Types of insomnia: causes and treatments

Often, When we have trouble sleeping we usually say that we have insomnia, but did you know that there are different types of insomnia? That’s how it is. There is not just one type, but several and each of them requires a different treatment. In this article we will focus on explaining the different types of insomnia and the treatment that is recommended in each case. Let’s dig deeper.

Insomnia is one of the most frequent reasons for consultation in primary care. and also, one of the symptoms that practically all psychological disorders share.

As with other problems that are very common in our society (such as anxiety or depression), Many people use the term insomnia incorrectly. For example, having trouble sleeping for a day or two is not having insomnia, or being very stressed and not being able to sleep properly would not be identified with this sleep disorder either. In the latter case, we would rather be under a stress process that has insomnia as a symptom.

As we see, There are certain specifications that are essential to understand this problem, evaluate it and design the treatment. Let’s look at each of these aspects below.

What is insomnia?

Insomnia is formally called primary insomnia, a sleep disorder in which the following characteristics are seen:

For at least four weeks the person experiences persistent difficulty sleeping.Difficulty may be experienced during sleep initiation, maintenance, termination, or feeling like non-restorative sleep (sleeping but not resting).There is no organic cause (head trauma, dementia, stroke) or medical/physiological that can explain insomnia (drug use, medication, medical illness that causes insomnia). There is also no psychological disorder such as anxiety or depression. Because in these cases we would be faced with a diagnosis of anxiety disorder or another disorder (with symptoms of insomnia related to another mental disorder according to the DSM-5).

Thus, there are three types of insomnia depending on the moment in which the person experiences difficulty sleeping:

Conciliation or onset insomnia. Maintenance insomnia or fragmented sleep. Late insomnia or early awakening.

Therefore, in order to say that we have insomnia (strictly speaking), it is necessary that we meet the diagnostic criteria described above. If we have another disorder or problem that causes insomnia, simply treating the sleep disorder will not end the problem. The main disorder must be diagnosed and addressed in order to put an end to sleep problems. Below we will delve into the three existing types of insomnia.

Conciliation or onset insomnia

This is the most common and well-known of the three types of insomnia. It is about the inability to sleep when we go to bed, That is, a problem is experienced when initiating sleep. Sleep insomnia is usually due to the maxim “we sleep as we live.” That is, if we spend the day stressed or worried, it is very difficult for the mind to disconnect and enter into sleep mode.

In the vast majority of cases, Sleep insomnia responds to a state of psychological discomfort, which is responsible for the difficulty in falling asleep. However, problems initiating sleep can also be experienced when changes occur in the usual schedule of our routine or in the hours of exposure to sunlight.

Treatment of sleep or onset insomnia

The recommended treatment for sleep insomnia has several phases. First of all, what is known as sleep hygiene is carried out. This approach is used because in most cases, with the development of insomnia the person acquires habits that are unhealthy and that make their situation even worse. In this way, as a first measure, some guidelines are worked on to have correct habits and break the association: going to bed →not sleeping →anticipatory anxiety about not sleeping.

Secondly, if sleep hygiene guidelines are not sufficient, different techniques or tasks are prescribed that seek to break the association between bedtime and not being able to sleep, along with the discomfort that this entails. For each case and person the psychologist designs a specific task, and also proposes a series of therapeutic objectives that seek to generate changes in your daily life.

However, it is necessary to remember that all the therapeutic approaches that we have mentioned are aimed at sleep insomnia as a primary disorder. That is, they are treatments and approaches that are designed in the event that other types of insomnia or psychological disorders such as anxiety, depression, obsessive-compulsive disorder or bipolar disorder are ruled out.

On the other hand, if the person cannot sleep using psychological techniques, it may be necessary to resort to a drug. The best options for sleep insomnia are non-bezodiazepine sleep aids. They are drugs that act quickly and for a very short time, with no anxiolytic or residual effect the day after. For example, zolpidem, zaleplon, or zopiclone.

In any case, Pharmacological treatment of insomnia always has to be prescribed and supervised by a doctor.this being the one who decides which drug is the most appropriate and for how long it should be taken.

Maintenance insomnia or fragmented sleep

In maintenance insomnia, difficulty staying asleep throughout the night is observed. In other words, the person is able to fall asleep but experiences frequent and prolonged nocturnal awakenings that usually occur especially in the middle of the night. When this happens, the negative consequences are very notable, since you have the sensation of having a non-restorative sleep.

If the diagnosis of maintenance insomnia is made, It is essential to rule out organic or physiological causes that are responsible for the problem. For example, hormonal problems that cause the person to wake up. Middle-of-the-night awakenings are very common when there is improper functioning of the thyroid gland or, in the case of women, when they experience irregularities in their hormonal cycle.

Treatment of maintenance insomnia or fragmented sleep

If medical causes are found to explain maintenance insomnia or fragmented sleep, these must be treated first. Once these causes have been controlled or ruled out, the treatment for this type of insomnia will involve all the techniques used in conciliation insomnia, but it must also include pharmacological treatment.

In this case, the recommended drug would be a benzodiazepine that acts throughout the night, since yes A medication is needed to keep the person asleep for that long.

On the other hand, There is no effective psychological treatment to date that can immediately reduce the number of nighttime awakenings. However, the work of a psychologist in these cases is also essential.

Most people who have fragmented sleep or maintenance insomnia also have psychological problems such as anxiety disorders or major depressive disorder. Therefore, the first thing that is sought in the short term is for the person to sleep correctly, and then be able to work, through psychotherapy, on all the psychological aspects that are the cause of this type of insomnia.

Late insomnia or early awakening

In the last type of insomnia what happens is that The person is able to fall asleep and does not wake up during the night, but cannot sleep all the hours they need. For example, we set the alarm for 7:00 am and wake up at 5:00 without being able to go back to sleep. This causes us to be more tired the rest of the day and even feel anxious or anguished.

This type of insomnia is closely associated with problems such as depression or work stress. First of all, Depression involves a series of changes in sleep cycles that usually result in the person waking up very early and not being able to go back to sleep. And secondly, when there is a high workload it is very common for the person to wake up earlier and not be able to go back to sleep either.

Treatment of late insomnia or early awakening

The treatment of late insomnia consists of a combination of pharmacological treatment to prevent the person from waking up early and psychological treatment to manage the emotions that cause early awakening.

The psychological approach is similar to that used in the other two types of insomnia, but in this case it is essential to carry out an intervention aimed at managing stress and emotions related to waking up.

It is also very important, although it may seem strange, that if we wake up early and do not fall asleep, we get out of bed. This is important because increasing tiredness is one of the best remedies against insomnia, and also, in this way we break the association between being in bed and the feeling of anguish caused by not being able to sleep.

Thus, while in the case of sleep insomnia the first choice treatment is psychological, in the case of the other two types of insomnia (maintenance or delayed) a drug must be combined with the psychological treatment.

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