Surprising Signs of Insomnia Suggesting Causes of Difficulty Sleeping

Fatigue, Depression, and Racing Thoughts May Accompany Poor Sleep

Insomnia is easy to recognize when you have the most common symptoms: difficulty falling asleep, difficulty staying asleep, early morning awakenings, or sleep that is not refreshing in the absence of another sleep disorder. However, there can be some surprising signs and symptoms of insomnia, too. These may be harder to recognize and could be overlooked by many. Learn about some of these surprising signs that may be associated with insomnia and may suggest causes of poor sleep and difficulty sleeping.

A woman checks her alarm clock, black and white image
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Anxiety or Depression

Mood disorders walk hand in hand with insomnia. A poor night’s sleep often leads to daytime mood consequences and, conversely, problems with mood during the day often impact sleep at night. Poor sleep can easily lead to irritability. Depression may be associated with early morning awakenings and difficulty returning to sleep. Anxiety may leave your mind buzzing at night: worries washing over you as you try to get to sleep. When sleep becomes difficult to obtain in chronic insomnia, this may fuel the fires of anxiety, making matters worse. Some people will even experience nightmares or wake from sleep in a panic attack. Post-traumatic stress disorder (PTSD) can profoundly affect sleep and lead to insomnia.

Suicidal Thoughts

It should not be too surprising that since insomnia is associated with depression it is also linked to an increased risk of suicide. When people do not sleep well at night, desperation may follow as things spiral out of control. Poor sleep and sleep deprivation may affect serotonin levels and the function of the frontal lobe of the brain. The frontal lobe is responsible for various executive functions, key in making rational choices and appropriate social interactions. When impaired, the ability to suppress suicidal thoughts, or even the outright impulse to kill oneself, may be lost. Studies suggest that the risk of suicide may double among those with insomnia, with the highest risk among those who wake too early, having three times as many suicide attempts. Anyone with such thoughts should seek help by contacting the National Suicide Prevention Lifeline toll-free at (800) 273-8255.

Inability to Nap

People with insomnia often cannot take naps during the day. If time allows, a person with insomnia will simply lie there awake with eyes closed. This has to do with a higher level of arousal that occurs in people with insomnia. This makes it easy to stay awake during the day, but hard to sleep at night. It likely relates to higher levels of neurotransmitters, or chemical messengers, that contribute to wakefulness. Like a bell ringing over and over, these prompts constantly prod the affected person with a message to “Wake up!” and this compromises even the ability to nap in the day.

Racing Thoughts

Those who suffer from insomnia may describe this phenomenon in various ways. Some experience it as almost like a movie, a series of rapid-fire images that race through their mind at night. These may be related topics, but often they are not. Wakefulness in the night may often simply be a time that worries come to mind. As Shakespeare said in Romeo and Juliet, “And where care lodges, sleep will never lie.” Stressors – whether professional, personal, financial, or otherwise – may flood a still mind at night. It can be hard to put these worries aside, and racing thoughts at night are a very common symptom of insomnia.

Sleep State Misperception

In a condition called paradoxical insomnia, some people lose the ability to differentiate between wakefulness and sleep. These individuals will often swear that they have gone days – or even weeks or months – without any sleep at all. This is not physiologically possible and objective observation demonstrates that these individuals do, in fact, sleep. This is sometimes called sleep state misperception. It likely more often occurs when light sleep is obtained. Stage 1 sleep, the lightest of the recognized sleep stages, is characterized by light dozing. It may be so light that it is mistaken for wakefulness. In fact, studies show that when people are observed to be in stage 1 sleep on an electroencephalogram (EEG), some of those who are awakened will say that they were not asleep while others will say that they were. This transition state of consciousness may contribute to this misperception of sleep.

Fatigue (Not Sleepiness)

Finally, people with insomnia more often experience fatigue. This is different from sleepiness. Fatigue may also be described as feeling tiredness, exhaustion, and low energy. It is deep in the bones and muscles. Conversely, sleepiness or drowsiness is a strong desire to fall asleep: eyelids get heavy, effort is needed to stay awake, and sleep soon ensues. People with insomnia are fatigued, not sleepy. In contrast, people with sleep apnea have excessive daytime sleepiness, easily taking naps and falling asleep swiftly. Fatigue is therefore a common symptom in insomnia and can be useful to differentiate from other sleep complaints.

A Word From Verywell

If you experience some of these symptoms or signs of insomnia, you may want to speak to a sleep specialist. It can be possible to discover potential causes. Fortunately, there are effective treatments available, including sleeping pills and cognitive behavioral therapy for insomnia (CBTI).

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Additional Reading
  • The Complete Works of William Shakespeare. Massachusetts Institute of Technology.

  • Kryger, MH et al. "Principles and Practice of Sleep Medicine." Elsevier, 6th edition.

  • Wojnar, M et al. “Sleep Problems and Suicidality in the National Comorbidity Survey Replication.” J Psychiatr Res. 2009 February; 43(5):526-531.