Why Can’t I Sleep? An Introduction to Insomnia
If you have found yourself on this page, you may have been experiencing sleep problems for some time, you might be experiencing a sudden onset of sleep challenges, or perhaps you are a person for whom trouble sleeping comes and goes. If any of these situations applies to you, please know you are not alone! In fact, most people will experience a period of poor sleep at some point during their lives. For many, the sleep problem will resolve on its own, while many others find that they require additional support to improve their sleep and how they feel during the day.
When poor sleep comes on suddenly and is significant enough to cause distress or impairment (interference with your daily life), we think of this as acute insomnia. If you are experiencing acute insomnia, it is often a very good idea to start with a consultation with your primary care physician to rule out a physical cause for the poor sleep. You might also think about the context in which your poor sleep is happening:
Have you recently experienced any significant life stressors?
Have there been major changes to routine or lifestyle?
Do you have any psychiatric or other medical conditions that might be flaring up?
Really thinking through these questions might give you some ideas about the drivers of the insomnia and what you might be able to do to help yourself through it.
If your poor sleep is persistent, distressing, and impairing, it is possible that you may meet diagnostic criteria for chronic insomnia, which is defined in the DSM-V as:
Significant difficulty falling asleep at the beginning of the night, significant difficulty staying asleep, and/or significant difficulty waking earlier than intended
This sleep difficulty is present at least 3 nights/week
This pattern of poor sleep is present for 3 months or longer
And the sleep difficulty is associated with significant impairment or distress
There are different types of chronic insomnia:
You would be considered to have what is called primary insomnia if your sleep problem is happening outside the context of another mental or physical health condition.
You would be considered to have what is termed secondary insomnia if your sleep problems are thought to be caused by another illness or disease.
Chronic insomnia can be driven by a range of causes, and, like with acute insomnia, every case of sleep difficulty is unique. That said, there are a number of empirically supported factors targeted by cognitive behavior therapy for insomnia (CBT-I) that are probably helpful to learn about for anyone who considers themselves to be a long-term poor sleeper.
General considerations offered in our “Why Can’t I Sleep?” series and those you can work on in depth in individualized CBT-I might be useful to consider for anyone struggling with their sleep. However, before making any behavioral changes based in cognitive behavior therapy for insomnia, it is always a good idea to see your primary care physician and rule out other potential causes of poor sleep (for example, a thyroid disease, anemia, or another sleep disorder like restless leg syndrome or sleep apnea).
Check out the other posts in this series to learn about some big common drivers of poor sleep and general suggestions about what you can do about them!
If you are ready to pursue individualized help for chronic insomnia or want to learn more click here.