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For many people, sleep is a luxury that they simply cannot afford. Did you know that chronic insomnia affects nearly one-third of the global population? Sleepless nights are more than just an annoyance – they could be deadly. Sleep deprivation caused by chronic insomnia has been linked to an increased risk of depression, anxiety, and even suicide

Chronic insomnia is a condition that affects millions of people worldwide, causing fatigue, irritability, and decreased productivity. According to recent studies, chronic insomnia costs the global economy billions of dollars each year.

chronic insomnia symptoms

From counting sheep to drinking warm milk, people have tried all sorts of remedies to combat the effects of chronic insomnia. Here we will shed more light on what really is chronic insomnia, what causes chronic insomnia, and how to identify its indicators and symptoms.

Chronic insomnia is a common sleep disorder characterized by difficulty falling asleep, staying asleep, or experiencing non-restorative sleep for at least three nights per week for three months or more, despite adequate opportunity to sleep (1). Chronic insomnia is different from acute insomnia, which typically lasts for a few days or weeks and is often caused by stress, illness, or medication. Chronic insomnia affects about 10% of adults and can significantly impact the quality of life, daytime functioning, and overall health (2).

Classification of Chronic Insomnia

Chronic insomnia can be classified as primary or secondary. Primary insomnia refers to insomnia that is not caused by an underlying medical or psychiatric condition. Secondary insomnia, on the other hand, is caused by an underlying medical or psychiatric condition, such as chronic pain, anxiety, depression, or sleep apnea (3). In some cases, chronic insomnia can also be classified as idiopathic, which means that the cause of the insomnia is unknown (4).

Types of Chronic Insomnia

There are two main types of chronic insomnia: sleep-onset insomnia and sleep-maintenance insomnia. Sleep-onset insomnia refers to difficulty falling asleep at the beginning of the night. Sleep-maintenance insomnia, on the other hand, refers to difficulty staying asleep throughout the night. Both types of insomnia can be disruptive to sleep and cause daytime fatigue and other negative health outcomes (5).

Pathophysiology of Chronic Insomnia

The pathophysiology of chronic insomnia is complex and involves a variety of biological and psychological factors. One of the primary mechanisms that contribute to chronic insomnia is hyperarousal, which refers to a state of increased physiological and psychological activation that interferes with sleep (6). Hyperarousal can be caused by various factors, including stress, anxiety, depression, and other psychiatric disorders.

Another factor that contributes to chronic insomnia is alterations in the circadian rhythm, which regulates sleep-wake cycles. Changes in the circadian rhythm can be caused by factors such as shift work, jet lag, or exposure to light at night (7).

Other factors that can contribute to chronic insomnia include genetic factors, neurotransmitter imbalances, and medical conditions such as sleep apnea, chronic pain, and restless leg syndrome (8).

Risk Factors for Chronic Insomnia

Several risk factors can increase the likelihood of developing chronic insomnia. Some of these risk factors include age, gender, and certain medical and psychiatric conditions. For example, women are more likely than men to develop chronic insomnia, and older adults are more likely than younger adults to experience sleep disturbances (9).

Other risk factors for chronic insomnia include a history of substance abuse, certain medications, and lifestyle factors such as smoking, alcohol consumption, and poor sleep hygiene (10).

In a nutshell, chronic insomnia is a common sleep disorder that affects millions of people worldwide. It is characterized by difficulty falling asleep, staying asleep, or experiencing non-restorative sleep for at least three nights per week for three months or more, despite adequate opportunity to sleep. Chronic insomnia can be classified as primary or secondary and further categorized as sleep-onset or sleep-maintenance insomnia. 

The pathophysiology of chronic insomnia is complex and involves a variety of biological and psychological factors, including hyperarousal, circadian rhythm disturbances, and neurotransmitter imbalances. There are several risk factors for chronic insomnia, including age, gender, certain medical and psychiatric conditions, and lifestyle factors such as substance abuse and poor sleep hygiene. 

Understanding the classification, types, pathophysiology, and risk factors of chronic insomnia is critical for developing effective prevention and treatment strategies for this common sleep disorder.

Chronic insomnia is a sleep disorder characterized by difficulty falling or staying asleep, or waking up too early and not being able to go back to sleep, that persists for at least three months (1). It affects approximately 10% of adults worldwide (10). Chronic insomnia can significantly impact daily functioning, quality of life, and overall health (3). In this article, we will discuss the 15 most common symptoms of chronic insomnia.

