Insomnia is the inability to sleep, despite the desire and opportunity to do so. Insomnia can be agonizing; lying awake in bed means you aren’t getting rest and you aren’t getting anything done. The combination can lead to anxiety about how much sleep you are missing, which can lead to more insomnia. It can be pretty clear when you aren’t able to get to sleep, but difficulty falling asleep isn’t the only sign of insomnia.
Insomnia can manifest in a number of different ways. The stereotypical image of insomnia is someone lying awake being unable to fall asleep at night. The inability to initiate sleep is indeed a sign of insomnia, but is not the only insomnia type.
Sometimes insomnia takes the form of being unable to remain asleep. Some insomnia sufferers know how to fall asleep fast, but wake throughout the night. After waking, they may be unable to return to sleep as quickly as they would like. If this occurs multiple times it can add up to a pretty significant amount of missed sleep.
Another manifestation of insomnia is short sleep. In this condition, someone falls asleep, stays asleep for the entire duration of their rest, but awakens in the morning before they are fully rested. They still feel tired and groggy, but can’t fall back to sleep.
It is important to note that in order to be considered insomnia, there must not be a cause of sleeplessness other than being unable to sleep. In other words, if someone can’t sleep because there is loud, intermittent noise preventing them from sleeping, then this is not considered insomnia. Similarly, if they were to drink three cups of coffee right before bed and couldn’t sleep, this doesn’t mean they have insomnia.
An isolated night of sleeplessness or difficulty sleeping doesn’t merit the diagnosis of insomnia either. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the authoritative text on psychiatric conditions, makes it clear that trouble sleeping must be a sustained problem before it can be deemed to be insomnia.
Specifically, someone must have difficulty sleeping at least three nights per week for at least three months before a diagnosis of insomnia is appropriate.1
Of course, if you suffer from sleeplessness, you might find the idea of having to wait three months before receiving a diagnosis of insomnia to be a brutal standard to meet. Even if you haven’t met the textbook definition of insomnia, you should still seek medical help if you find that you are unable to sleep until you feel rested.
It is important to remember that only trained medical professionals should provide any diagnosis of diseases. If you suspect you suffer from insomnia, you should see a doctor to receive an accurate diagnosis. The main indication that you may be suffering from insomnia is if you are unable to get as much sleep as you would like to get, there is ample opportunity to sleep, and you aren’t being kept awake by any type of stimulant. If this happens three or more nights a week for at least three months, then you may be suffering from insomnia.2
Technically, a diagnosis of insomnia requires there to be difficulty sleeping for at least three months. Insomnia may last for as long as the cause of the insomnia persists. For example, if anxiety is the underlying source of the difficulty sleeping, so long as the anxiety is present the insomnia may persist. Research has found that waiting for insomnia to spontaneously resolve itself may not be the best approach,3 and if you believe you suffer from insomnia you should seek medical help.
A study of primary care reports of insomnia found depression and anxiety to be far and away the most common causes of being unable to sleep.4 In fact, half of all patients presenting with insomnia suffered from depression, and nearly half had anxiety. The third most common insomnia risk factor, only present in nine percent of patients in the study, was obstructive sleep apnea.
The most obvious side effect of insomnia is being tired or unrested. Insomnia results in a host lack of sleep symptoms like being more error or accident prone, increased irritability or shorter temper, and difficulty paying attention. In addition, someone suffering from insomnia may develop sleep anxiety, where they are dogged by concerns about how much sleep they are getting.<5
© 2021 American Sleep Association.