Causes of Insomnia and Sleeplessness | How Do You Find the Real Cause? • Sleep & Pulmonology Clinic in Riyadh

The causes of insomnia and sleeplessness fall into three groups: physical, psychological, and behavioural. Identifying the right group is not an academic detail; it is what determines the entire treatment.

If the cause is physical or psychological, treating that cause is what resolves the insomnia. In behavioural cases, and in cases where no cause can be identified, treatment is fundamentally behavioural.

This explains why many people fail despite trying everything they have heard about. They are treating the symptom without knowing which type of insomnia they have in the first place.

What Is Insomnia?

Sleep gives the body the rest it needs after a full day of effort. During sleep, important biological changes and functions take place: tissue repair, hormone release, and rest for many of the body's organs.

Insomnia occurs when physical, psychological, or behavioural disturbances affect this sleep mechanism.

Insomnia takes several forms: difficulty falling asleep, fragmented sleep, waking early with no ability to return to sleep, or light unrefreshing sleep despite enough hours.

The accepted diagnostic criterion is difficulty persisting at least three nights a week for three months.

The causes of insomnia and sleeplessness range from what is visible to the patient to what is hidden from them. Some are linked to daily habits that can be observed, while others are only found through medical assessment. This gap is what makes self-diagnosis insufficient in most cases.

Any correct assessment starts by identifying the form of the insomnia and its duration, and that is where a sleep disorders consultation begins.

Physical Causes of Insomnia and Sleeplessness

This is the most overlooked group, because the patient looks for a cause in their sleep while the cause is in their body.

Other sleep disorders: the most serious is obstructive sleep apnea. Many patients complain of repeated awakenings with no known cause, while the cause is breathing pauses they do not feel. Treating insomnia here with sleeping pills is a mistake that may make the condition worse.
Restless legs syndrome: an unpleasant sensation that prevents falling asleep, commonly caused by low iron stores.
Chronic pain: joint pain, back pain, and migraine.
Gastroesophageal reflux: worsens when lying down and causes repeated awakenings.
Thyroid disorders: particularly an overactive thyroid.
Heart and lung disease: such as heart failure and nocturnal breathlessness.
Hormonal changes: pregnancy and menopause.
Frequent night urination: whether from a urinary cause or as a symptom of sleep apnea.

Psychological Causes of Insomnia and Sleeplessness

Psychological disorders are among the most common causes of insomnia, most notably generalised anxiety, depression, panic disorder, and obsessive-compulsive disorder.

The relationship runs both ways: anxiety prevents sleep, and lack of sleep increases anxiety. Over time, a loop forms whose starting point is hard to identify.

How Do You Recognise Psychological Insomnia?

Racing thoughts on lying down despite physical exhaustion.
Waking at three or four in the morning with no clear reason, a pattern common in depression.
A feeling of tension that starts as bedtime approaches.
Insomnia persisting despite regular sleep times and a well-adjusted environment.

Behavioural Causes of Insomnia and Sleeplessness

This is the widest group, and the one a patient can change themselves, provided they know what it contains.

Caffeine: it may stay in the body for many hours, so an evening cup affects sleep in the middle of the night without the person connecting the two.
Screens before bed: the blue light emitted by phones and devices can keep you from sleeping.
Irregular sleep times: particularly making up for late nights by sleeping during the day.
Shift work: disrupts the body clock.
Long or late naps: they draw down the sleep pressure needed at night.
The bedroom environment: outside noise, bright lighting, and unsuitable temperatures.
Working right up to bedtime: someone who works until the moment they sleep finds it hard to fall asleep, because the body has not had the wind-down it normally needs before sleep.

There is one behaviour that worsens insomnia more than anything else: trying to force yourself to sleep. Sleep does not come by force, and it is better to focus on something calm and settling instead of fighting with the bed.

Medication Causes Many People Overlook

Common medications may be the cause:

Some blood pressure and heart medications.
Corticosteroids.
Some antidepressants.
Stimulant asthma inhalers.
Thyroid medications.
Decongestants.
Some pain relievers containing caffeine.

Medications are among the causes of insomnia and sleeplessness that are hardest for a patient to connect to their condition, because they are usually medications they have been taking for a long time without problems.

No medication should be stopped on your own. But mentioning your medication list to the doctor at your insomnia assessment appointment may save you months.

Acute and Chronic Insomnia | A Difference That Determines Treatment

This division is the key to understanding the role of sleeping pills.

Acute insomnia: usually resolves once its cause resolves, such as a passing stressor or travel to distant regions producing a large time difference, known as jet lag. If symptoms are severe, sleeping pills may be prescribed during this period for no more than two weeks.

Chronic insomnia: lasts three months or more, and the approach here is completely different. Relying on sleeping pills may cause side effects such as impaired cognition, memory disturbance, psychological dependence, and the return of insomnia after stopping.

Sleeping pills are a short-term tool for a short-term condition. Chronic insomnia needs treatment that addresses the mechanism rather than the symptom.

Treating Insomnia and Poor Sleep

Treating insomnia and poor sleep starts by identifying which of the three groups of causes of insomnia and sleeplessness your case belongs to.

1. Treating Insomnia When the Cause Is Physical or Psychological

Treating the cause itself is what resolves the insomnia. Here it is best to see a specialist to diagnose and treat the underlying condition, whether it is sleep apnea, iron deficiency, a thyroid disorder, or depression.

This shows why assessment always starts by ruling out physical causes. A home sleep test may be what reveals the real cause after years of treating insomnia as a standalone condition.

