Why Can’t I Sleep? Overlake Sleep Specialist Answers Common Insomnia Questions

If you find yourself tossing and turning at night, you're not alone. Insomnia affects millions of people and can take a toll on your health, mood and daily life. From stress and anxiety to underlying sleep disorders, many factors can interfere with a good night's rest. Sleep specialist Tha Saw, MD, answers common questions about insomnia, including its causes, when to seek help and the most effective treatment options.

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Q: What exactly is insomnia?
A: Insomnia is more than just a bad night’s sleep. It’s when you regularly have trouble falling asleep, staying asleep, or waking up too early and not being able to fall back asleep. Some people experience it for a few days at a time (short-term insomnia), while others deal with it for months or longer (chronic insomnia). 

Q: What causes insomnia?
A: So many things can push someone into insomnia — stress, anxiety, jet lag, an active mind, or even an uncomfortable bed, to name a few. Often, the original “cause” might go away, but the insomnia persists. Therefore, we find it helpful to look at the bigger picture using a framework called the “3P Model of Insomnia” to figure out what causes someone to have insomnia and evaluate how it evolves over time (and, hopefully, prevent it from happening in the future):

• Predisposition – These are the traits that make someone likely to develop insomnia. Predisposing factors do not cause insomnia by themselves; it is helpful to know what makes someone vulnerable to having insomnia develop and persist. These include things like family history, personality traits (e.g., tendency to overthink, mood, etc.), or other conditions, like untreated sleep apnea.
• Precipitation – These are triggers that push someone into having insomnia. Sometimes they are obvious, but often they are subtle. Common triggers are increased stress/anxiety, irregular sleep schedules, hormonal changes, major life changes, or mental health conditions like anxiety or depression. Whatever the cause, it is helpful to identify it so we can learn from the past and try to prevent it in the future.
• Perpetuating – Perpetuating factors are things that turn acute insomnia into chronic insomnia. These factors are the reason insomnia continues after the original trigger is gone. Common examples include spending extra time in bed (e.g., going to bed earlier or staying in bed after waking up tossing/turning), napping during the day to make up for lost sleep, or sleep-related anxiety. These contribute to a negative subconscious relationship with the bedroom and make it that much harder to turn the mind off. 

All to say, insomnia can be exceedingly difficult to overcome. And it is more common than it should be. 

Q: What happens if insomnia goes untreated?
A: Chronic insomnia often goes together with insufficient sleep. Not getting enough sleep can have wide-ranging effects, both mentally and physically. Not everyone with insomnia will develop these issues, but the risk is higher the longer it goes untreated. Poor or insufficient sleep can increase the risk of heart disease, high blood pressure, depression, dementia, and daytime accidents due to fatigue. 

Q: How is insomnia diagnosed?
A: Since insomnia often has multiple causes, patients are evaluated for predisposing and precipitating factors, medications or substances that may be interfering with sleep, and maladaptive responses to sleeplessness. In some cases, an overnight (at the clinic) or at-home sleep study may be recommended to better understand whether other sleep disorders, like sleep apnea, may be contributing to sleepless nights. 

Q: What are the most effective treatments for insomnia?
A: The gold standard is cognitive behavioral therapy for insomnia (CBT-I). CBT-I trains your brain and body for better sleep and is often more effective than medication long term. At Overlake, we have access to a sleep psychologist who can perform CBT-I with patients. This evidence-based approach helps change the thoughts and habits that disrupt sleep. CBT-I is a brief treatment that typically lasts four to eight sessions. 

Q: Will CBT-I help me fall asleep faster?
A: There is abundant evidence that CBT-I will lead to significant improvements in those with chronic insomnia. Improvement typically occurs gradually over the course of therapy, and the benefits usually last beyond the treatment period.

Q: Can insomnia be cured or just managed?
A: Life comes at us in seasons, and insomnia can follow suit in a similar way. Sleepless nights are an inevitability, and unfortunately, there is no cure for that. However, managing our sleep behaviors can help us overcome a bad night or two. In a sense, the “cure” lies in maintaining good sleep hygiene. 

Q: When should I see a doctor for insomnia?
A: Everyone has restless nights now and then. But if poor sleep occurs at least three nights a week and lasts for three months or longer — especially if it’s affecting your mood, energy or performance during the day — it’s worth talking to a specialist.

If sleep issues are affecting your daily life, start by talking to your primary care provider. They may refer you to Overlake Clinics Sleep Medicine, where specialists diagnose and treat many sleep disorders. Overlake is home to a dedicated insomnia clinic led by a cognitive behavioral therapist with deep experience helping people manage this sleep disorder.