Insomnia can be one of the most challenging issues that anyone can face. One of the first steps to addressing it is to understand it.
Poor sleep seems to be the topic of many conversations these days. You may have heard your friends call themselves “insomniacs” or you may have wondered whether you have it yourself when experiencing sleep problems. Many people understand the term insomnia to be synonymous with the inability to sleep or general sleep issues. But everybody seems to have a bad night every once in a while, so when is it considered ‘Insomnia’?
Insomnia is the most common sleep disorder with a rate of 30% in Canada. But just because you can’t sleep properly does not necessarily mean that you have insomnia. Insomnia is one of over 100 sleep issues categorized under the sleep disorders umbrella and it is important to identify it correctly in order to treat it effectively. Even though inability to fall asleep is one of the hallmarks of insomnia, there is an actual clinical definition for this issue and in order to be diagnosed with it you will need to meet certain criteria.
Definition of Insomnia
There are a few diagnostic criteria for insomnia that various professionals may refer to. However, according to the International Classification of Sleep Disorders-Third Edition (ICSD3), in order to meet the diagnostic criteria for insomnia there needs to be issues with sleep initiation or maintenance (even if adequate opportunities and circumstances are available to sleep), as well as daytime consequences. So in short insomnia is:
all generally assess the predominant:
· inability to fall asleep or to stay asleep (including waking up too early in the morning)
· poor quality of sleep despite having the opportunity for sleep
· Daytime tiredness
Another trademark of insomnia is also associated with daytime tiredness and poor functioning, meaning you may have difficulty with your concentration, feeling foggy, tired, or sluggish during the day, but when it is time for nighttime sleep you are not able to get the rest you need. Due to this reason insomnia is considered a 24-hour disorder: It affects you both at night and during the day.
During insomnia, the cerebral cortex appears to be more active, which causes hyper arousal. (This is the part of the brain that is responsible for higher level of processing, like thoughts, emotions, memory, etc.) So what happens is that someone with insomnia who is trying to sleep experiences higher activation of their thoughts, emotions, and memories and trying to control any of this actually makes the insomnia worse, which can then lead to feeling frustrated, anxious, and hopeless.
There are a few types that I’ll talk about below and knowing which type(s) you are dealing with helps with figuring out the best treatment. The length of time you’ve been experiencing the symptoms also makes a difference in which type of insomnia you’re diagnosed with.
Short-term vs. Chronic Insomnia
What differentiates between short-term (also known as acute or transient) and chronic insomnia is based on how long the symptoms have been present. The short-term type is quite common and typically lasts less than 3 months. However, chronic insomnia refers to symptoms being present at least 3 times per week and lasting longer than 3 months. It is considered a chronic issue and sufferers may experience it for many years before seeking out treatment.
Types of Insomnia
There are a few forms of insomnia depending on when during the night your troubles are concentrated. Generally, many experience issues either towards the start of the night or towards the end of the nightly rest. You may be experiencing one or a combination of these types:
Sleep Onset Insomnia: Have you experienced laying in bed super tired, but not being able to fall asleep, tossing and turning and staring up at the ceiling (or the clock) worrying about how you’ll function tomorrow? Sleep onset insomnia is when you are not able to fall asleep at the beginning of the night. You may spend a long time trying to sleep and eventually only get short amount of sleep before you have to get up for your day. It can be short-term or chronic and caused by various triggers. However, the most common trigger is psychological distress, anxiety, and depression. It is also the most common type among younger adults.
Sleep Maintenance Insomnia: This is the type where you fall asleep, however, wake up in the middle of the night (or shortly after falling asleep) and have difficulty falling back to sleep. The waking can be caused by medical conditions or internal triggers, like stress and worry, or external or environmental changes like noise, movement, and temperature. It can take longer than 20-30 minutes to fall back to sleep and may happen multiple times a night. Often times it feels like your mind starts running a mile a minute when you’re up and it feels impossible to shut it off. It can cause frustration, reducing the hours you sleep and day-time tiredness. Middle-aged to older adults tend to experience this type the most.
Early Morning Awakening Insomnia: Some consider this as another type of sleep maintenance insomnia and others consider it a category of its own. This is the type of insomnia where you keep on waking up in early hours before it is time to get up but it is too late to try to get back to sleep. So you end up just tossing and turning and your thoughts are racing through your mind and it just feels like a struggle.
What Can You Do About it?
The first step is to find out what exactly is causing your symptoms and what you are dealing with. There are other disorder that mimic or contribute to insomnia or may have similar symptoms. If you are having sleep issues and are concerned whether it is insomnia or another sleep disorder, or your symptoms have become chronic or recurring and is preventing you from feeling rested and healthy, the first place to start is your doctor. It is important for your doctor to do a general assessment to find out any possible underlaying causes to rule out any other possible explanations for your sleep difficulties and to confirm whether it is in fact insomnia that is troubling you.
If you are experiencing short-term insomnia, there is a high possibility that your symptoms will go away once the cause is resolved and you will return to your normal sleep routine. However, you can still take precautions to prevent your insomnia from sticking around and becoming chronic.
If you are diagnosed with chronic insomnia it may feel demoralizing and you may think that there is no hope. However, this is not the case. No matter which type you are experiencing treatment is very effective, as long as you get the right one. There are many options out there, but research has shown Cognitive Behavioural Therapy for Insomnia (CBT-I) as the most effective and the “gold standard” first line of treatment for chronic insomnia. I talk about it in more detail HERE.
If you find that you are confused and/or frustrated about your symptoms, your next steps, or what options are available in treating your insomnia feel free to connect with me and I will be happy to answer any questions that you may have.