Signs you have insomnia

What Are the Different Types of Insomnia?

There are a few different types of insomnia. Each type is characterized by how long it lasts, how it affects your sleep, and the underlying cause.

Acute insomnia

Acute insomnia is short-term insomnia that can last from a few days to a few weeks. It’s the most common type of insomnia.

Acute insomnia is also referred to as adjustment insomnia because it typically occurs when you experience a stressful event, such as the death of a loved one or starting a new job.

Along with stress, acute insomnia can also be caused by:

  • environmental factors that disrupt your sleep, such as noise or light
  • sleeping in an unfamiliar bed or surroundings, such as a hotel or new home
  • physical discomfort, such as pain or being unable to assume a comfortable position
  • certain medications
  • illness
  • jet lag

Chronic insomnia

Insomnia is considered chronic if you have trouble sleeping at least three days per week for at least one month.

Chronic insomnia can be primary or secondary. Primary chronic insomnia, which is also called idiopathic insomnia, doesn’t have an obvious cause or underlying medical condition.

Secondary insomnia, also called comorbid insomnia, is more common. It’s chronic insomnia that occurs with another condition.

Common causes of chronic insomnia include:

  • chronic medical conditions, such as diabetes, Parkinson’s disease, hyperthyroidism, and obstructive and central sleep apnea
  • mental health conditions, such as depression, anxiety, and attention deficit hyperactivity disorder
  • medications, including chemotherapy drugs, antidepressants, and beta blockers
  • caffeine and other stimulants, such as alcohol, nicotine, and other drugs
  • lifestyle factors, including frequent travel and jet lag, rotating shift work, and napping

Onset insomnia

Onset insomnia is trouble initiating sleep. This type of insomnia can be short term or chronic.

Any of the causes of acute and chronic insomnia can make it difficult to fall asleep. Psychological or psychiatric issues are the most common causes. These include stress, anxiety, or depression.

According to a 2009 study, people with chronic onset insomnia often have another sleep disorder, such as restless leg syndrome or periodic limb movement disorder.

Caffeine and other stimulants can also prevent you from falling asleep.

Maintenance insomnia

Maintenance insomnia is difficulty staying asleep or waking up too early and having trouble getting back to sleep. This type of insomnia causes you to worry about not being able to fall back asleep and not getting enough sleep. This interferes with sleep further, creating a vicious cycle.

Maintenance insomnia can be caused by mental health conditions, such as depression. Other medical conditions that can cause you to wake up include:

  • gastroesophageal reflux disease
  • sleep apnea
  • asthma and other respiratory conditions
  • restless leg syndrome
  • periodic limb movement disorder

Behavioral insomnia of childhood

Behavioral insomnia of childhood (BIC) affects approximately 25 percent of children. It’s divided into three subtypes:

  • BIC sleep-onset. This type results from negative associations with sleep, such as learning to go to sleep by being rocked or nursed. They may also include having a parent present or watching TV while falling asleep.
  • BIC limit-setting. This type of BIC involves a child’s refusal to go to bed and repeated attempts to put off going to sleep. Examples of this behavior are asking for a drink, to go to the bathroom, or for a parent to read them another story.
  • BIC combined type. This form is a combination of the other two subtypes of BIC. This occurs when a child has a negative association with sleep and resists going to bed because of a lack of limit-setting by a parent or caretaker.

BIC can usually be resolved with a few behavioral changes, such as creating a healthy sleep routine or learning self-soothing or relaxation techniques.

“Do I have insomnia?” is the question often asked after a few nights of sleeplessness. Is your bad sleep just an isolated episode related to external factors or is it the part of a more persistent problem and how can you tell the difference? The following test will help you determine whether you have insomnia or not. Insomnia affects 1/3 of the population, with 10 % suffering from chronic insomnia. The impact of insomnia is felt not only in the day-to-day life of millions of people but also economically with insomnia costing the US government $63 billion in lost work.

About the insomnia test

This test is a variation on the ISI or Insomnia Severity Index, an assessment tool designed to determine the severity of someone’s insomnia. It was created by Charles M. Morin, Ph.D., Professor of Psychology at the Laval University in Quebec City, Canada who is one of the most influential and recognized sleep scientists in the world. This test is widely used in both clinical and observational studies as a way to screen and assess insomnia and answer this crucial question: “Do I have insomnia?”

Do I have insomnia? Take the test

It’s simple, you just have to rate the following criteria from 0 to 4. It is important to take into consideration the most recent data (i.e your insomnia for the last two weeks).

