Waking up in the middle of the night and struggling to fall asleep again is something most people have experienced. Sometimes it happens because of stress, an uncomfortable bedroom or simply having too much on your mind.
But for millions of people, sleepless nights are not an occasional inconvenience. They are a regular problem that can continue for months or even years, leaving them exhausted and struggling to function during the day.
Now, a major scientific review suggests that persistent insomnia may be connected to something far more serious than feeling tired.
Researchers have found that people experiencing insomnia have a significantly higher risk of stroke and are more likely to be admitted to hospital for other health problems.
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According to a study published in Sleep Medicine Reviews in September 2026, insomnia was also associated with several neurological and mental health conditions, including dementia and depression.
The findings have prompted researchers to argue that persistent sleep problems deserve greater medical attention, although they emphasize that the evidence does not prove insomnia directly causes these illnesses.
More than 1.3 million people were included in the stroke analysis
The research was conducted by an international team working with the European Academy of Neurology, including scientists from the Medical University of Vienna in Austria.
Rather than carrying out a single new experiment, the researchers examined evidence from numerous previous studies to understand how insomnia might be connected to different aspects of long-term health.
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The investigation included 16 existing systematic reviews and three additional reviews conducted by the research team.
Scientists examined seven areas of health, including stroke, dementia, depression, suicidal behavior, hospital admissions, mortality and workplace injuries.
One of the most important findings concerned stroke.
The researchers identified nine studies involving a combined total of 1,343,164 participants. Six of those studies provided data suitable for a combined statistical analysis.
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The results showed that people with insomnia had a 26 percent higher relative hazard of experiencing a stroke compared with people without the condition.
A stroke occurs when the blood supply to part of the brain is interrupted, either because a blood vessel becomes blocked or because bleeding occurs in the brain.
Without enough oxygen, brain cells can quickly become damaged, potentially causing lasting problems with movement, speech, memory or other functions.
Although stroke risk is influenced by many factors, including age, blood pressure, smoking and diabetes, the researchers believe sleep problems may deserve greater attention when assessing a person's overall health.
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The risk of hospitalization was also higher
Stroke was not the only concerning finding.
The researchers also examined five studies involving more than 517,000 participants to investigate whether people with insomnia were more likely to require hospital treatment.
They found that people experiencing insomnia had approximately 28 percent higher odds of being admitted to hospital for any reason.
That does not mean 28 percent of people with insomnia will require hospitalization. It means the odds were higher compared with people without insomnia in the studies analyzed.
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The distinction is important because relative risks and odds do not tell us an individual's actual likelihood of becoming seriously ill.
For example, a 26 percent relative increase in stroke risk would have a very different meaning for a healthy 25-year-old than for someone aged 75 who already has high blood pressure and several other cardiovascular risk factors.
The research did not establish how much insomnia changes the absolute risk for any particular individual.
Nevertheless, the findings suggest that persistent sleep difficulties may be an important indicator of broader health problems.
Researchers also found connections to dementia and depression
The study uncovered associations between insomnia and several conditions affecting the brain and mental health.
According to the Medical University of Vienna's official explanation of the findings, previous systematic reviews have linked insomnia with dementia, particularly Alzheimer's disease.
Researchers also found associations with depression and suicide-related outcomes.
However, the strength and consistency of these findings varied between the studies, meaning they should not all be treated as equally certain.
The researchers did not find a clear overall association between insomnia and mortality, while the evidence concerning workplace injuries was too limited to draw a firm conclusion.
These results also raise an important question about cause and effect.
People experiencing depression, anxiety or certain neurological conditions may struggle to sleep because of their existing illness. In other cases, persistent sleep difficulties could potentially contribute to worsening symptoms.
The available evidence cannot establish exactly which direction these relationships operate in, or how much other health and lifestyle factors influence them.
Dr. Stefan Seidel, a neurologist and sleep specialist involved in the review, emphasized the importance of taking sleep seriously as part of overall healthcare.
"Sleep should be part of the discussion on brain health at every stage of life," he said.
Why poor sleep could affect the heart and brain
Scientists have several theories about why long-term insomnia might be connected to cardiovascular problems.
One possible explanation involves the body's response to stress.
When someone experiences persistent insomnia, their nervous system may remain unusually alert, even during periods when the body should be resting.
This state, sometimes called hyperarousal, can involve changes in stress hormones, heart rate and other physiological processes.
Over time, these changes could potentially affect the cardiovascular system.
Dr. Christopher Yi, a vascular surgeon at MemorialCare Orange Coast Medical Center, discussed the possible connection in an interview with Medical News Today.
