Can You Inherit Insomnia? What is the Genetic Component of Sleeplessness?
Is yours the type of family for whom sleep is an ISSUE – with capital letters? When you wake up in the morning, do you discuss your sleep – how you struggled to fall asleep, how many times a night you woke up, how you lay awake for hours, and how this lack of sleep is probably going to wreck your day?
If sleep is an issue in your family, then there is probably a genetic component to your insomnia. Sleep scientists divide factors contributing to insomnia into three categories (predisposing, precipitating, and perpetuating), based on the 3P model of the famous sleep researcher Dr. Arthur Spielman. While there has been considerable research on precipitating and perpetuating factors, predisposing factors have received less scientific attention.1
Researchers have found that genes are amongst the most significant predisposing factors for insomnia.1 Heritability accounts for between 28% and 57% of a person’s likelihood of experiencing insomnia.2 Consequently, sleep disorders run in families.
Because insomnia is related to a multitude of negative mental, physical, and occupational health outcomes, you have reason to be concerned if your family has a history of insomnia and you have difficulty falling asleep, initiating sleep or maintaining sleep. If you experience non-restorative sleep at least three times a week for a minimum of ninety days and this causes you significant distress,1 it’s worth exploring the role your genetic predisposition has as a contributing factor to your insomnia.
Insomniac Genes Do Not Make You an Insomniac
The good news is that insomniac genes do not automatically condemn you to a life of sleeplessness. Circumstances can switch your insomniac genes on, or not. You may have the same genes as your sleepless sister, for example, but they may express differently in you than they do in her because your circumstances or your attitude is different from hers. Her environment might trigger her insomniac genes while yours does not.3
The Difference Between Genes and Gene Expression
It is important to understand the difference between genes and gene expression. Genes are embedded in your chromosomes and consist of DNA, which carries instructions for protein and RNA synthesis in your body. Gene expression determines if the encoded instructions are carried out, or not; in other words, whether the gene is switched on, or not.
Lifestyle, stress and other external factors play a role in switching on the genes associated with insomnia. While there’s not much you can do about your genetic heritage, you can actively adjust your lifestyle and moderate your stress levels to mitigate your genetic predisposition. Cognitive behavioral therapy, for example, can affect gene expression. A study done in 2015, found that CBT-I reduced the expression of genes encoding pro-inflammatory mediators associated with sleep disturbance.4
Is Genetic Testing for Insomnia an Option?
At the moment there are few commercial DNA tests capable of identifying genes associated with sleep disorders. Our scientific understanding of the genetics of insomnia is progressing despite limitations, and scientists have identified several potential molecular mechanisms for the development of the disorder. However, we have a long way to go to gain a full understanding of the genes that can potentially keep us awake at night.1
The best option at the moment for an insomnia diagnosis is a tried and tested questionnaire, called the ICSD-3 (International Classification of Sleep Disorders –Third Edition), which doctors use to diagnose sleep disorders. This diagnostic tool is the industry standard.5 If your family history suggests you may have genes that predispose you to insomnia and you’ve been battling your sleep for three months, it is useful to consult your doctor about the ICSD test.
Alternatively, our Dawn Health insomnia questionnaire is based on the ICSD, so a valuable first step would be to fill in our questionnaire if you suspect you’re suffering from insomnia.
Cognitive Behavioral Therapy for Insomnia
Dawn uses CBT-I, an evidence-based approach that treats insomnia by identifying and changing habits and thinking patterns that prevent you from falling asleep. We’ve known since 2013 that cognitive behavioral therapy affects gene expression in individuals suffering from PTSD.6 A recent meta-analysis, published in January 2022, indicated that CBT was associated with significant epigenetic effects, mainly in anxiety disorders.7
Insomnia may lie in your genes but it does not define you. The expression of the genes that predispose you to insomnia is influenced by your environment, which means you have control over that expressivity to some degree. It is this window of epigenetic influence that deserves the focus of all families who turn conversations at the breakfast table into retrospective sleep studies.
Lind, M.J., Gehrman P.R. (2016) Genetic Pathways to Insomnia. Brain Sciences. 6(4), 64. https://doi.org/10.3390/brainsci6040064
Juan J. Madrid-Valero, María Rubio-Aparicio, Alice M. Gregory, Julio Sánchez-Meca, Juan R. Ordoñana, The heritability of insomnia: Systematic review and meta-analysis of twin studies, Sleep Medicine Reviews, Volume 58, 2021. https://doi.org/10.1016/j.smrv.2021.101437
Finegold, D. N. (2021). Factors affecting gene expression. Merck Manual Professional Version. Retrieved June 15, 2022, from https://www.merckmanuals.com/professional/special-subjects/general-principles-of-medical-genetics/factors-affecting-gene-expression
Irwin, M.R. et al. (2015) Cognitive Behavioral Therapy and Tai Chi Reverse Cellular and Genomic Markers of Inflammation in Late-Life Insomnia: A Randomized Controlled Trial. Biological Psychiatry, 78 (10), 721-729. https://doi.org/10.1016/j.biopsych.2015.01.010
Sateia, M.J. (2014) International Classification of Sleep Disorders –Third Edition. Contemporary Reviews in Sleep Medicine, 146 (5), 1387 -1394. https://doi.org/10.1378/chest.14-0970
Levy-Gigi, E. (2013) Association among clinical response, hippocampal volume, and FKBP5 gene expression in individuals with posttraumatic stress disorder receiving cognitive behavioral therapy. Biol. Psychiatry 4(11), 793-800. doi: 10.1016/j.biopsych.2013.05.017
Pellicano G.R et al. (2022) Epigenetic correlates of the psychological interventions outcomes: A systematic review and meta-analysis. Journal of Affective Disorders Reports, 7, 100310. https://doi.org/10.1016/j.jadr.2022.100310
Dr. Colleen Ehrnstrom is a licensed clinical psychologist with a specialty practice in Acceptance and Commitment Therapy (ACT). Areas of expertise include insomnia and other sleep disorders, anxiety, and depression.
Dr. Ehrnstrom is not a medical provider and is not providing any recommendations regarding medications. Rather, she is sharing and reviewing the research as it relates to education when learning how best to treat insomnia.