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Duration of insomnia
If you have trouble falling asleep or staying asleep, even when sleeping conditions are good, you have insomnia. You may also have insomnia if the quality of your sleep is poor.
If your doctor diagnoses you with insomnia, your treatment plan may depend upon what type of insomnia you have. There are several ways to classify insomnia.
Some experts classify Insomnia according to how long the symptoms last. This system results in three types of insomnia:
- Transient insomnia. The condition corrects itself or responds to treatment, with symptoms lasting less than 1 month.
- Short-term insomnia. Symptoms last at least 1 month but no more than 6 months.
- Chronic insomnia. Symptoms are ongoing. If your symptoms last over 6 months, you may have chronic insomnia.
Primary and secondary insomnia
Experts also divide insomnia into two categories depending upon whether you have other conditions:
- Primary insomnia. You have no known conditions that can cause insomnia.
- Secondary insomnia. Your insomnia coexists with at least one other medical or psychiatric condition.
Some researchers have found that labeling insomnia as primary or secondary isn't helpful, for several reasons:
- It's difficult to prove a cause-and-effect relationship between insomnia and another condition.
- Often the two conditions interact in both directions, with insomnia also making the other condition worse.
- If the pre-existing condition goes away, insomnia often persists.
- Multiple conditions can contribute to insomnia at the same time.
Three patterns of insomnia
There are also three types of insomnia, depending upon when sleeplessness occurs:
- Trouble falling asleep. If you toss and turn for what seems like hours before falling asleep, you have sleep-onset insomnia.
- Trouble staying asleep. If you wake up during the night and can't go back to sleep, you have sleep-maintenance insomnia.
- Early waking. A third type of insomnia occurs when you wake before you want to and can't go back to sleep. This type may be a variation of sleep-maintenance insomnia.
Three types of insomnia according to cause
Some researchers see insomnia as a problem of hyperarousal. In hyperarousal, you are too sensitive to stimuli. Three types of stimuli can cause sleep difficulty.
- Mental stimulation. If your mind is still on problems when you go to bed, you may have trouble falling asleep. You may then worry about being unable to sleep. You may picture how tired you are going to be the next day. This makes you more tense and unable to sleep. You're in a state of cognitive hyperarousal.
- Physical stimulation. Some studies show that those with insomnia have a higher metabolic rate. Their heart rate may be faster, and their oxygen use may be higher. If your body has trouble slowing down for sleep, you may have physiologic hyperarousal.
- Arousal of the stress response system. Those with insomnia may have higher levels of stress hormones such as cortisol. Some people with unexplained insomnia have higher levels of these substances in the evening and the early part of the night. These stress hormones can interfere with sleep.
Miscellaneous types of insomnia
The International Classification of Sleep Disorders contains a more detailed breakdown of types of insomnia. Other types include:
- Psychophysiological insomnia. Those with this type of insomnia are overly concerned with sleep. They exhibit learned behaviors that interfere with sleep.
- Paradoxical insomnia. In this type, people complain of insomnia, but there is no proof of a problem with sleep.
- Idiopathic insomnia. This type appears in childhood for no apparent reason and can last for years.
Childhood insomnia
Most sleep disorders that affect children are behavioral. There are two main types, but some children exhibit a mixture of the two types.
Sleep-onset association type. Children with this type of insomnia learn to go to sleep in a certain way. Babies may depend on rocking or nursing to fall asleep. Older children may need to have a parent nearby, or they may learn to fall asleep while watching television. If something disrupts their sleep routine, they have trouble falling asleep.
Limit-setting. Children with this type of insomnia may refuse to go to bed. They may also put off bedtime by making repeated requests. This type may stem from parents who are not strict about bedtime. It can also happen when children have nighttime fears or other negative associations with sleep.
Is it really insomnia?
Do you have insomnia or just an occasional wakeful night? If you have trouble sleeping at least 3 times per week, and the problems persist for at least 1 month, you may have insomnia.
Insomnia usually causes these symptoms:
- Daytime fatigue or sleepiness
- Memory lapses
- Low energy
- Bad mood
- Difficulty concentrating
- Frequent errors or accidents
How much sleep is enough?
Most adults need at least 7 hours of sleep a night. Young people need more:
- Newborns require 14-17 hours of sleep a day
- Babies need 12-16 hours a day, including naps
- Toddlers should get 11-14 hours, including naps
- Preschool children need 10-13 hours, including naps
- School-age children need 9-12 hours
- Teens need 8-10 hours
If you have trouble sleeping, try keeping a sleep diary. Write down when you go to sleep, when you wake up, and a list of any periods of wakefulness during the night. You should also note factors that can affect sleep, including:
A sleep diary can help you and your doctor figure out your sleep problem. Apps and sleep trackers can also record your sleep patterns.
Treatment for insomnia
Researchers have found that people with insomnia are a varied group. They differ from each other in:
- Moods
- Thought patterns
- Personal traits
- Life events
- Family history
Because those with insomnia are so different, they may need different treatments. Most people should start with good sleep hygiene. That means creating an environment that promotes sleep and establishing a bedtime routine. It can also mean avoiding caffeine in the evening and shutting off screens before you go to bed.
Many people with insomnia benefit from cognitive behavior therapy (CBT). With CBT, you train yourself to sleep when you're tired and to wake when you're rested.
Sleep medications mostly treat the symptoms of insomnia, not the cause. Some doctors prescribe them only for short-term use.
