Causes of Insomnia: Long-Term Insomnia

Medical, Psychiatric, and Other Sleep Problems May Cause Trouble Sleeping

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When you chronically cannot get to sleep or if you wake frequently during the night, you no doubt will be interested in figuring out the cause of your difficulty sleeping. These troubles are called insomnia, and it is the most common of the sleep disorders. If it persists, lasting for more than 3 months, it is called chronic insomnia. What causes long-term insomnia? Can it manifest as the result of another sleep disorder or medical problem?

There are many causes of chronic insomnia, and to answer these questions let’s review an excerpt from UpToDate -- a trusted electronic medical reference used by health care providers and patients alike. After you have read the excerpt, continue reading below to discover what this information may mean for your situation.

"Common causes include the following:
  • Mental health problems, such as depression, anxiety disorders (including panic attacks), and posttraumatic stress disorder
  • Medical illnesses, especially those that cause pain, stress, or difficulty breathing
  • Neurological disorders, such as Parkinson's disease and Alzheimer's disease
  • Other sleep disorders, such as sleep apnea, restless legs syndrome, periodic limb movements, and circadian rhythm disorders
  • Medications or illegal drug use
  • Primary insomnia — Insomnia is called 'primary' or 'independent' if it is particularly prominent or if there is no identifiable problem causing poor sleep."

The relationship between insomnia and psychiatric problems is well established. Difficulty sleeping, especially waking early in the morning, is a characteristic symptom of depression. Posttraumatic stress disorder is likely to cause nightmares that may disrupt sleep. Moreover, anxiety may also have a role in causing insomnia.

The relationship is complicated by the fact that insomnia may worsen these mental health problems. In fact, insomnia is associated with a higher risk of suicide.

Any medical condition that causes pain may disrupt your sleep. Disorders or even medications that cause trips to the bathroom to urinate during the night (called nocturia) will interrupt sleep. Parkinson’s disease causes a reduction in movements, even during sleep, and this may lead to stiffness and discomfort when the affected person fails to turn in bed. Alzheimer’s disease can change the pattern, or circadian rhythm, of sleep. Disrupted sleep may be an early sign of dementia.

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.

Problems with your biological clock, or circadian rhythm, may lead to its own set of circadian rhythm disorders.

Primary Insomnia

If after careful with your discussion with your doctor there is not a clear explanation for your insomnia symptoms, then it is possible that you are experiencing primary insomnia. This condition cannot be attributed to another cause. Regardless, there are a variety of treatment options for insomnia, including:

Therefore, if you find yourself struggling to sleep, you should speak with your doctor and discuss what therapy option might be best for you.

Want to learn more? See UpToDate's topic, "Insomnia," for additional in-depth medical information.


Bonnet, Michael et al. "Insomnia." UpToDate. Accessed: December 2011.

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