What is insomnia and how is it classified?
Insomnia is a sleep disorder characterised by difficulty falling asleep, staying asleep or waking up too early, even when there is an opportunity to sleep. When it becomes frequent, it has a serious impact on quality of life, causing tiredness, difficulty concentrating and mood swings.
Insomnia is generally divided into two main groups:
Occasional insomnia: transient episodes caused by stress, travelling, changes in routine or occasional anxiety.
Chronic insomnia: occurs at least three nights a week for three months or more, with a clear impact on well-being and daily performance.
Types of insomnia according to when they occur
- Initial insomnia: difficulty falling asleep.
- Maintenance insomnia: frequent awakenings during the night.
- Terminal insomnia: waking up too early.
- Paradoxical insomnia: subjective feeling of sleeping too little despite normal objective assessments.
Causes and factors that perpetuate insomnia
Triggering factors
- High stress or worries.
- Time changes or jet lag.
- Acute illness, pain or discomfort.
- Consumption of stimulants close to bedtime.
- Unsuitable environment (light, noise, temperature).
Perpetuating factors
- Staying awake in bed for a long time.
- Long naps during the day.
- Irregular sleep schedules.
- Use of screens at night.
- Anxiety associated with the fear of “not sleeping”.
Predisposing factors
- Personal tendency to anxiety.
- Family history of sleep disorders.
- Associated medical or psychological conditions.
Symptoms to watch out for
During the night
- Difficulty falling asleep
- Frequent awakenings
- Waking up too early
- Feeling of light or non-restorative sleep
During the day
- Persistent tiredness
- Difficulty concentrating
- Irritability
- Low yields
- Daytime sleepiness
Diagnosis of insomnia
- Detailed clinical interview on sleep habits and patterns
- Sleep diary for weeks
- Standardised questionnaires (e.g. Insomnia Severity Index)
- Polysomnography when other disorders are suspected
- Evaluation of associated medical and psychological factors
Insomnia treatment
Behavioural and therapeutic interventions
- Cognitive Behavioural Therapy for Insomnia (CBT-I)
- Sleep hygiene and consistent routines
- Stimulus control (bed only for sleeping)
- Restricting time in bed when there is a lot of night waking
- Relaxation techniques and reducing mental activation
Use of medication
- Sleep medication under medical supervision
- Supplements or specific approaches to regulate circadian rhythm, when indicated
Medication is only a support and does not solve the behavioural causes of insomnia.
Lifestyle adjustments
- Regular exercise (not around bedtime)
- Avoid caffeine, alcohol and heavy meals in the evening
- Create a comfortable, dark environment
- Reduce the use of electronic devices before going to bed
Integrated approach
- Treat associated conditions (chronic pain, apnoea, emotional disorders)
- Monitor and adjust the treatment plan according to progress
When to seek medical help
Seek specialised support if:
- Insomnia lasts more than three weeks
- Changing habits didn't work
- Signs of apnoea (loud snoring, breathing pauses)
- There are symptoms of anxiety, depression or other conditions
Talking to a sleep professional is essential for proper diagnosis and treatment.
Conclusion
Insomnia can start as a one-off, but when it becomes chronic it requires structured intervention. Identifying the type, understanding the causes and applying behavioural strategies is essential. Medication can help, but it is no substitute for changes in habits and therapy. If the difficulty sleeping persists, seeing a specialist is the most important step towards recovering restful nights.
