Insomnia can arise from sleep-disorder processes such as obstructive sleep apnea, restless legs syndrome, or from emotional factors like anxiety and depression, and is often intensified by stress. This understanding comes from insights shared by Irina Zavalko, a neurologist-somnologist at the Neurological Scientific Center and a co-author of the first European guidelines for diagnosing and treating insomnia. Her perspective reflects a broad, clinical view of how sleep problems develop and how they interact with daily life.
Sleep apnea, defined as repeated pauses in breathing that last at least ten seconds, disrupts the normal architecture of sleep. Fragmentation, shallow breathing, and arousals can fragment the night, making restorative sleep hard to achieve. In more severe scenarios, the persistent interruptions can contribute to insomnia, especially when wakefulness is accompanied by a sensation of suffocation and racing thoughts upon waking. In such cases, the mind may stay alert long after the body has ceased struggling, setting the stage for ongoing sleep disruption. This explanation aligns with clinical observations that apnea-related disturbances often precede or coexist with insomnia symptoms, underscoring the need for comprehensive evaluation when sleep quality declines.
Restless legs syndrome also plays a role in sleep disruption. It manifests as unpleasant sensations in the legs that become noticeable in the evening before bedtime. The urge to move the legs frequently provides temporary relief, which leads to pacing or leg movements in bed and a disturbed sleep pattern. This ongoing discomfort can erode sleep quantity and quality, contributing to daytime symptoms such as forgetfulness, diminished concentration, fatigue, and irritability. Yet, Zavalko notes that insomnia in these cases is typically linked to the underlying motor or sensory discomfort rather than a standalone sleep disorder, pointing to the interconnected nature of these conditions.
Anxiety and depressive states are well-recognized triggers for sleep difficulties as well. Across clinical observations, stress remains the most common precipitant of insomnia. When stress takes hold, a person may struggle to fall asleep, or awaken during the night and find it hard to return to sleep. The worry about not sleeping can create a looping cycle—one that amplifies arousal and reinforces wakefulness, making recovery feel elusive. This pattern highlights the importance of addressing emotional load, not only to improve sleep but also to support overall mental health.
According to Zavalko, stress-related arousal, emotional tension, and anticipatory worry can significantly hamper both the onset and maintenance of sleep. People may lie in bed hoping for sleep that won’t come, or wake briefly with the sense that sleep has slipped away entirely. In these moments, practical strategies—such as establishing a consistent bedtime routine, reducing stimulants in the evening, and practicing relaxing techniques—can help slow the mind and invite sleep. These insights reinforce the idea that effective insomnia management often requires a holistic approach that targets sleep mechanisms, emotional health, and daily habits alike.
For readers curious about what happens to the brain during sleep, whether sleep mechanisms are altered in insomnia, and whether diagnostic testing is appropriate, there is an extensive discussion in the Zavalko report. The work also explores how music and tools like weighted blankets may assist some people in settling more easily for the night. These topics offer practical avenues to support better sleep while acknowledging that individual experiences vary and professional guidance remains valuable for persistent symptoms.
It is important to note that clinical recommendations emphasize avoiding blanket testing or overinvestigation when sleep complaints are mild or transient. A measured approach—grounded in patient history, sleep diaries, and targeted assessments—often yields the best outcomes. The goal is to identify drivers of insomnia and to implement a balanced plan that improves sleep quality without overwhelming the patient with unnecessary procedures or false assurances.