Types of Insomnia

Insomnia is a common sleep disorder that makes it hard to fall asleep and/or remain asleep. Insomnia prevents you from getting the amount and quality of sleep you need to function normally.

Without treatment, insomnia can affect daytime alertness. It can impact your ability to think, remember, and react. It can also affect your health and disease risk.

Not everyone who struggles with insomnia has the same issues. Different types of insomnia vary in their cause, the sleep problems associated with them, and how long they occur.

This article discusses the types of insomnia, their symptoms, and how the condition is diagnosed and treated.

Types of Insomnia

All types of insomnia interfere with getting the amount and quality of sleep you need. The effect of insufficient sleep on your body is generally the same across all types of insomnia.

Common symptoms across all types of insomnia include:

• Taking a long time to fall asleep
• Having a cycle of sleep and wakefulness through the night
• Feeling that you didn't sleep when you awaken
• Having daytime fatigue or sleepiness
• Lacking motivation or energy
• Having problems paying attention, remembering, or concentrating
• Being unable to perform normally at work or school
• Being irritable and moody
• Making preventable errors or having accidents
• Being concerned about your lack of sleep
  
• Waking up too early in the morning

Understanding the variations of insomnia can help you identify the factors that may be causing your problem so you can work to correct them.

Acute vs. Chronic Insomnia

Insomnia can be classified by the amount of time the problem affects your life. It can be described as acute (short term) or chronic (long term). It can also occur for a period, stop, and then recur.

Acute insomnia involves problems falling asleep or staying asleep at least three days per week for a period of between one week and three months. It is usually linked to one of the following factors:

• Stress at home and/or work
• Stress in personal or professional relationships
• Physical injury
• Environmental changes caused by light, noise, or temperature
• Acute pain
• A traumatic event such as the loss of a loved one, divorce, or job loss
• Jet lag
• Temporary use or withdrawal of caffeine, alcohol, illegal drugs, or prescribed medications
• Shift work

Chronic insomnia involves being unable to fall asleep or stay asleep at least three days per week for a period of three months or longer. It may result when the stressors that cause acute insomnia aren't handled.

Chronic insomnia can also occur as a symptom or side effect of one of the following conditions:

• Chronic medical conditions like GERD (gastroesophageal reflux disease), heart disease, or thyroid problems
• Other sleep disorders like sleep apnea or restless legs syndrome (RLS)
• Chronic mental health problems like depression, anxiety, or PTSD (post-traumatic stress disorder)
• Long-term use of certain medications or illegal drugs
• Long-term use of caffeine or alcohol
• Lack of regular sleep habits
  

Primary vs. Secondary Insomnia

Insomnia can also be classified based on the condition's relationship to other issues.

Primary insomnia occurs when your inability to sleep isn't linked to a known cause. The fact that you can't sleep and/or remain asleep isn't due to a side effect of a medical condition, psychological issue, or medication.

Primary insomnia may occur due to unknown causes, though it can be linked to the effects of the following issues:

• Long-lasting stress
• Emotional distress
• Travel or jet lag
• Shift work

Secondary insomnia accounts for most cases of insomnia. It can be acute or chronic. Secondary insomnia occurs as a side effect or symptom of one of the following factors:

• Medical conditions
• Psychological conditions
• Sleep disorders
• Substances like caffeine, alcohol, or tobacco
• Prescription medications or illegal drugs

Onset vs. Maintenance Insomnia

Insomnia can be defined based on where it interferes with the natural sleep cycle. It can prevent you from falling asleep and staying asleep.

Onset insomnia affects your ability to fall asleep at the time you wish. It is usually linked with psychological or psychiatric issues. Onset insomnia can also be a symptom secondary to a medical condition or sleep disorder.

Onset insomnia is more common in younger than older adults. It can also occur when children become stressed by being alone before sleep.

People who have onset insomnia often have one of the following conditions, though others are possible:

• Psychophysiological insomnia (PPI)
• Obstructive sleep apnea-hypopnea syndrome
• Periodic limb movements in sleep (PLMS)
  
• Delayed sleep phase syndrome
• Congestive heart failure
• Restless legs syndrome

Maintenance insomnia is a condition that makes it difficult to maintain sleep after you've fallen asleep. It occurs more often in older adults since sleep cycles change with age.

