Understanding Insomnia and What Keeps You Awake
Introduction
Do you lie awake in bed at night, unable to fall asleep? Or do you wake up feeling tired even after spending a hours sleeping? This could be an indication of insomnia. In India, insomnia affects approximately 33% of adults, with older adults being particularly vulnerable. Factors such as rapid urbanization, lifestyle changes, and surging stress levels all play a major role in this growing problem.1
Whether it is an occasional sleepless nights or a persistent battle with sleep, insomnia can take a serious toll on your health, productivity, and overall quality of life.
But before you can restore your sleep, you need to understand what type of insomnia you might be dealing with, and what’s causing it. This article breaks down the different types of insomnia, their causes, and how they appear, so you can start identifying your sleep challenges and take informed steps toward better rest.
What is Insomnia?
Insomnia is a common sleep disorder where a person has trouble falling asleep, staying asleep, or wakes up too early and can’t get back to sleep. It simple terms, it means you are not getting adequate rest, even if you spend enough time in bed. While, it may be a minor issue for some, for others, it can severely disrupt their day-to-day life.
Most adults need 7 to 9 hours of quality sleep each night to function properly. When insomnia lasts for a long time, it can lead to daytime sleepiness, poor focus, irritability, and increase the risk of long-term health issues such as heart disease and depression.
Types of Insomnia?
A) By Duration
1. Acute (short-term) insomnia:
Acute insomnia is generally caused by a stressor or change in a person’s life, which may be difficult for them to adjust to. The stressor can be positive, such as getting a new job, or negative, such as illness, a family crisis, or just a change in environment, such as jet lag.
It lasts less than three months, sometimes even less than that. Often, the condition resolves on its own once the stressor is removed.
Causes:
Acute insomnia is most commonly thought to be a reaction to one or more identifiable stressors or changes to one’s routine, such as:
a) Stress:
Concerns about personal or professional life, academics, or finances.
b) Traumatic events:
Loss of loved ones, divorce, or being laid off from work.
c) Environmental changes:
Extreme temperatures, sleeping in an unfamiliar or a turbulent environment.
d) Travel or work shifts:
Jet lag or rotating work shifts messes with the body's circadian rhythm.
e) Illness or pain:
A short-term illness or physical pain can interfere with sleep.
2. Chronic insomnia:
Chronic insomnia is a long-term insomnia, that may exist on its own or may be a result of an underlying health condition. It is characterized by trouble falling or staying asleep at least three nights per week for 3 months or longer. Unlike acute insomnia, it does not resolve without intervention and requires a more comprehensive treatment approach.
Chronic insomnia can be primary (idiopathic insomnia) which develops on its own and lacks a clear cause or underlying medical problem or secondary (comorbid insomnia), which is more common and occurs alongside another condition, such as sleep apnea.
Causes:
Numerous factors might contribute to the complex condition of chronic insomnia:
a) Genetic predisposition:
Brain structure and genetic makeup may increase susceptibility.
b) Psychosocial stressors:
Significant or prolonged stress can contribute to ongoing insomnia.
c) Persistent factors:
Over time, insomnia can be exacerbated by hyperarousal, behavioural adjustments (such as worrying about sleep), and emotional dysregulation.
d) Travel or work shifts:
Jet lag or rotating work shifts messes with the body's circadian rhythm.
e) Underlying health issues:
Chronic illnesses such as depression, anxiety, or sleep apnea.
3. Transient Insomnia:
A short-term variant of acute insomnia that lasts less than one month, usually just a few days to less than a week.
B) By Cause
1. Primary insomnia:
Primary insomnia occurs independently of any medical, psychiatric, or environmental condition. The exact cause is not always clear, but long-term stress, emotional distress, genetic predisposition, and shift work can play a role.
Causes:
Primary insomnia is presumed to be caused by an imbalance in the brain's sleep-wake cycle, though this is not entirely understood. It can be influenced by:
• Variations in brain chemistry.
• Emotional distress or prolonged tension.
• Learned behaviors and anxiety related to sleep.
• Genetic factors may have an influence.
2. Secondary (comorbid) insomnia:
This more common type of insomnia can occur independently or be considered a symptom or side effect of the underlying issue, such as; chronic pain, depression, anxiety, or sleep apnea can cause or worsen insomnia.
