“Insomnia” is one of those buzzwords with which most of us wish we were way less acquainted. But alas, the persistent problem with sleeping that keeps us from falling and staying amid our dreams affects an estimated 50 percent of us. A lesser-known fact, though, is that the condition is actually something multifaceted and varied. That’s right—there are six types of insomnia that may be keeping you from accessing peak snooze.
First, to be clear, the clinical criteria for insomnia clarifies that it takes place when a regular lack of a good night’s sleep is messing with your ability to function normally. According to the International Classification of Sleep Disorders, difficulty sleeping can be considered insomnia when someone has “a persistent difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity and circumstances for sleep, and results in some form of daytime impairment.”
Since there are different types of insomnia (and a person can suffer from different types concurrently) knowing the kind plaguing your lack of dreams is important intel for being able to effectively treat it, says neurologist and sleep specialist Kenneth Sassower, MD. Rounded up below are the types of insomnia doctors look for.
Acute insomnia happens when a person has trouble sleeping, but it doesn’t last for three months or more, says sleep medicine specialist Aneesa Das, MD. This is usually different from having one bad night of sleep. Rather, it’s persistent and impacts some aspect of your life. “It has to be bothersome to you,” Dr. Das says. “If someone says, ‘It takes me an hour to fall asleep but it doesn’t bother me,’ that’s not [acute insomnia].”
Acute insomnia can often be the result of a stressor, like losing a loved one or taking on a new, intense job, says sleep-medicine researcher and neurologist W. Christopher Winter, MD, author of The Sleep Solution: Why Your Sleep Is Broken and How to Fix It. The good news, he says, is that of all the types of insomnia, this one tends to resolve itself without any treatment.
Difficulty sleeping can be classified as chronic insomnia when it happens at least three times a week, for more than three months, Dr. Winter says. And to clarify, Dr. Das adds that people with chronic insomnia can either have trouble getting to sleep or staying asleep.
“Difficulty sleeping can be classified as chronic insomnia when it happens at least three times a week, for more than three months.” —sleep-medicine researcher W. Christopher Winter, MD
Treatment varies, but Dr. Winter says sleep specialists generally recommend chronic insomniacs to undergo Cognitive Behavioral Therapy for Insomnia (CBT-I), a form of counseling that aims to reframe a patient’s perception of sleep.
Dr. Das says this can take effect in several ways, one being changing the patient’s perception of how much sleep they actually need. “People who have chronic insomnia often think, ‘If I don’t fall asleep tonight, the world is going to end.’ We work on changing that to ‘I’ve had insomnia before and I’ve survived. I’ll survive again,” she says.
Sometimes medication may be used to help along with CBT-I, but it’s usually just for a short time, Dr. Das says.
This form of insomnia happens as a result of some other underlying illness, Dr. Sassower says. That could mean struggling with anxiety or depression that keeps you awake at night, having acid reflux that wakes you up in the middle of the night, or struggling with back pain that makes it hard to fall asleep.
In the case of comorbid insomnia, you want to try to treat the underlying issue first, Dr. Sassower says. Once you do, the insomnia should clear up.
Onset insomnia is difficulty falling asleep in the beginning of the night. People with onset insomnia usually take more than 30 minutes to fall asleep, Winter says.
Onset insomnia may be treated with CBT-I or sleep-restriction therapy, Dr. Das says. Sleep-restriction therapy involves a sleep-medicine specialist determining how much sleep you’re actually getting compared to how much time you’re in bed. They then restrict the amount of time you’re in bed to the time you’re actually sleeping (within reason). So, if you’re in bed for 10 hours but only sleeping for six to seven of those, your doctor might recommend that you only be in bed for seven hours. If you’re still struggling, that time will be reduced even more. “Once the patient has consolidated sleep, you slowly stretch it out again,” Dr. Das says.
People with maintenance insomnia are able to fall asleep just fine, but they wake up in the middle of the night and can’t get back to sleep, Dr. Sassower says. Treatment for this varies, he says, but it often involves trying to pinpoint why you’re waking up in the night and then troubleshooting that. For example, it could be that you struggle with sleep apnea and your own snoring is waking you up, or maybe it’s whatever’s making you wake up to use the bathroom in the middle of the night. Learning to work with or around those hurdles can go a long way toward treating this type of insomnia, Dr. Sassower says.
People with maintenance insomnia can also benefit from doing more exercise, spending less time in bed, and urging their partner to treat any sleep problems that persist, Dr. Winter adds.
Sleep is obviously important and, if you’re having difficulty clocking in your hours each night, that reality alone can stress you out. People who worry about their sleep and, in turn, don’t get enough, struggle with psychophysiological insomnia, Dr. Winter says.
Often, relaxation therapies can help treat this, Dr. Das says. That could mean going through guided imagery to steer your thoughts to a comfortable place, like walking through the woods or floating in the ocean. “You work on controlling your thoughts so that your daily worries aren’t in your thoughts at bedtime,” she adds. Progressive muscle relaxation, where you tense and then relax muscles throughout your body, can also be helpful.
If you’re struggling with sleep, Dr. Sassower recommends your first order of business being to make an appointment to talk about it with your primary-care physician. If problems persist, ask about getting a referral to a sleep medicine specialist.
Now that you’re familiar with the different types of insomnia, learn how one editor cured hers by sleep training. Plus, everything you need to know about orthosomnia, the cultural obsession with hacking your sleep.