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Insomnia Symptoms & Signs (List)

We’ve all had nights that we’ve gone to bed, closed our eyes, but no matter how much we relaxed or how many sheep we counted, we weren’t able to fall asleep.  An inability to fall asleep is medically referred to as “insomnia.”  Although an inability to fall asleep is a common manifestation of insomnia, sometimes insomnia manifests as frequent waking throughout the night or an inability to maintain sleep.

The problem with insomnia is that it can impair our performance at work, leading to reduced productivity, increased accidents, or a significant number of errors.  If left untreated, it may even get you fired from your job, especially if your occupation is cognitively-demanding or you work around heavy machinery.  Even among students, insomnia may compromise mental performance to the point that it may seem impossible to study, let alone pass exams.

If you have insomnia, it is important to make behavioral changes such as: adhering to a strict sleep schedule, engaging in relaxation at least 5 to 10 minutes per day, and avoiding electronics before bed.  That said, if you still don’t benefit from these behavioral changes, you may want to consult a sleep expert to determine the severity of your symptoms of insomnia, and get them properly treated.

Insomnia Symptoms & Signs (List)

Below is a list of symptoms associated with insomnia.  Keep in mind that the symptoms you experience may be different than those experienced by another person with insomnia.  There are not only many different causes of insomnia, but many types of insomnia, each of which will influence the specific symptoms.

Anxiety: Many people with anxiety disorders have insomnia, yet a lesser known fact is that many people with insomnia experience anxiety.  A lack of sleep creates significant changes in the levels of various neurotransmitters as well as brain activity.  Chronic sleep restriction or poor sleep quality as a result of insomnia can lead to high levels of anxiety.

If you have insomnia and anxiety, it is important to determine whether the anxiety is a result of the insomnia or vice versa.  Keep in mind that insomnia can also be a sign of a bigger issue such as a nervous breakdown, caused by overactivation of the sympathetic nervous system.  In any regard, lessening the severity of the insomnia should simultaneously improve the anxiety.

Compromised performance: Those with chronic insomnia may start to notice that they don’t perform as well at work, school, or even doing simple tasks like cleaning the house.  They may lack the mental and physical energy to perform to the best of their ability.  If the person is involved in sports, they may experience a noticeable decline in athletic performance or make more errors than they normally would.

The person may be highly accident prone after suffering from long-term insomnia.  Insomnia leads to poor sleep quality or deprivation of restorative sleep, essentially shutting off the prefrontal cortex of the brain.  This means that it may be highly risky to operate heavy machinery (e.g. a motor vehicle).

Cognitive impairment: Those with insomnia may appear cognitively impaired in that they aren’t able to learn new material or concentrate as well as they once did.  They may be unable to think critically, may appear to have significant brain fog or appear “spaced out,” and they may suffer from attentional deficits.  In many ways, those with chronic insomnia may have similar symptoms to someone with the inattentive subtype of ADHD.

The cognitive impairment is a common symptom that manifests as a result of many insomnia-induced neural alterations.  These alterations may include changes in neurotransmission, regional activation, as well as epigenetics.  Once the person corrects their insomnia, their cognition tends to improve significantly.

Daytime sleepiness: Since insomnia leads to an inability to fall asleep at night or frequent waking throughout the night, the person experiences “broken sleep.”  This means their total sleep quantity (hours) and quality is impaired.  This impairment leads a person to wake up feeling unrefreshed and severely sleepy throughout the day.

In fact they may feel such a wave of sleepiness during the day, that they’re forced to nap.  In other cases, they may inadvertently fall asleep or “doze off” on the job.  This is a result of the brain and body shutting down due to the fact that they didn’t get proper sleep the previous night.

Depression: While for some people depression is a direct cause of insomnia, for others insomnia is a direct cause of depression.  If you notice that on nights when your insomnia is severe that you wake up feeling depressed, it’s probably not just a coincidence.  Insomnia can lead to sleep restriction which shuts off parts of your brain (e.g. the prefrontal cortex) that help you regulate mood and stimulate positive thinking.

Difficulty falling asleep: The hallmark symptom of most insomnia diagnoses is an inability or difficulty falling asleep at night.  In many cases, people with insomnia feel exhausted when they go to bed, but no matter how physically or mentally tired they feel, something keeps them awake.  It’s almost as if the brain is stuck going full-speed down the highway and is unable to pull off onto a exit ramp and slow down for sleep.

Obviously if the difficulty falling asleep is self-induced such as from: using drugs, partying, staring at bright screens, Wi-Fi radiation, etc. – behavioral changes can correct this difficulty.  However if a person is eating healthy, avoiding electronics before bed, exercising early in the day, yet is still unable to sleep – they may have insomnia.

Fatigue: Most people with insomnia report feeling extreme fatigue during the daytime.  If you feel lethargic both mentally and physically, it could be a symptom of insomnia.  The fatigue may interfere with your ability to exercise, do housework, or even summon the motivation to go to work.

