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Insomnia is a sleep disorder in which you have persistent difficulty falling asleep, staying asleep, or getting good-quality sleep, even when you have enough time and opportunity to rest. These nighttime problems lead to daytime consequences such as fatigue, low energy, irritability, or trouble concentrating. Insomnia is one of the most common health complaints, and it is defined by both poor sleep and the daytime distress or impairment it causes.
Clinicians divide insomnia into two main types:
Insomnia rarely has a single cause. Sleep researchers describe it using three overlapping types of factors:
Common risk factors and contributors include:
Insomnia involves both nighttime sleep difficulty and daytime effects. Typical symptoms include:
Insomnia is diagnosed clinically, mainly through a detailed history rather than a single test. A clinician will ask about your sleep patterns, daytime symptoms, medical and mental health history, medications, and substance use. Diagnosis follows established frameworks such as the DSM-5 and the International Classification of Sleep Disorders, Third Edition (ICSD-3), which require sleep difficulty plus related daytime impairment, occurring frequently and persisting over time despite adequate opportunity to sleep.
Your clinician may ask you to keep a sleep diary for one to two weeks, or use a wearable or sleep questionnaire, to track bedtimes, wake times, and how you feel during the day. A sleep study (polysomnography) is not routinely needed for insomnia, but it may be ordered if another sleep disorder such as sleep apnea is suspected. Identifying and treating any underlying or contributing condition is an important part of the evaluation.
Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for chronic insomnia in adults. Major guidelines, including those from the American Academy of Sleep Medicine (AASM), give multicomponent CBT-I a strong recommendation. CBT-I is a short, structured program — usually about four to eight sessions — that combines several proven strategies:
CBT-I can be delivered in person, in groups, or through guided digital programs, and its benefits tend to last over time.
Medications may be considered when CBT-I is not available, not sufficient, or used together with therapy, based on a clinician's judgment. A 2025 AASM guideline on combination treatment suggests that pairing CBT-I with a medication may offer modest benefit over medication alone for some sleep outcomes (such as total sleep time); however, it does not recommend combination therapy over CBT-I alone, because CBT-I by itself often produces meaningful, durable improvement without the added risks of medication. FDA-approved medication categories include:
In its 2017 pharmacologic guideline, the AASM rated the evidence for specific sleep medications as weak (conditional) recommendations, meaning their use should be individualized. All sleep medications carry potential side effects (such as next-day drowsiness, dizziness, or dependence risk) and should be used only under medical supervision. Treatment choice depends on your symptoms, health conditions, and other medications.
Healthy sleep habits support any treatment plan:
Talk with a healthcare provider if your sleep problems last more than a few weeks, happen most nights, or interfere with your mood, work, relationships, or safety (such as drowsy driving). Seek prompt care if insomnia comes with depression, severe anxiety, thoughts of self-harm, loud snoring or gasping during sleep, or before starting or stopping any sleep medication. A clinician can confirm the diagnosis, look for treatable causes, and recommend CBT-I or other evidence-based options.
*This article is for general information and education only and is not medical advice. Always consult a qualified healthcare professional about your individual situation.*
The recommended first-line treatment for chronic insomnia is cognitive behavioral therapy for insomnia (CBT-I), which the American Academy of Sleep Medicine (AASM) gives a strong recommendation. When medication is appropriate, FDA-approved options span several classes: dual orexin receptor antagonists (suvorexant/Belsomra, lemborexant/Dayvigo, daridorexant/Quviviq); benzodiazepine receptor agonist "Z-drugs" (zolpidem/Ambien, eszopiclone/Lunesta, zaleplon/Sonata); the melatonin receptor agonist ramelteon for sleep-onset insomnia; and low-dose doxepin for sleep-maintenance insomnia. In the 2017 AASM pharmacologic guideline these medications carry weak (conditional) recommendations, and all sleep medications carry side-effect and dependence considerations. Medication choice should be individualized and supervised by a clinician; this is informational and not medical advice.
This page is for general information and is not medical advice. Always consult a qualified clinician about diagnosis and treatment. Individual results vary.