Patients often describe insomnia to me in terms of hours — “I only got five hours last night.” But that’s not actually the definition I use. Insomnia isn’t about hitting a number; it’s about whether the sleep you’re getting actually restores you. If you sleep five hours and wake up feeling genuinely fine, you don’t have insomnia. If you sleep eight and still feel like you were hit by a truck, you might.
Sleep needs vary meaningfully from person to person, which is part of why I don’t put much weight on a specific hours target. What matters clinically is sleep quality and how someone feels afterward — and, just as important, what’s driving the disruption in the first place. Insomnia is rarely its own isolated problem; it’s usually a symptom pointing at something else.
What insomnia tends to look like
- Difficulty falling asleep despite feeling tired
- Waking repeatedly through the night
- Waking and being unable to fall back asleep
- Sleep that doesn’t feel restorative, even when it’s long enough
- Relying on alcohol or sleep aids just to get to sleep
- Waking too early and being unable to return to sleep
- Daytime drowsiness, irritability, or trouble concentrating
What’s actually causing it
Short-term insomnia — a few rough nights tied to work stress, a relationship conflict, or jet lag — usually resolves on its own within days and doesn’t need much intervention. Insomnia that persists is worth taking seriously, and it typically traces back to one of a few categories:
- Psychological — depression, anxiety, chronic stress, bipolar disorder, PTSD
- Medications — certain antidepressants, cold and flu remedies, caffeinated pain relievers, diuretics, corticosteroids
- Medical conditions — asthma, allergies, Parkinson’s disease, hyperthyroidism, acid reflux, kidney disease, cancer, chronic pain
- Other sleep disorders — sleep apnea, narcolepsy, restless leg syndrome
When the fix is simple
For milder, more situational insomnia, a handful of changes go a long way: cutting back on caffeine and alcohol, limiting screens before bed, keeping the bedroom dark, quiet, and reserved for sleep, and getting adequate natural light during the day balanced against minimal light at night. These aren’t groundbreaking recommendations, but I’m consistently surprised how many patients haven’t actually tried them consistently before assuming they need medication.
When it’s not that simple
If insomnia is tied to significant stress, depression, anxiety, panic attacks, or a trauma history, that’s when I want to be involved directly. Treatment in that case usually combines therapy and medication — a therapist can teach relaxation techniques like deep breathing, progressive muscle relaxation, meditation, or visualization, which genuinely help some patients fall asleep and stay asleep, alongside medication when it’s clinically appropriate.
Sleep problems are often treated as something to push through. In my experience, that rarely works, and it delays addressing whatever’s actually driving the insomnia in the first place. If sleep has stopped working for you, I’d rather see you sooner.