About the quality of your sleep

1. How difficult do you find falling asleep?

0. Not difficult at all 1. Not really difficult 2. Moderately difficult 3. Difficult 4. Very difficult

2. How difficult do you find staying asleep? Do you wake up often during the night?

0. Not difficult at all 1. Not really difficult 2. Moderately difficult 3. Difficult 4. Very difficult

3. How difficult do you find waking up in the morning?

0. Not difficult at all 1. Not really difficult 2. Moderately difficult 3. Difficult 4. Very difficult

About the impact of insomnia on your life

4. How satisfied/ dissatisfied are you with your current (the past two weeks) sleep pattern?

0. Very Satisfied 1. Satisfied 2. Moderately satisfied 3. Dissatisfied 4. Very Dissatisfied

5. To what extent is your current sleep problem noticeable to others and impacting your quality of life?

0. Not at all noticeable 1. A little 2. Somewhat 3. Much 4. Very much noticeable

6. How worried/distressed are you about your current sleep problem?

0. Not at all worried 1. A Little 2. Somewhat 3. Much 4. Very much worried

7. How much is your current sleep problem interfering with their daily life (fatigue, mood, concentration, memory, etc…)?

0. Not at all interfering 1. A Little 2. Somewhat 3. Much 4. Very much

Add up your answers and the total (between 0 and 28) determines how severe your insomnia is:

  • 0-7: Absence of insomnia
  • 8-14: Sub-threshold insomnia
  • 15-21: Clinical insomnia (moderate)
  • 22-28: Clinical insomnia (severe)

If you score between 0 and 7, then you don’t need to worry. You have a very strong sleep structure, most likely with good sleep hygiene. Keep going!

If you score between 8 and 14 then you are still under the threshold and you cannot be considered as insomniac. However, your sleep can be affected by your daily life, stress, etc. It may be worth looking into to ways to handle these issues before they affect your sleep more severely.

If you score between 15 and 28, you present the symptoms of clinic insomnia (moderate or severe). It’s time to take action, insomnia is not a life sentence, sleeping pills are far from the most effective treatment and therapy has proven to be effective. For example, you can try Cognitive and Behavioral Therapy for Insomnia (CBT-I), the treatment recommended by the scientific and medical community.

Do I have insomnia? For a more in depth look

The ISI, Insomnia Severity Index is a self-assessment tool, so the answers are subjective. Nonetheless, it has been proven to be reliable and effective. That’s why it is widely used as an assessment tool. The ISI can represent the first step in someone’s journey to finding help to resolve their insomnia, or a check-in to later check the efficacy of the measures they take.

Obviously for a more precise idea of severity of someone’s insomnia or their progress as they try to resolve it, their ISI needs to be completed with more information, like objective sleep data. Among other things, Dreem 2 measures sleep with a precision comparable to that of a polysomnograph, providing a clear, detailed view of the state of your sleep night after night.

Up next: Insomnia treatments and solutions: Top 8

Do I have insomnia? Take the test 5/5 (3 vote)

Insomnia: What You Need to Know as You Age

Soothe into sleep. If your loved one has Alzheimer’s disease or another type of dementia, these steps can help:

  • Keep a consistent schedule in terms of bedtime, wake-up time and meals.
  • Encourage the person to be physically active during the day (but to avoid exercise in the evening).
  • Help your loved one avoid caffeine, nicotine and alcohol.
  • Remind your loved one to use the restroom before bed.
  • Provide some very low lighting in the evening—darkness can be upsetting to people with dementia.
  • Speak in a calm, soothing tone if your loved one wakes up at night.

Definitions

Dementia (di-men-sha): A loss of brain function that can be caused by a variety of disorders affecting the brain. Symptoms include forgetfulness, impaired thinking and judgment, personality changes, agitation and loss of emotional control. Alzheimer’s disease, Huntington’s disease and inadequate blood flow to the brain can all cause dementia. Most types of dementia are irreversible.

Restless legs syndrome (RLS): A disorder that creates a strong urge to move your legs often because you notice strange or unpleasant sensations: creeping, crawling, pulling, itching, tingling, burning, aching and even electric shocks. When you move your legs, it relieves the strange sensations. The unpleasant feelings are strongest when you are resting or inactive, and they can make it difficult to fall or stay asleep.

Sleep apnea (ap-ne-ah): A disorder in which your breathing repeatedly stops or becomes very shallow as you sleep. Your breathing may pause anywhere from a few seconds to a few minutes. This ongoing condition disrupts your sleep, making you tired during the day and increasing your risk for heart problems, diabetes, obesity and driving or work-related accidents.

