latency test](https://en.wikipedia.org/wiki/Multiple_sleep_latency_test "Multiple sleep latency test"). Specialists in [sleep medicine](https://en.wikipedia.org/wiki/Sleep_medicine "Sleep medicine") are qualified to diagnose disorders according to the [ICSD](https://en.wikipedia.org/wiki/International_Classification_of_Sleep_Disorders "International Classification of Sleep Disorders"), 81 major sleep disorder diagnostic categories.[\[90\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-90) Patients with some disorders, including [delayed sleep phase disorder](https://en.wikipedia.org/wiki/Delayed_sleep_phase_disorder "Delayed sleep phase disorder"), are often misdiagnosed with primary insomnia; when a person has trouble getting to sleep and awakening at desired times, but has a normal sleep pattern once asleep, a circadian rhythm disorder is a likely cause.
In many cases, insomnia is co-morbid with another disease, side effects from medications, or a psychological problem. Approximately half of all diagnosed insomnia is related to psychiatric disorders.[\[91\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Wilson-91) For those who have depression, "insomnia should be regarded as a co-morbid condition, rather than as a secondary one;" insomnia typically predates psychiatric symptoms.[\[91\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Wilson-91) "In fact, it is possible that insomnia represents a significant risk for the development of a subsequent psychiatric disorder."[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9) Insomnia occurs in between 60% and 80% of people with depression and can be a side effect of medications that treat depression.[\[92\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Luca2013-92)
The determination of causation is not necessary for a diagnosis.[\[91\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Wilson-91)
The [DSM-5](https://en.wikipedia.org/wiki/DSM-5 "DSM-5") criteria for insomnia include the following:[\[93\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-93)
"Predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms":
- Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention.)
- Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.)
- Early-morning awakening with inability to return to sleep.
In addition:
- The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
- The sleep difficulty occurs at least three nights per week.
- The sleep difficulty has been present for at least three months.
- The sleep difficulty occurs despite adequate opportunity for sleep.
- The insomnia is not better explained by and does not occur exclusively during another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia).
- The insomnia is not attributable to the physiological effects of a substance (e.g., a [drug of abuse](https://en.wikipedia.org/wiki/Drug_of_abuse "Drug of abuse"), a medication)."
The [DSM-IV TR](https://en.wikipedia.org/wiki/DSM-IV_TR "DSM-IV TR") includes insomnia but does not fully elaborate on the symptoms compared to the DSM-5. Instead of early-morning waking as a symptom, the DSM-IV-TR listed "[nonrestorative sleep](https://en.wikipedia.org/wiki/Nonrestorative_sleep "Nonrestorative sleep")" as a primary symptom. The duration of the experience was also vague in the DSM-IV-TR. The DSM-IV-TR stated that symptoms had to be present for a month, whereas the DSM-5 states that symptoms must be present for three months and occur at least three nights a week (Gillette).
Insomnia can be classified as transient, acute, or chronic.
- *Transient insomnia* lasts for less than a week. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe [depression](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder"), or by [stress](https://en.wikipedia.org/wiki/Stress_\(biology\) "Stress (biology)"). Its consequences – sleepiness and impaired psychomotor performance – are similar to those of [sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation").[\[94\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Roth-94)
- *[Acute](https://en.wikipedia.org/wiki/Acute_\(medicine\) "Acute (medicine)") insomnia* is the inability to consistently sleep well for less than a month. Insomnia is present when there is difficulty initiating or maintaining sleep or when the sleep that is obtained is [non-refreshing](https://en.wikipedia.org/wiki/Non-restorative_sleep "Non-restorative sleep") or of poor quality. These problems occur despite adequate opportunity and circumstances for sleep, and they must result in problems with daytime function.[\[95\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-95) Hyperarousal can be linked to acute insomnia since it activates the body's fight-or-flight response. When we encounter stress or danger, our bodies naturally become more alert, which can interfere with our capacity to both fall asleep and remain asleep. This heightened state of arousal can be useful in the short term during threatening situations, but if it continues over an extended period, it can result in acute insomnia.[\[96\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Acute_and_Chronic_Insomnia:_What_Ha-96) Acute insomnia is also known as *short term insomnia* or *stress related insomnia*.[\[97\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-r1-97)
- *[Chronic](https://en.wikipedia.org/wiki/Chronic_\(medical\) "Chronic (medical)") insomnia* lasts for longer than a month. It can be caused by another disorder, or it can be a primary disorder. Common causes of chronic insomnia include persistent stress, trauma, work schedules, poor sleep habits, medications, and other mental health disorders.[\[98\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-98) When an individual consistently engages in behaviors that disrupt their sleep, such as irregular sleep schedules, spending excessive time awake in bed, or engaging in stimulating activities close to bedtime, it can lead to conditioned wakefulness contributing to chronic insomnia.[\[96\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Acute_and_Chronic_Insomnia:_What_Ha-96) People with high levels of stress hormones or shifts in the levels of [cytokines](https://en.wikipedia.org/wiki/Cytokine "Cytokine") are more likely than others to have chronic insomnia.[\[99\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-99) Its effects can vary according to its causes. They might include muscular weariness, [hallucinations](https://en.wikipedia.org/wiki/Hallucination "Hallucination"), and/or [mental fatigue](https://en.wikipedia.org/wiki/Mental_fatigue "Mental fatigue").[\[94\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Roth-94)
Prevention and treatment of insomnia may require a combination of [cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy"),[\[13\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Tra2015-13) medications,[\[100\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-abad-100) and lifestyle changes.[\[101\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-mayo-101)
Among lifestyle practices, going to sleep and waking up at the same time each day can create a steady pattern which may help to prevent insomnia.[\[11\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Pun2012-11) Avoidance of vigorous [exercise](https://en.wikipedia.org/wiki/Physical_exercise "Physical exercise") and [caffeinated drinks](https://en.wikipedia.org/wiki/Caffeine "Caffeine") a few hours before going to sleep is recommended, while exercise earlier in the day may be beneficial.[\[101\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-mayo-101) Other practices to improve [sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene") may include:[\[101\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-mayo-101)[\[102\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-102)
- Avoiding or limiting [naps](https://en.wikipedia.org/wiki/Nap "Nap")
- Treating pain at bedtime
- Avoiding large meals, beverages, [alcohol](https://en.wikipedia.org/wiki/Alcohol_\(drug\) "Alcohol (drug)"), and [nicotine](https://en.wikipedia.org/wiki/Nicotine "Nicotine") before bedtime
- Finding soothing ways to relax into sleep, including the use of [white noise](https://en.wikipedia.org/wiki/White_noise "White noise")
- Making the bedroom suitable for sleep by keeping it dark, cool, and free of devices, such as clocks, cell phones, or televisions
- Maintain regular exercise
- Try relaxing activities before sleeping
It is recommended to rule out medical and psychological causes before deciding on the treatment for insomnia.[\[103\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-103) [Cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") is an effective first-line treatment for chronic insomnia.[\[104\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-104)[\[13\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Tra2015-13) The beneficial effects, in contrast to those produced by medications, may last well beyond the stopping of therapy.[\[105\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-105)