Difficulty falling asleep: The inability to fall asleep within 30 minutes after lying down in bed (11).

Frequent awakenings: Waking up several times during the night and having trouble falling back asleep (7).

Early morning awakening: Waking up earlier than intended and being unable to fall back asleep (9).

Non-restorative sleep: Feeling tired and unrefreshed upon waking up in the morning (12).

Fatigue: Experiencing persistent tiredness during the day, even after a full night’s sleep (13).

Difficulty concentrating: Having trouble focusing on tasks or remembering information due to sleep deprivation (14).

Mood disturbances: Feeling irritable, anxious, or depressed due to lack of sleep (15).

Increased errors and accidents: Being more prone to making mistakes or having accidents due to decreased alertness and impaired cognitive function (2).

Decreased motivation: Feeling less motivated to engage in activities and perform tasks due to fatigue and lack of energy.

Reduced productivity: Being less efficient at work or school due to decreased cognitive function.

Physical symptoms: Experiencing headaches, muscle aches, or stomach discomfort due to sleep deprivation.

Increased use of sleep aids: Relying on sleeping pills or other sleep aids to fall asleep.

Increased alcohol or drug use: Using alcohol or drugs to induce sleep, which can worsen insomnia in the long run.

Decreased social interaction: Avoiding social situations due to fatigue or mood disturbances.

Reduced quality of life: Overall dissatisfaction with life due to the impact of chronic insomnia on daily functioning.

The timeline of symptoms can vary for different individuals. Some people may experience symptoms immediately, while others may develop them gradually over time. It is important to note that chronic insomnia can also have a bidirectional relationship with some of these symptoms, where poor sleep can exacerbate symptoms and vice versa.

In conclusion, chronic insomnia can have a significant impact on an individual’s physical and mental health, as well as their daily functioning and quality of life. Recognizing the symptoms of chronic insomnia is essential to seek appropriate treatment and improving sleep quality. It is recommended to consult a healthcare provider if you experience any of these symptoms persistently.

Chronic insomnia, which is defined as difficulty initiating or maintaining sleep that lasts for at least 3 months, can have various underlying causes. Here are 15 causes of chronic insomnia, listed in order of most common to least common.

Psychiatric disorders: Psychiatric conditions, such as depression, anxiety, and post-traumatic stress disorder, are among the most common causes of chronic insomnia (11). These conditions can cause hyperarousal and lead to difficulty falling and staying asleep.

Medical conditions: Chronic pain, asthma, and other medical conditions can cause chronic insomnia (3). These conditions can cause physical discomfort, making it difficult to sleep.

Substance use: The use of certain substances, including alcohol, caffeine, and nicotine, can cause chronic insomnia (16). These substances can interfere with the body’s natural sleep-wake cycle, making it difficult to fall and stay asleep.

Sleep disorders: Sleep disorders such as sleep apnea and restless leg syndrome can cause chronic insomnia (17). These conditions disrupt the normal sleep cycle, making it difficult to get restful sleep.

Environmental factors: Environmental factors such as noise, light, and temperature can cause chronic insomnia (18). These factors can interfere with the body’s natural sleep-wake cycle.

Poor sleep habits: Poor sleep habits, such as irregular sleep schedules and using electronics in bed, can cause chronic insomnia. These habits can disrupt the body’s natural sleep-wake cycle.

Shift work: Shift work can cause chronic insomnia due to the disruption of the body’s natural sleep-wake cycle. The changing work schedule can make it difficult to establish a regular sleep routine.

Hormonal changes: Hormonal changes, such as those that occur during menopause, can cause chronic insomnia. These changes can cause hot flashes and night sweats, which can interfere with sleep.

Genetic factors: Genetic factors may play a role in chronic insomnia. Certain genetic variations may make it more difficult to fall and stay asleep.

Aging: Aging can cause changes in the body’s sleep-wake cycle, leading to chronic insomnia. Older adults may also experience other medical conditions that can interfere with sleep.

Neurological conditions: Neurological conditions, such as Parkinson’s disease and Alzheimer’s disease, can cause chronic insomnia. These conditions can disrupt the body’s natural sleep-wake cycle.