He explained that chronic insomnia may keep the body in a heightened stress state, potentially contributing to increased blood pressure, inflammation and stiffness in the arteries.
High blood pressure and damage to blood vessels are established risk factors for stroke, making this a plausible explanation for the association observed in the research.
However, the review did not directly test whether these biological changes caused strokes among participants.
Other explanations remain possible, including differences in underlying medical conditions, medication use, psychological health and lifestyle.
How do you know if your sleep problem is actually insomnia?
Everyone experiences poor sleep occasionally, but chronic insomnia is different from having one or two restless nights.
According to the US National Heart, Lung, and Blood Institute, chronic insomnia generally involves difficulty falling asleep or staying asleep at least three nights per week for three months or longer.
The sleep problems also affect daily functioning, making it harder to concentrate, work or carry out normal activities.
Common signs include lying awake for long periods, waking repeatedly during the night, waking much earlier than intended and feeling exhausted despite having enough time available for sleep.
Some people also become increasingly anxious about bedtime itself.
After several difficult nights, they may begin worrying about whether they will sleep, which can make it even harder to relax once they get into bed.
This can create a cycle in which frustration about sleep becomes part of the problem.
However, not all nighttime awakenings are caused by insomnia. Conditions such as sleep apnea, restless legs syndrome, chronic pain and certain medications can also interfere with sleep.
Identifying the underlying cause is therefore important before deciding on treatment.
The recommended treatment is not necessarily a sleeping pill
Many people assume that medication is the most effective solution when they cannot sleep.
But medical guidelines recommend a different approach as the first treatment for chronic insomnia.
The American College of Physicians recommends cognitive behavioral therapy for insomnia, commonly known as CBT-I, as the preferred initial treatment for adults with persistent sleep problems.
Unlike ordinary counseling, CBT-I specifically targets the thoughts and habits that can interfere with sleep.
Treatment may involve adjusting the amount of time someone spends in bed, establishing a consistent waking schedule and learning how to respond differently when sleep does not come.
For example, someone who repeatedly lies awake for hours may be encouraged to get out of bed temporarily and return when they feel sleepy, rather than remaining there frustrated and alert.
Other techniques address anxiety about sleep and help people develop a more predictable relationship between their bedroom and sleeping.
According to the National Institutes of Health, CBT-I commonly involves a structured program lasting approximately six to eight weeks and can be delivered in person, by telephone or online.
Some components, such as restricting time in bed, are best planned with a qualified professional rather than attempted without guidance.
Medication can still be appropriate for certain patients, particularly when symptoms are severe, but treatment decisions should account for potential side effects, dependence and other medical conditions.
Small changes can help improve your sleep
Although changing daily habits may not be enough to treat chronic insomnia on its own, sleep specialists still recommend several practical measures that can support better sleep.
The UK's National Health Service (NHS) advises maintaining consistent sleeping and waking times, creating a comfortable bedroom environment and avoiding substances that can interfere with sleep.
Caffeine can remain active in the body for several hours, meaning an afternoon coffee may still affect someone's ability to fall asleep at night.
Alcohol can also interfere with sleep quality, even if it initially makes a person feel drowsy.
Regular physical activity may help improve sleep, while a quiet, dark and comfortably cool bedroom can make it easier to rest.
However, people experiencing persistent insomnia should not assume they simply need better bedtime habits.
If the problem continues for months or significantly affects daily life, professional treatment may be more effective than repeatedly experimenting with sleep tips.
When sleepless nights deserve medical attention
The findings do not mean that people who occasionally wake up at night should worry about having a stroke.
The reported 26 percent increase represents a statistical association across large groups of people, not a prediction of what will happen to any one individual.
Nor does the study prove that treating insomnia will reduce stroke risk by the same percentage.
That question would require clinical studies specifically examining whether successful insomnia treatment changes long-term cardiovascular outcomes.
Nevertheless, the research supports taking persistent sleep problems seriously.
People who regularly struggle to sleep, feel exhausted during the day or notice that poor sleep is affecting their health should discuss the problem with a healthcare professional.
This is particularly important for anyone who also has established cardiovascular risk factors, such as high blood pressure, diabetes or smoking.
Loud snoring, gasping during sleep or witnessed pauses in breathing should also be assessed because they may indicate sleep apnea, a different condition that can have serious health consequences.
For now, the findings offer an important reminder that sleep is not simply a period of inactivity between busy days.
It is a fundamental part of physical and mental health, and struggling to get enough of it over an extended period deserves attention rather than being dismissed as an unavoidable part of modern life.
This article is made and published by Aksel Kryhlmand, who may have used AI in the preparation.