Medications have been used mainly to reduce symptoms in insomnia of short duration; their role in the management of chronic insomnia remains unclear.[\[8\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-WHO2009-8) Several different types of medications may be used.[\[106\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-106)[\[107\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-107)[\[100\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-abad-100) Many doctors do not recommend relying on prescription sleeping pills for long-term use.[\[101\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-mayo-101) These medications are not recommended for more than four or five weeks, although they can be used longer in certain instances.[\[6\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-AC2016-6)[\[15\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-riemann-23-15) It is also important to identify and treat other medical conditions that may be contributing to insomnia, such as depression, breathing problems, and chronic pain.[\[101\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-mayo-101)[\[108\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-insomnia_JAMA-108) As of 2022, many people with insomnia were reported as not receiving overall sufficient sleep or treatment for insomnia.[\[109\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-109)[\[110\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-110)
### Non-medication based
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=19 "Edit section: Non-medication based")\]
Non-medication-based strategies have comparable efficacy to [hypnotic](https://en.wikipedia.org/wiki/Hypnotic "Hypnotic") medication for insomnia, and they may have longer-lasting effects. Hypnotic medication is only recommended for short-term use because [dependence](https://en.wikipedia.org/wiki/Substance_dependence "Substance dependence") with [rebound withdrawal effects](https://en.wikipedia.org/wiki/Rebound_withdrawal_effects "Rebound withdrawal effects") upon discontinuation or [tolerance](https://en.wikipedia.org/wiki/Drug_tolerance "Drug tolerance") can develop.[\[111\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-111)
Non-medication-based strategies provide long-lasting improvements to insomnia and are recommended as a first-line and long-term strategy of management. Behavioral sleep medicine offers non-medication strategies to address chronic insomnia including [sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene"), [stimulus control](https://en.wikipedia.org/wiki/Stimulus_control "Stimulus control"), behavioral interventions, [sleep-restriction therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_for_insomnia#Sleep_restriction_therapy "Cognitive behavioral therapy for insomnia"), [paradoxical intention](https://en.wikipedia.org/wiki/Paradoxical_intention "Paradoxical intention"), patient education, and [relaxation therapy](https://en.wikipedia.org/wiki/Relaxation_technique "Relaxation technique").[\[112\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-112) Some examples are keeping a journal, restricting the time spent awake in bed, practicing [relaxation techniques](https://en.wikipedia.org/wiki/Relaxation_technique "Relaxation technique"), and maintaining a regular sleep schedule and a wake-up time. Behavioral therapy can assist a patient in developing new sleep behaviors to improve sleep quality and consolidation. Behavioral therapy may include learning healthy sleep habits to promote sleep relaxation, undergoing light therapy to regulate the [circadian rhythm](https://en.wikipedia.org/wiki/Circadian_rhythm "Circadian rhythm"), and regulating the circadian clock.[\[108\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-insomnia_JAMA-108)
Music may improve insomnia in adults (see [music and sleep](https://en.wikipedia.org/wiki/Music_and_sleep "Music and sleep")).[\[113\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-113) [EEG biofeedback](https://en.wikipedia.org/wiki/EEG_biofeedback "EEG biofeedback") has demonstrated effectiveness in the treatment of insomnia with improvements in duration as well as the quality of sleep.[\[114\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-114) Self-help therapy (defined as a psychological therapy that can be worked through on one's own) may improve sleep quality for adults with insomnia to a small or moderate degree.[\[115\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-115)
Stimulus control therapy is a treatment for patients who have conditioned themselves to associate the bed or sleep in general with a negative response. As stimulus control therapy involves taking steps to control the sleep environment, it is sometimes referred to interchangeably with the concept of [sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene"). Examples of such environmental modifications include using the bed for sleep and sex only, not for activities such as reading or watching television; waking up at the same time every morning, including on weekends; going to bed only when sleepy and when there is a high likelihood that sleep will occur; leaving the bed and beginning an activity in another location if sleep does not occur in a reasonably brief period after getting into bed (commonly ~20 min); reducing the subjective effort and energy expended trying to fall asleep; avoiding exposure to bright light during night-time hours, and eliminating daytime naps.[\[116\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-116)
A component of stimulus control therapy is sleep restriction, a technique that aims to match the time spent in bed with the actual time spent asleep. This technique involves maintaining a strict sleep-wake schedule, sleeping only at certain times of the day and for specific amounts of time to induce mild sleep deprivation. Complete treatment usually lasts up to 3 weeks and involves making oneself sleep for only a minimum amount of time that they are actually capable of on average, and then, if capable (i.e. when [sleep efficiency](https://en.wikipedia.org/wiki/Polysomnography#Interpretation "Polysomnography") improves), slowly increasing this amount (~15 min) by going to bed earlier as the body attempts to reset its internal sleep clock. [Bright light therapy](https://en.wikipedia.org/wiki/Bright_light_therapy "Bright light therapy") may be effective for insomnia.[\[117\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-117)
Paradoxical intention is a cognitive reframing technique where the insomniac, instead of attempting to fall asleep at night, makes every effort to stay awake (i.e., essentially stops trying to fall asleep). One theory that may explain the effectiveness of this method is that by not voluntarily making oneself go to sleep, it relieves the performance anxiety that arises from the need or requirement to fall asleep, which is meant to be a passive act. This technique has been shown to reduce sleep effort and performance anxiety and also lower subjective assessment of sleep-onset latency and overestimation of the sleep deficit (a quality found in many insomniacs).[\[118\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-118)
[Sleep hygiene](https://en.wikipedia.org/wiki/Sleep_hygiene "Sleep hygiene") is a common term for all of the behaviors that relate to the promotion of good sleep. They include habits that provide a good foundation for sleep and help to prevent insomnia. However, sleep hygiene alone may not be adequate to address chronic insomnia. Sleep hygiene recommendations are typically included as one component of [cognitive behavioral therapy for insomnia](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_for_insomnia "Cognitive behavioral therapy for insomnia") (CBT-I).[\[88\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Schutte-Rodin-88)[\[6\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-AC2016-6) Recommendations include reducing caffeine, nicotine, and alcohol consumption, maximizing the regularity and efficiency of sleep episodes, minimizing medication usage and daytime napping, the promotion of regular exercise, and the facilitation of a positive sleep environment.[\[119\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Ellis_2002-119) The creation of a positive sleep environment may also help reduce the symptoms of insomnia.[\[120\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Insomnia-120) On the other hand, a systematic review by the AASM concluded that clinicians should not prescribe sleep hygiene for insomnia due to the evidence of absence of its efficacy and potential delaying of adequate treatment, recommending instead that effective therapies such as CBT-i should be preferred.[\[14\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Behavioral_and_psychological_treatm-14)
#### Cognitive behavioral therapy
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=21 "Edit section: Cognitive behavioral therapy")\]
There is some evidence that cognitive behavioral therapy for insomnia (CBT-I) is superior not only in the long-term, but also in the short-term (2 months) to [benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepine "Benzodiazepine") and the [nonbenzodiazepines](https://en.wikipedia.org/wiki/Nonbenzodiazepine "Nonbenzodiazepine") in the treatment and management of insomnia.[\[121\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-121)[\[122\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Mitchell-2012-122) In this therapy, patients are taught improved sleep habits and relieved of counter-productive assumptions about sleep. Common misconceptions and expectations that can be modified include:\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\]
- Unrealistic sleep expectations.
- Misconceptions about insomnia causes.
- Amplifying the consequences of insomnia.
- Performance anxiety after trying for so long to have a good night's sleep by controlling the sleep process.
