11.04.22
Do You Have Insomnia or Just Suck at Sleeping?
It’s not just a bad night’s sleep.
If you have a tricky relationship with sleep lately, you might be Googling or wondering, “Do I have insomnia?” Well, the answer is (frustratingly): maybe! But not everyone who can’t sleep actually has insomnia.
A lot of the time, getting a bad night’s rest is just a normal reaction to stress, says behavioral sleep medicine specialist and licensed psychologist Sarah Silverman, PsyD. Feeling sleep deprived on the regular can also happen if you're going to bed too late or waking up too early, she adds. And those racing thoughts keeping you up at night might not be insomnia either. (To be fair, anxiety could turn into insomnia if it’s keeping you up consistently. The more you know.)
That said, insomnia is one of the most common sleep disorders, and about 10% of people have chronic or long-term insomnia, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), the guidebook that helps doctors and mental health professionals diagnose patients.
A lot of people who end up developing insomnia don’t know how to manage a few bad nights of sleep, says Dr. Silverman. Instead, they’ll do things that they think will help but ultimately make the problem worse, like trying to go to bed earlier only to lie awake, she explains. Then, you could fall into what the DSM-5-TR calls a “vicious cycle,” where you’re worried and frustrated about sleep. When that makes it even harder to get the sleep you need, proper treatment would be a solid idea.
Here, we break down what insomnia really is, how it’s diagnosed, who’s at risk, and how it’s treated so you can stop Googling and finally get some damn rest.
What is insomnia?
Insomnia happens when people consistently have trouble falling asleep and/or staying asleep, according to the American Academy of Sleep Medicine (AASM). During the day, people who have insomnia often feel like they aren’t rested, making them fatigued, irritable, and super anxious about their shuteye schedule, says Dr. Silverman. Maybe not surprisingly, insomnia can also impact attention, concentration, and memory. Obviously, a serious lack of sleep from insomnia can make someone appear low energy, but it can make them antsy or wired too, according to the DSM-5-TR.
There are two main types of insomnia, Dr. Silverman says. Short-term insomnia, also called adjustment insomnia or situational insomnia, often happens to people who are anticipating something like a work presentation or a wedding, since excitement and anxiety can affect the body in the same way, says Dr. Silverman. It usually goes away after a few nights or weeks, she adds. If sleep issues strike three nights per week or more and last three months or longer, then someone could be entering chronic insomnia territory, she explains.
Who gets insomnia?
Similar to a lot of conditions, you’re more likely to be diagnosed with insomnia if a close relative (like your mom) has a history of it. But sleeping in a room that’s too bright, loud, hot, or cold can also increase your likelihood of having it, according to the DSM-5-TR. And it’s more common for women since things like monthly hormonal changes and menopause may impact sleep, Dr. Silverman explains.
Medical conditions that wake you up in the middle of the night, like chronic pain and digestive issues, can also ramp up your risk of insomnia—same with sleep disorders like sleep apnea, which affects your breathing during sleep, says Dr. Silverman. And because getting older makes you more prone to medical issues, your age can up your risk for the disorder, she notes.
Plus, stress, anxiety, and depression—whether you have a diagnosable anxiety or depressive disorder or not—may increase your insomnia risk, Dr. Silverman says. In fact, improving your sleep can even help with symptoms of anxiety and depression, she notes.
One more thing: Sometimes anti-anxiety meds, antidepressants, and stimulants (like Adderall) can cause insomnia symptoms, says Dr. Silverman. Same goes for meds containing pseudoephedrine, like common cold and allergy medication, and for when you stop taking certain drugs, the AASM notes.
How is insomnia diagnosed?
If you’re having trouble sleeping and think you might have insomnia, you can head to your primary care provider, who can refer you out to a sleep doctor, a sleep psychologist, or other specialists. Or, if your insurance is cool with it, you can go straight to a sleep physician to get a diagnosis. Sleep doctors are good at ruling out if there are other physical issues going on like a breathing-related sleep disorder or restless legs syndrome, and a sleep psychologist—like Dr. Silverman—can help you address negative thoughts and learn skills to get better sleep via therapy.
Before you’re diagnosed, a doctor will ask you about your symptoms, family history, any existing health issues, and what meds you’re on, according to the National Heart, Lung, and Blood Institute (NHLBI). If you haven’t been keeping tabs on weird sleep patterns or how many hours of sleep you’ve been getting, a doctor will probably ask you to do that for a few weeks, says Dr. Silverman. JFYI: Keeping a sleep diary might up your anxiety about sleeping, which can lead to even less shuteye, she adds. Fun! So, if that happens to you, ask your doc if it’s 100% necessary.
You can also use a motion sensor on your wrist for up to two weeks to track your activity and sleep patterns at home with a method called actigraphy. And a doctor can rule out other sleep disorders by monitoring your brain waves, breathing, oxygen levels, and heart rate while you sleep (aka, a sleep study), according to the NHLBI.
Your doctor will evaluate the criteria for insomnia using something like the DSM-5-TR or The International Classification of Sleep Disorders (ICSD-3) and base a potential diagnosis off of what’s outlined there.
What’s the deal with insomnia treatment?
Cognitive behavioral therapy for insomnia, or CBT-I for short, pinpoints the thoughts and behaviors getting in the way of your sleep—and it’s the first line of treatment for chronic insomnia in adults, says Dr. Silverman. In fact, the American College of Physicians officially recommends it before medication, says clinical psychologist, behavioral sleep medicine specialist, and author of The Women’s Guide to Overcoming Insomnia Shelby Harris, PsyD.
In CBT-I, you learn sleep hygiene skills, like creating a consistent sleep schedule and not eating or working out too close to bedtime. But because people can have good sleep hygiene and still struggle with insomnia, CBT-I also tackles relaxation training like deep breathing exercises and meditation, how to address negative thoughts about sleep, setting boundaries with your bed (it’s for sleep and sex only, people!), and sleep restriction therapy, Dr. Silverman explains. Most people need four to 12 sessions to improve their sleep and keep sleeping well, says Dr. Harris.
Aside from CBT-I, some people can benefit from anti-anxiety meds (if they have underlying anxiety) or sleep meds, especially if they don’t have access to a provider who specializes in CBT-I, says Dr. Silverman.
The goal here is for people to eventually have restful ZZZs most nights of the week and feel like they have a consistent sleep schedule, Dr. Silverman explains. A few nights where you don’t have the best quality sleep is totally expected because, well, that’s life, she says.
Wondermind does not provide medical advice, diagnosis, or treatment. Any information published on this website or by this brand is not intended as a replacement for medical advice. Always consult a qualified health or mental health professional with any questions or concerns about your mental health.
