Most people with insomnia also live with other physical or mental health conditions, such as diabetes, hypertension, chronic pain, thyroid disorders, gastrointestinal issues, anxiety, or depression.
In earlier diagnostic frameworks, insomnia that occurred alongside another illness or disorder was referred to as secondary insomnia. This implied that insomnia was viewed as a symptom or result of those underlying conditions. As a result, until relatively recently, clinicians typically did not directly treat secondary insomnia.
However, in the early 2000s, both research and clinical practice began to show that this approach was flawed. Evidence suggests that insomnia can emerge before a primary condition or persist long after it has developed. Moving away from the distinction between primary and secondary insomnia marked a significant step forward, recognising insomnia as an independent disorder that often requires its own treatment.
Moreover, researchers have gathered strong evidence that treating sleep problems can also improve a range of other health conditions. Conditions such as chronic pain, chronic heart failure, depression, psychosis, alcohol dependence, bipolar disorder, and PTSD may all show improvement when patients address their sleep difficulties.
Insomnia can affect almost anyone, although it is more common among women, older adults, and individuals from lower socio-economic backgrounds.
These groups tend to face a mix of biological, psychological, and social risk factors that increase their likelihood of long-term sleep disruption. For instance, women may experience hormonal changes, pregnancy and childbirth, breastfeeding, menopause, domestic violence, caregiving responsibilities, and higher rates of anxiety and depression—all of which can contribute to ongoing sleep difficulties.
Current challenges in insomnia research include better understanding the different types of symptoms and how they relate to health and performance risks. For instance, evidence suggests that difficulty falling asleep, compared with trouble staying asleep or waking too early, may be linked to a higher risk of depression.
Researchers also continue to investigate changes in brain activity, heart rate, and stress hormones associated with insomnia. As with other mental health conditions, reliable biomarkers for insomnia have yet to be identified.
Treating insomnia
There are steps people can take to help prevent episodes of insomnia from developing into chronic insomnia, which is more difficult to treat. When symptoms occur on most nights and persist for more than three months, a diagnosis of insomnia disorder, or chronic insomnia, may be made.
Scientists have found that staying awake in bed can lead to ongoing cognitive arousal and, over time, trains the brain to stop associating the bed with sleep.
Therefore, if you’re unable to sleep at night, it’s better to get out of bed and engage in another absorbing activity.
However, caution is needed with daytime naps, as they can reduce sleepiness at night and make it even harder to fall asleep later.
Cognitive behavioural therapy for insomnia (CBTI) is a set of techniques aimed at increasing sleepiness at bedtime. It follows a structured approach designed to change both behaviour and thought patterns. Certain factors can predict better outcomes, including a shorter history of insomnia (years rather than decades), lower levels of depression or pain, and more positive expectations about CBTI. However, CBTI is generally effective for most people with insomnia.
Even so, only a small proportion of people who experience insomnia symptoms seek medical help. Many may view the symptoms as minor or manageable on their own, or they may simply be unaware that treatment options are available.
Do sleeping pills work?
Sleeping tablets are not considered a suitable long-term solution. They can be linked to notable cognitive and motor impairment, a higher risk of falls, dependence, tolerance, and withdrawal symptoms, as well as daytime drowsiness, dizziness, and headaches.