What Is Sleep-Onset Insomnia?
If you lay awake for hours before drifting off or frequently get jolted awake while you are still in the early stages of sleep, you may have sleep-onset insomnia. Experts define sleep-onset insomnia as having trouble falling asleep after initially going to bed. This sleep disorder often affects your physical and mental functioning. 
While sleep-onset insomnia primarily causes symptoms in the beginning of the night, other types of insomnia strike at other times. Sleep maintenance insomnia occurs if you wake up frequently or for long periods during the night, after having first fallen asleep, and early morning awakening insomnia is a condition in which you wake up too early in the morning and can’t get back to sleep again. You may experience one, some or all of these insomnia types. 
Symptoms of Sleep-Onset Insomnia
Sleep-onset insomnia is closely linked to sleep latency — a term that describes how much time it takes to transition into sleep. Prolonged sleep latency (taking a long time to get to sleep) is the main symptom of sleep-onset insomnia.
This issue affects everyone from time to time. Acute insomnia or sudden insomnia is temporary — it may last for a couple of days or weeks, and naturally disappear on its own.3 However, chronic sleep-onset insomnia is defined as having a sleep onset latency of 30 minutes or more per night for at least three nights per week, lasting three months or more. 
Insomnia can lead to multiple symptoms, including: , 
- Feeling groggy or unrested when you wake up the next morning
- Noticing that you feel particularly sleepy or fatigued during the day
- Experiencing mood swings or irritability
- Having trouble remembering or concentrating
- Experiencing symptoms of anxiety or depression
- Having an elevated risk of making mistakes
- Feeling worried or anxious about sleep
In the long run, sleep-onset insomnia could lead to health problems. Having untreated insomnia makes you more likely to have chronic health conditions such as high blood pressure, heart disease, diabetes, and obesity. It also leads to a higher risk of developing mental health conditions. Additionally, insomnia can increase your chances of becoming injured or getting into a car accident. 
Sleep-Onset Insomnia Causes
Many different factors can contribute to sleep-onset insomnia. Acute insomnia is often triggered by identifiable stressors, such as extra stress at work, school, or home or a traumatic event. Chronic insomnia is often reinforced by another medical condition or by lifestyle factors. 
It is important to get a complete physical as some research has found that many people with sleep-onset insomnia have another sleep disorder, such as: 
- Periodic limb movements in sleep (PLMS) — Repetitive jerking or kicking movements of the toes, feet, legs, or arms while sleeping
- Restless legs syndrome (RLS) — Uncomfortable sensations in the legs that lead to an intense, uncontrollable urge to move the legs
- Obstructive sleep apnea (OSA) — Breathing problems during sleep in which your airways get temporarily closed off
- Congestive heart failure — A condition in which the heart isn’t pumping blood as well as it needs to
- Delayed sleep phase syndrome — A disorder that leads to falling asleep and waking up much later than usual, due to problems with the circadian rhythm (internal body clock)
Medical conditions may also be the cause of your sleeping problems. Insomnia can be a symptom of diabetes, heart disease, thyroid problems, gastroesophageal reflux disease (GERD), chronic pain, or another disorder. 
In general, insomnia is more likely to affect females than males and occurs more often in older adults. However, research has found that the sleep-onset insomnia subtype is more common in men and in teens and younger adults. This condition also has a higher chance of affecting people who describe themselves as night owls rather than early birds. 
Lifestyle factors can also exacerbate sleep-onset insomnia. You are less likely to get good rest if you: , 
- Have a lot of ongoing stress
- Don’t get a lot of physical activity
- Drink a lot of coffee or alcohol
- Tend to eat a lot right before bed
- Frequently travel across time zones
- Work the night shift, or your work hours frequently change by several hours
- Are at a lower income level
- Use certain medications, such as pain relievers, antidepressants, blood pressure medications, or allergy or cold medications
Can Anxiety Cause Insomnia?
Different mental health conditions, including anxiety, post-traumatic stress disorder (PTSD), and depression, can increase insomnia risk. In particular, people with anxiety are more likely to have sleep-onset insomnia compared to other types of insomnia, including sleep maintenance insomnia and early morning awakening insomnia. 
To learn more about how anxiety makes it harder to sleep, and to discover tips for overcoming anxiety-related insomnia, read our blog post “How To Go to Sleep When You’re Feeling Anxious.”
Treating Sleep-Onset Insomnia
Your health care provider can help you determine the cause of your insomnia. They can diagnose other potential sleep disorders or health conditions. Based on the cause of your insomnia, your health care provider can guide you to find the right course of treatment and start getting a healthy, restful, consistent night’s sleep.
Medication that has a sedating effect may be used to treat sleep-onset insomnia by promoting drowsiness. The goal when using sleep medication should always be to return to a natural cycle of sleep and not to create dependency on medication to achieve good rest. For this reason, sleep experts recommend only using sleep aids in the short term.6
Cognitive-Behavioral Therapy for Insomnia (CBT-I)
CBT-I is a program that helps you understand how the things you do and the way you think affect how you sleep. CBT-I providers can help you discover thought patterns and habits that are leading to a poor night’s sleep and learn how to correct these patterns. 
In CBT-I, you will:
- Learn strategies to challenge unhelpful thinking patterns.
- Get help identifying and changing habits that stand in the way of a great night of sleep.
- Understand how the connection between thoughts, feelings, and behaviors is central to your sleep patterns.
CBT-I techniques have been proven in numerous clinical trials to help treat insomnia, including sleep-onset insomnia. This program helps people fall asleep twice as quickly on average. In the short term, CBT-I works just as well as medication, and in the long term, it is actually more effective. Sleep experts recommend CBT-I as the first treatment option for people with insomnia. 
Start Your Journey to a Restful Night’s Sleep!
- Park, H.S., Joo, E.Y., & Hong, S.B. (2009). Sleep Onset Insomnia. Journal of Korean Sleep Research Society, 6(2), 74-85. https://doi.org/10.13078/jksrs09015
- Bjorøy, I., Jørgensen, V. A., Pallesen, S., & Bjorvatn, B. (2020). The Prevalence of Insomnia Subtypes in Relation to Demographic Characteristics, Anxiety, Depression, Alcohol Consumption and Use of Hypnotics. Frontiers in psychology, 11, 527. https://doi.org/10.3389/fpsyg.2020.00527
- MedlinePlus. (2022, March 29). Insomnia. https://medlineplus.gov/insomnia.html
- Mayo Clinic. (2016, October 15). Insomnia: Symptoms & Causes. https://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167
- Cleveland Clinic. (2020, October 15). Insomnia. https://my.clevelandclinic.org/health/diseases/12119-insomnia
- MedlinePlus. (2022, April 1). Insomnia. https://medlineplus.gov/ency/article/000805.htm
- Mayo Clinic. (2016, September 28). Insomnia Treatment: Cognitive Behavioral Therapy Instead of Sleeping Pills. https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/insomnia-treatment/art-20046677
- Muench, A., Vargas, I., Grandner, M. A., Ellis, J. G., Posner, D., Bastien, C. H., Drummond, S. P., & Perlis, M. L. (2022). We know CBT-I works, now what?. Faculty reviews, 11, 4. https://doi.org/10.12703/r/11-4
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.