Do I Have Insomnia? Symptoms and Diagnosis for the Common Sleep Disorder

  • A sleep log (a diary you keep to track the details of your sleep over several days, weeks, or months)
  • A sleep inventory (a more extensive questionnaire about your sleep habits, medical history, and personal health)
  • Blood tests (which help the doctor rule out underlying medical conditions)
  • A sleep study (an overnight sleep test in a lab that lets a doctor objectively evaluate your sleep)

Using all of these tools gives doctors a picture of the factors affecting your sleep and helps them determine if there might be an underlying psychological or medical problem behind your sleep trouble that needs to be addressed, or what type of help you need.

One critical component of diagnosing insomnia is accurately and comprehensively measuring the problems the condition is causing so that all of those symptoms can be addressed in a treatment plan. For instance, if there’s an unidentified underlying medical condition, say, arthritis, that’s contributing to your insomnia, any amount of behavioral therapy you do may be futile if no one’s addressing the chronic pain keeping you awake at night.

If you have sleep problems, here are some topics you may want to bring up with your doctor, according to the National Sleep Foundation:

  • What your sleep troubles look like, when you experience them, and how often
  • How long you have had trouble sleeping
  • Your typical sleep routine (including daytime naps, if you take them)
  • Whether your weekend and weeknight sleep schedules are different
  • What you do when you can’t sleep
  • Any feelings of anxiousness, stress, or worry when you can’t sleep
  • Where you sleep and what your sleep environment looks like
  • Whether you’ve recently started a new job, moved, or had any other major life changes
  • Any chronic medical conditions

And remember, the sooner you tell your doctor about sleep problems, the easier they tend to be to address. Insomnia can be like a bad habit, in that the longer you let it continue, the tougher it is to change (which is what happens when acute insomnia becomes chronic insomnia). You want to address your sleep problems — or the underlying problems triggering them — before they become a bad habit.

What Is Chronic Insomnia and How Is It Treated?

A number of at-home and professional treatment options are available for chronic insomnia. Treatment will depend on the cause of your insomnia and may involve medication or therapy to address an underlying condition.

Along with treating any existing conditions, your doctor may recommend one or a combination of treatment options for chronic insomnia.

Cognitive behavioral therapy (CBT)

Research has shown CBT to be as effective, or more effective, than sleep medications in treating chronic insomnia. It involves educating you on sleep and better sleep habits, while teaching you to change the beliefs and behaviors that interfere with your ability to sleep.

Some of the strategies of CBT that are specifically focused on insomnia, known as CBT-I, include the following:

Cognitive techniques

Using journaling to write down worries or concerns before going to bed may help keep a person from actively attempting to work them out while also trying to sleep.

Stimulus control

This entails altering behaviors that condition your mind to fight sleep. Setting a sleep and wake time routine is part this strategy.

Other examples are using your bed only for sleep and sex, and leaving your bedroom if you’re unable to fall asleep within a set number of minutes.

Sleep restriction

This therapy involves limiting the amount of time you spend in bed, including avoiding naps. The goal is to deprive you of enough sleep so that you’re tired at bedtime. Your time in bed is gradually increased as your sleep improves.

Relaxation techniques

Breathing exercises, yoga, guided meditation, and other techniques are used to reduce muscle tension and control your breathing and heart rate so that you’re able to relax.

Paradoxical intention

This strategy involves focusing on staying awake in bed instead of expecting to fall asleep. It helps reduce worry and anxiety over being able to fall asleep. It’s most effective in treating learned insomnia.

Medications

There are a number of prescription medications and over-the-counter (OTC) sleep aids that may help you get to sleep or remain asleep.

While effective, doctors don’t typically recommend using sleeping pills long term because of the side effects, which can include daytime sleepiness, forgetfulness, sleepwalking, balance problems, and falling. Certain classes of sleeping pills are also habit-forming.

Some of the prescription medications that are approved for treating insomnia include:

OTC sleep aid options may include:

  • diphenhydramine (Benadryl)
  • doxylamine succinate (Unisom SleepTabs)
  • melatonin
  • valerian root
  • chamomile tea

Always speak to your doctor before taking an OTC sleep aid, including natural remedies, such as melatonin and valerian root. Just like prescription drugs, OTC and natural sleep aids can cause unwanted side effects and interfere with other medications.

What Causes Insomnia?

Insomnia & Depression

Insomnia can be caused by psychiatric conditions such as depression. Psychological struggles can make it hard to sleep, insomnia itself can bring on changes in mood, and shifts in hormones and physiology can lead to both psychiatric issues and insomnia at the same time.

Sleep problems may represent a symptom of depression, and the risk of severe insomnia is much higher in patients with major depressive disorders. Studies show that insomnia can also trigger or worsen depression.