Numerous studies have reported positive outcomes of combining cognitive behavioral therapy for insomnia treatment with treatments such as stimulus control and relaxation therapies. [Hypnotic](https://en.wikipedia.org/wiki/Hypnotic "Hypnotic") medications are equally effective in the short-term treatment of insomnia, but their effects wear off over time due to [tolerance](https://en.wikipedia.org/wiki/Drug_tolerance "Drug tolerance"). The effects of [CBT-I](https://en.wikipedia.org/wiki/CBT-I "CBT-I") have sustained and lasting effects on treating insomnia long after therapy has been discontinued.[\[123\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-JacobsG2004Cognitive-123)[\[124\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-124) The addition of hypnotic medications with CBT-I adds no benefit in insomnia. The long-lasting benefits of a course of CBT-I shows superiority over pharmacological hypnotic drugs. Even in the short term, when compared to short-term hypnotic medication such as zolpidem, CBT-I still shows significant superiority. Thus, CBT-I is recommended as a first-line treatment for insomnia.[\[125\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-125)
Common forms of CBT-I treatments include stimulus control therapy, sleep restriction, sleep hygiene, improved sleeping environments, relaxation training, paradoxical intention, and biofeedback.[\[126\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-126) Sleep restriction (also called "time-in-bed restriction"), stimulus control and cognitive restructuring are key components.[\[127\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-127)
CBT is a well-accepted form of therapy for insomnia since it has no known adverse effects, whereas taking medications to alleviate insomnia symptoms has been shown to have adverse side effects.[\[128\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-128) Nevertheless, the downside of CBT is that it may take a lot of time and motivation.[\[129\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-129)
#### Acceptance and commitment therapy
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=22 "Edit section: Acceptance and commitment therapy")\]
Treatments based on the principles of [acceptance and commitment therapy](https://en.wikipedia.org/wiki/Acceptance_and_commitment_therapy "Acceptance and commitment therapy") (ACT) and [metacognition](https://en.wikipedia.org/wiki/Metacognition "Metacognition") have emerged as alternative approaches to treating insomnia.[\[130\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-130) ACT rejects the idea that behavioral changes can help insomniacs achieve better sleep since they require "sleep efforts" - actions which create more "struggle" and arouse the nervous system, leading to [hyperarousal](https://en.wikipedia.org/wiki/Hyperarousal "Hyperarousal").[\[131\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-meadows-131) The ACT approach posits that acceptance of the negative feelings associated with insomnia can, in time, create the right conditions for sleep. [Mindfulness](https://en.wikipedia.org/wiki/Mindfulness "Mindfulness") practice is a key feature of this approach, although mindfulness is not practiced to induce sleep (this in itself is a *sleep effort* to be avoided) but rather as a longer-term activity to help calm the nervous system and create the internal conditions from which sleep can emerge.
A key distinction between CBT-I and ACT lies in the divergent approaches to time spent awake in bed. Proponents of CBT-i advocate minimizing time spent awake in bed, on the basis that this creates a cognitive association between being in bed and wakefulness. The ACT approach proposes that avoiding time in bed may increase the pressure to sleep and arouse the nervous system further.[\[131\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-meadows-131)
Research has shown that "ACT has a significant effect on primary and comorbid insomnia and sleep quality, and ... can be used as an appropriate treatment method to control and improve insomnia".[\[132\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Salari_2020-132)
#### Internet Interventions
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=23 "Edit section: Internet Interventions")\]
Despite the therapeutic effectiveness and proven success of CBT, treatment availability is significantly limited by a lack of trained clinicians, poor geographical distribution of knowledgeable professionals, and expense.[\[133\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-133) One way to potentially overcome these barriers is to use the Internet to deliver treatment, making this effective intervention more accessible and less costly. The Internet has already become a critical source of health care and medical information.[\[134\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pewinternet.org-134) Although the vast majority of health websites provide general information,[\[134\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pewinternet.org-134)[\[135\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-135) there is growing research literature on the development and evaluation of Internet interventions.[\[136\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-136)[\[137\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-ritter-137)
These online programs are typically behaviorally based treatments that have been operationalized and transformed for delivery via the Internet. They are usually highly structured, automated, or human-supported, based on effective face-to-face treatment; personalized to the user; interactive; enhanced by graphics, animations, audio, and possibly video; and tailored to provide follow-up and feedback.[\[137\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-ritter-137)
There is good evidence for the use of computer-based CBT for insomnia.[\[138\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-138)
Many people with insomnia use [sleeping tablets](https://en.wikipedia.org/wiki/Sleeping_tablet "Sleeping tablet") and other [sedatives](https://en.wikipedia.org/wiki/Sedative "Sedative"). In some places, medications are prescribed in over 95% of cases.[\[139\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-139) They, however, are a second line treatment.[\[140\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-140) In 2019, the US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") stated it is going to require warnings for [eszopiclone](https://en.wikipedia.org/wiki/Eszopiclone "Eszopiclone"), [zaleplon](https://en.wikipedia.org/wiki/Zaleplon "Zaleplon"), and [zolpidem](https://en.wikipedia.org/wiki/Zolpidem "Zolpidem"), due to concerns about serious injuries resulting from abnormal sleep behaviors, including [sleepwalking](https://en.wikipedia.org/wiki/Sleepwalking "Sleepwalking") or driving a vehicle while asleep.[\[141\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-141)
The percentage of adults using a prescription sleep aid increases with age. During 2005–2010, about 4% of U.S. adults aged 20 and over reported that they took prescription sleep aids in the past 30 days. Rates of use were lowest among the youngest age group (those aged 20–39) at about 2%, increased to 6% among those aged 50–59, and reached 7% among those aged 80 and over. More adult women (5%) reported using prescription sleep aids than adult men (3%). Non-Hispanic white adults reported higher use of sleep aids (5%) than non-Hispanic black (3%) and Mexican-American (2%) adults. No difference was shown between non-Hispanic black adults and Mexican-American adults in use of prescription sleep aids.[\[142\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid24152538-142)
As an alternative to taking prescription drugs, some evidence shows that an average person seeking short-term help may find relief by taking [over-the-counter](https://en.wikipedia.org/wiki/Over-the-counter "Over-the-counter") [antihistamines](https://en.wikipedia.org/wiki/Antihistamines "Antihistamines") such as [diphenhydramine](https://en.wikipedia.org/wiki/Diphenhydramine "Diphenhydramine") or [doxylamine](https://en.wikipedia.org/wiki/Doxylamine "Doxylamine").[\[143\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-BBDinsomnia-2-143) Diphenhydramine and doxylamine are widely used in nonprescription sleep aids. They are the most effective over-the-counter sedatives currently available, at least in much of Europe, Canada, Australia, and the United States, and are more sedating than some prescription [hypnotics](https://en.wikipedia.org/wiki/Hypnotic "Hypnotic").[\[144\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-drugbankDB00366-144) Antihistamine effectiveness for sleep may decrease over time, and [anticholinergic](https://en.wikipedia.org/wiki/Anticholinergic "Anticholinergic") side-effects (such as dry mouth) may also be a drawback with these particular drugs. While addiction does not seem to be an issue with this class of drugs, they can induce dependence and rebound effects upon abrupt cessation of use.[\[145\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-145) However, people whose insomnia is caused by restless legs syndrome may have worsened symptoms with antihistamines.[\[146\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-146)
