Types of Insomnia — Causes and Treatments

Written by Abby McCoy, RN, Health Writer

Methodology

At Sleepopolis, we’re constantly monitoring new sleep health developments in order to keep our articles as up-to-date and accurate as possible.

Just Updated

This article has been updated to reflect more recent medical consensus around the types of insomnia.

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Long Story Short

• Insomnia, the most common sleep disorder, is characterized by difficulty falling or staying asleep. 
• There are three main types of insomnia, but most fall under two categories — acute and chronic — along with several subtypes. (1)
• The most common type of insomnia is acute insomnia, which impacts as much as 37 percent of the population. (2)
• Almost 15 percent of adults had trouble falling asleep most days or every day in 2020. (3)
• Middle (maintenance) insomnia —  which happens when you wake up during the night — is the most common chronic insomnia subtype, affecting almost two thirds of people with this sleep disorder. (4)
• Treatments for insomnia include cognitive behavioral therapy (CBT-I), temporary medications, and practicing good sleep hygiene. 

Insomnia can steal just a few night’s sleep, or it can hang around for years. Over the decades, experts have categorized and re-categorized the different types of insomnia, and while all insomnias fall under three main umbrellas now, your specific insomnia may also be in a subcategory. Figuring out your own special blend of sleeplessness can feel overwhelming, but we’re here to help you wade through the insomnia types and understand their differences.

Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t be taken as medical advice, and it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately. Additionally, restrictions and regulations on supplements may vary by location. If you ever have any questions or concerns about a product you’re using, contact your doctor.

The Primary Types of Insomnia

The three main types of insomnia are acute insomnia, chronic insomnia, and “other” insomnia, which simply means your insomnia doesn’t meet the criteria for the other two categories. (1) (5)

Insomnia definitions are complicated because people respond differently to various situations, emotions, and illnesses; however, most insomnias fall under one of two categories: acute and chronic. Both of these also have some subtypes, which we’ll dig into a little bit later. (6)

Acute Insomnia

Acute insomnia (also known as short-term insomnia) means you don’t sleep well at least three days per week from anywhere between one week and three months. (2) When you have acute insomnia, sleep loss is typically transient (temporary). 

Adjustment Insomnia

Adjustment insomnia describes a type of acute insomnia that causes loss of sleep surrounding an adjustment period. It’s most common in women and older adults. (7)

“Acute insomnia…is usually caused by a source of stress, like a major life event, illness or change in routine,” says Dr. Andrea Matsumura, sleep medicine physician and spokesperson for the American Academy of Sleep Medicine (AASM). Jet lag after traveling across time zones can also cause temporary insomnia. (8)

Negative sources aren’t the only sleep-stealers — this insomnia type can follow positive events, too, says Karin Voelker, PsyD, a licensed clinical psychologist specializing in behavioral sleep medicine. “Humans generally don’t do well with change. So, if we get divorced or married, if we get laid off or promoted, and if we file for bankruptcy or win the lottery, sleep may be affected,” Voelker says.

Luckily, acute insomnia typically resolves when the triggering factors pass, adds Matsumura, so you may not have to worry about treatment if you find yourself lying awake before a big move or your first day at a new job. 

Chronic Insomnia 

Insomnia becomes chronic (“long-term”) when it happens more than three nights a week for over three months, and no other health problem can explain it. (9) A 2024 survey by the AASM reports 12 percent of Americans have a chronic insomnia diagnosis, but one in three Americans experience insomnia symptoms. (10) (11)

“Chronic insomnia has a huge effect on a person’s ability to function during the day because of continuous issues with falling asleep, staying asleep or waking up early,” says Matsumura, who adds that this type of insomnia can be caused by persistent stress, underlying physical or mental health issues, or even inconsistent sleeping patterns. (5)

Unlike acute insomnia, or transient insomnia (which lasts for just a few nights), long-term insomnia can last indefinitely without treatment. (12) When chronic insomnia causes long-term sleep deprivation, it can increase your risk for: (1) (5)

• Heart disease
• High blood pressure
• Type two diabetes
• GI reflux
• Asthma
• Kidney disease
• Stroke
• Depression

We know that list looks intense, but it’s important to remember these things mostly happen if you stay sleepless over years. (13) Let’s look at some other insomnia subtypes and categories and then we’ll talk about what you can do to get your sleep back.