Gastrointestinal distress: Oddly enough, those complaining of stomach cramps, aches, and digestive problems may be suffering from insomnia.  While issues with the gastrointestinal tract can be related to a variety of medical conditions, they also can be a direct symptom of insomnia.  It is also important to consider the fact that gastrointestinal conditions can also cause insomnia.

Grogginess: This is a term that signifies being “dazed” and “weakened” (usually from lack of sleep).  If you constantly wake up in the morning feeling groggy, it could be a result of insomnia-induced lack of sleep.  Feeling groggy can make it difficult to get out of bed or may result in feelings of tiredness throughout the day.  This may be a sign that you’re out of tune with your body’s natural sleep cycles and circadian rhythm.

Headaches: Those with severe headaches such as migraines can experience insomnia as a result of the excruciating pain that keeps them awake during the night.  However, in many cases, headaches – (specifically tension headaches) – may directly stem from insomnia.  I suffered from chronic insomnia for 8 years and can testify to the fact that tension headaches are common and can get pretty painful.

Impulsivity: Another symptom that can result from insomnia is that of impulsivity.  Those with chronic insomnia usually get insufficient sleep, leading to abnormalities in brain function, specifically with the prefrontal cortex.  When the prefrontal region is underactivated, people rely in their older, reptilian regions to get them through the day.

These older regions are associated with ensuring survival of the species and don’t generally require complex thought.  Therefore a person may start to engage in behavior without thinking about it.  They may behave foolishly or recklessly without assessing potential risks.

Inability to focus: As was already mentioned, most people with insomnia deal with some sort of cognitive impairment.  The cognitive impairment may be mild, moderate, or severe depending on the amount of sleep lost or the reduction in quality.  The most obvious sign of cognitive impairment is an inability to focus.

The problems with focus and concentration may be a result of alterations in neurochemistry (e.g. neurotransmitters, hormones, etc.) that occur with circadian rhythm disruptions.  Furthermore, it is well documented that the prefrontal cortex, a region responsible for promoting focus could become compromised as a result of insomnia.

Irritability: We’ve all had nights where we don’t get as much sleep as necessary and wake up feeling irritable or grumpy.  The irritability may result in us lashing out at others in anger or becoming emotionally unstable.  When we don’t get enough sleep, we naturally feel agitated due to the fact that our circadian rhythm is disrupted.

Premature wakefulness: An extremely common symptom of insomnia is waking up too early in the morning.  If you were striving to get 8 hours of sleep, but only ended up getting 5, there’s a good chance you have insomnia.  If this pattern seems to be recurring and you generally fall short of the number of sleep hours you were trying to attain, this is a problem.

Many people wake up too early, realize that it’s earlier than they wanted to wake up, but are unable to fall back asleep.  The person’s brain activity seems to race and no matter how hard they try or what techniques they use, they aren’t able to escape their premature awakening.  This can lead to excessive daytime fatigue and lethargy due to a lack of sleep quantity.

Prolonged sleep-onset latency: If you have a prolonged sleep-onset latency, it means that you take a long time to fall asleep after you lie down in bed.  Sleep-onset latency refers to the duration of time it takes for you to transition from wakefulness to sleep.  Those with extremely short sleep-onset latencies (e.g. under 5 minutes) are thought to suffer from sleep deprivation.

However if you’re lying in bed and aren’t able to sleep after an hour, there’s a chance that you may suffer from insomnia.  Understand that sleep-onset latency is affected by circadian rhythms, so if you aren’t in tune with your body’s circadian rhythm, you may be contributing to insomnia.  That said, if you experience a prolonged sleep-onset latency no matter how you adjust your sleep schedule, you may have insomnia.

Moodiness: Many people with insomnia wake up feeling extremely moody because they didn’t get enough sleep.  This moodiness could be related to a variety of insomnia-induced brain changes.  It should be noted that mood disturbances can trigger insomnia, but chronic insomnia can also trigger mood disturbances.  The symptom of moodiness often appears when insomnia keeps you awake to the point that you don’t get enough sleep.

Poor sleep quality: It can be difficult to definitively track your sleep quality, but a panel of sleep experts can do it.  There are even apps available for the iPhone such as “Sleep Cycle” that may give you a rough estimate of your sleep quality.  If you frequently notice poor sleep quality, it may be a symptom of insomnia – preventing you from falling asleep or waking you up during the night.

Reliance on substances to sleep: Another sign of insomnia is when you resort to using various substances such as alcohol, antihistamines, marijuana, opioids, or sleeping pills to help you fall asleep.  While pharmaceutical drugs may be prescribed by a sleep doctor to help you cope with insomnia, many individuals with insomnia resort to self-medicating.  If you often find yourself popping over-the-counter drugs to help you get sleep, it’s probably a sign of insomnia.