Stress: Stressful life events, such as a divorce or job loss, can cause chronic insomnia. Stress can cause hyperarousal and interfere with the body’s natural sleep-wake cycle.

Medications: Certain medications, such as antidepressants and corticosteroids, can cause chronic insomnia. These medications can interfere with the body’s natural sleep-wake cycle.

Gastrointestinal disorders: Gastrointestinal disorders, such as acid reflux and irritable bowel syndrome, can cause chronic insomnia. These conditions can cause physical discomfort and interfere with sleep.

Other sleep-related disorders: Other sleep-related disorders, such as narcolepsy and circadian rhythm disorders, can cause chronic insomnia. These conditions disrupt the body’s natural sleep-wake cycle.

In conclusion, chronic insomnia can have various underlying causes, including psychiatric disorders, medical conditions, substance use, sleep disorders, environmental factors, poor sleep habits, shift work, hormonal changes, genetic factors, aging, neurological conditions, stress, medications, gastrointestinal disorders, and other sleep-related disorders. It is important to identify the underlying cause of chronic insomnia to develop an effective treatment plan.

Chronic insomnia is a serious condition that affects a significant portion of the global population. It is characterized by difficulty falling or staying asleep, which can have a range of negative consequences on a person’s health and well-being. The symptoms of chronic insomnia can include fatigue, irritability, decreased productivity, and an increased risk of accidents and injuries.

There are a number of different factors that can contribute to the development of chronic insomnia. These can include underlying medical conditions, lifestyle factors, and certain medications. While the exact causes of chronic insomnia can vary from person to person, it is important to recognize the signs and seek treatment as soon as possible.

 If you are experiencing symptoms of chronic insomnia, there are a number of strategies that you can use to manage the condition. These can include establishing a regular sleep routine, avoiding stimulating activities before bed, and creating a relaxing sleep environment. Additionally, there is a range of medical treatments that may help manage the symptoms of chronic insomnia, including prescription medications and cognitive behavioral therapy.

Ultimately, the key to managing chronic insomnia is to recognize the symptoms and seek treatment as soon as possible. With the right approach, it is possible to overcome this challenging condition and enjoy better sleep and improved overall health and well-being.

  1. American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.
  2. Morin CM, LeBlanc M, Bélanger L, et al. Prevalence of Insomnia and Its Treatment in Canada. Can J Psychiatry. 2011;56(9):540-548.
  3. Roth T, Coulouvrat C, Hajak G, et al. Prevalence and perceived health associated with insomnia based on DSM-IV-TR; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; and Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition criteria: results from the America Insomnia Survey. Biol Psychiatry. 2011;69(6):592-600.
  4. Smith MT, Perlis ML, Park A, et al. Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry. 2002;159(1):5-11. /
  5. Espie CA, Kyle SD, Williams C, et al. A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep. 2012;35(6):769-781.
  6. Irwin MR, Cole JC, Nicassio PM. Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and older adults 55+ years of age. Health Psychol. 2006;25(1):3-14.
  7. Buysse DJ, Germain A, Moul DE, et al. Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med. 2011;171(10):887-895.
  8. Taylor DJ, Mallory LJ, Lichstein KL, Durrence HH, Riedel BW, Bush AJ. Comorbidity of chronic insomnia with medical problems. Sleep. 2007;30(2):213-218. doi:10.1093/sleep/30.2.213
  9. Lichstein KL, Riedel BW. Insomnia and daytime functioning. Sleep Med Rev. 1994;8(4):227-243.
  10. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6(2):97-111.
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  12. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-545.
  13. Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297-307.
  14. Harvey AG, Sharpley AL, Ree MJ, Stinson K, Clark DM. An open trial of cognitive therapy for chronic insomnia. Behav Res Ther. 2007;45(10):2491-2501.
  15. Kyle SD, Morgan K, Spiegelhalder K, Espie CA. No pain, no gain: an exploratory within-subjects mixed-methods evaluation of the patient experience of sleep restriction therapy (SRT) for insomnia. Sleep Med. 2011;12(8):735-747.
  16. Roehrs T, Roth T. Insomnia pharmacotherapy. Neurotherapeutics. 2012;9(4):728-738.
  17. Bonnet MH, Arand DL. Treatment of insomnia. UpToDate. Updated June 24, 2021.
  18. Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation’s updated sleep duration recommendations: final report. Sleep Health. 2015;1(4):233-243.


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