Causes:
a) Medical conditions:
Gastric reflux disease (GERD), asthma, heart disease, chronic pain (such as arthritis), and hormonal changes (such as menopause).
b) Mental health conditions:
Post-traumatic stress disorder (PTSD), depression, and anxiety disorders.
c) Medications:
Certain blood pressure drugs, antidepressants, and asthma therapies may cause sleeplessness.
d) Lifestyle factors:
Irregular sleep patterns, working shifts, and consuming too much alcohol, nicotine, or caffeine.
e) Additional sleep disorders:
Insomnia can be caused as a side effect or as a symptom of sleep apnea and restless legs syndrome.
C) By Sleep Disruption Patterns
1. Initial (sleep-onset) insomnia:
The primary indication of this insomnia is the inability to fall asleep at the beginning of the night. It can be short-term or chronic and is often associated with anxiety or a hyperaroused state, when the person’s mind is overly active with the concern of falling asleep or is racing with too many thoughts.
2. Middle (sleep-maintenance) insomnia:
People with this type may wake up too frequently throughout the night and are unable to fall back asleep.
It is the most common form of insomnia and is often associated with medical conditions such as chronic pain, sleep disorders (sleep apnea or restless leg syndrome), or depression.
Causes:
a) Aging:
The quality of deep sleep declines as people age, making them prone to frequent awakenings.
b) Medical conditions:
Gastrointestinal problems, sleep apnea, chronic pain, and frequent urination.
c) Psychological health:
Nighttime awakenings are often linked with anxiety and depression.
d) Use of addictive substances:
Consuming alcohol disturbs sleep later in the night
3. Terminal (late or early waking) insomnia:
In terminal insomnia, the person wakes up too early in the morning and cannot get back to sleep. It is common among individuals with depression and can result in significant daytime sleepiness.
Causes
a) Depression:
One of the main signs of serious depressive disorder.
b) Aging:
The circadian rhythm may change as people age, causing them to wake up earlier.
c) Persistent medical issues:
The last stage of sleep can be disrupted by disorders like persistent pain or other illnesses.
4. Paradoxical insomnia (sleep state misperception):
Paradoxical insomnia is a type of insomnia where a person feels like they barely slept, even though sleep tests show they actually slept normally. People with this condition may say they were awake most of the night, yet they don’t feel very tired during the day. This misunderstanding of their sleep can increase worry and make sleep problems worse.
Causes:
a) Hyperarousal:
The brain remains somewhat alert during sleep due to anxiety or the fear of sleeplessness.
b) Sleep anxiety:
Worrying too much about sleep leads the brain to perceive light sleep periods as being awake.
c) Underlying mental health issues:
Depression and chronic stress can distort how sleep is recognized.
5. Mixed Insomnia:
Mixed Insomnia is a combination of sleep onset and sleep maintenance insomnia.
Causes
The causes are similar to those outlined for other insomnia types, and they frequently involve a blend of behavioral, psychological, and medical issues.
D) Children's insomnia
Behavioral insomnia of childhood (BIC) This type of insomnia manifests in children as a result of learned behaviour around sleep. It usually develops when a child does not have consistent bedtime routines or when parents struggle to set limits around sleep.
Subtypes and causes:
1. BIC sleep-onset association:
The child needs specific conditions like being rocked, held, or nursed to fall asleep. When they naturally wake up in the night, they need these conditions to fall asleep again.
Teaching the child to fall asleep on their own through a consistent bedtime routine and self-soothing skills usually helps correct this.
2. BIC limit-setting:
The child resists going to or staying in bed by delaying or throwing tantrums. This occurs when parents or caregivers set inconsistent or inadequate boundaries around the nighttime sleep routine.
3. BIC combined type:
This is the combination of both the above two subtypes. The child displays a blend of sleep-onset association and limit-setting habits.
Conclusion
Understanding which type of insomnia you are suffering from and what is the cause behind insomnia, is the key to reclaiming your sleep. Whether it is short-term stress or a long-term sleep disorder, insomnia is not something you should ignore.
One of the most effective long-term treatments is Cognitive Behavioral Therapy for Insomnia (CBT-I), a clinically proven method that addresses the root causes of poor sleep, negative sleep patterns, racing thoughts, and behavioral triggers.
If you are looking for a convenient, evidence-based way to retrain your sleep habits, consider exploring our Digital CBT-I Course: Designed by sleep experts, it offers a structured, step-by-step approach to help you overcome insomnia without medication and restore natural, restful sleep.
References: 1. Anjanappa, J., & Mehta, K. (2024). Management of insomnia in India: expert consensus insights with a focus on zolpidem. International Journal of Research in Medical Sciences, 13(1), 484–497. https://doi.org/10.18203/2320-6012.ijrms20243776.
