There are two types of insomnia: acute and chronic. Both involve trouble falling asleep, staying asleep, returning to sleep after waking up prematurely, or a combination of the three. The difference is that acute insomnia is a short-term disorder lasting for three months or less, whereas chronic insomnia describes any sleep trouble lasting more than three consecutive months. Chronic insomnia affects roughly 10% of US adults each year, and they are more likely to develop health problems including depression, diabetes, and high blood pressure. Here we discuss the symptoms, causes, and treatments for chronic insomnia.
SymptomsThe main symptom of chronic insomnia is the consistent lack of quality sleep for at least three months. As a result, chronic insomnia often comes with additional symptoms, including:Difficulty concentrating or remembering thingsImpaired performance at work, school, or social situationsIrritabilityLess energy and motivation Headaches, tenseness in body, and gastrointestinal problemsCausesThere are two types of chronic insomnia: primary and secondary.
Secondary insomnia is caused by an underlying medical condition, such as sleep apnea, that prevents you from getting a full night’s rest, says Vishesh K. Kapur, MD, the director of sleep medicine at the University of Washington medical school.In contrast, primary insomnia is the direct result of how your brain and body are working as you try to sleep. “People with primary insomnia tend to be hyperalert,” says Kapur, “and have greater sympathetic nervous system activity.” The sympathetic nervous system is involved in the body’s response to stressful situations. People with primary insomnia also struggle because they have come to expect poor sleep.
“If I’m a good sleeper, I associate my bedroom with falling asleep quickly, easily,” says Kapur, but “if I’ve struggled with insomnia over time, my mind will be thinking, ‘I’m not going to be able to fall asleep,’ and it becomes a self-fulfilling prophecy.”Lifestyle factorsSome of the lifestyle factors that can cause primary chronic insomnia are difficult to change, such as working a night shift or living somewhere with a lot of outside noise. Other things that negatively impact our sleep may be easier to adjust. The aspects of our daily life that can contribute to primary chronic insomnia include:An uncomfortable bedNot getting enough physical activityLots of stressLight exposure in the eveningCaffeine consumptionAlcohol consumption
These factors can contribute to how alert you are at bedtime. Stress and caffeine, for example, stimulate your body’s sympathetic nervous system, while alcohol suppresses the calming effects of the parasympathetic nervous system.Medical conditionsMedical conditions and medications can both contribute to secondary chronic insomnia, says Kapur, and include:Medications known to play a part in causing chronic insomnia include:
Amphetamines, such as Adderall, and stimulants, such as Ritalin, which are both usually usually taken for attention deficit hyperactivity disorder (ADHD)Steroids, such as prednisoneSome antidepressants, such as Wellbutrin TreatmentChronic insomnia is treatable, though it’s highly individualized. What method works for you may not work for another, says Kapur. In general, chronic insomnia is best treated with cognitive behavioral therapy for Insomnia (CBT-I), says Kapur. CBT-I is a program of roughly one to two months of weekly visits with a sleep therapist who learns about when, how, and for how long you sleep — often by having you keep a sleep diary — and then gives you exercises that help reset how you sleep. For example, your therapist may ask you to deprive yourself of enough sleep so that when you do go to bed, you fall asleep right away. After enough nights of this, your body and brain will associate bedtime with quickly falling asleep, and you can increase how much you sleep each night until you are getting enough rest.
Medications can also play a role in treatment, according to Kapur, and include:Not everyone needs therapy and medication to improve their sleep. According to the Mayo Clinic, basic changes that can improve your sleep include reducing the amount of light you’re exposed to before bed — including from phones and television — as well as avoiding alcohol and caffeine in the hours before.Others may have lifelong difficulties even with treatment, Kapur says, and alternate between times of better and worse rest. For example, a 2008 study from Sweden’s Örebro University found that 44% of people with insomnia still had the disorder one year later. On the other hand, 56% of people with insomnia had recovered.
The bottom line If you’ve struggled to get quality sleep for several months, chronic insomnia — on its own or as the result of another medical condition — may be the reason. Fortunately, insomnia doesn’t have to last forever. Treatments including cognitive-behavioral therapy, medication, and lifestyle changes can help you regain restful sleep.