This informational guide, part of POPSUGAR's Condition Center [1], lays out the realities of this health concern: what it is, what it can look like, and strategies that medical experts say are proven to help. You should always consult your doctor regarding matters pertaining to your health and before starting any course of medical treatment.

Tossing and turning occasionally isn't a big deal. But chronic insomnia — difficulty sleeping at least three days a week for at least 12 weeks — can affect how you feel and function during the day, and can put you at risk for a number of serious health problems. The longer you ignore the problem, the more difficult it can be to break yourself out of the exhausting cycle.

Understanding Insomnia

Around one in four people in the US [2] have symptoms of insomnia. The key signs are lying awake for a long time before drifting off (i.e., initial insomnia); waking up in the night, unable to fall back asleep (i.e., middle insomnia); and waking up too early in the morning (i.e., terminal insomnia). These types of insomnia can lead you to feel tired when you get out of bed in the morning; you may also experience irritability, anxiety, low energy or feeling blue, and difficulty concentrating throughout the day.

"Long-term sleep issues can lead to serious health problems," says Ashley Mason, PhD [3], core faculty at the Osher Center for Integrative Health at the University of California, San Francisco. The risks of diabetes, high blood pressure, heart disease, stroke, and obesity can increase when you frequently sleep poorly. Impaired sleep is a risk factor for Alzheimer's, too, according to 2019 study published in the International Journal of Molecular Sciences [4].

Causes and Risk Factors of Insomnia

There are many factors that could be contributing to your insomnia, ranging from stress to certain medical conditions, per the Mayo Clinic [5] and Dr. Mason.

• Hormonal shifts can pack a wallop. "Women often have trouble sleeping in the week between ovulation and when their periods start," Dr. Mason says. There's a spike in insomnia during the third trimester of pregnancy as well — and when perimenopause hits, with its night sweats and hot flashes, even the best sleepers are likely to start waking up at night. This may be one reason why more women than men [6] report experiencing insomnia symptoms.
• Stress plays a central role in keeping people up at night, and can be hard to avoid.
• Depression and anxiety contribute, too, although it can be tough to tease out which came first: the sleep problem or the mood disturbances.
• Lifestyle habits can also cause sleep problems. Watching TV or catching up on the news right before bed can rev you up, making it difficult to fall asleep, Dr. Mason says. Eating late at night can also delay your ability to fall asleep due to feelings of discomfort or heartburn. And alcohol can be problematic, because while it may help you conk out at night, it ultimately leads to lower-quality sleep [7]; you may even wake up once its effects wear off.
• Certain medications (including high-blood-pressure medications like alpha and beta blockers; SSRI antidepressants; and corticosteroids [8]) and medical conditions (such as chronic pain, cancer, diabetes, and asthma [9]) have also been linked to insomnia.

Most Effective Insomnia Treatments

If your sleep problems just began, try these small changes from the American Academy of Sleep Medicine [10] and Dr. Mason to improve your sleep hygiene:

• Go to bed and wake up at about the same time every day.
• Don't nap after 3 p.m., and limit naps to 30 minutes.
• Limit alcohol consumption.
• Don't use electronic devices, which emit wakefulness-inducing blue light, an hour before bed.
• Create a relaxing presleep routine — for example, take a bath or meditate. And if you can't sleep, get out of bed, and read something boring until you feel tired.
• "Swap your down comforter for breathable cotton blankets," Dr. Mason suggests. "Keeping your body temperature low promotes sleep."
• "Don't ingest fluids in the hour or so before bed, so you won't have to go to the bathroom," she adds.

If you struggle with middle-of-the-night worrying specifically, one strategy that Dr. Mason finds successful is scheduling 20 minutes of "worry time" at 4 p.m. "Write down every concern, along with ideas for how to handle it, so it doesn't cause anxiety at night," she says. If this doesn't work for you, a therapist or sleep-disorder specialist can help you find a more personalized remedy.

Sleeping pills can help you catch up on your sleep debt when you're desperate and can help you get past insomnia being caused by a short-term stressor. But long-term use of these medications can carry risks for dependence and rebound insomnia, per Cleveland Clinic [11]. Some sleeping pills have also been linked to memory loss [12]. So you'll also want to take steps to address the underlying causes of insomnia. For that, the most effective treatment is cognitive behavior therapy (CBT-I), which can help you change inaccurate thoughts about sleep and teaches relaxation strategies, among other things. It helps 70 to 80 percent of people with insomnia, according to the Sleep Foundation [13]. You can access CBT-I instruction through apps, like SHUTi or the CBT-I Coach.