What is insomnia?
Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or waking too early and being unable to return to sleep. It affects daytime functioning and quality of life.
Unlike occasional sleepless nights, insomnia persists despite adequate opportunity for sleep. When symptoms occur at least three nights per week for three months or longer, it's classified as chronic insomnia disorder.
Key fact: Insomnia is not just about sleep duration. Many people with insomnia spend enough time in bed but experience poor sleep quality, leading to daytime fatigue, irritability, and difficulty concentrating.
Types of insomnia
Insomnia can be categorized by duration and cause:
Acute Insomnia
Short-term sleep difficulty lasting days to weeks, often triggered by stress, life changes, or environmental factors. Usually resolves without treatment.
Chronic Insomnia
Sleep problems occurring at least 3 nights per week for 3+ months. Requires clinical evaluation and treatment, often with CBT-I as first-line therapy.
Onset Insomnia
Difficulty falling asleep initially. Often related to anxiety, caffeine use, or delayed sleep phase disorder.
Maintenance Insomnia
Difficulty staying asleep or early morning awakening. Common in depression, sleep apnea, and chronic pain conditions.
Evidence-based treatments
Multiple effective treatments exist. CBT-I is recommended as first-line therapy by the American College of Physicians and American Academy of Sleep Medicine.
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Gold Standard
Cognitive Behavioral Therapy for Insomnia (CBT-I)
Structured therapy addressing thoughts and behaviors that interfere with sleep. Includes sleep restriction, stimulus control, and cognitive restructuring. 70-80% of patients show significant improvement. Effects are long-lasting, unlike medication.
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Foundation
Sleep Hygiene
Consistent sleep schedule, cool dark bedroom, limiting caffeine/alcohol, avoiding screens before bed, and regular exercise. While not sufficient alone for chronic insomnia, essential for all treatment plans.
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Short-term
Medications
Sedative-hypnotics (e.g., zolpidem) or low-dose sedating antidepressants may be prescribed short-term. Guidelines recommend trying CBT-I first due to better long-term outcomes and no dependency risk.
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Adjunctive
Relaxation Techniques
Progressive muscle relaxation, deep breathing, meditation, and mindfulness can reduce pre-sleep arousal. Often incorporated into CBT-I programs.
Struggling with sleep?
If insomnia is affecting your daily life, evidence-based treatment can help. Most people improve significantly with CBT-I.
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