sleeplessness

Sleeplessness is difficulty initiating or maintaining sleep or experiencing nonrestorative sleep, occurring despite adequate opportunity to sleep, with daytime consequences. In clinical terms, this condition is most often described as insomnia. Sleeplessness can be acute, lasting days to a few weeks, or chronic, persisting for months or longer.

Common symptoms include trouble falling asleep, frequent awakenings, waking too early, unrefreshing sleep, and daytime symptoms such as fatigue, concentration problems, mood disturbances, and reduced functioning.

Causes are multifactorial. They include stress, acute life events, medical or psychiatric conditions (pain, depression, anxiety), medications or substances (caffeine, alcohol, stimulants), sleep disorders (sleep apnea, restless legs syndrome), poor sleep hygiene, and environmental factors. Risk factors include female sex, older age, high stress, comorbid illness, and shift work.

Diagnosis relies on patient history and reported sleep patterns. Sleep diaries and, if indicated, actigraphy or polysomnography may be used to exclude other sleep disorders. Criteria for insomnia disorder include dissatisfaction with sleep quantity or quality, associated daytime impairment, occurring at least three times per week for three months (per DSM-5), though shorter episodes may be clinically significant.

Treatment emphasizes nonpharmacologic approaches, especially cognitive-behavioral therapy for insomnia (CBT-I), sleep hygiene education, stimulus control, and relaxation techniques. Addressing underlying conditions and limiting caffeine and screen exposure can help. Pharmacotherapy is considered when necessary and should be used with caution; options include short-term sedative-hypnotics, melatonin, and newer agents such as orexin antagonists, with attention to risk of dependency, tolerance, and rebound insomnia.

Prognosis varies with underlying causes and treatment access; many people improve with CBT-I and behavioral changes, though sleeplessness can recur if stress or health issues return.