Comorbid Insomnia

When insomnia is diagnosed alongside another chronic illness like diabetes, sleep apnea, or depression, it’s known as “comorbid insomnia.” (1) (5)

Subtypes of Chronic Insomnia

Chronic insomnia can have multiple subtypes defined by their causes, including psychophysiological insomnia, idiopathic insomnia, paradoxical insomnia, sleep hygiene insomnia, and behavioral insomnia of childhood. Even though these categories were recently taken out of the insomnia diagnostic handbook (the ICSD-III), some people may still use these terms. (6) (14)

Psychophysiological Insomnia

Psychophysiological insomnia may make you feel like your brain is buzzing at bedtime. People with psychophysiological insomnia feel tired all day, but wide awake when they hit the sheets. (1) (15) 

This inability to turn your brain off could stem from excessive worry about sleep or trouble drifting off in your current sleep space. You may sleep great in new places or snag easy spontaneous naps on the sofa, but your brain has learned that your bed is no place to catch your zzzs. (16) (17)

Idiopathic Insomnia

Idiopathic insomnia starts early in childhood and hangs around throughout adulthood. Experts think people with idiopathic insomnia may have some genetic differences in their sleep-wake cycle, which is when your body naturally gets sleepy or feels wakeful. (1) (18)

It can be hard to tell idiopathic and psychophysiological insomnia apart, and to do so, your provider may ask you a lot of questions about your sleep in childhood. Luckily, not every light-sleeping child ends up with insomnia, so no need to panic if your child seems to have some symptoms. (6) 

Paradoxical Insomnia

When you have paradoxical insomnia, you feel wakeful throughout the night, but you actually get a decent night’s sleep. In sleep studies on people with this type of insomnia, measurements confirm they slept all night, but when they wake, they feel like they didn’t. (1)

Experts disagree on paradoxical insomnia’s exact definition (and some don’t even recognize its existence!) but it may be caused by worry about sleep loss and brief periods of wakefulness which may feel much longer than they are in reality. (20)

Sleep Hygiene Insomnia

Sleep hygiene insomnia happens when you neglect your good sleep habits. Sleep hygiene describes your daily and pre-bed activities, like avoiding caffeine and alcohol before bed, as well as creating a restful sleeping environment (Keeping your room cool, dark, and quiet, for example). 

When you don’t stick to activities that promote sleep, you may experience sleep hygiene insomnia. Keep reading for good sleep hygiene tips below. (1) (21)

Behavioral Insomnia Of Childhood (BIC)

Behavioral insomnia of childhood (BIC) describes difficulty sleeping in children that may be caused by their environment or by a lack of limits around sleep. (1) “Behavioral insomnia in children usually falls into two main categories,” says Matsumura: sleep-onset BIC and limit-setting BIC. (22)

In sleep-onset BIC, kids rely on a specific type of stimulation, object, or setting to get to sleep in the evening and after any night wakings. (22) These stimuli can include being rocked, holding a bottle or sleeping in their parents’ bed, says Matsumura. “When those conditions aren’t there, they struggle to fall asleep on their own.”

Limit-setting BIC looks like bedtime stalling or straight-up refusal to go to bed, and can happen when parents don’t set enough (and maintain) consistent boundaries around bedtime. (22) (We feel you, tired parents — this may describe every single child at some point in their life!) This typically starts after a child turns two and resolves with firm bedtime limits.

Some kids decide to do both (combined-type BIC), just to give their parents the extra challenge they never wanted. “Establishing a consistent bedtime routine and sticking to it can be really helpful in managing this condition,” says Matsumura. (22) But remember to be kind to yourself, parents — start as slow as you need, and do your best to get educated about your options and lean on your support system. You also need to protect your own sleep, even when you’re working with your child on theirs.

Other Ways to Categorize Insomnia 

To add to this already long and complex list, insomnia is sometimes categorized by timing and other causes, including sleep-onset insomnia, terminal insomnia, and drug-induced insomnia. (1) Below, we’ll explain this final batch of categories and then move on to what you can do about them.

Sleep Onset Insomnia

Sleep onset insomnia means you have trouble falling asleep when you first go to bed, but then you sleep okay once you finally drift off. (1) “This type of insomnia is often associated with anxiety, stress or irregular sleep schedules, leaving people lying awake for extended periods before sleep finally comes,” says Matsumura. (4)

This may sound a lot like acute insomnia, and their causes can overlap, but acute insomnia resolves by three months, whereas sleep onset chronic insomnia continues after that three-month mark.

Sleep Maintenance Insomnia 

Sleep maintenance insomnia (middle insomnia) happens when you wake up during the night and can’t fall back to sleep. You know it’s middle insomnia if you often can’t fall asleep for 30 minutes or more after waking, says Voelker, and this can happen multiple times in the night. (23)

In one study of 456 insomnia patients, this subtype of insomnia was the most common. (19) “These repeated awakenings can reduce overall sleep quality and leave individuals feeling unrested in the morning,” says Matsumura, who adds that it’s often linked to medical conditions, mental health disorders, hormonal shifts, or environmental disturbances like noise or light.

Late or Terminal Insomnia 

Terminal or late insomnia describes when you wake up at least 30 minutes before you want to in the morning and can’t go back to sleep. (24) Late insomnia can lead to daytime fatigue because you may be unable to complete a full sleep cycle, says Matsumura.

