Insomnia
Basics
Description
Difficulty initiating or maintaining sleep or nonrestorative sleep despite adequate opportunity and circumstances for sleep, resulting in at least one of the following forms of daytime impairment:
- Fatigue or malaise
- Attention, concentration, or memory impairment
- Social or vocational dysfunction or poor school performance
- Mood disturbance or irritability
- Daytime sleepiness
- Motivation, energy, or initiative reduction
- Proneness for errors or accidents at work or while driving
- Tension, headaches, or GI symptoms in response to sleep loss
- Concerns or worries about sleep
Epidemiology
- Predominant age: increases with age
- Predominant sex: female > male (5:1)
Prevalence
- Insomnia (transient and chronic): 5–35% of the population; 10–15% associated with daytime impairment
- Chronic insomnia: 10% middle-aged adults; 1/3 of people aged >65 years
Etiology and Pathophysiology
- Transient/intermittent (<30 days) and short-term (<3 months)
- Usually caused by an identifiable stressor
- Stressor can be:
- Physical (e.g., medical illness, high altitude)
- Psychological (e.g., stress, excitement, bereavement)
- Psychosocial (e.g., work deadlines, housing insecurity)
- Interpersonal (e.g., arguments)
- Usually resolves when stressor is removed
- Chronic (>3 months)
- Usually not due to one single cause
- Possible contributing factors:
- Medical (e.g., gastroesophageal reflux disease, sleep apnea, chronic pain)
- Psychiatric (e.g., mood, anxiety, psychotic disorders)
- Primary sleep disorder (e.g., idiopathic, psychophysiologic [heightened arousal and learned sleep-preventing associations], paradoxical [sleep state misperception])
- Circadian rhythm disorder (e.g., irregular pattern, jet lag, delayed/advanced sleep phase, shift work)
- Environmental (e.g., lights, noises, movements [partner/young children/pets])
- Behavioral (e.g., poor sleep hygiene, adjustment sleep disorder)
- Substance induced
- Medications (e.g., antihypertensives, antidepressants, corticosteroids, levodopa-carbidopa, phenytoin, quinidine, theophylline, thyroid hormones)
Genetics
No known factors
Risk Factors
- Age
- Female gender
- Medical comorbidities
- Unemployment
- Psychiatric illness
- Impaired social relationships
- Shift work
- Separation from spouse or partner
- Drug and substance abuse
- Family or personal history of insomnia
General Prevention
- Practice consistent sleep hygiene:
- Fixed wake-up times and bedtimes regardless of amount of sleep obtained (weekdays and weekends)
- Avoid naps. Go to bed only when sleepy.
- Sleep in a cool, dark, quiet environment.
- No activities in bedroom associated with anything but sleep or sex
- 30-minute wind-down time before sleep
- If unable to sleep within 20 minutes, move to another environment and engage in quiet activity until sleepy.
- Limit caffeine intake to mornings.
- No alcohol after 4 PM
- Fixed eating times
- Avoid medications that interfere with sleep.
- Regular moderate exercise
Commonly Associated Conditions
- Psychiatric disorders
- Painful musculoskeletal conditions
- Obstructive sleep apnea
- Restless leg syndrome
- Drug or alcohol addiction/dependence
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Citation
Domino, Frank J., et al., editors. "Insomnia." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816561/all/Insomnia.
Insomnia. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816561/all/Insomnia. Accessed October 13, 2024.
Insomnia. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816561/all/Insomnia
Insomnia [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 October 13]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816561/all/Insomnia.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Insomnia
ID - 816561
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816561/all/Insomnia
PB - Wolters Kluwer
ET - 33
DB - Medicine Central
DP - Unbound Medicine
ER -