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What Is Insomnia: Defining Both Acute and Chronic Insomnia


You know how awful one night of bad sleep can make you feel. Now multiply that one bad night by weeks, even months, and it’s easy to understand why insomnia can take a tremendous mental and physical toll on people.

By definition, even having just a few restless nights of sleep qualifies as a bout of insomnia. (1) In and of itself, a night or two of bad sleep isn’t a critical problem. But one or two nights of bad sleep can easily turn into a persistent problem. And it’s the repetitive nights of continued sleep woes that are the biggest drain on the body and brain.

If you struggle to sleep, you’re not alone. Estimates suggest approximately 10 percent of adults suffer from chronic insomnia, and between 15 and 35 percent of adults suffer from some level of short-term insomnia lasting anywhere from a few days to up to three months. (2)

Those numbers are worrying because sleep is one of the foundations of good health. If you’re not getting the slumber you need, you could be putting your health in jeopardy.

“Epidemiological studies show that lack of sleep is associated with obesity, diabetes, and heart disease, even Alzheimer’s,” says Sara Nowakowski, PhD, a clinical psychologist and sleep researcher at the University of Texas Medical Branch in Galveston. Other consequences of insomnia include increased risk for psychiatric disorders and motor vehicle accidents. When it comes to health, she adds: “Sleep is just as important as diet and other lifestyle behaviors.”

That’s why dealing with insomnia and getting the help you need is critical. So how do you know if you have insomnia, and how do you treat it if you do have it? Read on to get answers to your most pressing questions.

What Is Insomnia: Defining Both Acute and Chronic Insomnia
Insomnia is the most common sleep disorder. Unlike many other medical conditions, it has a relatively simple definition. “Insomnia means an inability to sleep,” says Gerard J. Meskill, MD, a neurologist and sleep disorders specialist with the Tricoastal Narcolepsy and Sleep Disorders Center in Texas. Characteristics of insomnia include not being able to fall asleep, not staying asleep throughout the night, and waking up too early in the morning.

More specifically, there are two types of insomnia: acute and chronic. Acute insomnia means you have trouble sleeping for only a short period of time, even if that means only for one night. “Virtually everybody gets acute insomnia every once in a while,” Dr. Meskill says. But this insomnia is so short lasting that once the cause behind it disappears, you return to your normal sleep patterns. (3)

Acute insomnia can still be a problem, however, because if ignored and not addressed it can lead to longer-term chronic insomnia.

Chronic insomnia is more severe and involves difficulty sleeping three or more days per week over the course of three months. Individuals with chronic insomnia also report disruptions in their daytime functioning, including sleepiness, irritability, or anxiety, or difficulty paying attention, focusing on tasks, or remembering, Dr. Nowakowski says.

While acute insomnia can usually be solved without professional help, the same isn’t true for people with chronic insomnia. These individuals need to work with a trained professional, and the sooner they bring someone on board, the more quickly they can stop problems from becoming even more severe and thus taking longer to solve.

Signs and Symptoms of Insomnia
Determining if you have insomnia usually isn’t difficult. In most cases, you know if you’re not sleeping well. “Most patients see me already knowing their diagnosis,” Meskill says.

But there are also some people who may not be aware that they have insomnia. “It’s possible that these people have so much going on that they might perceive symptoms of daytime fatigue as a result of other chronic health conditions or a busy schedule,” he says.

Taking 30 minutes or longer to fall asleep at night suggests you have insomnia. (4) When it comes to middle-of-the-night awakenings, most people have a few of those each night. But if yours tend to last more than a few seconds or minutes — that is, you’re fully awake and can’t get back to sleep — that’s indicative of insomnia. (5)

Waking up early in the morning before you intend to (and therefore cutting your total sleep time for the night short) can also be a sign of insomnia. (1)

Keep in mind that adults need seven or more hours of sleep each night. There are individual differences in sleep needs: some people need just seven hours to feel perfectly rested and others need closer to nine. And everyone’s going to have a poor night of sleep from time to time. But if you’re waking up just four or five hours after going to bed often, that’s a problem, according to the Centers for Disease Control and Prevention (CDC). (6)

In addition to having trouble falling asleep at night, staying asleep, or waking up too early in the morning, common insomnia symptoms include: (2)

Fatigue
Problems with focusing or concentration
Poor memory
Mood disturbance
Daytime sleepiness
Low motivation or energy
Increased errors or accidents
If you’re at all concerned about your sleep issues, talk with your doctor. Your doctor can then direct you to a qualified sleep specialist.

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Causes and Risk Factors of Insomnia
Insomnia doesn’t just have one cause — it can be caused by a number of factors.

According to the National Sleep Foundation, these causes can include: (7)

Medical conditions, such as arthritis, asthma, chronic pain, sleep apnea, and neurological conditions (including Parkinson’s disease)
Medication
Psychiatric conditions, such as depression, anxiety, schizophrenia, attention deficit hyperactivity disorder (ADHD), and bipolar disorder (insomnia can also contribute to or raise your risk for anxiety and depression.)
Dietary habits, such as consuming heavy meals too close to when you go to sleep, or consuming too much caffeine or alcohol
Nicotine use
Jet lag
Unhealthy sleep habits, such as having an inconsistent or irregular sleep schedule

To better understand how insomnia develops and its causes in a specific individual, sleep experts often use what’s called the “Spielman model” or “3P behavioral model” of insomnia. It helps sleep doctors chart various factors that might trigger insomnia, and account for any possible contributing causes.

Per past research, here’s what each “P” means, and how each can potentially contribute to insomnia: (8)

Predisposing Factors This category includes most psychological, biological, and social factors that could make you more prone to insomnia. For example, anxiety, being a woman (because statistics show insomnia is more common in women than in men), and hyperarousal (meaning that you’re at greater risk of anxiety or have a higher wake drive than normal) are all predisposing psychological or biological factors. Predisposing social factors include an unconventional work schedule, and also a bed partner whose sleep schedule doesn’t align with yours.
Precipitating Factors These are new and often stress-related events that trigger insomnia. For instance, you might be dealing with stress at work, financial worries, bad news about something important in life, or travel. Pain, depression, illnesses, and medication may also play into this, and all of these factors can lead to chronic insomnia. Note, though, that an ongoing medical issue like chronic pain or untreated obstructive sleep apnea can serve as both precipitating and perpetuating factors, Meskill says.
Perpetuating Factors These are generally behaviors or beliefs people have adopted that either maintain their sleep difficulties or make them worse, all of which perpetuate chronic insomnia. This could include changes in daytime behaviors — many people take naps or try to sleep in later, which can in some cases make insomnia worse — or beliefs about sleep that fuel the insomnia flame. For instance, people with insomnia often develop anxieties connected to their bed, fear about not sleeping, and even worries about how lack of sleep will affect their daytime routines. Medical issues, as Meskill mentioned above, can also fall into this category.
Though in some cases any one of these causes may be problematic enough to trigger insomnia, for most individuals who have trouble sleeping, a combination of factors from each of these categories contributes to insomnia.