Chronic Insomnia: Causes, What to Do, and When to See a Doctor

Chronic insomnia means trouble falling asleep, staying asleep, or waking too early at least 3 nights a week for more than 3 months, with effects on how you function during the day. International clinical guidelines recommend CBT-I (Cognitive Behavioral Therapy for Insomnia) as the first-line treatment, not sleeping pills. See a doctor if 2–4 weeks of better sleep habits don't help, or if you snore loudly, stop breathing during sleep, or feel very sleepy during the day.

What is chronic insomnia?

Under the International Classification of Sleep Disorders (ICSD-3) from the American Academy of Sleep Medicine (AASM), chronic insomnia requires all three of the following:

1. A sleep complaint: difficulty falling asleep, difficulty staying asleep, or waking earlier than intended
2. At least 3 nights a week for at least 3 months, despite adequate opportunity to sleep
3. Daytime impact, such as fatigue, poor concentration, irritability or reduced performance

If it has lasted less than 3 months, it's called short-term insomnia, usually triggered by stress or life events and often resolving once the cause passes.

What causes chronic insomnia?

• Stress, anxiety and depression: the most common contributors, and the relationship runs both ways
• Sleep habits: irregular schedules, phones in bed, afternoon caffeine, long daytime naps
• Medical conditions: obstructive sleep apnea (OSA), chronic pain, reflux, thyroid problems, frequent night-time urination
• Substances and medications: alcohol, nicotine, caffeine and some prescription drugs
• The "fear of not sleeping" loop: worrying about sleep keeps the brain alert, until the bed itself becomes linked with stress

What can I do about chronic insomnia? 7 steps to start tonight

1. Wake up at the same time every day, weekends included. A fixed wake time resets your body clock better than trying to go to bed early.
2. Use your bed only for sleep. No work, shows or scrolling in bed.
3. If you can't sleep after about 20 minutes, get up. Do something quiet in dim light and return when sleepy.
4. No caffeine after midday. It stays in your system for hours.
5. Avoid alcohol before bed. It may help you fall asleep but fragments sleep later in the night.
6. Dim screens an hour before bed and wind down with reading or breathing exercises.
7. Keep naps under 20–30 minutes and avoid napping after 3 pm.

If there's no improvement after 2–4 weeks, talk to a professional.

What is CBT-I, and why is it the first-line treatment?

CBT-I (Cognitive Behavioral Therapy for Insomnia) is a structured therapy that changes both the behaviours and the thoughts that keep insomnia going. It usually takes around 4–8 sessions and includes:

• Stimulus control: rebuilding the link between bed and sleep
• Sleep restriction: strengthening sleep drive for deeper, more continuous sleep
• Cognitive restructuring: reducing worry about sleep
• Sleep hygiene and relaxation

The American College of Physicians (2016) and the AASM (2021) recommend CBT-I as the first-line treatment for chronic insomnia in adults because its benefits last and it carries no risk of dependence.

Do sleeping pills help?

Sleeping pills can help short-term or in specific situations, but they are not a long-term solution. Some carry risks of tolerance, dependence and morning grogginess, so they should only be used under a doctor's care. Don't self-medicate or stop medication abruptly.

When should I see a doctor?

• Insomnia 3+ nights a week for more than a month that hasn't improved with better habits
• Loud snoring, pauses in breathing during sleep, or waking up gasping
• Strong daytime sleepiness, especially while driving
• Low mood, anxiety or panic alongside poor sleep
• Relying on sleeping pills or alcohol most nights

Do I need a home sleep test?

A home sleep test is mainly for people suspected of having sleep apnea, for example loud snorers with heavy daytime sleepiness. You wear a small device at home for one night to measure breathing and oxygen levels, with no hospital stay. For typical insomnia without these signs, a sleep test usually isn't needed. Your doctor will advise.

Check your insomnia level

Take the free Insomnia Severity Index (ISI) self-assessment. It's a standard 7-question clinical tool that takes about 2 minutes and gives you something concrete to discuss with a doctor.

Frequently asked questions

How many hours of sleep do adults need?

The AASM recommends adults regularly sleep at least 7 hours a night. Waking up feeling refreshed matters as much as the number of hours.

Does melatonin help chronic insomnia?

Evidence is limited. The AASM does not recommend melatonin as a main treatment for chronic insomnia in adults, though it may help with body-clock problems or jet lag. Ask a doctor before using it.

Is insomnia linked to depression?

Closely. Insomnia is both a symptom of depression and anxiety and a risk factor for developing them. If you have both, try our depression self-assessment (PHQ-9).

Should I see a psychiatrist or a sleep doctor?

If stress, worry or low mood are part of the picture, a psychiatrist can treat both your sleep and the underlying cause. If snoring or breathing pauses are suspected, you'll need a sleep assessment. Plernnarom offers both in one team.

Sleep care at Plernnarom

Plernnarom is a mental wellness clinic near BTS Ari, Bangkok, offering complete sleep care: psychiatrist consultations, a sleep specialist, at-home sleep testing, and treatment that doesn't rely primarily on medication. English-speaking and confidential.

Message us on LINE to book a sleep consultation, or call +66 61 414 6363.

References

• American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd ed. (ICSD-3), 2014
• Qaseem A, et al. Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline from the American College of Physicians. Annals of Internal Medicine, 2016
• Edinger JD, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an AASM clinical practice guideline. Journal of Clinical Sleep Medicine, 2021
• Sateia MJ, et al. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: an AASM guideline. Journal of Clinical Sleep Medicine, 2017
• Watson NF, et al. Recommended Amount of Sleep for a Healthy Adult: AASM and Sleep Research Society consensus. Sleep, 2015

This article is for general information only and is not a substitute for diagnosis or treatment by a doctor.