Sleep insomnia takes on many different forms. If you can’t relax and think you may have a sleep disorder, there are a few different insomnia meanings you should be aware of. Insomnias can be primary or secondary and acute or chronic.
Unlike secondary insomnia, primary insomnia is not due to an underlying medical condition. Acute insomnia may only last a few nights while chronic insomnia can plague you for months or even years.
While an insomnia definition may vary from person to person, everyone’s goal is to get better sleep. Figuring out what is causing your insomnia is an important part of the treatment process. Here’s what you need to know about the different types of insomnia and how to treat them.
What is Insomnia?
Insomnia may be defined as the inability to fall asleep and stay asleep even when a person spends enough time in bed. According to the National Institutes of Health, about 30 percent of people have disrupted sleep. About 10 percent suffer from impaired daytime performance as a result of their sleepless nights (1).
To receive an insomnia diagnosis, a person must experience at least one of the following symptoms:
- Problems with falling asleep at night
- Waking up several times throughout the night
- Waking up too early
- Being unable to fall back asleep after waking in the night
- Waking up feeling tired or unrefreshed despite spending enough time in bed
About half of all people who took a 2005 National Sleep Foundation Poll reported having sleep problems at least a few nights each year. Another 33 percent claimed they had insomnia symptoms nightly or almost every night within the past year. A similar poll conducted by the National Sleep Foundation found that 63 percent of women have insomnia while 54 percent of men experience symptoms at least a few times each week (1).
Other polls have reported the following insomnia statistics (1):
- 68 percent of adults between the ages of 18 and 29 have insomnia symptoms
- 59 percent of adults between the ages of 30 and 64 have insomnia symptoms
- 44 percent of adults over the age of 65 have insomnia symptoms
- 66 percent of people who have children and 54 percent of individuals without children have insomnia
According to a 2012 study, insomnia may cause an increased risk of psychiatric disorders, more trips to the doctor, a higher risk of getting into a car accident, and poor job performance. The study found that depression, anxiety, and alcohol use were linked to insomnia. Other risk factors included being a non-white female, having health issues such as kidney or bladder problems, and having a high caffeine intake (2).
What Are The Different Types of Insomnia?
Sleep is a complicated process and so is insomnia. Most cases of insomnia are either primary or secondary. They can further be divided into acute (short-term) or chronic (long-term) insomnia. According to a 2004 study, most people experience chronic insomnia, but it is often undertreated (3). Primary insomnia is not caused by any other underlying conditions, such as a physical or psychological disorder. Secondary insomnia occurs as a result of another disease, such as chronic pain, movement disorders, or psychiatric conditions.
Transient insomnia is a third type of insomnia that may only last for a few days. It is often caused by environmental factors, such as temperature changes, medications or jet lag. In many cases, insomnia is treated as a symptom of another disease and not necessarily a primary disease itself. The majority of treatment options are aimed at finding the root of the underlying medical condition. For people with primary insomnia, there may not be another condition causing them to lose sleep. Furthermore, insomnia falls into a broad range of subcategories.
According to the Perelman School of Medicine at the University of Pennsylvania, insomnia can be broken down into the following types (4):
- Difficulty initiating and maintaining sleep (DIMS): a general term that is used to describe any of the different subcategories of insomnia
- Idiopathic insomnia: a lifelong type of insomnia that usually occurs within the first few weeks of life. Characteristics include a severe inability to initiate and maintain sleep.
- Inadequate sleep hygiene insomnia: a type of insomnia that includes a failure to fall asleep or stay asleep due to unhealthy lifestyle factors that are disruptive to the sleep process. Examples include staying up late at night, exposure to light, and excessive stimulant use.
- Initial insomnia (sleep onset insomnia): a type of insomnia that refers to difficulty falling asleep due to stress. It is associated with extreme daytime sleepiness.
- Insomnia not otherwise specified (NOS): a type of insomnia that occurs as a result of unknown factors.
- Late insomnia (sleep offset insomnia): a form of insomnia that occurs when a patient wakes up earlier than desired. It is often associated with depression.
- Middle insomnia (maintenance insomnia): a type of insomnia that occurs when a person falls asleep early and has problems staying asleep. They may wake up in the middle of the night and are unable to fall back asleep.
- Paradoxical insomnia: this type of insomnia is described as “insomnia without objective findings.” It occurs as a result of a sleep misperception in which a person’s brain stays awake while their body sleeps.
- Physiological insomnia (psychophysiological insomnia): a type of insomnia that occurs as a result of being stressed over one’s lack of ability to sleep. During physiological insomnia, a person may inadvertently prevent themselves from being able to fall asleep because they are anxious over their inability to sleep. It is one of the most common forms of insomnia, yet it is hard to treat.
No matter the type, insomnia worsens just about any medical condition. Sleep loss causes the body to make more stress hormones, such as cortisol and epinephrine, which leads to weight gain, a damaged immune system, and an increased risk of osteoporosis and diabetes (5)(6)(7). Sleep loss also enhances the production of inflammatory chemicals called interleukin-6 and tumor necrosis factor-alpha that increase the risk of heart disease and inflammatory bowel disease (8).
