The most common sleep disorder people can suffer from is insomnia - the inability to get to sleep or stay asleep. When a person has insomnia, they may experience daytime sleepiness and may not feel rejuvenated when they wake up.
The Cleveland Clinic found that 50 percent of adults have insomnia from time to time and that one in 10 people suffers from chronic insomnia.
It’s important to understand that insomnia does not discriminate – anybody can have it. While it’s more common in women and older adults, anybody can be affected by it. Insomnia can last several days or weeks, and in extreme cases become chronic. There are many reasons behind insomnia, including but not limited to:
Here’s a look at the many kinds of insomnia.
Table of Contents
A person may have problems sleeping for one week or less. Due to the brief disruption of sleep it’s one of the most recognizable types of insomnia. This disorder usually resolves itself – no treatment is necessary. Notable symptoms of transient insomnia include daytime sleepiness, difficulty to fall asleep, and waking up early in the morning. Some causes of it are:
- side effects of medications
- short-term illness (cold, flu, allergies, etc.).
This type of insomnia lasts longer than a week, but less than a month. Doctors will diagnose a patient with this type of insomnia if they experience three or more nights of sleep disruption each week. It’s often tied to:
- adjustment to a higher altitude
- illness/pain (after surgery pain included)
- new job or move
A person may have symptoms for no more than three months (this condition occurs in about 20 percent of sufferers). There are several causes behind this type:
- birth of a baby
- death in the family
- employment problems
- financial problems
- illness or other medical problem
- moving – new home or location.
Chronic insomnia (insomnia disorder)
This type of insomnia happens when a patient has been unable to sleep for a period lasting more than three months for three or more nights a week. The condition may result from acute insomnia or short-term anxiety, and become a lifelong issue. About 10 percent of American adults have this sleep disorder. The triggers of chronic insomnia include:
- conditioned negative response to the sleeping environment or the attempt to sleep
- medical problems, such as hyperarousal or head injuries. In hyperarousal the sympathetic nervous system is causing an extra release of cortisol (stress hormone).
There are many health problems associated with this type of insomnia – impairment of memory and cognitive functions, changes in mood, diminished alertness, increased risk of workplace injury, etc. A person who has chronic insomnia may also have problems maintaining relationships at work and home. The quality of life is reduced.
This type of insomnia is tied to a life event, but the underlying factors of the condition are lack of familiarity, anxiety, and stress. Many people describe adjustment insomnia as acute insomnia because they have similar causes. About 20 percent of people have adjustment insomnia every year. When the person learns how to address the positive or negative trigger, the problem usually resolves itself. What are some of the causes?
- death in the family
- starting at a new school/job
- moving home/new location
- birth of a child or pet.
This type of insomnia refers to sleeping problems because of drug or medication use. Caffeine is the number one offender, but cold medications, alcohol, ADHD drugs, cannabis, and opioids can also cause the disorder.
While cannabis has been reported to help some people go to sleep, it reduces the time spent in REM sleep, which decreases dreaming and increases alertness. Withdrawal from cannabis use can lead to insomnia. Stimulants like amphetamines and cocaine can reduce REM sleep and damage the circadian rhythm. This can cause permanent sleep damage in some cases. Medications can lead to an array of sleep disorders:
- parasomnias (exploding head syndrome and sleep paralysis)
- REM sleep behavior disorder
- restless leg syndrome
- sleep eating.
It’s not uncommon for some drug users to fall into a vicious cycle of taking stimulants to stay awake and sedatives to induce sleep. Once they quit using drugs, they may suffer from withdrawal and rebound insomnia. People who abuse opiates and alcohol are prime suspects for these symptoms which can persist for weeks.
Nicotine, smoked or vaped, can lead to sleep disruptions. Nicotine also increases the risk of another sleep disorder that may contribute to insomnia - sleep apnea. While trying to quit nicotine use can produce insomnia, they are far more noticeable when using it.
