What Causes Chronic Insomnia?

There are many possible reasons why you can't sleep

Man using laptop at night in bed
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Insomnia is the most common sleep disorder and it may cause you to not get enough sleep or wake frequently during the night. If your difficulty sleeping persists and lasts for more than three months, it is called chronic insomnia. 

What causes long-term insomnia? Can it manifest as the result of another sleep disorder or medical problem? These are common questions among people who have trouble sleeping and any number of potential causes may be affecting you.

Common Causes

There are many causes of chronic insomnia. According to UpToDate—a trusted electronic medical reference used by health care providers and patients alike—the most common causes include: 

  • Mental health conditions
  • Medical illnesses
  • Neurological disorders
  • Other sleep disorders
  • Medications or illicit drug use
  • Primary insomnia

Mental Health Conditions

The relationship between insomnia and psychiatric conditions is well established. Difficulty sleeping, especially waking early in the morning, is a characteristic symptom of depression. Post-traumatic stress disorder (PTSD) is likely to cause nightmares that may disrupt sleep as well. Moreover, anxiety and panic attacks may also have a role in causing insomnia.

The relationship is complicated by the fact that insomnia may worsen any of these conditions because your body is not getting the sleep it requires. In fact, insomnia is associated with a higher risk of suicide.

Medical Conditions

Any medical condition that causes pain or difficulty breathing may disrupt your sleep. Additionally, the stress that can result in dealing with an illness can also keep you awake at night.

There are also a number of disorders and medications that may cause frequent trips to the bathroom to urinate during the night.

This is known as nocturia it can relate to a number of conditions, including sleep apnea, diabetes, or prostate problems. 

Neurological disorders may become a factor in insomnia as well. For instance, Parkinson’s disease causes a reduction in movements, even during sleep. This may lead to stiffness and discomfort when the person fails to turn in bed as they normally would.

It's also important to keep in mind that disrupted sleep may be an early sign of dementia. Alzheimer’s disease, for example, is known to change the pattern, or circadian rhythm, of sleep.

Sleep Disorders

There are a number of sleep disorders that may disrupt your sleep. These are important to diagnose as the treatment is different from that of insomnia.

For example, if you have trouble breathing at night because of sleep apnea, this may lead to frequent awakenings. These awakenings may cause excessive sleepiness much like insomnia, but the remedy may be an intervention such as continuous positive airway pressure (CPAP).

Similarly, abnormal movements during the night caused by restless legs syndrome (RLS) or periodic limb movement syndrome (PLMS) will require unique treatment. Likewise, problems with your biological clock, or circadian rhythm, may lead to its own set of circadian rhythm disorders.

Medications and Illicit Drugs

The side effects of a number of prescription medications can include a disruption in normal sleep patterns. However, one study found that these warnings likely do not apply to everyone taking a particular medication. Instead, it is a generalization that it may occur in some people who take it.

Disturbances in sleep have been found to be prevalent in people who use illicit drugs as well. ​Researchers also report that the length of drug use plays a significant role. It is not limited to illegal drugs like heroin and methamphetamine, either. Alcohol and cigarette smoking can also disturb a person's sleep patterns.

Primary Insomnia

Primary insomnia means that there is no identifiable cause for long-term sleep loss. This is often determined only after careful discussion with your doctor, who has ruled out all other causes. 

Despite the fact that the cause of this condition is unknown, there are a variety of treatment options for insomnia, including:

A Word From Verywell

Chronic insomnia can have a significant impact on your daily life. If you find yourself struggling to sleep, it is recommended that you speak with your doctor. They will be able to determine any potential causes and discuss the treatment options available to you.

Source:

Bonnet M, Arand D. Patient Education Insomnia (Beyond the Basics). UpToDate. 2017.

Jinsong T, et al. Sleeping Problems in Chinese Illicit Drug Dependent Subjects. BMC Psychiatry. 2015;15:28. doi: 10.1186/s12888-015-0409-x

Lehnich AT, et al. Do Patients With Intake of Drugs Labelled as Sleep Disturbing Really Sleep Worse? a Population Based Assessment From the Heinz Nixdorf Recall Study. British Journal of Clinical Pharmacology. 2016;82(3): 869–877. doi: 10.1111/bcp.13015