Types of Insomnia

There are different types of insomnia, such as:

• Sleep-onset insomnia: You have trouble getting to sleep.
• Sleep-maintenance insomnia: You have trouble staying asleep through the night or wake up too early.
• Mixed insomnia: You have trouble falling asleep and staying asleep through the night.  
• Terminal insomnia: When a person wakes up too early and cannot go back to sleep.
• Comorbid insomnia: You have trouble falling asleep due to another health disorder, e.g. anxiety, GERD, etc.
• Paradoxical insomnia: You underestimate the time you’re asleep, meaning you feel like you sleep a lot less than you do.

Sleep-onset insomnia

Sleep-onset insomnia occurs when a person has trouble falling asleep at the start of the night or for shift workers when they try to go to bed. It involves tossing and turning without being able to drift off to sleep.

Those with this type of insomnia often find themselves unable to fall asleep even after lying in bed for 20-30 minutes. This difficulty leads to a decrease in total sleep time and can result in feeling the effects of sleep deprivation the following day.

Sleep-maintenance insomnia

Sleep maintenance insomnia refers to the difficulty of remaining asleep throughout the night. Typically, this involves waking up at least once at night and finding it challenging to fall back asleep for at least 20-30 minutes.

Interrupted sleep linked to poor sleep maintenance reduces both the amount and quality of sleep, leading to an increased likelihood of feeling tired or lethargic during the day.

Mixed insomnia

While not an official classification, the term “mixed insomnia” can describe individuals who experience a combination of difficulties with falling asleep, staying asleep, and waking up early in the morning. Essentially, the umbrella term “insomnia” can encompass mixed insomnia because it is common for individuals to have overlapping sleep issues.

Additionally, those with insomnia may notice that their symptoms change over time, making it challenging to categorise them solely within the categories of sleep onset, sleep maintenance, or early morning awakenings.

Terminal insomnia

Terminal insomnia, also known as late insomnia, occurs when a person wakes up too early and cannot go back to sleep. Early morning awakening insomnia involves waking up well before the intended time in the morning.

Some experts see terminal insomnia and early awakenings as part of sleep maintenance, while others see it as a distinct type of insomnia. Not getting enough sleep can affect a person’s physical and mental capabilities the following day.

Chronic late insomnia could result in a cycle of excessive daytime fatigue, falling asleep prematurely, and ultimately waking up early once more in the morning.

Comorbid insomnia

Recent studies have provided a more in-depth insight into insomnia, acknowledging that sleep disorders are often intertwined with other health concerns in a two-way relationship. For instance, while anxiety can contribute to insomnia, insomnia can also worsen or spark anxiety. Additionally, insomnia stemming from another health issue may persist even after the underlying problem is treated.

Examples of comorbid insomnia:

• anxiety
• depression
• GERD (gastroesophageal reflux disease)
• Alcohol or drug addiction
• Sleep apnea

Due to the intricate nature of these connections, categorizing insomnia solely as comorbid or secondary has become challenging. As a result, classification systems in the field of sleep medicine have shifted towards a more comprehensive understanding of insomnia, moving away from the previous terminology.

Paradoxical insomnia

Paradoxical insomnia, also known as sleep state misperception, is characterized by individuals mistakenly believing they have been awake throughout the night when they have actually slept for a normal duration.

This condition highlights the contradiction between perception and reality when it comes to sleep patterns.