Insomnia may increase the perception of pain in chronic pain disorders such as fibromyalgia and osteoarthritis by changing pain signals sent to the brain and causing you to become more sensitive to them. Because of this, treating insomnia is an important part of reducing pain in patients with chronic pain disorders.
Insomnia may also increase your risk of a stroke. A 2013 study found that healthy people who slept six hours a night or less were at a four-fold increased risk of developing a stroke when compared to individuals who slept seven to eight hours (9).
Causes of Insomnia
Insomnia may be produced by a wide variety of internal and external factors. Research shows that some people are genetically inclined to have insomnia while other cases of insomnia are due to environmental cues, such as temperature and light exposure.
A 2017 study found that insomnia might not be purely due to a physiological condition. The study stated that there are seven genes associated with insomnia. These genes are linked to other traits, such as depression, neuroticism, and anxiety disorders, as well as a low perception of overall well-being (10).
People with secondary insomnia can thank an underlying condition for their sleep loss. There is a clear link between insomnia and mental health conditions, such as depression and anxiety. Mental health conditions can cause insomnia. Likewise, insomnia can increase the risk of developing a mental disorder. Research shows that people with insomnia are more likely to develop depression within a year (11). Other data indicate that insomnia is linked to certain personality traits, such as repressing your feelings or being a social introvert (12).
In some cases, you can cause your own insomnia by worrying about not being able to sleep. Psychophysiological insomnia occurs when you obsess over your inability to sleep. In other words, if you think you can’t fall asleep, then you won’t be able to. The condition appears to be due to a type of hyper-arousal before going to bed. Experts believe that people with psychophysiological insomnia become restless at night or have a hard time relaxing, which results in racing thoughts that prevent them from falling asleep. This causes them to focus on their inability to sleep and causes further physiological distress. In time, their insomnia leads to unhealthy bedtime habits and sleep loss that affects their daytime productivity.
General insomnia may be caused by one of the following health conditions:
- Cardiovascular disese
- Digestive diseases
- Musculoskeletal disease
- Immune system problems
- Respiratory illnesses
- Urinary problems
- Neurological disorders
- Hormonal imbalances
- Thyroid disorders
- Lifestyle habits or poor sleep hygiene
- Working the night shift
Most patients with insomnia can benefit from changing their sleep habits, even if poor sleep hygiene is not the primary cause of their condition. Developing proper sleep hygiene can help you relax at bedtime and ease your mind into sleep. Light exposure is one of the biggest driving forces behind your circadian rhythm or your internal sleep cycle. When your brain senses light, it stops the production of melatonin, a hormone that makes you sleepy. People who expose themselves to artificial light late at night could be throwing off their sleep cycle by interrupting the production of melatonin.
Insomnia may turn deadly in rare cases. Obstructive sleep apnea is a sleep disorder that occurs when a person’s airway collapses during the night and limits their oxygen flow. Disrupted sleep occurs as a result of low oxygen in the individual’s bloodstream even if they don’t remember waking up. Research shows that up to seven percent of adults have obstructive sleep apnea, which causes fatigue, poor sleep quality, and snoring (13). Obstructive sleep apnea has been shown to increase the risk of coronary heart disease in men by 68 percent (14). It also causes an increased risk of hypertension, cholesterol, type two diabetes, stroke, and death due to cancer (15)(16)(17).
How To Treat Insomnia
Treatment methods for insomnia depend on the type you have. For example, people with secondary insomnia may want to address their sleep loss by treating the underlying cause. Be cautious when turning to prescription sleep medications as these may cause the following side effects (18):
- Digestive distress such as gas, bloating, diarrhea and constipation
- Daytime drowsiness
- Memory problems
- Balance problems
- Changes in appetite
- A burning or numbness sensation in the arms, legs, hands, and feet
- Cognitive dysfunction the next day, such as problems making simple decisions
- Abdominal or stomach pain and discomfort
- Muscle weakness or pain
- Nightmares or unusual dreams
Some prescription medications are highly addictive and may even cause you to become more tired the next day. Research shows that people who take synthetic sleep aids are more likely to get into a car accident (19). Sleeping pills have even been linked to death (20). Because of this, many insomnia patients turn to non-drug methods of treatment.
Research shows that cognitive behavioral therapy may help people with both primary and secondary insomnia by developing habits that are more conducive to sleep (21). One study even found that cognitive behavioral therapy was more effective in treating insomnia in older adults than the prescription medication zopiclone (22). The best part about using cognitive behavioral therapy is that there are no side effects associated with this type of treatment.
The principles behind cognitive behavioral therapy can be taught in the office of a mental health professional, such as a therapist. Meditation is another form of treatment that can be used without taking prescription drugs. Studies show that meditation is effective at treating fatigue, anxiety, stress, insomnia and depression symptoms (23). It also reduces inflammatory factors that are linked to many diseases.
Just about anyone can benefit from participating in better sleep habits at night. This includes limiting your exposure to light late at night, making your bedroom a comfortable place to rest, and enjoying dinner as the lightest meal of your day. Develop your body’s internal sleep cycle by going to bed at the same time every night and waking up at the same time every morning. Exercising earlier in the day and limiting stimulants such as caffeine and alcohol can also help improve your sleep.