alarm clocks and sleep aids

Chronic Insomnia: Treatment, Causes, Symptoms, and More

A significant portion of Americans report not getting the recommended seven hours of sleep each night. Insomnia is a widespread sleep disorder where you might struggle to fall asleep, stay asleep, or both.

Insomnia usually lasts for a few days or weeks, often striking during stressful times or life changes. Once your routine settles down, your sleep should normalize, too.

That’s known as Acute Insomnia and it’s typically little more than one of life’s inconveniences. Unfortunately, there are versions of this sleep disorder that don’t seem tied to a temporary event, and that’s what we’re here to discuss.

When Sleeplessness Persists

Chronic Insomnia, a true nightmare for many, is when sleep is impacted night after night (after night). There’s a technical definition of chronic when sleep problems persist more than three nights a week over a period that stretches three months or longer.

Across a number of countries, the estimate is that 8% of adults suffer from chronic insomnia. Women are more likely to experience this than men. And older adults, especially those with significant medical conditions, report the highest rates of persistent sleeplessness.

Patterns of Chronic Insomnia

*  Difficulty falling asleep
*  Waking up frequently during the night
*  Trouble staying asleep or returning to sleep
*  Waking up too early

As you can see, insomnia doesn’t impact everyone the same way. There are many people who just struggle to fall asleep, but that can be easy for others who then wake up in the middle of the night and can’t find a way to drift back off.

The bottom line is that chronic insomnia begins to quickly impact your normal waking hours, too. Lack of restorative sleep means that your brain and body will never begin the day properly.

Perhaps you’ve experienced some of the following:

*  Daytime drowsiness or grogginess
*  Not feeling refreshed after sleep
*  Irritability
*  Mood changes, such as depression
*  Difficulty concentrating
*  Memory issues
*  Increased mistakes and accidents

Those conditions range from minor annoyances all the way up to life-altering and dangerous. Imagine having to drive a truck or operate heavy construction machinery while exhausted. The risks are extreme.

What Makes it Chronic?

As you may have seen above, chronic insomnia is significantly more likely to occur if you are an adult with other lingering medical conditions. This can include physical complications from things like gastroesophageal reflux, neurodegenerative diseases, or chronic pain.

However, it’s not just physical ailments that tend to go and in hand with chronic sleeplessness. Up to 40% of patients being treated for their insomnia also report a psychiatric condition, typically depression or anxiety.

In fact, insomnia that exists alongside a co-morbid health issue is so common that it has a name: secondary insomnia. I bet your first thought is, well, what’s a primary version then?

Well, put simply, the primary version is just chronic insomnia with no real evidence of another condition. By most measures, primary and secondary insomnia are equally prevalent; but both are subsets of chronic sleeplessness and each are quite serious, even if treatment options can be substantially different.

Let’s talk a bit about those treatment possibilities.

Treatment Options a little brighter out there right now for Chronic Insomnia

This type of insomnia might be tied to fluctuations in certain brain chemicals, but research is ongoing. Because primary insomnia isn’t linked to other medical conditions or medications, it remains poorly understood by scientists.

Advanced MRI scans are being used to study it.

You’ll find a broad range of possible solutions – everything from sleep routine changes to pharmaceuticals. Solutions can also lie in therapy and/or lifestyle adjustments.

Cognitive Behavioral Therapy (CBT)

Research shows that CBT can be as effective, or even more effective, than sleep medications for chronic insomnia. Sessions with therapists use a feedback process to create helpful behavior modifications.

It involves educating about sleep and better habits while teaching how to change beliefs and parts of a daily routine that may hinder sleep.

Various Techniques Used in Cognitive Behavioral Therapy for Insomnia (CBT-I)

Cognitive Techniques: Journaling worries or concerns before bedtime can prevent actively working them out while trying to sleep.

Stimulus Control: This involves changing behaviors that condition the mind to resist sleep. Setting consistent sleep and wake times is part of this strategy.

Examples include using the bed only for sleep and sex, and leaving the bedroom if sleep doesn’t come within a set number of minutes.

Sleep Restriction: This therapy limits the time spent in bed, including avoiding naps, to induce sleep deprivation, making bedtime more welcome. Gradually, time in bed increases as sleep improves.

Relaxation Techniques: Breathing exercises, yoga, guided meditation, and other methods help reduce muscle tension and control breathing and heart rate, aiding relaxation.

Paradoxical Intention: Focusing on staying awake in bed instead of expecting to fall asleep can reduce worries and anxiety about sleeping.

It’s particularly effective for learned insomnia.


Prescription medications and over-the-counter (OTC) sleep aids can help with falling or staying asleep.

Despite their effectiveness, doctors usually don’t recommend long-term use of sleeping pills due to side effects like daytime sleepiness, forgetfulness, sleepwalking, balance issues, and habit formation.

Prescription medications for insomnia include:

*  Zolpidem (Ambien)
*  Eszopiclone (Lunesta)
*  Zaleplon (Sonata)
*  Doxepin (Silenor)
*  Ramelteon (Rozerem)
*  Suvorexant (Belsomra)
*  Temazepam (Restoril)

OTC sleep aids may include:

*  Diphenhydramine (Benadryl)
*  Doxylamine succinate (Unisom SleepTabs)
*  Melatonin
*  Valerian root
*  Chamomile tea

Always consult a doctor before taking OTC sleep aids, including natural remedies like melatonin and valerian root, as they can cause side effects and interact with other medications.

Addressing Underlying Conditions

Treating chronic insomnia often involves addressing underlying medical conditions like acid reflux or pain. Managing these conditions can alleviate insomnia.

Discuss with your doctor about changing medications or treatment plans if a drug is causing sleep issues.

At-Home Remedies for Chronic Insomnia

Improving sleep hygiene is a key strategy. This involves changing behavior patterns to enhance sleep quality.

Here are some tips:

*  Avoid caffeine, especially later in the day.
*  Refrain from alcohol use and smoking before bed.
*  Engage in regular physical activity.
*  Skip naps.
*  Avoid large meals in the evening.
*  Maintain a consistent sleep schedule, even on days off.
*  Steer clear of computers, smartphones, TV, or other devices an hour before bed.
*  Keep your bedroom dark or use a sleep mask.
*  Ensure your bedroom is at a comfortable temperature.
*  Make sure your mattress is comfortable.