There Are 13 Types of Insomnia—Here’s What to Know About Each One
Update published at Health.com - co-author: Health Editors
You don't have to lie awake for hours past your bedtime to have insomnia—this sleep-robbing condition can manifest in several different ways.
Having trouble falling asleep, staying asleep, and even waking up too early are all signs of a sleep disorder. To help you determine what kind you may have, Health has compiled a list of 13 classifications of insomnia, with help from the American Academy of Sleep Medicine.
General Insomnia
General insomnia is a classification of sleep disorders in which a person has trouble falling asleep, staying asleep, or waking up too early. These disorders are either short-term or chronic, and fall into the categories of primary and secondary. Primary insomnia exists independently of any of other condition. Secondary or comorbid insomnia occurs alongside another condition. For example, anxiety may cause you to lose sleep, but insomnia can also cause anxiety, so they are dually problematic, per the Sleep Foundation.
Insomnia affects up to 40 percent of the general population each year, per the American Psychological Association. Additionally, reports of insomnia tend to rise with age and are more common in women, according to The New England Journal of Medicine. Other factors that can contribute to insomnia are divorce, separation, and losing a loved one, as well as lower socioeconomic status. Essentially, there is a significant correlation between extensive angst, and the development of insomnia.
Adjustment Insomnia
This primary insomnia, also called acute insomnia, is a type of short-term insomnia, meaning it lasts fewer than three months, according to the Sleep Foundation.
Adjustment insomnia disturbs your sleep and usually stems from a specific source of stress. This sleep problem resolves itself when the source of stress is gone or when you’ve adapted to the stress. This stress does not have to come from a negative experience. Something positive can also make you too excited to sleep well, such as a pregnancy or new job. That being said, adjustment insomnia can turn into chronic insomnia, so if you find yourself losing sleep for longer than three months, you should seek out a sleep specialist.
Behavioral Insomnia of Childhood
As children grow, their sleep behavior changes drastically. Naps are discontinued, nocturnal sleep is extended, and the standard bed time is pushed further and further back. These changes are known as behavioral insomnia of childhood (BIC), and can cause sleep disruption in approximately 25% of children, according to the National Institutes of Health (NIH). Per the NIH—and defined by theInternational Classification of Sleep Disorders—there are three subtypes of this primary insomnia:
BIC sleep-onset association type results from negative sleep associations, meaning lack of behaviors that encourage sleep such as setting a bedtime or reading a story before bed. A lack of these behaviors contributes to difficulty falling asleep or frequently waking up.
BIC limit-setting type occurs when a child refuses to go to sleep, and attempts to delay bedtime, by asking for a drink or to go to the bathroom.
BIC combined type is when these behaviors are combined, meaning a lack of a consistent routine at bedtime and letting children delay sleep by catering to their procrastination requests.
BIC is manageable with specified bedtimes and relaxing sleep routines.
Psychophysiological Insomnia
This primary type of insomnia is prevalent in older children and adolescents, as well as adults. According to the NIH, this insomnia is associated with excessive anxiety or worry, specifically focused on not being able to sleep. The insomnia may begin suddenly following an event or develop slowly over many years.
Unfortunately, it’s cyclical, meaning the very act of worrying about sleep makes sleep very difficult to achieve. People with this sleep disorder become tense and anxious as bedtime approaches, and develop a negative association with sleep, making this type of insomnia tricky to navigate. According to Neurology and General Medicine, Fourth Edition, common treatments of this type of insomnia include sleep hygiene (consistent atmosphere and routine), behavioral therapy (such as breathing or relaxation techniques), and occasionally hypnotics (medication to help you sleep).
Idiopathic Insomnia
Idiopathic insomnia is a primary form of chronic insomnia that is not identified by visible signs of its cause, according to the American Sleep Association (ASA). It may result from an imbalance in your body, such as an overactive awakening system and/or an underactive sleep system, but the true cause of this disorder is unknown. It is NOT a result of any of the following: other sleep disorders, medical problems, psychiatric disorders, stressful events, medication use, or other behaviors.
Idiopathic insomnia often occurs nightly and may include short sleeping times, numerous unexplained awakenings, and difficulty falling asleep even when you feel tired. Idiopathic is one of the rarest types of insomnia, affecting just under 1% of the population, per the ASA.
Paradoxical insomnia
Paradoxical insomnia is a complaint of severe insomnia. This primary insomnia occurs without objective evidence of any sleep disturbance. Daytime effects vary in severity, but they tend to be far less severe than one would expect given the expressed sleep complaints.
People with this disorder often report little or no sleep for one or more nights. They also describe having an intense awareness of the external environment or internal processes consistent with being awake. This awareness suggests a state of hyperarousal. A key feature is an overestimation of the time it takes them to fall asleep. They also underestimate their total sleep time. A research article in the journal Neurotherapeutics suggests that this condition occurs in less than 5% of insomniac patients.
Inadequate sleep hygiene insomnia
Inadequate Sleep Hygiene is a disorder associated with common daily activities that are inconsistent with good-quality sleep and full daytime alertness, according to the NIH. These activities could include irregular sleep patterns (going to bed at 3 a.m. and sleeping until noon), stimulating activities before bedtime (exercising late at night), and substances ingested before bed such as caffeine, alcohol, or cigarette smoke. Researchers say this type of primary insomnia only affects certain people, and one element may cause more sleep disturbance than another, depending on the individual.
Insomnia due to a medical condition
This secondary insomnia is caused by a medical or neurological disorder, where the insomnia is a symptom of the disorder, according to the NIH. The course and severity of insomnia are directly linked to that of the medical condition, but the insomnia is a separate focus of treatment. This insomnia is a disorder only if it is severe enough to require separate treatment.
Medical conditions often linked to insomnia include chronic pain, cancer, diabetes, heart disease, gastroesophageal reflux disease, overactive thyroid, Parkinson’s disease and Alzheimer’s disease, per the Mayo Clinic.
Insomnia due to a drug or substance
This type of secondary insomnia occurs when your sleep is disrupted by the use of a substance such as alcohol, caffeine, food, or medication. With alcohol, caffeine and food, sleep problems occur because these substances, when used in high concentrations, stay in your body for several hours after consumption.
Research has shown that sleepers who drink large amounts of alcohol before going to bed are often prone to delayed sleep onset, and may also experience sleep disruptions and poor sleep quality. Caffeine is a stimulant, so experts recommend limiting caffeine about four or five hours before bedtime, and eating your last large meal 2 to 3 hours before sleeping. With medication, side effects from certain drugs (allergy, blood pressure, anti-depressant, etc.) can make falling asleep difficult for some people, according to the ASA.
Unfortunately, this type of sleep problem may also occur when you stop using a substance, so weaning yourself off of a substance you normally ingest before bed is better than stopping cold-turkey.
Unspecified Insomnia
Unspecified insomnia is when a cause has yet to be specifically proven, so further testing is required to discover the exact cause. “Unspecified” is used as a temporary classification while further evaluation and testing are completed. There are two sub-types of unspecified insomnia:
Insomnia nonorganic, unspecified. This type of insomnia suggests that known substances and other physical causes of the insomnia have been ruled out. This means that the cause of insomnia is most likely due to an underlying mental health disorder, psychological factor, or sleep disruptive behaviors. This name is used when a person with insomnia does not meet the criteria for another type of insomnia.
Insomnia organic, unspecified. This type of insomnia is caused by a medical disorder, physical condition, or substance exposure, but the specific cause remains unclear. This name is used when a person with insomnia does not meet the criteria for another type of insomnia.
