Dealing with sleeplessness can be infuriating. Whether you have trouble falling asleep or staying asleep, this condition is known as insomnia, and if left untreated, it can affect your ability to get enough rest, which can impact your daily life and overall health. There are many types of insomnia, depending on duration, severity, and what type of sleep trouble you have, so one of the first steps is understanding what kind of insomnia you have.
The different types of insomnia include:
- Short-term insomnia (aka acute insomnia)
- Transient insomnia
- Chronic insomnia
- Sleep onset insomnia
- Sleep maintenance insomnia
- Early-morning awakening insomnia
- Mixed insomnia
- Primary insomnia
- Secondary insomnia (aka comorbid insomnia)
- Behavioral insomnia of childhood
- Paradoxical insomnia
The first consideration is the length of sleep troubles — short-term insomnia can last just a few nights, and chronic insomnia persists beyond 30 days. Other factors in addressing the kind of insomnia include when it occurs during your sleep (or planned sleep) and whether or not it occurs in relationship with other health concerns as a primary or secondary issue.
Understanding how long insomnia lasts can help you know when to see a doctor, but understanding which of the more specific types of insomnia you’re facing can help you identify triggers and solve problems before they become chronic.
Main types of insomnia
The first way that insomnia is categorized is by how long it lasts. A short bout of sleep trouble is defined as short-term or transient insomnia, depending on the duration. Sleep psychologist Jade Wu, Ph.D., a Sleep Advisor to Sleep.com, says that insomnia has become chronic when someone has been struggling with it for more than a month.
Also known as acute insomnia, short-term insomnia comes on quickly and often passes within a few days. These cases often have simple causes that can be situational, physical, or psychological. Causes can include a noisy sleep space, illness or injury, or something mental, such as jitters ahead of an event or anxiety about something that’s occurred in the past. It can also be a side effect of some medications.
All in all, with short-term insomnia, the trouble passes quickly without long-term impact on your sleep or ensuing daily life. While your sleep may be disrupted for a few nights, causing you to struggle through your days, overall you’ll be able to get back to good rest without medical intervention. If you find that this trouble persists over several weeks, you may be dealing with transient insomnia.
Transient insomnia has the same basic sources as acute insomnia: Environment, behavior, illness, or medications cause it. Transient insomnia is longer-lasting than acute insomnia. While there are different definitions of exactly when acute insomnia shifts into transient insomnia, acute insomnia is generally considered to last for less than two weeks while transient insomnia lasts for two to four weeks.
Insomnia becomes chronic insomnia once it persists beyond a month. “At that point, it’s probably not the original stressful trigger that’s keeping insomnia going, but rather other factors that are causing insomnia to take on a life of its own,” Wu says. Once sleep insomnia has become chronic, simple solutions like making sure the bedroom is dark enough or not drinking caffeine after a certain time may not be sufficient. The issues may require a visit with your physician or a sleep specialist. At the appointment, Wu suggests asking questions like:
- Am I going to bed before I’m sleepy enough?
- Am I staying in bed, tossing and turning, making myself more anxious and frustrated about whether I’m sleeping?
- Am I trying too hard to fall asleep?
- Do I have enough opportunities to slow down and rest during the day?
While insomnia that lasts for only a couple weeks can be remedied at home — often by adjusting your bedtime routine or sleep hygiene — insomnia that persists for a month or longer typically necessitates a conversation with your doctor about treatment options.
Beyond duration, insomnia is also categorized by the point during your sleep journey when troubles occur.
Sleep onset insomnia
This is the most well-known type of insomnia — the kind you see in commercials and movies and read about in articles. It is difficulty falling asleep, often taking longer than 20-30 minutes. It’s one of the behavioral sleep issues commonly seen in children. There are many different causes for a single night of bad sleep, from grief to anxiety to excitement. Medications, alcohol, caffeine, or other chemicals can all affect the ability to fall asleep.
Anyone can also be affected by sleep onset insomnia in the short term. It has been found to be exacerbated by feelings of anxiety and is often accompanied by other medical or sleep-disrupting issues, including obstructive sleep apnea or movement disorders, such as restless legs syndrome. Kate Reeves, a licensed therapist based in Seattle, says that she often sees insomnia interact with anxiety in a chicken and egg way. “People may find themselves seeking stimulation as a way to avoid whatever is showing up in quiet moments,” she notes. “Highly stimulating input, like video games or social media, may help manage anxiety, but it results in difficulty falling asleep, which isn’t helpful over time.”