In one small study, late insomnia was more common in people over 65 and least common in those under 45. (25) In a larger study review, researchers found if you have depression with terminal insomnia, you may experience more nightmares. (26) 

Drug or Substance-Induced Insomnia

Substance-induced insomnia can happen if you use certain medications, illicit drugs, or alcohol. (27) For example, some prescription medications for depression, diabetes, blood pressure, asthma, and pain can steal your sleep. (28)

Apart from prescriptions, the use and abuse of Illicit drugs like cocaine and heroin affect falling asleep, staying asleep, and the quality of your rest. (29) Alcohol, on the other hand, can make you feel sleepy, and may even help you fall asleep easier, but it will disrupt your deep sleep later on, keeping you from feeling rested the next day. (30)

Treatments For Insomnia

Successful insomnia treatment typically includes several aspects, which may include medications, cognitive behavioral therapy, psychotherapy, and lifestyle adjustments. “When it comes to treating insomnia, the approach really depends on what’s causing it, but there are a few key strategies that work well across the board,” says Matsumura.

For example, short-term insomnia may respond well to stress management and relaxation techniques, says Matsumura, whereas for people with insomnia tied to other medical conditions, it’s important to treat those underlying problems at the same time for best results.

Let’s break down the options, starting with cognitive behavioral therapy.

Cognitive Behavioral Therapy (CBT-I)

Cognitive behavioral therapy for insomnia (CBT-I) is a six to eight-week treatment plan designed to help you change negative thought patterns and behaviors around sleep. (22) “CBT-I is one of the most effective treatments for long-term insomnia because it helps people change the habits and thoughts that get in the way of good sleep,” says Matsumura. It also gives you the skills to help you sleep without medications, with benefits that can last a lifetime. 

“This therapy goes beyond sleep hygiene,” says Voelker, although it often includes the adoption of sleep hygiene habits. You can participate in CBT-I with a trained medical professional in person, on the phone, with an app, or on a video call. 

Sleep Hygiene 

Although sleep hygiene is a part of CBT-I, it’s important enough that it gets its own section. Sleep hygiene creates the best possible conditions for you to get great quality sleep — and enough of it. (22)

To practice good sleep hygiene: (22)

• Keep your room dark, quiet, and cool.
• Avoid TV or hand-held electronics before bed to steer clear of blue light that may confuse your internal clock and skip emotional highs that may delay your zzzs.
• Follow the same sleep schedule (sleep and wake times) seven days a week.
• Cut off your caffeine, nicotine, and alcohol close to bedtime (you may need to experiment with your cut-off times to find what’s right for you). If you can, try to cut out alcohol and nicotine all together for maximum health benefits.
• Exercise during the day (at least five or six hours before going to bed).
• Nap sparingly, and not later in the day.
• Stick to small, healthy snacks before bed — no large pre-sleep meals.
• Follow a consistent bedtime routine to wind down for sleep, like reading, listening to soft music, or taking a warm shower.
• Invest in a mattress that fits your needs, cozy bedding, and a supportive pillow.

Following these tips might just give you your best chance at a solid night’s snoozing. (21)

Sleep Medications

While medications are sometimes needed for good sleep, they’re usually a temporary fix, says Matsumura. (22) Sleep medications can be prescription or over-the-counter.

Prescription Sleep Medications

Some medications were created to help you sleep and must be prescribed by a healthcare provider. These include: (22) (31)

• Benzodiazepine receptor agonists (“Z-drugs”): zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta)
• Melatonin receptor agonist: ramelteon (Rozerem)
• Orexin receptor antagonists: suvorexant (Belsomra) 
• Benzodiazepines: diazepam (Valium) and clonazepam (Klonopin) 

It’s important to note that benzodiazepines aren’t often used by sleep medicine physicians because they can be habit-forming, and are typically not recommended. (31)

Off-Label Sleep Medications

Other sleep medicines are prescribed as “off label,” meaning they weren’t designed for better sleep, but may offer it all the same. (31) (22)

• Antipsychotic medications: olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal)
• Antidepressants: trazodone, mirtazapine (Remeron), amitriptyline (Elavil), and nortriptyline (Pamelor)
• Anticonvulsants: gabapentin (Neurontin) and pregabalin (Lyrica) 

These medications basically come with a handy side effect of better sleep.

Over-the-Counter Medications and Supplements

Some medicines that can be bought over the counter (without a prescription) can be used as temporary sleep aids after your provider’s okay. (22) (31)

• Antihistamines: diphenhydramine (Benadryl)
• Melatonin supplements: synthetic versions of your natural melatonin hormone

What Is Melatonin?

Melatonin, a naturally occurring hormone, works closely with your circadian rhythm (internal clock) to help your brain and body prepare for sleep as bedtime approaches. Some people take melatonin supplements, which may help you get sleepy at night, but be sure to check with your healthcare provider before you try it. (31) Keep in mind that supplements aren’t regulated the same way prescription drugs are, so they may not have the amount of melatonin on the label.

Although you can buy supplements and non-prescription medications without your provider’s official say-so, it’s always a good idea to double check with your health team before you try anything new. (22)

FAQs

The Last Word From Sleepopolis

Insomnia can come in many forms, and experts have categorized it into a multitude of types over the years. Now, insomnia breaks down into two main types: acute, or short-term, and chronic, or long-term. No matter what type of insomnia you have, through cognitive therapies and excellent sleep hygiene, you can work to treat it and reclaim good sleep. 

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