Insomnia

Doctors categorize insomnia in several ways to make it easier to understand and treat.

Acute vs. Chronic
Many adults experience insomnia for a short period of time (acute insomnia) at some point in their lives. If it does not improve after about three months (chronic insomnia), it’s time to talk to your doctor.

Primary vs. Secondary
Insomnia that develops on its own is called primary insomnia. Secondary insomnia is caused by or related to another condition -- for example, another sleep disorder like sleep apnea, depression, or anxiety, which are very common in people with insomnia.

Sleep Onset vs. Sleep Maintenance
Sleep onset insomnia describes difficulty falling asleep. Sleep maintenance insomnia describes difficulty staying asleep.

Subtypes

• Psychophysiological insomnia: This is the most common subtype of insomnia. People with psychophysiological insomnia usually feel tired, but when they try to sleep, they feel wide awake.
• Paradoxical insomnia: This rarer subtype of insomnia can be difficult to treat. Someone with paradoxical insomnia has an abnormal sense of being awake when they are actually asleep.

To determine whether you have insomnia or another condition, such as a circadian rhythm disorder, your doctor will listen to your concerns and ask questions about your sleep patterns. A sleep study may be recommended if your provider suspects another sleep disorder is contributing to your insomnia.

The first-line treatment for insomnia is to practice good sleep hygiene. This includes avoiding caffeine and screens before bed, establishing a bedtime routine, and maintaining a comfortable sleeping environment that is free of distractions. Your doctor can help you create a plan that works for your lifestyle.

Medications
Although some over-the-counter sleep aids can help with acute insomnia, they may have side effects. Talk to your doctor before starting new medications. 

A wide range of prescription medications can help you sleep better. Sleep specialists may recommend medications based on your unique symptoms and contributing factors (such as pain or restless legs, for example). 

Some sleep medications can contribute to abnormal sleep behaviors, like sleep talking or sleep walking. Other sleep medicines can become addictive. Duke sleep specialists take extreme care when prescribing these medications to ensure their benefits outweigh any risks.

Although medications can help you sleep, they don't cure the underlying cause of insomnia and may not be recommended for long-term use.

Cognitive Behavioral Therapy 
Cognitive behavioral therapy for insomnia (CBT-I) is the most effective treatment for insomnia. By following a strict set of sleep and wake patterns, CTB-I aims to re-train your brain to sleep when you’re tired and wake up when you’re rested. Duke sleep specialists recommend community sleep psychologists who are specifically trained in administering CBT-I. Most people successfully restore good sleep after two or three months of CBT-I.

Advanced Care for Difficult-to-Treat Insomnia
Duke’s sleep disorders team includes sleep psychiatrists who are specially trained to care for people with difficult-to-treat insomnia. Sleep psychiatrists are uniquely positioned to treat insomnia that overlaps with mental health concerns and to manage medications when needed.

Sleep Specialists and Sleep Center Resources
Duke’s established sleep center brings together sleep experts from various specialties including psychiatry, psychology, pulmonology, neurology, and more. That means you benefit from a sleep team effort, rather than treatment from a single provider.

Clinical Trials
You may qualify to participate in clinical trials that can help researchers learn more about insomnia and how best to treat it. This could give you access to therapies before they are widely available.