Learn
Stellar Sleep Learn

Everything you need to know about insomnia

Insomnia can feel overwhelming. Sleep advice is everywhere and a lot of it is noise. Start here to understand what you're dealing with, what the evidence actually says, and what you can do about it.

Written by George Wang
Medically reviewed by Robert Stevens, MD
Reviewed

What to know first

  • Chronic insomnia disorder means difficulty falling asleep, staying asleep or waking too early, at least three nights a week, for at least three months, with a daytime consequence — and not explained by simply not having enough opportunity to sleep.
  • CBT-I — cognitive behavioral therapy for insomnia — is what sleep specialists recommend first. It's the only treatment the AASM strongly recommends and it outranks sleeping pills.
  • In the AASM's review, every medication recommendation was rated weak, which makes it a case-by-case decision with your prescriber rather than a general recommendation.
  • Not everything that looks like insomnia is insomnia. A body clock that runs late, a breathing problem, or simply too little time in bed can all cause lost sleep — and knowing which one you're dealing with is what points you to the right fix.
  • Start with the four-question test if you want to know which of these describes you, or with the symptoms and diagnosis path if you want to understand the condition first.

CBT-I = cognitive behavioral therapy for insomnia · AASM = American Academy of Sleep Medicine

For education only, and not a substitute for advice from your own doctor or prescriber.

I'm not sure whether I have insomnia

  1. STEP 1

    What Is Insomnia? Symptoms, Causes and Treatment

    Insomnia is not a number of hours. It is a specific pattern with specific criteria, and knowing them is the difference between a bad month and a treatable condition.

  2. STEP 2

    Insomnia Severity Index: What Your Score Means

    Seven questions, a score between 0 and 28, and four categories that help interpret the score. Here is where the score can be useful, and where its limitations lie.

  3. STEP 3

    Sleep Apnea vs Insomnia: How to Tell the Difference

    Two different conditions, two different treatments, and a large overlap that catches people out.

  4. STEP 4

    Delayed Sleep-Wake Phase Disorder: Is This Insomnia?

    Delayed sleep-wake phase disorder and chronic insomnia are often mistaken for each other. The answer to one question separates them, and getting it wrong can mean years of the wrong treatment.

I know I have it and want to know what works

  1. STEP 1

    What Is CBT-I? The First-Line Treatment for Insomnia

    CBT-I is the only insomnia treatment that carries a strong recommendation from both the American College of Physicians and the American Academy of Sleep Medicine. It is also the one many people have never heard of.

  2. STEP 2

    Sleep Restriction Therapy: How It Works

    It's the treatment that asks an exhausted person to spend less time in bed, which sounds counter-intuitive. Here is the reasoning behind it, and why it is the component that moves someone with chronic insomnia toward better sleep.

  3. STEP 3

    What to Do When You Can't Fall Asleep

    The most effective answer is also the simplest, and the least welcome: do not just lie there. Here is why getting out of bed is the thing that breaks the habit.

  4. STEP 4

    How to Find CBT-I Treatment

    The top treatment for chronic insomnia that the American Academy of Sleep Medicine (AASM) and the American College of Physicians (ACP) recommend is one most people are never offered. Here is who provides it and how to find CBT-I treatment.

I'm taking something for sleep

  1. STEP 1

    Sleep Medications: What the Guidelines Actually Recommend

    There is no single safest sleeping pill. But US guidelines do say which medicines have evidence behind them, and which ones to avoid.

  2. STEP 2

    Is It Bad to Take Melatonin Every Night?

    Melatonin is the supplement most people try first for insomnia. Sleep guidelines from the AASM and the VA/DoD suggest not using it for that.

  3. STEP 3

    Over-the-Counter Sleep Aids: Do They Work?

    Not needing a prescription tells you how a product is regulated, not how safe it is. Here is what the guidelines say about what is in the box.

  4. STEP 4

    What Is CBT-I? The First-Line Treatment for Insomnia

    CBT-I is the only insomnia treatment that carries a strong recommendation from both the American College of Physicians and the American Academy of Sleep Medicine. It is also the one many people have never heard of.

By topic

All 33 articles →
11

Symptoms & diagnosis

What insomnia is, what it is not, and the conditions that mimic it.

11 articles11

CBT-I & treatment

The first-line treatment, its components, and how to get it.

11 articles8

Sleep medication

What the guidelines recommend, what they recommend against, and why.

8 articles3

Sleep & anxiety

Dread at bedtime, racing thoughts, and the loop between worry and wakefulness.

3 articles

Every article

Newest first

Common questions

What is insomnia?
Chronic insomnia disorder is difficulty falling asleep, staying asleep, or waking earlier than intended, occurring at least three nights a week for at least three months, with a daytime consequence such as fatigue or impaired concentration, and not explained purely by inadequate opportunity or circumstances for sleep.
What is the best treatment for insomnia?
Cognitive behavioral therapy for insomnia. It carries the only strong recommendation in the AASM's 2021 behavioral guideline, and the AASM's 2026 combination guideline places CBT-I alone ahead of both combination treatment and medication alone.
Do sleeping pills work?
The AASM's 2017 guideline reviewed fourteen agents and graded every pill recommendation as weak — including the ones it suggests using. It also suggests clinicians not use trazodone, diphenhydramine, melatonin, L-tryptophan or valerian for insomnia.
How do I know this information is reliable?
Every factual claim on this site is traced to a clinical practice guideline, an FDA label, or an NIH publication, and each article lists the sources with what each one supports. Where we could not find a source, the article says so rather than hedging. Articles are reviewed by a named clinician and supply the review date.
Where should I start?
If you are not sure whether or not your condition is insomnia, start with the assessment or with 'What Is Insomnia?'. If you already know and want to understand the treatment, start with the CBT-I explainer. If you are currently taking something for sleep, start with the medication guide.