Most people view alcohol as a depressant that can help induce sleep. However, it’s a drug that can lead to middle insomnia (when you wake up at night and are unable to return to sleep). Alcohol will depress the central nervous system, and when it wears off, users may wake up and find it hard to get back to sleep.
The steroid prednisone commonly used to treat pain and inflammation is also known to lead to sleep disturbances and restlessness. Drugs for respiratory disorders, such as asthma, are also responsible for insomnia.
This type of insomnia is the result of another disorder or illness such as bipolar disorder, anxiety, or depression. This sleep disorder can also be due to other medical problems that cause chronic pain – cancer, arthritis, gunshot wound injuries, migraines, shingles, autoimmune disorders, etc.
Neurological disorders (for example dementia) can upset the circadian rhythm and central nervous system, leading to problems with sleep. Migraines are also culprits because of nausea and pain associated with them.
People who suffer from Tourette’s syndrome or some type of movement disorder may have tics while sleeping, which can lead to insomnia.
Insomnia is often experienced at the end of life for a multitude of reasons:
- medications (steroids)
- noisy hospital environment.
Cancer and end-stage renal disease may require treatments that can upset the ability to sleep.
Onset, middle and late insomnia
hese types of insomnia describe the time of night when a person suffers from symptoms of insomnia. While some people experience one of them, it’s not uncommon for sufferers to have insomnia in two or all three stages.
This type refers to the inability to fall asleep at the beginning of the night. It’s ubiquitous and typically delays sleep for 30 minutes or more. The reasons for it include:
- alcohol or caffeine consumption
- poor sleep hygiene (use of electronics before going to bed).
The disorder is often associated with stress and anxiety, and can be temporary, acute, or chronic. It’s also possible to be tied to middle and late insomnia.
Middle insomnia is also called maintenance insomnia, which happens when a person can’t stay asleep. Sufferers may wake up several times a night and have problems going back to sleep. It’s often seen with use of alcohol, in babies who want to be fed at night, and chronic pain disorders.
Menopause is one of the biggest reasons for middle insomnia. How come? Estrogen drops during this time, though this hormone is vital in helping the body get to sleep. Besides, sleep can be disrupted because of hot flushes and night sweats.
Decreased levels of estrogen and progesterone during perimenopause - a condition that can happen years before menopause - can also lead to sleep difficulties.
Middle insomnia may also be linked to other sleep disorders – restless leg syndrome or sleep apnea. These conditions can constantly disrupt a person’s sleep, making it hard to fall into deep sleep. REM sleep behavior disorder may also cause frequent awakening due to absence of normal muscle paralysis which happens during REM sleep.
If you wake up too early and can’t go back to sleep, you may have late insomnia. This type of insomnia means that a person may wake up between 2 and 4a.m., and even though they know it’s too early to get up, they can’t go back to sleep for whatever reason.
Late insomnia means that a person wakes up 30 (or more) minutes earlier than planned at least three times a week. Clinical depression can cause this type of insomnia, but other reasons include:
- emotional problems
- hunger (low blood sugar)
- changes in the room temperature.
Conditioned insomnia (psychophysiological) insomnia
A conditioned response to going to bed is typically the reason behind this type of insomnia (also known as learned insomnia). Sufferers often experience a disturbing event that initiates sleeping problems, but once the trigger is eliminated, they still have insomnia.
Women are far more likely to suffer from this sleep disorder than men. Preparing for bedtime can also bring on conditioned insomnia due to anxiety or fear. Not getting enough sleep as well as fear of not being able to sleep may become habitual. Until the condition is diagnosed and treated it can continue for weeks, months, and years.
According to the latest research conditioned insomnia may be tied to nervous system hyperarousal - exaggerated stress response prevalent even during sleep. This issue can lead to high blood pressure, worry, and an increase in emotional reactivity. Exaggerated stress response may be the cause of conditioned insomnia, not the result of it. And it’s a vicious cycle of bodily reactions that only worsen the problems.
Behavioral insomnia of childhood (BIC)
This type starts when a child is not given a strict bedtime routine. Children of five years and younger often suffer from behavioral insomnia of childhood.