Short sleep duration: If the number of hours you sleep per night is less than you expected or your total sleep duration is shorter than you wanted, you may suffer from insomnia.  Those with insomnia find themselves lying in bed, totally awake, sometimes for hours before they finally fall asleep.  Others may wake up too early or in the middle of the night and are unable to fall back asleep – limiting their total sleep time.

Sleep-related phenomenon: If you begin experiencing sleep-related phenomenon and bizarre sensory experiences around sleep times, these could be a result of insomnia.  Those with insomnia are more likely to experience hypnagogic hallucinations, hypnopompic hallucinations, and even sleep paralysis – compared to individuals who don’t have insomnia.

Waking up during the night: If you find yourself waking up frequently throughout the night without any apparent reason, you may have sleep-maintenance insomnia.  Most people with sleep-maintenance insomnia have medical conditions, psychiatric illnesses, and/or a suboptimal sleep environment.  However, if you’ve tweaked your sleep environment (e.g. removed the Wi-Fi router from under your pillow), have a comfortable room temperature and bed, but still wake up a lot – this could be a symptom of insomnia.

Worrying about sleep: If you constantly worry about whether you’ll be able to fall asleep at night, whether you’re going to get enough sleep, or whether you’re going to stay asleep throughout the night – this could be a sign of insomnia.  Those with severe insomnia tend to worry about whether they’ll actually be able to sleep because they know that without sufficient sleep, their performance (at work, school, etc.) is often impaired.

Note: Some people with insomnia will experience nearly all of the symptoms on this list, while others may only experience a couple symptoms with high severity.

How is insomnia diagnosed?

Generally a doctor will diagnose insomnia based on the objective symptoms as well as degree of functional impairment that the symptoms present.  The diagnosis can be made by a sleep expert or by a general practitioner.  To ensure that the diagnosis is accurate, you’ll want to work with a sleep expert or team of sleep experts as sleep-related disorders like insomnia are their specialty.

  • Blood tests: A doctor may recommend getting a panel of blood tests conducted to rule out potential medical conditions, hormone imbalances, and nutritional deficiencies that could be contributing to insomnia.  Should a doctor notice a condition like hyperthyroidism (or overactive thyroid), they will be able to prescribe a medication that targets the root problem. Blood tests are conducted because insomnia is often a sign of a more serious condition.
  • Overnight sleep study: A sleep expert may recommend participating in an overnight sleep study (polysomnography).  This means you’ll sleep overnight in a laboratory in a comfortable environment.  Researchers will hook you up to an EEG (electroencephalograph) to monitor your brain waves and gather information about your transition through sleep cycles.  They may also measure oxygen levels, number of movements, heart rhythms, and breathing patterns.
  • Questionnaires: You may be instructed to fill out a brief questionnaire that records your subjective perception of the insomnia.  It may ask questions about whether you have trouble falling asleep, difficulty staying asleep, whether you wake up too early, whether you feel groggy or irritable in the morning, whether you’re sleepy throughout the day, etc.  The questionnaire is basically a brief survey to help the doctor get some insight into the severity of your insomnia.
  • Sleep logs: Many people are instructed to keep sleep “logs” or diaries that give doctors information about their sleep habits.  These generally include things like when the individual went to bed, how long it took them to fall asleep, the total time they slept, when they woke up, how they felt, etc.  This log may also report whether the person felt sleepy throughout the day and any uncomfortable symptoms they may experience (e.g. tension headaches).
  • Verbal questioning: If you visit a doctor or sleep expert, they may ask you a series of questions in their office such as: “How difficult is it for you to fall asleep at night?” or “How difficult is it for you to stay asleep at night.”  This panel of questions will help them get a better idea as to how debilitating the insomnia is, as well as how long it has been occurring.

Insomnia symptoms or a separate condition?

It is important to realize that many of the above symptoms could certainly be a result of insomnia, but they could also be a result of other conditions.  Among those diagnosed with anxiety disorders, it may be difficult to determine whether the anxiety caused the insomnia or the insomnia caused the anxiety.  There may be certain mechanisms of each condition that overlap, leading to comorbidity of these diagnoses.

Many psychiatric conditions will trigger anxiety, but insomnia may also trigger latent or underlying psychiatric conditions.  This brings about significant confusion because a person experiencing both insomnia and a condition like depression may not know whether the “chicken” (depression) or the “egg” (insomnia) came first.  Usually by taking measures to treat the insomnia, the other comorbid condition will improve; vice-versa also applies.

If you have insomnia, what symptoms are most debilitating?

If you suffer from insomnia, feel free to post a comment below describing which symptoms tend to be most debilitating.  For many people, the excessive daytime fatigue and lethargy may be problematic, while for others impaired cognitive function may be the most difficult to cope with.  Anyone that suspects they have untreated insomnia should consult a sleep expert and/or medical professional to learn ways in which symptoms can be dealt with and/or overcome.

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