Other Types of Insomnia

Other types of insomnia include the following:

Behavioral Insomnia of Childhood

Some types of insomnia are more common in children. They occur when children associate certain behaviors with falling asleep. They include:

• Sleep-onset association insomnia occurs when children rely on actions, such as being rocked or held, to fall asleep. They become unable to sleep without the specific action.
• Limit-setting insomnia occurs when a child acts out before bedtime. They typically make repeated demands and refuse to go to sleep. This often occurs because they don't have a strict bedtime routine that is enforced nightly.

Idiopathic Insomnia

Idiopathic insomnia is a form of chronic insomnia. It occurs without any visible causes. It often begins in childhood and becomes a lifelong problem that occurs nightly.

Inadequate Sleep Hygiene 

Inadequate sleep hygiene is a sleep disorder that occurs when you have sleep habits that interfere with sleep. This problem can develop when you don't have a healthy bedtime routine to help you fall asleep naturally.

Paradoxical Insomnia

Paradoxical insomnia is a disorder in which you complain of getting poor sleep or not getting enough sleep, even though there is no evidence of a sleep problem.

Psychophysiological Insomnia

Psychophysiological insomnia is defined as having a state of heightened arousal, worry, and anxiety about sleep and sleeplessness. Instead of falling asleep, people focus on their sleep and are concerned about not getting enough of it.

Psychophysiological insomnia is considered a learned form of insomnia. It usually occurs when you can't sleep and then become overly concerned about getting enough sleep. Even though you may realize that your anxiety interferes with sleep, the worry increases as you remain awake.

Complications of Poor Sleep

Getting inadequate or poor sleep due to insomnia can have a dramatic impact on your physical and mental health. Without proper rest, your body and brain don't have a chance to repair themselves. Lack of sleep can impact your overall well-being.

Insomnia can increase your risk of the following complications:

• High blood pressure
• Coronary artery disease
• Cancer
• Diabetes
• Obesity
• Stroke
• Depression
• Injury to yourself or others in an accident as a result of impaired cognitive abilities

How Insomnia Is Diagnosed

Your healthcare provider may recommend that you see a sleep specialist if you complain of insomnia that doesn't improve with lifestyle changes. To determine the cause of your sleep problems, your healthcare provider or sleep specialist may do the following:

• Take your medical history, including medical conditions, medications, and sources of stress
• Take your sleep history, preferably from a sleep diary that you have kept to describe the type of sleep problem you're having, what it feels like, and how long it has occurred
• Perform a physical exam to find any physical causes for your insomnia
• Refer you for or perform a polysomnogram (sleep study) overnight in a sleep lab to monitor a sleep cycle

Treatment and Prevention

The type of treatment your healthcare provider recommends depends on the type of insomnia you have and the cause of the problem. The condition is usually resolved when the underlying medical or psychological cause is treated.

Research indicates that the best results are achieved by combining medical and nonmedical treatments rather than using one alone.

Common treatments for insomnia include:

• Cognitive-behavioral therapy (CBT, a type of talk therapy)
• Lifestyle changes
• Prescription medication to help you sleep
• Over-the-counter sleep aids that contain antihistamines or diphenhydramine
• Melatonin supplement (lab-made form of the hormone melatonin)

You can help prevent insomnia by taking these precautions:

• Avoid substances like caffeine, alcohol, and some medications that can prevent quality sleep.
• Follow the same sleep routine every night, including waking at the same time every day.
• Get out of bed if it takes too long to fall asleep, then try again 15 minutes later.
• Avoid napping.
• Sleep in a cool, dark room.
• Don't use electronics or your phone in the bedroom.
• Avoid eating, drinking, or exercising close to the time you want to fall asleep.
• Learn relaxation and deep breathing techniques to help you relax.
• Treat and maintain physical and psychological conditions.
  

Summary

Insomnia is a common sleep disorder. It can prevent falling asleep and staying asleep. There is more than one type of insomnia. Types differ by cause, how long they last, and how they affect you.

To treat insomnia, you must treat the cause of your sleep problems. Treatment can include cognitive behavioral therapy, medications, and lifestyle changes. Using both medical and nonmedical therapies can improve your sleep.

A sleep expert can help you find the treatment you need. Insomnia often improves or resolves when the primary cause is treated. This can help you enjoy the health and mental benefits of a good night's sleep.

A Word From Verywell

Living with any insomnia can affect your quality of life. Without enough sleep, it's normal to feel tired and moody throughout the day.

Chronic irritability can affect both personal and work relationships. It can also increase your risk of causing accidents as your thinking skills weaken without enough sleep.

The good news is that insomnia can often improve when you treat the cause of the problem. Consult your healthcare provider to get started on a plan to fix your sleep problems. The result can improve your health, relationships, and the way you feel.