INSOMNIA (SLEEP DIFFICULTY) GUIDE: SCIENCE-BASED, PLAIN-LANGUAGE Q&A “Good sleep is the overnight maintenance team for immunity, brain, and metabolism.” Insomnia can be a standalone disorder or a signal of another underlying issue. Common triggers include stress/anxiety, irregular sleep schedules, excess caffeine/nicotine, late heavy meals or alcohol, evening screen exposure, shift work, and low physical activity. Medical contributors include depression/anxiety disorders, thyroid disease, chronic pain, reflux, asthma, restless legs syndrome, obstructive sleep apnea (snoring and breathing pauses), and certain medications. Distinguish “I don’t feel sleepy” from “I can’t sleep”: in sleep apnea, people may think they sleep but quality is poor, leading to daytime fatigue and impaired attention. A practical clinical threshold: difficulty falling/staying asleep at least 3 nights per week for at least 3 months with daytime impairment suggests chronic insomnia. First-line care is typically not medication but CBT-I (cognitive behavioral therapy for insomnia) plus sleep-hygiene and routine stabilization. If there is loud snoring, gasping awakenings, marked daytime sleepiness, or nightly leg discomfort, evaluation should target those conditions. Evidence base: ACP recommends CBT-I as initial treatment for chronic insomnia; AASM provides evidence-based guidance for when medications are appropriate; insufficient sleep is strongly linked with neurocognitive and cardiometabolic risk.