Insomnia is a broad term that refers to many different symptoms. If you have been diagnosed with insomnia, then you likely have trouble falling asleep or staying asleep. Newer research states that sleep loss must also cause daytime impairment for a diagnosis to be made. For example, insomnia may cause you to feel less alert or unable to make simple decisions during the day.
Insomnia can be broken down into several main types and subcategories. The different types of insomnia are categorized by their causes, symptoms, and how or where they occur in your body. Primary insomnia occurs when a person experiences sleep problems that are not directly related to any other condition. Secondary insomnia can be a symptom of another disease. Insomnia can either be acute (short-term) or chronic (long-lasting). Here is a breakdown of the types of insomnia and how to treat them.
Different Types of Insomnia
Classifying the different types of insomnia is important because it allows your doctor to suggest the best treatment plan for you. Early classification systems used to group insomnia types according to their primary symptoms because there was little knowledge available about other sleep disorders. The three most important types were insomnia, abnormal events that take place during sleep, and excessive sleepiness.
In 2005, the second version of the International Classification of Sleep Disorders was published. It underwent revision and no longer classified insomnia types by symptoms alone. Instead, researchers grouped types of insomnia by symptoms (trouble falling asleep), how they occur (circadian rhythm disruptions), and what body parts they affect (such as breathing disorders). The third edition of the International Classification of Sleep Disorders was published in 2014. It contains the most up to date classification of insomnia disorders (2).
Key findings of the third edition of the International Classification of Sleep Disorders include the following (3):
- The most current and advanced classification of sleep disorders according to experts.
- There are six divisions of sleep disorders: insomnia, central disorders of hypersomnolence, circadian rhythm disorders, sleep-related breathing disorders, parasomnias, and sleep-related movement disorders.
- The “other sleep disorder” category has been added for sleep disorders that do not fit the other six categories.
- Two appendices were added: ICD-10-CM coding for sleep disorders caused by substance abuse and sleep-related neurological and medical disorders.
According to the most recent publications, insomnia conditions are much shorter than they were in the 2005 edition because all chronic insomnia cases have been classified into one category. The general definition of insomnia remains unchanged. It states that insomnia is a persistent difficulty with sleep related duration, consolidation, quality or initiation that occurs even though there are adequate opportunities and circumstances for sleep. Symptoms also need to result in daytime impairment (3). The six types of insomnia include (3):
- Chronic insomnia disorder
- Short-term insomnia disorder
- Other insomnia disorder
- Normal variants and isolated symptoms
- Excessive time spent in bed
- Short sleepers
To be diagnosed with chronic insomnia, the following criteria must be met (3):
- The patient reports one or more of the following: difficulty falling asleep, problems with staying asleep; waking up earlier than wanted; unable to follow an appropriate bedtime schedule; and unable to sleep without intervention from a parent or caregiver.
- The patient experiences one or more of the following symptoms: fatigue; attention or memory problems; impaired social, professional, family or academic performance; irritability or mood problems; sleepiness during the day; behavioral problems such as aggression, impulsivity or hyperactivity; reduced energy or motivation; increased errors or accidents; and concerns about sleep loss or dissatisfaction.
- The patient experiences sleep or wake complaints that are not caused by inadequate sleep opportunity, such as not spending enough time in bed, or environmental influences, including a bedroom that is not quiet and comfortable enough for sleep.
- Sleep problems and daytime symptoms occur at least three days every week.
- Sleep issues have been present continuously for at least three months.
- An underlying medical disorder does not explain the sleep problems.
Short-term insomnia disorder is sometimes called transient insomnia or adjustment sleep disorder. It often occurs as a reaction to stress, such as a major or traumatic event. Losing your job or a loved one, becoming ill, or suffering from an injury can cause short-term insomnia. In some cases, a minor event can cause short-term insomnia, such as extreme weather conditions, traveling, work problems, taking an exam or test, and eating the wrong foods. For most people with short-term insomnia, sleep patterns return to normal when the stressor goes away. Treatment is only needed if sleep loss affects daytime functioning or if it continues for more than a few weeks (4).
Other causes of short-term insomnia may include fluctuations in hormones, such as when a woman menstruates or becomes pregnant. A woman may return to her normal sleep schedule when the hormones stabilize. Jet lag or traveling across several time zones may cause sleep disturbances that work themselves out within a few days. Light, noise or extreme temperature changes can cause insomnia. Excessive light at night or insufficient light during the day can disrupt sleep patterns. Caffeine intake, your partner’s sleeping habits, or medications can also cause short-term insomnia disorder.
“Other insomnia disorders” refers to any condition that for whatever reason does not belong to any other category. A physician can help determine if your insomnia belongs to this classification. Patients who fall into the “other insomnia disorder” category usually complain of persistent sleep difficulty despite adequate opportunity for sleep and daytime dysfunction. This group of people may not meet the qualifications for chronic insomnia or short-term insomnia disorder (3).
Short sleepers are defined as people who do not complain of daytime impairment despite getting less than six hours of sleep a night (3). For a person to be considered a normal short sleeper, they must sleep for six hours a night without any other insomnia symptoms, including memory or attention problems. If you know anyone who appears to function well on only a few hours of sleep each night, they might be one of the few people who are normal short sleepers.