To see the testing steps and the start of treatment from the patient's perspective, you can read the article on my experience with sleep apnea.

2. Treating Insomnia and Poor Sleep With Behavioural Methods

If the cause is behavioural or unidentified, treatment is fundamentally behavioural, and it can be supported in its early stages by sleeping pills for a limited period.

Cognitive behavioural therapy for insomnia (CBT-I) is the accepted first-line option today. It targets the behaviours and thoughts linked to sleep and achieves long-term results without medication.

Data show that between 70% and 80% of patients with primary insomnia improve with this treatment.

It works through four steps:

Identifying the thoughts, feelings, and behaviours contributing to the symptoms.
Examining beliefs about sleep to see how accurate they are.
Observing behaviours to see whether they actually promote sleep.
Reframing incorrect thoughts and behaviours so they better support sleep.

Cognitive behavioural therapy sessions for insomnia are offered at Subat Clinics within an integrated plan, coordinated with the treating consultant. You can review the available consultations to choose what suits your case.

3. Treating Insomnia and Poor Sleep With Medication

The role of medication in treating insomnia and poor sleep is limited and temporary. It is used in acute insomnia for no more than two weeks, or as interim support at the start of behavioural treatment. Extended use in chronic insomnia carries the risks of dependence and the return of symptoms after stopping.

Basic Rules for Healthy Sleep

A patient with insomnia should try to keep their sleep regular and follow good sleep habits in all cases:

Keep your bedtime and wake time fixed every day, including holidays.
Wind down before bed and do not work until the moment you sleep.
Do not force yourself to sleep. If it has not come within 20 minutes, leave the bed and do something calm until you feel sleepy.
Use the bed for sleep only.
Keep the room dark, quiet, and moderately cool.
Avoid caffeine in the evening.
Stay away from screens before bed.
Reduce daytime naps and avoid them after late afternoon.

An important note: these rules are a supporting element, not a treatment in themselves. They will not be enough for someone with chronic insomnia, and they will not help at all when the cause is physical.

When Should You See a Doctor?

Although many causes of insomnia and sleeplessness are simple and manageable, some signs call for specialized assessment. See a specialist if:

Insomnia has lasted more than three months.
It has affected your concentration, mood, or performance at work.
You have noticed snoring or pauses in breathing during your sleep.
You wake up tired despite sleeping enough hours.
You have relied on sleeping pills for more than two weeks.
Insomnia appeared after starting a new medication.
It is accompanied by an unpleasant sensation in the legs.

If a physical or psychological cause is possible, seeing a specialist is the right step, rather than trying remedies or medications without a diagnosis.

Assessment or follow-up can be arranged through a remote consultation for those living outside Riyadh.

Why Subat Clinics?

At Subat Clinics, we look into the causes of insomnia and sleeplessness before prescribing any treatment, because insomnia is a symptom, and treating it without identifying its cause may prolong the suffering.

Ruling out physical causes first: through fully home-based sleep tests, so the patient sleeps in their own bed with no overnight lab stay.
Specialized behavioural treatment: CBT-I sessions for those whose insomnia is behavioural or of unidentified cause.
A Saudi team specialized in pulmonary medicine and sleep disorders.

Start by Finding the Cause

Years of trying remedies and pills do not equal one appointment that identifies which type of insomnia you have. Behavioural insomnia needs behavioural treatment, and physical insomnia needs its cause treated. Confusing the two is what prolongs the suffering.

📍 Othman Bin Affan Road, Al Taawun District, Riyadh 12477
🕔 Sunday to Wednesday, 5 – 9 PM
📞 0112011100
💬 WhatsApp: 0505999713

Book your appointment now

Sources:

This content is for health awareness purposes and does not replace a personal medical consultation. Do not start or stop any medication, including sleeping pills, without consulting your doctor.

Medically reviewed by:
Dr. Ahmed Alruhaimi — Consultant in Pulmonary Medicine and Sleep Medicine, Subat Clinics.
Last reviewed: August 2026.

Frequently Asked Questions

How many hours of sleep do I actually need?
Most adults need at least seven hours, but the need varies. The more accurate measure is not the number of hours but how rested you feel during the day: if you wake up tired after eight hours, the problem is sleep quality, not quantity.

Can more than one cause be present at the same time?
Yes, and this is very common. Behavioural causes of insomnia and sleeplessness may combine with an underlying physical cause, and treating one without the other is not enough.

What is the fastest way to treat insomnia and poor sleep?
There is no fast method that suits everyone, because treatment follows the cause. The fastest real route is a correct diagnosis from the start, rather than trying solutions one after another for months.

Does insomnia cause disease?
Short-term insomnia is unpleasant but not harmful to health. When it continues for a long time, it is linked to high blood pressure, mood disorders, and weakened immunity.

Why do I wake up at the same time every night?
Repeatedly waking at a fixed time may point to a regular physiological cause, such as reflux, sleep apnea, low blood sugar, or a depressive pattern. That regularity is itself a clue that helps the doctor with diagnosis.

Is melatonin a treatment for insomnia?
Melatonin regulates sleep timing rather than inducing sleep. It helps with body clock disruption and jet lag, but it usually does not resolve chronic insomnia with a behavioural or physical cause.

When is insomnia a psychological symptom?
When it recurs for more than two weeks with no clear physical cause and no pressing environmental circumstances, alongside accompanying symptoms such as low mood, poor concentration, and reduced motivation.

Can sleeping pills be stopped suddenly?
That is not advised without supervision, because stopping suddenly may cause severe rebound insomnia. A gradual reduction schedule is set with the doctor, preferably timed with the start of behavioural treatment.