What are the causes of insomnia?

From the Guidelines

Insomnia can be caused by various factors, including stress, anxiety, depression, poor sleep habits, and medical conditions, as well as certain medications and environmental factors, and understanding these causes is crucial for developing effective treatment strategies. The causes of insomnia can be categorized into several types, including:

• Adjustment insomnia, which is associated with an identifiable stressor, such as psychosocial, physical, or environmental disturbances 1
• Psychophysiological insomnia, which is characterized by heightened arousal and learned sleep-preventing associations 1
• Paradoxical insomnia, which is a complaint of severe or nearly “total” insomnia that greatly exceeds objective evidence of sleep disturbance 1
• Idiopathic insomnia, which is a persistent complaint of insomnia with insidious onset during infancy or early childhood and no or few extended periods of sustained remission 1
• Insomnia due to mental disorder, which occurs exclusively during the course of a mental disorder, and is judged to be caused by that disorder 1
• Inadequate sleep hygiene, which is insomnia associated with voluntary sleep practices or activities that are inconsistent with good sleep quality and daytime alertness 1
• Insomnia due to a drug or substance, which is sleep disruption due to use of a prescription medication, recreational drug, caffeine, alcohol, food, or environmental toxin 1
• Insomnia due to a medical condition, which is insomnia caused by a coexisting medical disorder or other physiological factor 1 Other factors that can contribute to insomnia include:
• Hormonal changes during menstruation, pregnancy, or menopause 1
• Neurological conditions like Parkinson's disease or Alzheimer's disease 1
• Age-related changes in sleep patterns and circadian rhythm disorders from shift work or jet lag 1
• Mental health disorders such as PTSD or bipolar disorder 1 It is essential to address underlying conditions, improve sleep hygiene, and consider using appropriate sleep medications under medical supervision to manage insomnia effectively 1.

From the FDA Drug Label

Sleep disturbance may be the presenting manifestation of an underlying physical and/or psychiatric disorder Worsening of insomnia may be the consequence of an unrecognized psychiatric or physical disorder The causes of insomnia may include underlying physical and/or psychiatric disorders.

• Unrecognized psychiatric disorders
• Unrecognized physical disorders 2

From the Research

Causes of Insomnia

The causes of insomnia can be diverse and complex, involving various factors. Some of the key causes include:

• Social factors: insomnia rates are higher among divorced, separated, or widowed individuals, and those with lower scholastic levels, domestic income, or who are unemployed 3
• Environmental factors: working constraints, overcharge of external events, deep intrapsychic conflicts, and interpersonal conflicts can contribute to insomnia 3
• Medical and physiologic causes: conditions such as restless legs syndrome, recurrent limb movements, sleep apnea, narcolepsy, and excessive use of certain medications can lead to insomnia 3
• Chronobiological factors: night working, day-night shift, and jet-lag can disrupt the body's internal clock and lead to insomnia 3
• Toxic factors: substances like amphetamines, antidepressants, and excessive caffeine and alcohol consumption can interfere with sleep 3
• Behavioral factors: poor night routines, intellectual activities before bedtime, late meals, and physical hyperactivity can contribute to insomnia 3
• Psychiatric factors: insomnia often co-occurs with mental health conditions such as depression, anxiety disorders, and schizophrenia 3, 4
• Psychological factors: overstimulation, stress, and intrapsychic conflicts can also play a role in the development of insomnia 3

Comorbidities and Insomnia

Insomnia often co-occurs with other sleep disorders, psychological, and somatic disorders, making diagnosis and treatment challenging 4, 5. Conditions like obstructive sleep apnea, circadian rhythm sleep-wake disorders, and mental health disorders can have insomnia as a symptom or comorbidity 5. A thorough assessment is necessary to correctly diagnose and treat insomnia, considering its potential comorbidities 5.

Treatment and Management

Cognitive behavioral therapy for insomnia (CBT-I) is considered the first-line treatment for insomnia, with digital CBT-I emerging as a scalable option for managed care 6. Treatment of insomnia may also have a preventive and neuroprotective role, particularly when using CBT-I, which has shown efficacy in improving sleep and reducing symptoms of psychopathology 4.