According to the National Sleep Foundation, there are several ways to group insomnia. Acute insomnia explains a brief period of sleeping difficulties while chronic insomnia is a long-term problem that usually occurs in people with a history of sleep disturbances (5).
Comorbid insomnia happens when a person has sleep problems in addition to another condition. For example, anxiety and depression are known to coexist within insomniacs. In some cases, a medical condition such as arthritis or back pain may cause a person to become uncomfortable at night. Onset insomnia occurs when a person only has trouble falling asleep first thing at night. Maintenance insomnia is when a person can’t stay asleep. They may wake up in the middle of the evening and can’t get back to sleep (5).
Insomnia can be categorized as either primary or secondary. Research shows there are six main types of primary insomnia (6):
- Psychophysiological insomnia: a form of insomnia that occurs for at least a month. It is brought on by a heightened awareness of one’s surroundings due to learned sleep behaviors that prevents a person from being able to fall asleep. In other words, a person with this type of insomnia is obsessed with their inability to sleep.
- Paradoxical insomnia: a severe form of insomnia that is present in less than five percent of insomniac patients. It occurs when a person experiences little or no sleep at all on most nights.
- Idiopathic insomnia: this form of insomnia may have started when the patient was a child. It occurs without periods of remission. Experts are not sure what factors bring on idiopathic insomnia.
- Inadequate sleep hygiene: a type of primary insomnia that occurs when a person has a quality sleep and full alertness during the day, but they may have an irregular bedtime or wake up times. They may also have poor sleep hygiene, such as ingesting caffeine or nicotine before bed. These disturbances do not always cause sleep loss in other people.
- Behavioral insomnia of childhood: a form of insomnia that features sleep-onset association disorder and limit-setting sleep disorder. Limit-setting sleep disorder occurs when a person stalls or refuses to go to sleep and has to be coerced to bed by a caregiver. Sleep-onset association disorder happens when a person relies on certain factors to help them fall asleep, such as falling asleep in your favorite chair, in a well-lit room, or while watching TV. Children who can only fall asleep while being rocked may belong to this category.
- Adjustment insomnia: a sleep disorder that occurs when a person experiences a significant amount of stress. It only lasts for a few days and goes away on its own in most cases.
Many different types of secondary insomnia exist. They may occur when a person becomes dependent on a stimulant, including alcohol, caffeine, or a recreational drug. Insomnia may occur when a person ingests or discontinues use of these substances. Inadequate sleep hygiene or an underlying medical condition may be to blame. Some medical conditions that are known to cause insomnia may include cardiovascular disease, irritable bowel disease, diabetes, stroke, and neurological disorders. Treatment for secondary insomnia involves treating the primary condition.
Types of Insomnia Medication
Medication can be used to treat insomnia, but you might want to stay away from them. Research shows that common side effects of prescription sleeping pills may include the following (7):
- Intestinal gas
- Balance issues
- Abdominal pain
- Dry mouth
- Drowsiness in the daytime
- Excessive sedation
- Attention or memory problems
- Changes in appetite or body temperature
- Burning sensation in the limbs
- Tremors or shaking
- Muscle weakness or pain
- Vivid dreams and nightmares
Synthetic sleep aids do not mix well with other problems, including alcohol and even grapefruit juice. According to WebMD, eating grapefruit or drinking its juice can cause oversedation because it enhances the amount of time the drug stays in your bloodstream (7). People who take prescription sleep aids are at an increased risk of becoming dependent on them. They may also wear off the longer you take them, which increases the need to take more to get the same results. Some research even shows that synthetic sleep aids may shorten your lifespan.
Many sleep experts recommend using natural remedies to improve insomnia. Cognitive behavioral therapy is better at treating insomnia than taking a drug, according to researchers at Consumer Reports (8). One report argues that sleeping aids don’t work very well. Cognitive behavioral therapy has been shown to work even after the patient discontinues treatment. It works by teaching you how to redirect negative thoughts and behaviors that prevent sleep.
For example, you might learn how to develop regular sleep habits by changing your behavior using methods such as controlling stimulus and sleep restriction. You will also work with a therapist to change the way you think about sleep. The report indicated that cognitive behavioral therapy has no side effects and is effective for most adults with chronic insomnia. After spending some time working with a qualified sleep specialist, you can use cognitive behavioral therapy to treat insomnia whenever sleep problems arise. They also prevent you from developing another sleep disorder.
Some people use cognitive behavioral therapy in addition to a natural sleep aid. Experts recommend establishing a bedtime routine that includes doing something relaxing before bed. You may wish to enjoy dinner followed by a warm cup of chamomile tea and then read a book. Other people like to relax in a hot bath or partake in a meditation session. You can combat stress early in the day by exercising or taking short breaks when you need them. Take a natural sleep aid shortly before climbing in bed or diffuse lavender essential oil into your room.
Research shows there are six types of insomnia. Sleep disorders are characterized by their symptoms, how they occur, and what part of the body they affect. A sleep specialist can help determine which one you have and how to treat your condition. Resist taking a prescription medication. Instead, use cognitive behavioral therapy or just a natural aid along with proper sleep hygiene to get the rest you need.