Insomnia: Causes, Treatments, and Why It Matters
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Key Facts
- Up to 10% of adults suffer from chronic insomnia, with even more experiencing short-term episodes.
- Cognitive Behavioral Therapy for Insomnia (CBT-I) remains the most effective and recommended treatment.
- A 2025 study found inpatient CBT-I to be more effective than outpatient care.
- Insomnia is linked to both mental disorders and cardiovascular dysfunction.
- New therapies, such as Jujuboside A and personalized sleep plans, are showing early promise.
Insomnia is a common sleep disorder and one of the most common sleep problems in adults worldwide. As part of the broader category of sleep disorders, insomnia is characterized by symptoms of insomnia such as trouble falling asleep, trouble sleeping through the night, waking up too early and daytime impairments.
Unlike those who sleep well, people with insomnia struggle to get the rest they need. This sleep disorder can be short term insomnia—often triggered by stressful life events and lasts a few days to weeks or long term insomnia—a chronic condition that can interfere with daily living.
The effects of insomnia are daytime sleepiness, feeling tired when waking and reduced mental clarity and physical energy. People with insomnia report trouble sleeping and trouble falling asleep which can lead to ongoing fatigue and overall wellbeing. As researchers continue to unravel this complex condition, there’s growing consensus it’s more than just “bad sleep”—it’s a multi-factorial disorder with public health implications.
Table of Contents
- Prevalence and Public Health Impact
- Root Causes: A Multifactorial Disorder
- Gold-Standard Treatment: Cognitive Behavioral Therapy for Insomnia (CBT-I)
- Pharmacologic and Complementary Therapies
- Insomnia’s Connection to Mental and Cardiovascular Health
- The Road Ahead: Clinical Gaps and Research Needs
- Closing Thoughts
- References
Prevalence and Public Health Impact
Insomnia is super common. Large studies estimate up to 10% of adults meet criteria for insomnia disorder—a clinical diagnosis of persistent sleep difficulties. Rates are even higher for short term or occasional episodes [7] [10] [13].
It’s one of the most common health complaints in primary care. Insomnia often co-occurs with mental health conditions and mental health disorders such as depression and anxiety, highlighting the link between sleep and mental wellbeing. A 2021 global cross-sectional study linked insomnia to a wide range of psychiatric conditions including anxiety, mood disorders and substance use disorders [13].
Beyond mental health, poor sleep can also impact physical wellbeing. Chronic insomnia has been linked to increased risk of hypertension, diabetes and cardiovascular disease [8] [9]. In some cases insomnia may be caused or worsened by an underlying medical condition such as an overactive thyroid. Untreated insomnia can also contribute to chronic pain and further impact quality of life.
Lack of quality sleep affects everything from hormone balance to immune system function, making insomnia a key player in overall health—not just a bedtime nuisance. Public health strategies that promote good sleep hygiene and early intervention can prevent insomnia and reduce its long term impact.
Root Causes: A Multi-Factorial Disorder
Insomnia isn’t a single disease—it’s a syndrome with many parts. There are different types including primary insomnia which occurs without an underlying medical condition and secondary insomnia which is caused by other health issues or factors. Acute insomnia is a short term form that lasts from one night to a few weeks often triggered by stressful life events or changes in routine.
Genetics, stress, mental health issues, medical conditions and even poor sleep habits can all play a role. Other sleep disorders such as sleep apnea or restless legs syndrome may need to be ruled out during assessment. Review of medical history and identifying risk factors are essential steps in diagnosing insomnia. Disruptions in the sleep wake cycle or sleep cycle can also contribute to sleep difficulties.
Modifiable factors like sleep hygiene—behavioural and environmental practices that promote healthy sleep—are important to address. Lifestyle contributors such as the decision to drink alcohol can negatively impact sleep quality and worsen insomnia.
Specialists in internal medicine are often involved in evaluating and managing these complex cases. According to a foundational review published in JAMA [1] treating insomnia effectively requires addressing these multiple underlying contributors.
A newer concept gaining traction is “personomics”—the idea that treatment should be tailored to an individual’s unique sleep patterns, routines and challenges [3]. This shift towards personalized insomnia care reflects a broader trend in medicine to treat the person not just the symptoms.