A study published in 2021 found that Kundalini yoga decreased sleep onset latency to under 30 minutes and increased total sleep time. More than 50% of participants in the yoga part of the study decreased their insomnia severity index by at least 8 points.
Sleep maintenance insomnia
Maintenance insomnia is difficulty staying asleep. It can also mean waking too early to be fully rested, but having difficulty falling back asleep. Some people report not being able to fall asleep at all; others can take more than 30 minutes to go back to sleep.
This kind of insomnia is characterized by sleep anxiety and frustration, since people who experience mid-sleep awakenings are anxious to get needed rest, and that anxiety can augment the sleep challenges, creating a vicious cycle that perpetuates the sleep troubles.
Maintenance insomnia often affects people with physical conditions, such as acid reflux disease, sleep apnea, asthma, or movement disorders, and is more likely to affect people who are middle aged or older; it is also reported by pregnant people, particularly in later weeks of pregnancy. Because this type of insomnia is often related to medical conditions, seeing a doctor can be helpful to rule out any undiagnosed health concerns.
Early morning awakening insomnia
Sometimes considered part of sleep maintenance insomnia — characteristics of insomnia can sometimes overlap — early morning awakening insomnia is defined by a morning awakening that occurs significantly earlier than an intended wake-up time, with an inability to fall back to sleep. It is frequently reported by older people. One study reported that this tendency was because of age-related changes to circadian rhythms combined with physical changes, such as increased amounts of arthritis or sleep apnea. Changes in lifestyle can also affect sleep, Wu notes. When someone retires, they might become less active, which can affect the amount of sleep the body needs.
Primary insomnia means that the only condition you are trying to manage is insomnia; you are otherwise free of health concerns and aren’t managing mental health or physical conditions that could impact your ability to sleep.
Also known as comorbid insomnia, secondary insomnia means that your insomnia is a side effect of, or related to, something else. For example, people who are diabetic might have difficulty staying asleep for physical reasons.
Understanding the difference is key for determining the best way to approach your insomnia. For primary insomnia, behavioral and environmental changes may be more than enough to address the issues, but with secondary insomnia, managing the primary condition may be necessary first.
What to know about behavioral insomnia in childhood
Just like adults, children can experience insomnia, and it can present in several different ways. Up to 25% of children will experience insomnia at some point in their childhood. As kids age, the types of insomnia that are most common can also change. Babies are prone to waking up during the night, while toddlers may resist bedtime, older children may wake up too early, and teenagers can experience hypersomnia, making them very difficult to awaken in the mornings. When considering how to manage sleep for a child, it’s important to consider their age. While most insomnia disorders in children are behavioral, there can be physical causes as well.
Common types of insomnia in children
- Sleep onset insomnia for children: Children struggle to fall asleep. This is common in younger children when they are excited, sick, or often over-tired. It can also occur when children are in a new setting or parents are out for the night.
- Limit-setting insomnia for children: This happens when parental behavior is interfering with healthy sleep patterns. Having a consistent bedtime routine that gets kids into bed at a time that allows them to get enough sleep is crucial to kids, especially at a young age.
- Combined types of insomnia for children: In many cases, parents’ difficulty in managing behavior combines with issues falling asleep, leading to difficult nights.
How to improve insomnia for children
Wu notes that insomnia in kids is almost always a behavioral issue. “Creating a consistent routine, protecting sleep time, and having parenting strategies for gently but firmly holding boundaries are often enough” to get sleep back on track.
Treatment and when to see a doctor
When should you consider seeing a doctor about your insomnia? As soon as it begins to affect your daily life. This can look like daytime tiredness, increased depression or anxiety, or worsening performance at work or school. Whatever you do, don’t ignore poor sleep, as even a few nights of inferior sleep can affect performance and amass as sleep debt.
Reeves notes that something she tries to acknowledge with her clients is the value of sleep, which can be difficult in this country, where society does not value sleep. “It starts with school schedules,” she says, “the ‘pulling an all-nighter’ culture, and bragging about how little sleep someone gets or needs. Research shows we are not okay with so little sleep. It’s bad for everything, from blood pressure to impulsivity.”
Takeaway about types of insomnia
Insomnia is a common ailment, experienced by up to half the population. Since there are so many different types of insomnia, understanding which kind you are experiencing can help you to target your solutions and possible culprits correctly. And if your attempts and solutions aren’t working, consider seeing a sleep specialist, especially if you find that insomnia is affecting your life.