While insomnia is a common symptom of depression, [antidepressants](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant") are effective for treating sleep problems whether or not they are associated with depression. While all antidepressants help regulate sleep, some antidepressants, such as [amitriptyline](https://en.wikipedia.org/wiki/Amitriptyline "Amitriptyline"), [doxepin](https://en.wikipedia.org/wiki/Doxepin "Doxepin"), [mirtazapine](https://en.wikipedia.org/wiki/Mirtazapine "Mirtazapine"), [trazodone](https://en.wikipedia.org/wiki/Trazodone "Trazodone"), and [trimipramine](https://en.wikipedia.org/wiki/Trimipramine "Trimipramine"), can have an immediate sedative effect and are prescribed to treat insomnia.[\[147\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-147) Trazodone was at the beginning of the 2020s the most prescribed drug for sleep in the United States despite not being indicated for sleep.[\[148\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Dunleavy-148)
Amitriptyline, doxepin, and trimipramine all have [antihistaminergic](https://en.wikipedia.org/wiki/Antihistaminergic "Antihistaminergic"), [anticholinergic](https://en.wikipedia.org/wiki/Anticholinergic "Anticholinergic"), [antiadrenergic](https://en.wikipedia.org/wiki/Antiadrenergic "Antiadrenergic"), and [antiserotonergic](https://en.wikipedia.org/wiki/Antiserotonergic "Antiserotonergic") properties, which contribute to both their therapeutic effects and side effect profiles, while mirtazapine's actions are primarily antihistaminergic and antiserotonergic and trazodone's effects are primarily antiadrenergic and antiserotonergic. Mirtazapine is known to decrease sleep latency (i.e., the time it takes to fall asleep), promoting sleep efficiency and increasing the total amount of sleeping time in people with both depression and insomnia.[\[149\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-149)[\[150\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-150)
[Agomelatine](https://en.wikipedia.org/wiki/Agomelatine "Agomelatine"), a melatonergic antidepressant with claimed sleep-improving qualities that does not cause daytime drowsiness,[\[151\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-151) is approved for the treatment of depression though not sleep conditions in the European Union[\[152\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-emea-152) and [Australia](https://en.wikipedia.org/wiki/Australia "Australia").[\[153\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-PI-153) After trials in the United States, its development for use there was discontinued in October 2011[\[154\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-154) by [Novartis](https://en.wikipedia.org/wiki/Novartis "Novartis"), who had bought the rights to market it there from the European pharmaceutical company [Servier](https://en.wikipedia.org/wiki/Servier "Servier").[\[155\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Bentham-155)
A 2018 [Cochrane review](https://en.wikipedia.org/wiki/Cochrane_review "Cochrane review") found the safety of taking antidepressants for insomnia to be uncertain with no evidence supporting long term use.[\[156\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-156)
[Melatonin receptor agonists](https://en.wikipedia.org/wiki/Melatonin_receptor_agonist "Melatonin receptor agonist") such as [melatonin](https://en.wikipedia.org/wiki/Melatonin_\(medication\) "Melatonin (medication)") and [ramelteon](https://en.wikipedia.org/wiki/Ramelteon "Ramelteon") are used in the treatment of insomnia. [Prolonged-release melatonin](https://en.wikipedia.org/wiki/Melatonin_as_a_medication_and_supplement "Melatonin as a medication and supplement") improves insomnia mainly in adults ≥55, and ramelteon improves sleep generally, with both effective versus placebo but less effective than most licensed insomnia drugs and showing limited long-term benefits.[\[16\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid35843245-16)[\[157\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-157)[\[158\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-158)[\[159\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-159)
The usage of melatonin as a treatment for insomnia in adults has increased from 0.4% between 1999 and 2000 to nearly 2.1% between 2017 and 2018.[\[160\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-160)
While the use of melatonin in the short term has been proven to be generally safe and is shown not to be a dependent medication, side effects can still occur.[\[161\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Pros_and_cons_of_melatonin-161)
Most common side effects of melatonin include:[\[161\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Pros_and_cons_of_melatonin-161)
- Headache
- Dizziness
- Nausea
- Daytime drowsiness
Studies have also shown that children who have an [autism spectrum disorder](https://en.wikipedia.org/wiki/Autism_spectrum_disorder "Autism spectrum disorder") or a learning disability, such as [attention-deficit hyperactivity disorder](https://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorder "Attention-deficit hyperactivity disorder") (ADHD) or related [neurological](https://en.wikipedia.org/wiki/Neurological "Neurological") diseases, can benefit from the use of melatonin. This is because they often have trouble sleeping due to their disorders. For example, children with ADHD tend to have trouble falling asleep because of their [hyperactivity](https://en.wikipedia.org/wiki/Hyperactivity "Hyperactivity") and, as a result, tend to be tired during most of the day. Another cause of insomnia in children with ADHD is the use of stimulants to treat their disorder. Children who have ADHD, as well as the other disorders mentioned, may be given melatonin before bedtime to help them sleep.[\[162\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-162)
[](https://en.wikipedia.org/wiki/File:Normison.jpg)
Normison ([temazepam](https://en.wikipedia.org/wiki/Temazepam "Temazepam")) is a [benzodiazepine](https://en.wikipedia.org/wiki/Benzodiazepine "Benzodiazepine") commonly prescribed for insomnia and other [sleep disorders](https://en.wikipedia.org/wiki/Sleep_disorders "Sleep disorders").[\[163\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-163)
The most commonly used class of hypnotics for insomnia are the [benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepine "Benzodiazepine").[\[52\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Psych4th-52): 363 Benzodiazepines are [not significantly](https://en.wikipedia.org/wiki/Statistical_significance "Statistical significance") better for insomnia than [antidepressants](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant").[\[164\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid17619935-164) Chronic users of [hypnotic](https://en.wikipedia.org/wiki/Hypnotic "Hypnotic") medications for insomnia do not have better sleep than chronic insomniacs not taking medications. In fact, chronic users of hypnotic medications have more regular night-time awakenings than insomniacs not taking hypnotic medications.[\[165\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-165) Many have concluded that these drugs cause an unjustifiable risk to the individual and to [public health](https://en.wikipedia.org/wiki/Public_health "Public health") and lack evidence of long-term effectiveness. It is preferred that hypnotics be prescribed for only a few days at the lowest effective dose and avoided altogether wherever possible, especially in the elderly.[\[166\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-166) Between 1993 and 2010, the prescribing of benzodiazepines to individuals with sleep disorders has decreased from 24% to 11% in the US, coinciding with the first release of [nonbenzodiazepines](https://en.wikipedia.org/wiki/Nonbenzodiazepine "Nonbenzodiazepine").[\[167\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Kaufmann-167)