Gold Standard Treatment: Cognitive Behavioural Therapy for Insomnia (CBT-I)
The gold standard treatment across all guidelines is Cognitive Behavioural Therapy for Insomnia (CBT-I). It’s non-drug, evidence-based and aims to treat insomnia by changing the unhelpful thoughts and behaviours that keep people stuck in poor sleep cycles [1] [2] [5] [6].
CBT-I is also effective for anxiety disorders making it a versatile tool in mental health care. As part of insomnia treatment patients typically learn techniques like sleep restriction, stimulus control and relaxation training—all proven to improve sleep quality. Keeping a regular sleep schedule and using a sleep diary to track progress are key strategies to help individuals fall asleep and stay asleep.
But access is a barrier. Complementary and integrative health approaches can be used as adjuncts or alternatives to CBT-I for those seeking holistic insomnia treatment. In some cases prescription drugs may be considered when CBT-I is not available or as part of a broader treatment plan.
A 2025 randomised controlled trial found inpatient CBT-I significantly reduced insomnia severity compared to outpatient care [14] hinting at the need for more robust service delivery. Unfortunately a shortage of trained providers continues to limit widespread use [2].
Pharmacologic and Complementary Therapies
While behavioural therapy is the first line approach, medications are used for short term relief especially when symptoms are severe or CBT-I is not available. Pharmacologic options include sleeping pills, prescription sleep aids and other sleep medications which can help people fall asleep and address trouble falling asleep. These sleep aids which also include non-prescription options carry risks of dependence, daytime drowsiness and rebound insomnia [1].
Before starting medication a thorough assessment is recommended. This may involve a sleep study conducted at a sleep centre to diagnose insomnia and confirm the insomnia diagnosis and rule out other sleep disorders.
Meanwhile researchers are exploring safer alternatives. A 2025 experimental study found that Jujuboside A, a natural compound derived from the jujube plant, restored mitochondrial function in brain cells and reduced insomnia symptoms in animal models [12]. More human trials are needed before widespread use.
Insomnia and Mental and Cardiovascular Health
There’s a two-way street between insomnia and mental health. A 2025 network analysis found that people with insomnia experience a complex web of symptoms: depression, anxiety, stress and cognitive difficulties [11]. These aren’t side effects—they’re part of the condition itself.
Insomnia often co-occurs with mental health disorders so comprehensive treatment is essential. For patients with comorbid conditions treatment may include prescription drugs which should be managed by a healthcare provider.
Insomnia also has cardiovascular implications. A 2021 study found that people with sleep-onset insomnia had reduced vagal tone and impaired baroreflex sensitivity both of which are essential for heart function [9]. In other words your heart pays the price when your sleep suffers.
Sleep apnea is another sleep disorder that can impact cardiovascular health and symptoms of insomnia may overlap with other sleep disorders. This highlights the need for differential diagnosis to rule out or identify conditions such as sleep apnea, restless legs syndrome or narcolepsy.
This growing body of evidence is changing how clinicians view insomnia—not as an isolated complaint but as a central health issue that can amplify other medical problems.
The Future: Clinical Gaps and Research Needs
Despite decades of attention many questions remain. A 2021 narrative review called for better quantification of the societal and economic costs of insomnia and investment in treatments that are safe and scalable [4]. Future research should also focus on long term insomnia given its significant health impacts and chronic nature.
Meanwhile a 2022 review urged the medical community to dig deeper into the neurobiology of insomnia—particularly how brain circuits governing arousal and rest interact and the importance of understanding the sleep cycle in this context [5].
Personalized sleep apps, AI-based diagnostics and digital CBT-I platforms offer new pathways forward. Research tools such as the sleep diary and sleep study are essential for tracking sleep patterns and diagnosing underlying disorders often conducted in a sleep centre which also serves as a site for clinical trials and research. But real progress will depend on funding, awareness and equitable access to care.
Closing Thoughts
Insomnia is more than just occasional restlessness—it’s a common, underdiagnosed and undertreated condition with far reaching impact on mental, cardiovascular and public health. While CBT-I is the gold standard, new approaches—natural compounds, digital therapies and personalized treatment plans—are opening up new possibilities.
