The first time Erika Zar saw a doctor about her inability to sleep, or insomnia, she was 9 years old. “I mostly remember him asking questions about how much soda I drank,” she said. Unfortunately, the doctor wasn’t able to help her. Zar’s insomnia followed her into adulthood, worsening her mental health problems along the way.
“For the many years before I learned to manage it, insomnia was no doubt a contributing factor to my lifelong anxiety and depression,” Zar said. “I remember many dark nights feeling nearly suicidal.”
Insomnia can take a toll on physical and mental well-being, worsening existing health problems and increasing your risk of chronic illness down the road. And it can also affect your ability to function during the day. Fortunately, there are things you can do to get more and better sleep.
Sleep disorders, including insomnia, affect millions
Sleep disorders, which are any condition that cause a change in the way you sleep, affect approximately 70 million Americans. While there are more than 80 types of sleep disorders, the most common are insomnia, sleep apnea, restless legs syndrome and narcolepsy.
Insomnia can be further grouped into two types: acute and chronic. Acute insomnia is a short-term problem that lasts for days to weeks and is often accompanied by a specific stressor — a worry that keeps you up at night.
Chronic insomnia is a long-term condition, lasting months or more. Like acute insomnia, it can be tied to stressful situations, said Dr. Smita Patel, an integrative neurologist and sleep medicine physician at the iNeuro Institute and a member of HealthyWomen's Women's Health Advisory Council (WHAC). It may also have other causes, Patel said: irregular sleep schedules, poor sleep hygiene, persistent nightmares, mental health disorders, underlying physical problems, medications, a loud or restless bed partner, or other sleep disorders.
With both acute and chronic insomnia, people have a hard time falling or staying asleep to the point that it affects their ability to function during the day. It’s important to note that insomnia isn’t the same as sleep deprivation, Patel said.
“Usually, people with insomnia want to sleep, may go to bed at a regular time, etc., but generally are unable to get to sleep or stay asleep, or awake too early,” she said. In other words, staying up too late binge-watching your favorite show doesn’t count as insomnia.
Changing hormones, disturbed sleep
According to Patel, women are twice as likely as men to have difficulties falling asleep or maintaining sleep, and hormones play a key role in this gender gap. Because estrogen and progesterone influence sleep, insomnia is more common during the premenstrual period and postmenopausal years, when hormonal changes are most extreme.
Insomnia is also a major issue for women during perimenopause, the transitional period leading up to menopause. In one study, between 31% and 42% of perimenopausal women reported experiencing insomnia, with symptoms worsening as the women got closer to menopause.
Stress, nutrition among risk factors for insomnia
Stress is one of the biggest risk factors for insomnia, as many of us have learned the hard way during the Covid-19 pandemic. Almost 3 million people googled “insomnia” in the U.S. during the first five months of 2020 — a 58% increase over the same time frame in the previous three years. Whether the stress is immediate (anxiety about a test the next day) or chronic (worries about the future), it can prevent you from falling or staying asleep.
Nutrition may also play a role in insomnia. Patel points to research showing that a diet high in sugar and trans fats, and low in fiber can negatively affect your ability to fall and stay asleep. The relationship between nutrition and insomnia is often a double-edged one, since lack of sleep can cause you to crave the kinds of food that make insomnia worse.
Other risk factors for insomnia include being over age 60, having a family history of insomnia and not having a regular sleep schedule. There also appears to be a connection between psychiatric disorders, such as depression and anxiety, and insomnia. “Many with chronic insomnia have a psychiatric disorder, and the majority with a psychiatric disorder have insomnia,” Patel said.
Saundra Jain, PsyD, LPC, a psychotherapist and adjunct clinical affiliate at the University of Texas at Austin and a member of HealthyWomen’s WHAC, said she hears about problems associated with lack of sleep in her psychotherapy practice quite often. “Data supports that sleep difficulties are very common in those that suffer from mental health challenges like depression, anxiety, bipolar disorder and other conditions,” Jain said.
Long-term impacts of insomnia
In addition to worsening preexisting health problems, insomnia may increase your risk of developing new ones. Lack of sleep is associated with chronic conditions such as depression and other mood disorders, high blood pressure, cardiovascular disease, Type 2 diabetes, and obesity.
Insomnia may also be linked to brain problems, including memory loss and difficulty concentrating. “Over the long term, poor sleep may put someone at a higher risk of cognitive decline and dementia,” Patel said.
Sleep helps the brain conduct important housekeeping tasks, clearing out potentially dangerous substances such as beta amyloid proteins that are associated with Alzheimer’s disease. Many factors contribute to Alzheimer's risk and lack of sleep may be one of these factors. "Studies have found that even one night of sleep deprivation can increase the amount of beta amyloid in the brain,” Patel said.
Taking steps toward better sleep
The good news? Even the most severe insomnia can be managed. Patel and Jain recommend these steps for better sleep:
Set a consistent wake-up time. The time you wake up has a big impact on how you sleep. Patel suggests getting up at the same time every day — even on the weekend. Once you’re up, let your body know it’s time to start the day by exposing yourself to bright light as soon as possible. Natural light is best, but a full-spectrum light box also works.
Add movement to your routine. “Many people, especially those working from home, aren't moving enough during the day,” Patel said. And Zar said, “I never fall asleep faster or stay asleep better than when I've done a good bit of strenuous physical activity during the day.”
Consume carbs and caffeine in moderation. Since high-carbohydrate diets are linked to poor sleep quality, people with insomnia may benefit from eating fewer complex carbs. As for caffeine, Patel said it’s best consumed early in the day if you’re sensitive to it.
Seek professional support. Insomnia often results in excessive worrying about not being able to sleep, Jain explained, which fuels further poor sleep and causes a negative cycle. She recommends cognitive behavioral therapy for insomnia (CBT-i), a program that has helped many of her patients break the cycle. Medication may also be an option to help treat insomnia.
Taking insomnia one night at a time
Although she still has the occasional sleepless night, Zar is no longer at the mercy of insomnia. With consistent practice of techniques like those suggested above (including the help of a good therapist), Zar is getting the rest she needs. Where in the past she worried she’d never sleep again, now she knows she will — even if it takes a little work to get there.
This resource was created with support from Eisai.