The [benzodiazepine](https://en.wikipedia.org/wiki/Benzodiazepine "Benzodiazepine") and [nonbenzodiazepine](https://en.wikipedia.org/wiki/Nonbenzodiazepine "Nonbenzodiazepine") [hypnotic](https://en.wikipedia.org/wiki/Hypnotic "Hypnotic") medications also have several side effects, such as daytime fatigue, motor vehicle crashes and other accidents, cognitive impairments, and falls and fractures. Elderly people are more sensitive to these side effects.[\[168\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-168) Some benzodiazepines have demonstrated effectiveness in sleep maintenance in the short term but in the longer term benzodiazepines can lead to [tolerance](https://en.wikipedia.org/wiki/Drug_tolerance "Drug tolerance"), [physical dependence](https://en.wikipedia.org/wiki/Physical_dependence "Physical dependence"), [benzodiazepine withdrawal syndrome](https://en.wikipedia.org/wiki/Benzodiazepine_withdrawal_syndrome "Benzodiazepine withdrawal syndrome") upon discontinuation, and long-term worsening of sleep, especially after consistent usage over long periods. Benzodiazepines, while inducing unconsciousness, actually worsen sleep as – like alcohol – they promote light sleep while decreasing time spent in deep sleep.[\[169\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-169) A further problem is, with regular use of short-acting sleep aids for insomnia, daytime [rebound anxiety](https://en.wikipedia.org/wiki/Rebound_anxiety "Rebound anxiety") can emerge.[\[170\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-170) Although there is little evidence for benefit of benzodiazepines in insomnia compared to other treatments and evidence of major harm, prescriptions have continued to increase.[\[171\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-handbook_of_integrative-171) This is likely due to their addictive nature, both due to misuse and because – through their rapid action, tolerance and withdrawal they can "trick" insomniacs into thinking they are helping with sleep. There is a general awareness that long-term use of benzodiazepines for insomnia in most people is inappropriate and that a gradual withdrawal is usually beneficial due to the adverse effects associated with the [long-term use of benzodiazepines](https://en.wikipedia.org/wiki/Long-term_use_of_benzodiazepines "Long-term use of benzodiazepines") and is recommended whenever possible.[\[172\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-172)[\[173\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Authier--173)
Benzodiazepines all bind unselectively to the [GABAA receptor](https://en.wikipedia.org/wiki/GABAA_receptor "GABAA receptor").[\[164\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid17619935-164) Some theorize that certain benzodiazepines (hypnotic benzodiazepines) have significantly higher activity at the α1 subunit of the GABAA receptor compared to other benzodiazepines (for example, triazolam and temazepam have significantly higher activity at the α1 subunit compared to alprazolam and diazepam, making them superior sedative-hypnotics – alprazolam and diazepam, in turn, have higher activity at the α2 subunit compared to triazolam and temazepam, making them superior anxiolytic agents). Modulation of the α1 subunit is associated with sedation, motor impairment, respiratory depression, amnesia, ataxia, and reinforcing behavior (drug-seeking behavior). Modulation of the α2 subunit is associated with anxiolytic activity and disinhibition. For this reason, certain benzodiazepines may be better suited to treat insomnia than others.[\[120\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Insomnia-120)
[Nonbenzodiazepine](https://en.wikipedia.org/wiki/Nonbenzodiazepine "Nonbenzodiazepine") or [Z-drug](https://en.wikipedia.org/wiki/Z-drug "Z-drug") sedative–hypnotic drugs, such as [zolpidem](https://en.wikipedia.org/wiki/Zolpidem "Zolpidem"), [zaleplon](https://en.wikipedia.org/wiki/Zaleplon "Zaleplon"), [zopiclone](https://en.wikipedia.org/wiki/Zopiclone "Zopiclone"), and [eszopiclone](https://en.wikipedia.org/wiki/Eszopiclone "Eszopiclone"), are a class of hypnotic medications that are similar to benzodiazepines in their mechanism of action, and indicated for mild to moderate insomnia. Their effectiveness at improving time to sleeping is slight, and they have similar—though potentially less severe—side effect profiles compared to benzodiazepines.[\[174\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-174) Prescribing of nonbenzodiazepines has seen a general increase since their initial release on the US market in 1992, from 2.3% in 1993 among individuals with sleep disorders to 13.7% in 2010.[\[167\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Kaufmann-167)
[Orexin receptor antagonists](https://en.wikipedia.org/wiki/Orexin_receptor_antagonist "Orexin receptor antagonist") are a more recently introduced class of sleep medications and include [suvorexant](https://en.wikipedia.org/wiki/Suvorexant "Suvorexant"), [lemborexant](https://en.wikipedia.org/wiki/Lemborexant "Lemborexant"), and [daridorexant](https://en.wikipedia.org/wiki/Daridorexant "Daridorexant"), all of which are FDA-approved for treatment of insomnia characterized by difficulties with [sleep onset](https://en.wikipedia.org/wiki/Sleep_onset "Sleep onset") and/or sleep maintenance.[\[175\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid35043499-175)[\[176\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-prescribing_info-176) They are oriented towards blocking signals in the brain that stimulate wakefulness, therefore claiming to address insomnia without creating dependence. There are three [dual orexin receptor (DORA)](https://en.wikipedia.org/wiki/Orexin_antagonist "Orexin antagonist") drugs on the market: [Belsomra](https://en.wikipedia.org/wiki/Suvorexant "Suvorexant") ([Merck](https://en.wikipedia.org/wiki/Merck_%26_Co. "Merck & Co.")), [Dayvigo](https://en.wikipedia.org/wiki/Lemborexant "Lemborexant") ([Eisai](https://en.wikipedia.org/wiki/Eisai_\(company\) "Eisai (company)")) and [Quviviq](https://en.wikipedia.org/wiki/Daridorexant "Daridorexant") ([Idorsia](https://en.wikipedia.org/wiki/Idorsia "Idorsia")).[\[148\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Dunleavy-148)
Certain [atypical antipsychotics](https://en.wikipedia.org/wiki/Atypical_antipsychotic "Atypical antipsychotic"), particularly [quetiapine](https://en.wikipedia.org/wiki/Quetiapine "Quetiapine"), [olanzapine](https://en.wikipedia.org/wiki/Olanzapine "Olanzapine"), and [risperidone](https://en.wikipedia.org/wiki/Risperidone "Risperidone"), are used in the treatment of insomnia.[\[177\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid27544830-177)[\[178\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Morin2014-178) However, while common, the use of antipsychotics for this indication is not recommended as the evidence does not demonstrate a benefit, and the risk of adverse effects is significant.[\[177\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid27544830-177)[\[179\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-179)[\[180\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-180)[\[181\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Off-Label_Use-181) A major 2022 systematic review and network meta-analysis of medications for insomnia in adults found that quetiapine did not demonstrate any short-term benefits for insomnia.[\[16\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid35843245-16) Some of the more serious adverse effects may also occur at the low doses used, such as [dyslipidemia](https://en.wikipedia.org/wiki/Dyslipidemia "Dyslipidemia") and [neutropenia](https://en.wikipedia.org/wiki/Neutropenia "Neutropenia").[\[182\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-182)[\[183\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-183) Such concerns of risks at low doses are supported by Danish observational studies that showed an association of use of low-dose quetiapine (excluding prescriptions filled for tablet strengths \>50 mg) with an increased risk of major cardiovascular events as compared to use of [Z-drugs](https://en.wikipedia.org/wiki/Z-drugs "Z-drugs"), with most of the risk being driven by cardiovascular death.[\[184\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-184) Laboratory data from an unpublished analysis of the same cohort also support the lack of dose-dependency of metabolic side effects, as new use of low-dose quetiapine was associated with a risk of increased fasting triglycerides at one-year follow-up.[\[185\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-185) Concerns regarding side effects are greater in the elderly.[\[186\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Conn_271%E2%80%93287-186)
[Gabapentinoids](https://en.wikipedia.org/wiki/Gabapentinoid "Gabapentinoid") like [gabapentin](https://en.wikipedia.org/wiki/Gabapentin "Gabapentin") and [pregabalin](https://en.wikipedia.org/wiki/Pregabalin "Pregabalin") have sleep-promoting effects, but are not commonly used for the treatment of insomnia.[\[187\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid29487083-187) Gabapentin is not effective in helping alcohol related insomnia.[\[188\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-NIHR_Evidence_2022-188)[\[189\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Hong_2022-189)
