Understanding insomnia: Causes, effects, and solutions for better sleep - Mayo Clinic Press (2025)

Do you frequently toss and turn much of the night, wishing you could just fall asleep? It’s possible that you have insomnia. It’s a common sleep disorder that’s often frustrating and can surface gradually or suddenly. Insomnia is one of many sleep-related topics included in the Mayo Clinic Guide to Better Sleep. In the following excerpt, Mayo Clinic sleep experts Timothy I. Morgenthaler, M.D., and Bhanu Prakash Kolla, M.B.B.S., M.D., go into detail about insomnia, highlighting how the sleep disorder can develop. Learning more about sleep and how to achieve high-quality sleep is the goal of this extensive, easy-to-follow guide that features 14 chapters full of informative insights from Mayo Clinic sleep experts.

Recipe for insomnia

Sleep might have come easily to you for many years, then changed, gradually or suddenly, into a maddening problem. Exactly why this happens varies from person to person, and the underlying causes can be difficult to pin down.

Experts have found some commonalities, however, and they tend to approach insomnia as a combination of ingredients coming together at a specific time to disrupt sleep.

These ingredients often include underlying risk factors for insomnia combined with stressful or disruptive life circumstances or events. The result is a change in sleep, along with worries about being able to sleep. The combination can lead to unhealthy habits, exacerbating the problem.

The three Ps

Sleep experts sometimes refer to the risk for developing insomnia in terms of “three Ps.” The three Ps model suggests that certain predisposing, precipitating and perpetuating factors contribute to the sleep disorder. This framework takes into account that how you respond to periods of sleeplessness might actually contribute to the problem.

Predisposing Some people are simply more likely to develop insomnia than others. Women are typically at greater risk than men. Family history also can play a role, with some people being genetically predisposed to the condition. Daily circumstances, including working the night shift or sleeping with a bed partner who snores or tosses and turns, can make you more prone to poor sleep. Predisposing factors don’t cause insomnia but can set the stage.

Precipitating For people who are predisposed to insomnia, even something small can trigger sleep troubles. If you tend to have trouble sleeping, the story about a princess who couldn’t sleep because of a tiny pea beneath her mattresses might not sound like a fairy tale at all.

Among individuals who aren’t predisposed to poor sleep, traumatic events such as the death of a loved one, a divorce or the loss of a job can bring on sleep problems. In some cases, these precipitating factors can be cumulative, with multiple stresses building up and pushing you toward insomnia.

Perpetuating When sleeplessness does occur because of predisposing and precipitating factors, it often resolves itself, perhaps over several weeks or a couple of months. Sometimes, though, how you respond to sleep troubles may perpetuate the problem. You may begin to take naps during the day, drink more coffee to stay alert or alcohol to help you sleep. Or you may spend nights you can’t sleep surfing the web on your cell phone or computer.

Choices such as these can make it more difficult to fall asleep, prompting you to grow increasingly anxious as you lie awake. You may begin to spend more time in bed, thinking this will surely help you get the sleep you need. But the additional time in bed only adds to the angst, and your body begins to associate your bed with anxiety, not rest. These reactions are completely understandable, but they can lead to long-term problems sleeping.

The sleep-wake balance

In addition to the “three Ps,” sleep experts have developed other ways of thinking about insomnia, creating models to help guide research and treatment. One such model is known as circadian and homeostatic sleep regulation. Here’s how it works.

In a sense, being awake makes you sleepy. This is because the longer you’re awake, the more tired you become. During the day, you’re constantly adding to this pressure to sleep, which becomes one of the primary forces urging you to turn in for the night. This process is referred to as sleep homeostasis.

At the same time, humans and other living creatures experience physiological cycles during the day known as circadian rhythms. These cycles, or rhythms, are an evolutionary adaptation to the fact that we live on a planet that has night and day. There are advantages to being awake and active during daylight, and to resting at night so that your body and brain can conduct routine maintenance — the basic role of sleep. Your circadian rhythms drive you toward sleep at night and keep you alert during the day.

During a 24-hour day, your homeostatic and circadian systems work in sync, regulating the processes that keep you awake, as well as those that orchestrate sleep. These systems are kept in exquisite balance: As processes slow on one side of the sleep-wake scale, others engage on the opposite side. During daytime, your body is kept awake and alert. With night approaching, the processes that keep you active begin to wind down, and you get sleepy.

Under healthy conditions, this choreographed balance between sleep and wakefulness goes unnoticed. Sometimes, though, the balance is disrupted. When this happens, the systems stop working in harmony and begin to produce friction and conflict. Pressure to sleep naturally rises during the day to make you sleepy, but the systems that keep you awake fail to disengage as they should.

You find yourself both sleepy and alert — “tired but wired,” as it’s sometimes described. The result is a poor night’s sleep that leaves you unrestored and less resilient the next day.

An excerpt from Mayo Clinic Guide to Better Sleep by Timothy I. Morgenthaler, M.D., and Bhanu Prakash Kolla, M.B.B.S., M.D.

Understanding insomnia: Causes, effects, and solutions for better sleep - Mayo Clinic Press (1)

Relevant reading

Holistic Health Bundle

Are you tired of playing catch-up with your health, always racing to address problems rather than preventing them in the first place? The Holistic Health Bundle will help you cultivate all aspects of your health — mind, body and spirit — regardless of your health status. Mayo Clinic Guide to…

Buy NowShop Now

Understanding insomnia: Causes, effects, and solutions for better sleep - Mayo Clinic Press (2025)

References

Top Articles
Latest Posts
Recommended Articles
Article information

Author: Reed Wilderman

Last Updated:

Views: 6340

Rating: 4.1 / 5 (52 voted)

Reviews: 83% of readers found this page helpful

Author information

Name: Reed Wilderman

Birthday: 1992-06-14

Address: 998 Estell Village, Lake Oscarberg, SD 48713-6877

Phone: +21813267449721

Job: Technology Engineer

Hobby: Swimming, Do it yourself, Beekeeping, Lapidary, Cosplaying, Hiking, Graffiti

Introduction: My name is Reed Wilderman, I am a faithful, bright, lucky, adventurous, lively, rich, vast person who loves writing and wants to share my knowledge and understanding with you.