Types of Insomnia

Key Takeaways

• Insomnia is often categorized by duration, with short-term insomnia lasting days or weeks and chronic insomnia occurring at least three times per week for three months or longer.
• Sleep experts may also classify insomnia based on symptoms, such as trouble falling asleep (sleep-onset insomnia) or difficulty staying asleep (sleep-maintenance insomnia).
• Primary insomnia occurs on its own, while secondary insomnia is linked to another issue such as stress, medical conditions, mental health disorders, medications, or substance use.

Short-Term Insomnia

Sleep experts categorize most cases of insomnia as either short-term or chronic. Short-term insomnia is a type of insomnia in which symptoms last for less than three months.

All types of insomnia involve three core features:

• Difficulty sleeping
• Sufficient opportunities for sleep
• Daytime symptoms

Difficulty sleeping can include trouble falling asleep or staying asleep, including waking up too early or spending long periods awake at night. Unlike sleep deprivation, where there may not be enough time in a person’s schedule to get adequate rest, people with short-term insomnia have sleep issues even though they spend plenty of time in bed each night.

Daytime symptoms of insomnia may include:

• Daytime tiredness, fatigue, or loss of energy
• Irritability and mood changes
• Difficulties with attention, concentration, or motivation
• Challenges in relationships, at school, or at work
• Persistent worry about sleep

In short-term insomnia, these symptoms persist for days or weeks, often after a stressful experience or life event. Common stressors that can trigger short-term insomnia include:

• Traveling or moving
• Relationship issues or divorce
• Death of a loved one
• Job loss
• Medical condition

Finding a resolution or learning to adapt to a stressful situation may improve short-term insomnia. However, if sleep issues persist, a person may develop chronic insomnia.

Chronic Insomnia

Chronic insomnia may be diagnosed when a person experiences the symptoms of insomnia at least three times a week for three or more months. Many people with chronic insomnia have symptoms that persist for years.

The symptoms of chronic insomnia are the same as short-term insomnia, namely trouble falling asleep, staying asleep, and daytime impairment from sleep loss. It’s common for people with chronic insomnia to have symptoms that ebb and flow, becoming more or less severe based on current stressors, medical conditions, or other factors.

While chronic insomnia can be triggered by a stressful experience, symptoms can also persist without a clear cause. In some people, short-term sleep issues can lead to chronic insomnia because the person gets into a cycle where short-term sleep loss increases stress and worry, which then make it harder to fall asleep.

The average adult takes about 10 to 20 minutes to fall asleep, while a person with sleep onset insomnia might take 30 minutes or longer, leading to feelings of frustration and anxiety.

Other Ways of Classifying Insomnia

In the past, there were several additional subtypes of insomnia, often based on a person’s specific symptoms or other characteristics.

In the most recent manual for classifying sleep disorders, experts have simplified the way that they categorize insomnia. While these types of insomnia are no longer given as a diagnosis, they may still be used by researchers and health professionals to describe a person’s condition.

Primary and Secondary Insomnia

Primary and secondary insomnia is a way of classifying insomnia based on its cause. Primary insomnia occurs independently of other diagnoses, while secondary insomnia refers to sleep issues that arise as a symptom of another physical or mental health condition.

While primary and secondary insomnia were once an important way of classifying insomnia, doctors often found it challenging to differentiate between the two in practice.

Additionally, ongoing research into the causes of insomnia shows that it’s often difficult to determine whether insomnia develops secondary to another health condition. Insomnia and other health conditions often have a complex relationship with insomnia developing before, after, or at the same time.

Behavioral Insomnia of Childhood

Behavioral insomnia of childhood is a specific set of sleep issues that are common in children. Symptoms include refusing or resisting going to bed, trouble falling asleep, or lengthy nighttime awakenings. Behavioral insomnia of childhood is believed to be caused by unhelpful patterns around bedtime or a caregiver’s challenges in setting limits.

For example, an infant or young child may get used to falling asleep while being held, rocked, or fed and have increasing difficulty falling asleep on their own. Challenges in setting and enforcing a bedtime can also lead to symptoms of insomnia.