As the result of not learning a regular sleep routine and habits children struggle with falling or staying asleep. Another potential trigger is the need to sleep with their parent. The symptoms of BIC may extend into adulthood and affect the sleeping habits for a lifetime.
The majority of children between the ages of 3 and 5 years need at least 12 hours of sleep with naps in between. Children who develop BIC don’t get near this amount of sleep and thus can suffer from other insomnia related problems such as hyperactivity, aggression, and daytime sleepiness.
Untreated BIC can also cause problems at school such as temper tantrums and poor grades. Erratic bedtimes may only exacerbate the problem because the circadian rhythm is out of sync. It’s thought that 25 percent of children have this sleep disorder in the first five years of their lives.
There are two kinds of BIC – sleep-onset association and limit-setting insomnia.
Both kinds involve anxiety of falling asleep – similar to conditioned insomnia, but occurring in children. With limit-setting insomnia it’s often the child’s defiance to bedtime routine or specific bedtimes. They may try tactics such as crying, asking for food or water, or to use the bathroom to delay going to bed.
Sleep-onset association is a sleep disorder that relates to a negative association with bedtime - watching TV or playing video games being stopped because the child must go to bed.
A child who relies on a parent's singing, reading, or rocking may have a hard time "wanting" to go to sleep without these actions.
Sleep-onset disorder is often more than just an anxiety of going to bed or bedtime routine. It’s often linked to other behavioral problems such as ADHD.
This type of insomnia is thought not to have an apparent underlying cause (such as psychological or medical condition), however some researches believe that it’s tied to hyperarousal of the body’s central nervous system. Hyperarousal may be the result of deregulated stress response causing the body to remain in a hypervigilant state. Continuous release of cortisol (the stress hormone) makes it harder for a person to fall asleep.
A rise in body temperature, heart rate, and metabolic rate also contribute to the inability to sleep well.
According to sleep studies all types of insomnia are found in people who have a hyperaroused central nervous system. The constant response to stress, even during sleep, could lead to insomnia once labeled as idiopathic.
Paradoxical (pseudo-) insomnia
This type is tied to complaints of chronic or severe insomnia that isn’t accurately taking place. A person may exaggerate how long it takes them to go to sleep or how long they stay awake. People with the disorder may also underestimate how much they sleep.
Sleep studies on this disorder usually find normal sleep/wake patterns. Sleep efficiency and onset are healthy even when sufferers claim that they don’t get enough sleep or spend hours awake. They are really not as sleep deprived as they claim to be.
The physical effects of paradoxical insomnia are not as serious as those of other types of insomnia, but there are psychological effects associated with it:
- frequent visits to the doctor
- repeated sleep testing
Sleep hygiene insomnia
This type occurs because a person does not have good sleep hygiene. Their bedroom may be too hot or cold, or their mattress may be uncomfortable. Any poor sleeping habits such as drinking alcohol or caffeine in the evening or using electronics just before bed can hinder a person from getting the sleep they need.
This is one of the most common types of insomnia, and one of the most easily resolvable ones.
Poor sleeping habits can lead to disruptions in the circadian rhythm and sleep hygiene insomnia. A new baby or pet, inconsistent bedtime, bright lights, or noise can also be culprits to this disorder.
Sleep hygiene insomnia is highly noticeable in homes that have electronics in their bedrooms. After all, the blue light from phones and TVs can upset the circadian rhythm and hinder a person from getting a good night’s rest.
Facts about insomnia that you may find interesting
- There is a rare type of insomnia called fatal familial insomnia. This is a genetic brain disorder that can be diagnosed by worsening insomnia and dysfunction of the autonomic nervous system (rapid heart rate and sweating).
- About 90 million Americans suffer from snoring, which can hinder them from getting a good night’s sleep.
- Researchers say that there is a 25% increase in heart attacks after the time jumps forward in the spring (Daylight Saving Time) due to lost sleep.
- Sleep deprivation can lower a person’s pain threshold, which means that it’s painful not to be able to fall or stay asleep in more than one way.