<unk>  of insomnia can be caused by or be associated with: *Sleep breathing disorders, such as sleep apnea or upper airway resistance syndrome *Use of psychoactive drugs (such as stimulants), including certain medications, herbs, caffeine, nicotine, cocaine, amphetamines, methylphenidate, aripiprazole, MDMA, modafinil, or excessive alcohol intake *Use of or withdrawal from alcohol and other sedatives, such as anti-anxiety and sleep drugs like benzodiazepines *Use of or withdrawal from pain-relievers such as opioids *Heart disease *Restless legs syndrome, which can cause sleep onset insomnia due to the discomforting sensations felt and the need to move the legs or other body parts to relieve these sensations *Periodic limb movement disorder (PLMD), which occurs during sleep and can cause arousals of which the sleeper is unaware *Pain: an injury or condition that causes pain can preclude an individual from finding a comfortable position in which to fall asleep, and can also cause awakening. *Hormone shifts such as those that precede menstruation and those during menopause *Life events such as fear, stress, anxiety, emotional or mental tension, work problems, financial stress, birth of a child, and bereavement *Gastrointestinal issues such as heartburn or constipation *Mental, neurobehavioral, or neurodevelopmental disorders such as bipolar disorder, clinical depression, generalized anxiety disorder, post traumatic stress disorder, schizophrenia, obsessive compulsive disorder, autism, dementia, ADHD, Asperger syndrome, and FASD *Disturbances of the circadian rhythm, such as shift work and jet lag, can cause an inability to sleep at some times of the day and excessive sleepiness at other times of the day. Chronic circadian rhythm disorders are characterized by similar<unk> . * Certain neurological disorders such as brain lesions, or a history of traumatic brain injury *Medical conditions such as hyperthyroidism *Abuse of over-the-counter or prescription sleep aids (sedative or depressant drugs) can produce rebound insomnia *Poor sleep hygiene, e.g., noise or over-consumption of caffeine *A rare genetic condition can cause a prion-based, permanent and eventually fatal form of insomnia called fatal familial insomnia *Physical exercise: exercise-induced insomnia is common in athletes in the form of prolonged sleep onset latency *Increased exposure to the blue light from artificial sources, such as phones or computers *Chronic pain *Lower back pain *Asthma Sleep studies using polysomnography have suggested that people who have sleep disruption have elevated nighttime levels of circulating cortisol and adrenocorticotropic hormone. They also have an elevated metabolic rate, which does not occur in people who do not have insomnia but whose sleep is intentionally disrupted during a sleep study. Studies of brain metabolism using positron emission tomography (PET) scans indicate that people with insomnia have higher metabolic rates by night and by day. The question remains whether these changes are the causes or consequences of long-term insomnia. Genetics Heritability estimates of insomnia vary between 38% in males to 59% in females. A genome-wide association study (GWAS) identified 3 genomic loci and 7 genes that influence the risk of insomnia, and showed that insomnia is highly polygenic. In particular, a strong positive association was observed for the MEIS1 gene in both males and females. This study showed that the genetic architecture of insomnia strongly overlaps with psychiatric disorders and metabolic traits. It has been hypothesised that the epigenetics might also influence insomnia through a controlling process of both sleep regulation and brain-stress response having an impact as well on the brain plasticity. Substance-induced Alcohol-induced Alcohol is often used as a form of self-treatment of insomnia to induce sleep. However, alcohol use to induce sleep can be a cause of insomnia. Long-term use of alcohol is associated with a decrease in NREM stage 3 and 4 sleep as well as suppression of REM sleep and REM sleep fragmentation. Frequent moving between sleep stages occurs, with awakenings due to headaches, the need to urinate, dehydration, and excessive sweating. Glutamine rebound also plays a role as when someone is drinking; alcohol inhibits glutamine, one of the body's natural stimulants. When the person stops drinking, the body tries to make up for lost time by producing more glutamine than it needs. The increase in glutamine levels stimulates the brain while the drinker is trying to sleep, keeping him/her from reaching the deepest levels of sleep. Stopping chronic alcohol use can also lead to severe insomnia with vivid dreams. During withdrawal REM sleep is typically exaggerated as part of a rebound effect. Benzodiazepine-induced Like alcohol, benzodiazepines, such as alprazolam, clonazepam, lorazepam, and diazepam, are commonly used to treat insomnia in the short-term (both prescribed and self-medicated), but worsen sleep in the long-term. While benzodiazepines can put people to sleep (i.e., inhibit NREM stage 1 and 2 sleep), while asleep, the drugs disrupt sleep architecture: decreasing sleep time, delaying time to REM sleep, and decreasing deep slow-wave sleep (the most restorative part of sleep for both energy and mood). Opioid-induced Opioid medications such as hydrocodone, oxycodone, and morphine are used for insomnia that is associated with pain due to their analgesic properties and hypnotic effects. Opioids can fragment sleep and decrease REM and stage 2 sleep. By producing analgesia and sedation, opioids may be appropriate in carefully selected patients with pain-associated insomnia. However, dependence on opioids can lead to long-term sleep disturbances. Risk factors Insomnia affects people of all age groups but people in the following groups have a higher chance of acquiring insomnia: *Individuals older than 60 *History of mental health disorder including depression, etc. *Emotional stress *Working late night shifts *Traveling through different time zones *Having chronic diseases such as diabetes, kidney disease, lung disease, Alzheimer's, or heart disease *Alcohol or drug use disorders *Gastrointestinal reflux disease *Heavy smoking *Work stress
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