Although this category remains useful for doctors trying to determine the cause of sleep problems in children, it’s now considered a form of either short-term or chronic insomnia.

Experts have shifted away from this diagnosis because people of any age can develop insomnia related to unhelpful associations with sleep and challenges in setting limits. For example, some teens or adults may have trouble falling asleep without the TV or struggle to stick to a consistent sleep schedule.

Sleep Onset Insomnia

Sleep onset insomnia is another way of categorizing sleep difficulties, still used by researchers and sleep experts to describe difficulty falling asleep. People who experience sleep onset insomnia may have trouble falling asleep when they want or spend excessive time in bed trying to fall asleep.

Sleep Maintenance Insomnia

Sleep maintenance insomnia is a term used to describe difficulties staying asleep through the night. This type of insomnia is associated with frequent and lengthy nighttime awakenings or waking up too early in the morning.

Most adults can sleep through the night with limited time spent awake. However, a person with sleep maintenance insomnia may wake up multiple times throughout the night and struggle to fall back asleep for 30 minutes or more.

Early Morning Awakening Insomnia

Early morning awakening insomnia occurs when a person wakes up earlier in the morning than they planned. A doctor may consider waking up too early a symptom of insomnia when a person gets up 30 minutes or more before they should. Older adults are more likely to experience unwanted early morning awakenings as a symptom of insomnia.

Mixed Insomnia

Some people experience difficulties both falling asleep and staying asleep. This type of insomnia is called mixed insomnia because it involves symptoms of both sleep onset insomnia and sleep maintenance insomnia.

When to See a Doctor

You’ve probably experienced a night where you lie in bed feeling wide awake, tossing and turning all night. But one bad night of sleep doesn’t always mean you have insomnia. Sleep issues associated with insomnia are persistent and lead to daytime symptoms.

If you experience more than the occasional bad night’s sleep, consider talking with your doctor. A doctor can give you a full evaluation, help you distinguish between insomnia and intermittent sleep issues, and develop a personalized treatment plan to improve your sleep.

How a Sleep Coach Can Help

If insomnia is affecting your daily life, additional support may help. Sleep Doctor's Sleep Consult connects you with a licensed sleep professional who can help identify possible causes of your sleep issues and discuss personalized next steps.

For more ongoing support, Sleep Doctor's Sleep Coaching provides personalized guidance, accountability, and practical strategies to improve sleep habits and build a healthier sleep routine over time.

Frequently Asked Questions

What is fatal familial insomnia?

Fatal familial insomnia is a very rare inherited brain disorder that causes progressively worsening insomnia and severe neurological symptoms. The condition is caused by a genetic mutation, and over time, fatal familial insomnia can lead to cognitive decline, movement problems, and loss of autonomic nervous system function.

What is pregnancy insomnia?

Pregnancy insomnia refers to sleep difficulties that occur during pregnancy. People with pregnancy insomnia may have trouble falling asleep, staying asleep, or getting restful sleep due to hormonal changes, physical discomfort, anxiety, frequent urination, heartburn, or fetal movement. Sleep problems are especially common during the third trimester.

What is rebound insomnia?

Rebound insomnia is a temporary worsening of sleep problems after stopping or reducing certain sleep medications or substances. It commonly occurs after discontinuing sedatives, sleep aids, or alcohol and may cause difficulty falling asleep or staying asleep for several days. Symptoms often improve as the body adjusts.

What is psychophysiological insomnia?

Psychophysiological insomnia is a form of chronic insomnia in which people become overly anxious or focused on their sleep problems. Over time, stress and worry about sleep can create a cycle that makes it harder to fall asleep, even when the original cause of insomnia has resolved.

What is paradoxical insomnia?

Paradoxical insomnia is a sleep disorder in which a person feels like they are barely sleeping despite evidence that they are getting more sleep than they realize. People with paradoxical insomnia often underestimate how long they sleep and may feel awake for most of the night even when sleep studies show otherwise.