Are You Sleeping? Part I Western Classifications of Insomnia

This is the first part in a three part series that I am doing on insomnia and sleep. Today the topic is how western medicine classifies insomnia.

Sleep is a topic that hits close to home for me. I have struggled with insomnia and sleep issues for many many years. I know I am not alone either. Thousands and thousands of people have complaints about sleep. It may be difficulty falling asleep, staying asleep, sleep quality or quantity. 

For me personally I would describe my trouble with sleep as a strange limbo state between sleep and awake, walking though a lucid dream state, not ever really sleeping. But my partner would say different, he sees me sleeping and time passes and the sun goes down and come up. I hear every sound, feel every movement on the mattress. He doesn’t understand when I say that I struggle with insomnia. So this got me thinking. Perhaps there is a specific name that goes with what I am describing. What are the different types of insomnia out there? In Chinese medicine they they don’t have names. The description of you sleep problems are just pieces of a larger puzzle so to be honest I haven’t really ever done the western medical research. So I thought in this blog post I would just dig around and describe some different types of insomnia and sleep disorders from a western medical perspective. The in the next post I will explore what is being done to treat some of these conditions. 

As with everything on the web there are varying opinions about how may types of insomnia there are out there. The National Sleep Foundation has five categories Acute, Chronic, Comorbid, Onset, and Maintenance insomnia. They describe Acute insomnia as a “brief episode of difficulty sleeping. Acute insomnia is usually caused by a life event.” Chronic insonmia is described as a “ long-term pattern of difficulty sleeping. Insomnia is usually considered chronic if a person has trouble falling asleep or staying asleep for a certain number of days out of every week.  Chronic insomnia has many causes. Comorbid insomnia occurs with another condition. An example is psychiatric symptoms — such as anxiety and depression —  or certain medical conditions. Onset insomnia is difficulty falling asleep at the beginning of the night and Maintenance insomnia is an inability to stay asleep. People with maintenance insomnia wake up during the night and have difficulty returning to sleep. Think that most of these descriptions are pretty general and cover most of the bases with the general population but I didn’t really find any of these descriptions to be very helpful for placing a name to what I feel like I struggle with. 

But wait !! I kept digging and I hit upon a sleep study that was done using sleep education to treat a condition called Paradoxical Insomnia. Eureka!! This study describes this condition as, “a complaint of severe insomnia disproportional to the presence of objective sleep disturbance or daytime impairment (American Academy of Sleep Medicine [AASM], 2005). Previously known as sleep state misperception, paradoxical insomnia has been a difficult subtype of insomnia to assess and treat (Edinger & Krystal, 2003). Hypervigilance occurs while the patient is trying to sleep, suggesting paradoxical insomnia has a hyperarousal component, and there may be physiological or perceptual deficits that affect sleep/wake discrimination causing sleep time underestimation (Bonnet & Arand, 1997). Improving sleep/wake discriminations in people with paradoxical insomnia may lead to reductions in sleep complaints (Downey & Bonnet, 1992).” I know that was a long description but that description hit every nail on the head. From that I have been reading it a more rare form of insomnia then those described on the National Sleep Foundation's page.

Great I have Paradoxical Insomnia now what? Or great I have acute insomnia now what? If you have ever struggled with sleep you understand that you don't really care what its called you just want it to get better.  Next post we will explore some of the ways that it is being treated in western medicine.