As science advances so must our thinking. Sleep health is not a luxury—it’s a foundation of wellbeing that deserves a place at the top of our health system.
References
[1] Buysse D. J. (2013). Insomnia. JAMA, 309(7), 706–716. https://doi.org/10.1001/jama.2013.193
[2] Burman D. (2017). Sleep Disorders: Insomnia. FP essentials, 460, 22–28. https://pubmed.ncbi.nlm.nih.gov/28845958/
[3] Porosnicu Rodriguez, K. A., Salas, R. M. E., & Schneider, L. (2023). Insomnia: Personalized Diagnosis and Treatment Options. Neurologic clinics, 41(1), 1–19. https://doi.org/10.1016/j.ncl.2022.07.004
[4] Roach, M., Juday, T., Tuly, R., Chou, J. W., Jena, A. B., & Doghramji, P. P. (2021). Challenges and opportunities in insomnia disorder. The International journal of neuroscience, 131(11), 1058–1065. https://doi.org/10.1080/00207454.2020.1773460
[5] Riemann, D., Benz, F., Dressle, R. J., Espie, C. A., Johann, A. F., Blanken, T. F., Leerssen, J., Wassing, R., Henry, A. L., Kyle, S. D., Spiegelhalder, K., & Van Someren, E. J. W. (2022). Insomnia disorder: State of the science and challenges for the future. Journal of sleep research, 31(4), e13604. https://doi.org/10.1111/jsr.13604
[6] Sutton E. L. (2021). Insomnia. Annals of internal medicine, 174(3), ITC33–ITC48. https://doi.org/10.7326/AITC202103160
[7] Roth, T., & Roehrs, T. (2003). Insomnia: epidemiology, characteristics, and consequences. Clinical cornerstone, 5(3), 5–15. https://doi.org/10.1016/s1098-3597(03)90031-7
[8] Cunnington, D., Junge, M. F., & Fernando, A. T. (2013). Insomnia: prevalence, consequences and effective treatment. The Medical journal of Australia, 199(8), S36–S40. https://doi.org/10.5694/mja13.10718
[9] Tsai, H. J., Kuo, T. B. J., Yang, A. C., Tsai, S. J., & Yang, C. C. H. (2021). Difficulty in initiating sleep is associated with poor morning cardiovascular function. Psychiatry research, 295, 113518. https://doi.org/10.1016/j.psychres.2020.113518
[10] Morin, C. M., & Jarrin, D. C. (2022). Epidemiology of Insomnia: Prevalence, Course, Risk Factors, and Public Health Burden. Sleep medicine clinics, 17(2), 173–191. https://doi.org/10.1016/j.jsmc.2022.03.003
[11] Carpi, M., Marques, D. R., & Liguori, C. (2025). Unraveling the insomnia web: a network analysis of insomnia and psychological symptoms in good and poor sleepers among young adults. Sleep medicine, 132, 106590. https://doi.org/10.1016/j.sleep.2025.106590
[12] Zhang, Z., Che, X., Feng, T., Zou, J., Chen, G., Guo, W., Ma, C., Yuan, H., Chen, J., & Xu, X. (2025). Jujuboside A improves insomnia by maintaining mitochondrial homeostasis in prefrontal neurons. Brain research bulletin, 226, 111372. https://doi.org/10.1016/j.brainresbull.2025.111372
[13] Aernout, E., Benradia, I., Hazo, J. B., Sy, A., Askevis-Leherpeux, F., Sebbane, D., & Roelandt, J. L. (2021). International study of the prevalence and factors associated with insomnia in the general population. Sleep medicine, 82, 186–192. https://doi.org/10.1016/j.sleep.2021.03.028
[14] Li, G., Li, M., Xu, X., Zhang, J., Li, Q., & Cai, Q. (2025). Inpatient vs outpatient cognitive behavioral therapy for insomnia: A two-arm parallel randomized controlled trial. Comprehensive psychiatry, 141, 152609. Advance online publication. https://doi.org/10.1016/j.comppsych.2025.152609
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