It’s important to know that symptoms of depression (such as low energy, loss of interest or motivation, feelings of sadness or hopelessness) and insomnia can be linked, and one can make the other worse. The good news is that both are treatable regardless of which came first.

Insomnia & Anxiety

Most adults have had some trouble sleeping because they feel worried or nervous, but for some it’s a pattern that interferes with sleep on a regular basis. Anxiety symptoms that can lead to insomnia include:

  • Tension
  • Getting caught up in thoughts about past events
  • Excessive worrying about future events
  • Feeling overwhelmed by responsibilities
  • A general feeling of being revved up or overstimulated

It’s not hard to see why these symptoms of general anxiety can make it difficult to sleep. Anxiety may be associated with onset insomnia (trouble falling asleep), or maintenance insomnia (waking up during the night and not being able to return to sleep). In either case, the quiet and inactivity of night often brings on stressful thoughts or even fears that keep a person awake.

When this happens for many nights (or many months), you might start to feel anxiousness, dread, or panic at just the prospect of not sleeping. This is how anxiety and insomnia can feed each other and become a cycle that should be interrupted through treatment. There are cognitive and mind-body techniques that help people with anxiety settle into sleep, and overall healthy sleep practices that can improve sleep for many people with anxiety and insomnia.

Insomnia & Lifestyle

Insomnia can be triggered or perpetuated by your behaviors and sleep patterns. Unhealthy lifestyles and sleep habits can create insomnia on their own (without any underlying psychiatric or medical problem), or they can make insomnia caused by another problem worse.

Examples of how specific lifestyles and sleep habits can lead to insomnia are:

  • You work at home in the evenings. This can make it hard to unwind, and it can also make you feel preoccupied when it comes time to sleep. The light from your computer could also make your brain more alert.
  • You take naps (even if they are short) in the afternoon. Short naps can be helpful for some people, but for others they make it difficult to fall asleep at night.
  • You sometimes sleep in later to make up for lost sleep. This can confuse your body’s clock and make it difficult to fall asleep again the following night.
  • You are a shift worker (meaning that you work irregular hours). Non-traditional hours can confuse your body’s clock, especially if you are trying to sleep during the day, or if your schedule changes periodically.

Some cases of insomnia start out with an acute episode but turn into a longer-term problem. For example, let’s say a person can’t sleep for a night or two after receiving bad news. In this case, if the person starts to adopt unhealthy sleep habits such as getting up in the middle of the night to work, or drinking alcohol before bed to compensate, the insomnia can continue and potentially turn into a more serious problem. Instead of passing, it can become chronic.

Once this happens, worry and thoughts such as, “I’ll never sleep,” become associated with bedtime, and every time the person can’t sleep, it reinforces the pattern.

This is why it’s important to address insomnia instead of letting it become the norm. If lifestyle and unhealthy sleep habits are the cause of insomnia, there are cognitive behavioral techniques and sleep hygiene tips that can help. If you have tried to change your sleep behaviors and it hasn’t worked, it’s important to take this seriously and talk to your doctor.

How Much Sleep Do You Need?

Certain substances and activities, including eating patterns, can contribute to insomnia. If you can’t sleep, review the following lifestyle factors to see if one or more could be affecting you:

Alcohol is a sedative. It can make you fall asleep initially, but may disrupt your sleep later in the night.

Caffeine is a stimulant. Most people understand the alerting power of caffeine and use it in the morning to help them start the day and feel productive. Caffeine in moderation is fine for most people, but excessive caffeine can cause insomnia. A 2005 National Sleep Foundation poll found that people who drank four or more cups/cans of caffeinated drinks a day were more likely than those who drank zero to one cups/cans daily to experience at least one symptom of insomnia at least a few nights each week.

Caffeine can stay in your system for as long as eight hours, so the effects are long lasting. If you have insomnia, do not consume food or drinks with caffeine too close to bedtime.

Nicotine is also a stimulant and can cause insomnia. Smoking cigarettes or tobacco products close to bedtime can make it hard to fall asleep and to sleep well through the night. Smoking is damaging to your health. If you smoke, you should stop.

Heavy meals close to bedtime can disrupt your sleep. The best practice is to eat lightly before bedtime. When you eat too much in the evening, it can cause discomfort and make it hard for your body to settle and relax. Spicy foods can also cause heartburn and interfere with your sleep.

Insomnia & The Brain

In some cases, insomnia may be caused by certain neurotransmitters in the brain that are known to be involved with sleep and wakefulness.

There are many possible chemical interactions in the brain that could interfere with sleep and may explain why some people are biologically prone to insomnia and seem to struggle with sleep for many years without any identifiable cause—even when they follow healthy sleep advice.

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