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Insomnia
Category: Mind, Mood & Sleep · All mind & sleep symptoms
What it can feel like
Insomnia means difficulty falling asleep, staying asleep, or waking too early, despite adequate opportunity — with daytime consequences: fatigue, poor concentration, irritability and low mood. Short-term insomnia follows stress and disruption; chronic insomnia (three nights a week for three months) becomes a self-maintaining pattern of conditioned wakefulness in bed.
Possible causes
A symptom can have many causes, and most are not serious. The lists below group conditions this symptom can be associated with — common causes first. They are possibilities to discuss with a clinician, not a diagnosis.
Common causes
Insomnia can be associated with stress and anxiety, low mood, irregular schedules and shift work, caffeine and alcohol (which fragments the second half of the night), screens and light exposure, pain, and an overactive mind at bedtime.
Other possible causes
Insomnia can also be associated with sleep apnoea (broken sleep with snoring and morning headache), restless legs, an overactive thyroid, menopausal night sweats, and medicines including steroids and some antidepressants.
Red flags — when to seek help promptly
- Insomnia with loud snoring, witnessed apnoeas or dangerous daytime sleepiness (possible sleep apnoea)
- Insomnia with low mood and any thoughts of self-harm — seek support promptly (US 988, UK Samaritans 116 123)
- Insomnia with weight loss, tremor and palpitations (possible thyroid)
- Sleep loss triggering unusually elevated, pressured mood (possible mania) — urgent mental health assessment
- Insomnia causing accidents or near-misses while driving
What a clinician may do
A clinician will take a two-week sleep history (a diary helps), screen mood, snoring and legs, review caffeine, alcohol and medicines, and check thyroid where features fit. First-line treatment for chronic insomnia is a structured therapy (CBT-I) rather than sleeping tablets, which are reserved for short-term crises.
Watch: related videos
Examination and clinical videos from the MedicalVideos.com library relevant to this symptom. Some clinical footage is graphic — that is the nature of a medical video library.
Related guides on MedicalVideos.com
Frequently asked questions
Why is therapy first-line when tablets exist?
Sleeping tablets sedate but do not rebuild natural sleep architecture, lose effect within weeks, and create rebound insomnia on stopping. CBT-I — stimulus control, sleep restriction, cognitive work — produces durable sleep improvement that outlasts treatment, which is why guidelines put it first.
Is waking at 3 a.m. a hormone problem?
Early-morning waking is a classic feature of depression and of the menopause transition (with night sweats), and also just of ageing sleep becoming lighter. The company it keeps — mood, sweats, snoring — guides which thread to pull first.
Related symptoms — Mind, Mood & Sleep
Browse the I section of the A–Z list or return to the Symptoms A–Z hub.