[Barbiturates](https://en.wikipedia.org/wiki/Barbiturate "Barbiturate"), while once used, are no longer recommended for insomnia due to the risk of addiction and other side effects.[\[190\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-190)
#### Comparative effectiveness
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=33 "Edit section: Comparative effectiveness")\]
Medications for the treatment of insomnia have a wide range of [effect sizes](https://en.wikipedia.org/wiki/Effect_size "Effect size").[\[16\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid35843245-16) When comparing drugs such as [benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepine "Benzodiazepine"), [Z-drugs](https://en.wikipedia.org/wiki/Z-drug "Z-drug"), sedative [antidepressants](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant") and [antihistamines](https://en.wikipedia.org/wiki/Antihistamine "Antihistamine"), [quetiapine](https://en.wikipedia.org/wiki/Quetiapine "Quetiapine"), [orexin receptor antagonists](https://en.wikipedia.org/wiki/Orexin_receptor_antagonist "Orexin receptor antagonist"), and [melatonin receptor agonists](https://en.wikipedia.org/wiki/Melatonin_receptor_agonist "Melatonin receptor agonist"), the orexin antagonist [lemborexant](https://en.wikipedia.org/wiki/Lemborexant "Lemborexant") and the Z-drug [eszopiclone](https://en.wikipedia.org/wiki/Eszopiclone "Eszopiclone") had the best profiles overall in terms of [efficacy](https://en.wikipedia.org/wiki/Efficacy "Efficacy"), [tolerability](https://en.wikipedia.org/wiki/Tolerability "Tolerability"), and [acceptability](https://en.wikipedia.org/wiki/Acceptability "Acceptability").[\[16\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid35843245-16)
### Alternative medicine
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=34 "Edit section: Alternative medicine")\]
[Herbal products](https://en.wikipedia.org/wiki/Herbal_product "Herbal product"), such as [valerian](https://en.wikipedia.org/wiki/Valerian_\(herb\) "Valerian (herb)"), [kava](https://en.wikipedia.org/wiki/Kava "Kava"), [chamomile](https://en.wikipedia.org/wiki/Chamomile "Chamomile"), and [lavender](https://en.wikipedia.org/wiki/Lavender "Lavender"), have been used to treat insomnia.[\[15\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-riemann-23-15)[\[191\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid25644982-191)[\[192\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid29356580-192) However, there is no [quality evidence](https://en.wikipedia.org/wiki/Quality_evidence "Quality evidence") that they are effective and safe.[\[15\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-riemann-23-15)[\[191\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid25644982-191)[\[192\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid29356580-192) The same is true for [cannabis](https://en.wikipedia.org/wiki/Cannabis_\(drug\) "Cannabis (drug)") and [cannabinoids](https://en.wikipedia.org/wiki/Cannabinoid "Cannabinoid").[\[193\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid33244728-193)[\[194\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid32603954-194)[\[195\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-pmid24726015-195)
[Acupuncture](https://en.wikipedia.org/wiki/Acupuncture "Acupuncture") is often promoted for insomnia, but evidence for its effectiveness is mixed. It is unclear whether acupuncture is helpful for treating insomnia in the general population.[\[196\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-196) In people with [cancer](https://en.wikipedia.org/wiki/Cancer "Cancer"), acupuncture may reduce insomnia severity and improve sleep quality, though its effects are often similar to those of sham acupuncture. While acupuncture can help alleviate insomnia and enhance sleep, it is generally less effective than [cognitive behavioural therapy for insomnia](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_for_insomnia "Cognitive behavioral therapy for insomnia") (CBT-I).[\[197\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-197)
[](https://en.wikipedia.org/wiki/File:Insomnia_world_map_-_DALY_-_WHO2004.svg)
[Disability-adjusted life year](https://en.wikipedia.org/wiki/Disability-adjusted_life_year "Disability-adjusted life year") for insomnia per 100,000 inhabitants in 2004:
no data
less than 25
25–30.25
30\.25–36
36–41.5
41\.5–47
47–52.5
52\.5–58
58–63.5
63\.5–69
69–74.5
74\.5–80
more than 80
A survey of 1.1 million residents in the United States found that those who reported sleeping about 7 hours per night had the lowest rates of mortality, whereas those who slept for fewer than 6 hours or more than 8 hours had higher mortality rates. Severe insomnia—sleeping less than 3.5 hours in women and 4.5 hours in men—is associated with a 15% increase in mortality, while getting 8.5 or more hours of sleep per night was associated with a 15% higher mortality rate.[\[198\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Kripke-2002-198)
With this technique, it is difficult to distinguish the lack of sleep caused by a disorder, which is also a cause of premature death, versus a disorder that causes a lack of sleep, and the lack of sleep, causing premature death. Most of the increase in mortality from severe insomnia was discounted after controlling for [associated disorders](https://en.wikipedia.org/wiki/Comorbidity "Comorbidity"). After controlling for sleep duration and insomnia, the use of sleeping pills was also found to be associated with an increased [mortality rate](https://en.wikipedia.org/wiki/Mortality_rate "Mortality rate").[\[198\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Kripke-2002-198)
The lowest mortality was seen in individuals who slept between six and a half and seven and a half hours nightly. Even sleeping only 4.5 hours per night is associated with a very small increase in mortality. Thus, mild to moderate insomnia for most people is associated with increased [longevity](https://en.wikipedia.org/wiki/Longevity "Longevity"), and severe insomnia is associated only with a very small effect on mortality.[\[198\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Kripke-2002-198) It is unclear why sleeping longer than 7.5 hours is associated with excess mortality.[\[198\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Kripke-2002-198)
Between 10% and 30% of adults have insomnia at any given point in time and up to half of people have insomnia in a given year, making it the most common sleep disorder.[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9)[\[8\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-WHO2009-8)[\[10\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Tas2015-10)[\[199\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-199) About 6% of people have insomnia that is not due to another problem and lasts for more than a month.[\[9\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Th2007-9) People over the age of 65 are affected more often than younger people.[\[7\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-Wil2008-7) Females are more often affected than males.[\[8\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-WHO2009-8) Insomnia is 40% more common in women than in men.[\[200\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-200)
There are higher rates of insomnia reported [among university students](https://en.wikipedia.org/wiki/Sleep_deprivation_in_higher_education "Sleep deprivation in higher education") compared to the general population.[\[201\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-201)
## Society and culture
\[[edit](https://en.wikipedia.org/w/index.php?title=Insomnia&action=edit§ion=37 "Edit section: Society and culture")\]
The word insomnia is from [Latin](https://en.wikipedia.org/wiki/Latin_language "Latin language"): *in* + *[somnus](https://en.wiktionary.org/wiki/somnus#Latin "wiktionary:somnus")* "without sleep" and *\-ia* as a [nominalizing](https://en.wikipedia.org/wiki/Nominalization "Nominalization") [suffix](https://en.wikipedia.org/wiki/Suffix "Suffix").
The [popular press](https://en.wikipedia.org/wiki/Popular_press "Popular press") have published stories about people who supposedly never sleep, such as that of [Thái Ngọc](https://en.wikipedia.org/w/index.php?title=Th%C3%A1i_Ng%E1%BB%8Dc&action=edit&redlink=1 "Thái Ngọc (page does not exist)") and [Al Herpin](https://en.wikipedia.org/wiki/Al_Herpin "Al Herpin").[\[202\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-202) Horne writes "everybody sleeps and needs to do so", and generally this appears true. However, he also relates from contemporary accounts the case of Paul Kern, who was shot in 1915 fighting in [World War I](https://en.wikipedia.org/wiki/World_War_I "World War I") and then "never slept again" until he died in 1955.[\[203\]](https://en.wikipedia.org/wiki/Insomnia#cite_note-203) Kern appears to be a completely isolated, unique case.
1. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Ov_1-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Ov_1-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Ov_1-2) [***d***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Ov_1-3) [***e***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Ov_1-4)
["What Is Insomnia?"](https://www.nhlbi.nih.gov/health/insomnia). *Health Topics*. [NHLBI](https://en.wikipedia.org/wiki/NHLBI "NHLBI"). 24 March 2022. [Archived](https://web.archive.org/web/20160728012148/http://www.nhlbi.nih.gov/health/health-topics/topics/inso) from the original on 28 July 2016. Retrieved 26 November 2023.
2. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Ca_2-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Ca_2-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Ca_2-2) [***d***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Ca_2-3)
["What Causes Insomnia?"](https://www.nhlbi.nih.gov/health/insomnia/causes). *NHLBI*. 13 December 2011. [Archived](https://web.archive.org/web/20160728012201/http://www.nhlbi.nih.gov/health/health-topics/topics/inso/causes) from the original on 28 July 2016. Retrieved 9 August 2016.
3. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Diag_3-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Diag_3-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Diag_3-2)
["How Is Insomnia Diagnosed?"](https://www.nhlbi.nih.gov/health/insomnia). *NHLBI*. 13 December 2011. [Archived](https://web.archive.org/web/20160811091424/http://www.nhlbi.nih.gov/health/health-topics/topics/inso/diagnosis) from the original on 11 August 2016. Retrieved 9 August 2016.
4. **[^](https://en.wikipedia.org/wiki/Insomnia#cite_ref-4)**
Watson NF, Vaughn BV (2006). [*Clinician's Guide to Sleep Disorders*](https://books.google.com/books?id=M9zKBQAAQBAJ&pg=PA10). CRC Press. p. 10. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0-8493-7449-4](https://en.wikipedia.org/wiki/Special:BookSources/978-0-8493-7449-4 "Special:BookSources/978-0-8493-7449-4")
.
5. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Tx_5-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Tx_5-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-NIH2011Tx_5-2)
["How Is Insomnia Treated?"](https://web.archive.org/web/20160728012302/http://www.nhlbi.nih.gov/health/health-topics/topics/inso/treatment). *NHLBI*. 13 December 2011. Archived from [the original](https://www.nhlbi.nih.gov/health/health-topics/topics/inso/treatment) on 28 July 2016. Retrieved 9 August 2016.
6. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-AC2016_6-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-AC2016_6-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-AC2016_6-2) [***d***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-AC2016_6-3) [***e***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-AC2016_6-4) [***f***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-AC2016_6-5) [***g***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-AC2016_6-6)
Qaseem A, Kansagara D, Forciea MA, et al. (July 2016). ["Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians"](https://doi.org/10.7326%2FM15-2175). *Annals of Internal Medicine*. **165** (2): 125–133\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.7326/M15-2175](https://doi.org/10.7326%2FM15-2175). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27136449](https://pubmed.ncbi.nlm.nih.gov/27136449).
7. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Wil2008_7-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Wil2008_7-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Wil2008_7-2) [***d***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Wil2008_7-3) [***e***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Wil2008_7-4)
Wilson JF (January 2008). "In the clinic. Insomnia". *Annals of Internal Medicine*. **148** (1): ITC13–1–ITC13–16. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.7326/0003-4819-148-1-200801010-01001](https://doi.org/10.7326%2F0003-4819-148-1-200801010-01001). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [18166757](https://pubmed.ncbi.nlm.nih.gov/18166757). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [42686046](https://api.semanticscholar.org/CorpusID:42686046).
8. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-WHO2009_8-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-WHO2009_8-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-WHO2009_8-2) [***d***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-WHO2009_8-3) [***e***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-WHO2009_8-4) [***f***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-WHO2009_8-5) [***g***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-WHO2009_8-6)
["Dyssomnias"](https://web.archive.org/web/20090318104517/http://www.who.int/selection_medicines/committees/expert/17/application/Section24_GAD.pdf) (PDF). WHO. pp. 7–11\. Archived from [the original](https://www.who.int/selection_medicines/committees/expert/17/application/Section24_GAD.pdf) (PDF) on 18 March 2009. Retrieved 25 January 2009.
9. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-2) [***d***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-3) [***e***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-4) [***f***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-5) [***g***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-6) [***h***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-7) [***i***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-8) [***j***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-9) [***k***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Th2007_9-10)
Roth T (August 2007). ["Insomnia: definition, prevalence, etiology, and consequences"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978319). *[Journal of Clinical Sleep Medicine](https://en.wikipedia.org/wiki/Journal_of_Clinical_Sleep_Medicine "Journal of Clinical Sleep Medicine")* (Supplement). **3** (5 Suppl): S7–10. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.5664/jcsm.26929](https://doi.org/10.5664%2Fjcsm.26929). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [1978319](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978319). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [17824495](https://pubmed.ncbi.nlm.nih.gov/17824495).
10. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Tas2015_10-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Tas2015_10-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Tas2015_10-2)
Tasman A, Kay J, Lieberman JA, et al. (2015). [*Psychiatry, 2 Volume Set*](https://books.google.com/books?id=l2KRBgAAQBAJ&pg=PT4253) (4 ed.). John Wiley & Sons. p. 4253. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1-118-75336-1](https://en.wikipedia.org/wiki/Special:BookSources/978-1-118-75336-1 "Special:BookSources/978-1-118-75336-1")
. [Archived](https://web.archive.org/web/20230112211935/https://books.google.com/books?id=l2KRBgAAQBAJ&pg=PT4253) from the original on 2023-01-12. Retrieved 2017-09-01.
11. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Pun2012_11-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Pun2012_11-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Pun2012_11-2)
Punnoose AR, Golub RM, Burke AE (June 2012). ["Insomnia"](https://doi.org/10.1001%2Fjama.2012.6219). *[JAMA](https://en.wikipedia.org/wiki/JAMA "JAMA")* (JAMA patient page). **307** (24): 2653. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jama.2012.6219](https://doi.org/10.1001%2Fjama.2012.6219). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [22735439](https://pubmed.ncbi.nlm.nih.gov/22735439).
12. **[^](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Banno2022_12-0)**
Banno M, Tsujimoto Y, Kohmura K, et al. (September 2022). ["Unclear Insomnia Concept in Randomized Controlled Trials and Systematic Reviews: A Meta-Epidemiological Study"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9566752). *International Journal of Environmental Research and Public Health*. **19** (19) 12261. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.3390/ijerph191912261](https://doi.org/10.3390%2Fijerph191912261). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [9566752](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9566752). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [36231555](https://pubmed.ncbi.nlm.nih.gov/36231555).
13. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Tra2015_13-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Tra2015_13-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Tra2015_13-2)
Trauer JM, Qian MY, Doyle JS, et al. (August 2015). "Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis". *Annals of Internal Medicine*. **163** (3): 191–204\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.7326/M14-2841](https://doi.org/10.7326%2FM14-2841). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26054060](https://pubmed.ncbi.nlm.nih.gov/26054060). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [21617330](https://api.semanticscholar.org/CorpusID:21617330).
14. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Behavioral_and_psychological_treatm_14-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Behavioral_and_psychological_treatm_14-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Behavioral_and_psychological_treatm_14-2) [***d***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-Behavioral_and_psychological_treatm_14-3)
Edinger JD, Arnedt JT, Bertisch SM, et al. (February 2021). ["Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853211). *Journal of Clinical Sleep Medicine*. **17** (2): 263–298\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.5664/jcsm.8988](https://doi.org/10.5664%2Fjcsm.8988). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [7853211](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853211). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [33164741](https://pubmed.ncbi.nlm.nih.gov/33164741).
15. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-riemann-23_15-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-riemann-23_15-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-riemann-23_15-2) [***d***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-riemann-23_15-3) [***e***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-riemann-23_15-4)
Riemann D, Espie CA, Altena E, et al. (2023). ["The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023"](https://onlinelibrary.wiley.com/doi/abs/10.1111/jsr.14035). *Journal of Sleep Research*. **32** (6) e14035. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/jsr.14035](https://doi.org/10.1111%2Fjsr.14035). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [1365-2869](https://search.worldcat.org/issn/1365-2869). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [38016484](https://pubmed.ncbi.nlm.nih.gov/38016484).
16. ^ [***a***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-pmid35843245_16-0) [***b***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-pmid35843245_16-1) [***c***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-pmid35843245_16-2) [***d***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-pmid35843245_16-3) [***e***](https://en.wikipedia.org/wiki/Insomnia#cite_ref-pmid35843245_16-4)
De Crescenzo F, D'Alò GL, Ostinelli EG, et al. (July 2022). ["Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis"](https://doi.org/10.1016%2FS0140-6736%2822%2900878-9). *Lancet*. **400** (10347): 170–184\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0140-6736(22)00878-9](https://doi.org/10.1016%2FS0140-6736%2822%2900878-9). [hdl](https://en.wikipedia.org/wiki/Hdl_\(identifier\) "Hdl (identifier)"):[11380/1288245](https://hdl.handle.net/11380%2F1288245). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [35843245](https://pubmed.ncbi.nlm.nih.gov/35843245). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [250536370](https://api.semanticscholar.org/CorpusID:250536370).
17. **[^](https://en.wikipedia.org/wiki/Insomnia#cite_ref-17)**
Attarian HP (2003). ["chapter 1"](https://books.google.com/books?id=Fx-sBAAAQBAJ&pg=PT20). *Clinical Handbook of Insomnia*. Springer Science & Business Media. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1-59259-662-1](https://en.wikipedia.org/wiki/Special:BookSources/978-1-59259-662-1 "Special:BookSources/978-1-59259-662-1")
.
18. **[^](https://en.wikipedia.org/wiki/Insomnia#cite_ref-18)**
["Insomnia \> Complications"](https://web.archive.org/web/20090208085332/http://mayoclinic.com/health/insomnia/DS00187/DSECTION%3Dcomplications). *Mayo Clinic*. Archived from [the original](http://www.mayoclinic.com/health/insomnia/ds00187/dsection=complications) on 8 February 2009. Retrieved 5 May 2009.
19. **[^](https://en.wikipedia.org/wiki/Insomnia#cite_ref-BBDinsomnia_19-0)**
[Consumer Reports](https://en.wikipedia.org/wiki/Consumer_Reports "Consumer Reports"), [Drug Effectiveness Review Project](https://en.wikipedia.org/wiki/Drug_Effectiveness_Review_Project "Drug Effectiveness Review Project") (January 2012). ["Evaluating New Sleeping Pills Used to Treat: Insomnia Comparing Effectiveness, Safety, and Price"](http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/InsomniaUpdate-FINAL-July2008.pdf) (PDF). *Best Buy Drugs Consumer Reports*: 4. [Archived](https://web.archive.org/web/20131209122641/http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/InsomniaUpdate-FINAL-July2008.pdf) (PDF) from the original on 9 December 2013. Retrieved 4 June 2013.
20. **[^](https://en.wikipedia.org/wiki/Insomnia#cite_ref-20)**
Chaudhary NS, Grandner MA, Jackson NJ, et al. (October 9, 2016). ["Caffeine consumption, insomnia, and sleep duration: Results from a nationally representative sample"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6230475). *Nutrition (Burbank, Los Angeles County, Calif.)*. **32** (11–12\): 1193–1199\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.nut.2016.04.005](https://doi.org/10.1016%2Fj.nut.2016.04.005). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6230475](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6230475). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27377580](https://pubmed.ncbi.nlm.nih.gov/27377580).
21. **[^](https://en.wikipedia.org/wiki/Insomnia#cite_ref-21)**
["Symptoms"](https://www.sleepfoundation.org/insomnia/symptoms). [Archived](https://web.archive.org/web/20190415172923/https://www.sleepfoundation.org/insomnia/symptoms) from the original on 15 April 2019. Retrieved 15 April 2019.
22. **[^](https://en.wikipedia.org/wiki/Insomnia#cite_ref-22)**
Kertesz RS, Cote KA (2011). "Event-related potentials during the transition to sleep for individuals with sleep-onset insomnia". *Behavioral Sleep Medicine*. **9** (2): 68–85\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1080/15402002.2011.557989](https://doi.org/10.1080%2F15402002.2011.557989). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21491230](https://pubmed.ncbi.nlm.nih.gov/21491230). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [30439961](https://api.semanticscholar.org/CorpusID:30439961).
23. **[^](https://en.wikipedia.org/wiki/Insomnia#cite_ref-23)**
Cormier RE (1990). Walker HK, Hall WD, Hurst JW (eds.). [*Sleep Disturbances; In: Clinical Methods: The History, Physical, and Laboratory Examinations; chapter 77*](https://www.ncbi.nlm.nih.gov/books/NBK401/) (3rd ed.). Boston: Butterworths. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[9780409900774](https://en.wikipedia.org/wiki/Special:BookSources/9780409900774 "Special:BookSources/9780409900774")
. [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [21250242](https://pubmed.ncbi.nlm.nih.gov/21250242). Retrieved 2024-11-15.
24. **[^](https://en.wikipedia.org/wiki/Insomnia#cite_ref-24)**
Doghramji K (2007). [*Clinical Management of Insomnia*](https://archive.org/details/clinicalmanageme0000dogh). Caddo, OK: Professional Communications, Inc. p. [28](https://archive.org/details/clinicalmanageme0000dogh/page/28). [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1-932610-14-7](https://en.wikipedia.org/wiki/Special:BookSources/978-1-932610-14-7 "Special:BookSources/978-1-932610-14-7")
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Jiang XL, Zheng XY, Yang J, et al. (December 2015). "A systematic review of studies on the prevalence of insomnia in university students". *Public Health*. **129** (12): 1579–84\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.puhe.2015.07.030](https://doi.org/10.1016%2Fj.puhe.2015.07.030). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26298588](https://pubmed.ncbi.nlm.nih.gov/26298588).
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Horne J (2016). [*Sleeplessness Assessing Sleep Need in Society Today*](https://books.google.com/books?id=A5TlDAAAQBAJ&pg=PA114). Springer. p. 114. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-3-319-30572-1](https://en.wikipedia.org/wiki/Special:BookSources/978-3-319-30572-1 "Special:BookSources/978-3-319-30572-1")
. [Archived](https://web.archive.org/web/20230112211952/https://books.google.com/books?id=A5TlDAAAQBAJ&pg=PA114) from the original on 2023-01-12. Retrieved 2017-09-01. "Everyone sleeps and needs to do so"
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Horne J (2016). [*Sleeplessness Assessing Sleep Need in Society Today*](https://books.google.com/books?id=A5TlDAAAQBAJ&pg=PA114). Springer. p. 116. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-3-319-30572-1](https://en.wikipedia.org/wiki/Special:BookSources/978-3-319-30572-1 "Special:BookSources/978-3-319-30572-1")
. [Archived](https://web.archive.org/web/20230112211952/https://books.google.com/books?id=A5TlDAAAQBAJ&pg=PA114) from the original on 2023-01-12. Retrieved 2017-09-01.
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