Sleep is so precious, and unfortunately, many Americans struggle to get it. According to Cleveland Clinic, up to 70 million Americans every year deal with sleep disorders, including insomnia. They note that insomnia symptoms occur in approximately 33% to 50% of the adult population, and Chronic Insomnia disorder affects 10% to 15%. “Insomnia is defined as problems falling asleep, staying asleep, waking too early or a combination of both. It occurs most days per week and has occurred for less than 3 months,” explains Dr. Alicia Roth, PhD, of Cleveland Clinic’s Sleep Disorders Center. “Most importantly, it causes problems with daytime functioning (working, social life, exercising, concentration, etc).” But when we talk about sleep, we often talk about both acute (“regular”) and chronic insomnia. But what’s the difference?
Chronic vs acute insomnia
According to Dr. Roth, the biggest difference between chronic insomnia and acute (“regular”) insomnia is simply the duration of time with insomnia. Chronic insomnia is insomnia that persists for three months or longer. However, chronic insomnia has a snowball effect. “We used to think insomnia was always a symptom of something else such as a stressful life event or medical problem. Therefore, if the stressor is managed or resolved, the insomnia would go away,” says Dr. Roth. “Although that’s true for a lot of people, a smaller subset of people will go on to develop chronic insomnia (lasting more than three months) even when the stressor is better.” She explains that this happens because once you start to experience insomnia and sleep deprivation, your days become very uncomfortable. And your brain is not wired to sit with discomfort, so it looks for a way out of the discomfort of sleep deprivation. “That takes many forms: extra caffeine, napping, going to bed early, canceling plans, not exercising. Worrying or feeling anxious about sleep deprivation is also a way to deal with the discomfort,” says Dr. Roth. “So although those things relieve the immediate discomfort, they can cause subsequent bad nights. And then you can get caught in a vicious cycle.” And that looks like this: I’m not sleeping well so I drink extra coffee in the afternoons, but because I drink extra coffee my sleep isn’t great again. However, insomnia is not the same thing as sleep deprivation. “Many individuals confuse the two conditions. Sleep deprivation causes excessive sleepiness or drive to sleep,” explainsW. Christopher Winter, MD, neurologist and author of The Sleep Solution: Why Your Sleep Is Broke and How to Fix It. “A sleep deprived individual generally does not have trouble falling asleep, just like a food-deprived individual generally does not have trouble finding food to eat in a cafeteria.”
How are acute insomnia and chronic insomnia treated?
Regardless of whether you struggle with chronic insomnia or acute insomnia, Dr. Roth says that all insomnias are best treated with Cognitive Behavioral Therapy for Insomnia (CBTI). “This is the scientifically supported gold standard for insomnia treatment. It is more effective than sleep medications in the long run,” she says. “It involves identifying behaviors and conditions that are creating those vicious cycles and behaviors, which may be: what time you’re going to bed, what you’re doing to wind down, what do you do when you can’t sleep, what is your activity like during the day, are your bed and wake times right for you.” Dr. Winter adds that the aim is to get you back to a pre-insomnia way of thinking. “The anxiety and heightened arousal around sleep must be systematically deprogramed,” says Dr. Winter. Medications are really not appropriate in most sleep doctors’ opinions for the treatment of chronic insomnia. In CBTI, you will work on “cognitions,” are thoughts, emotions, or beliefs about sleep—like worry about sleep or having rigid incorrect beliefs about sleep. For example, I need eight hours to function properly. However, Dr. Roth says that sleep medication is often used in those with acute insomnia, but not chronic insomnia. “They are designed to work in the short term (maybe a couple weeks or months),” she says. “But they often lose effectiveness in the long term, and are not a great option for chronic insomnia.”
When to see a doctor
If you are concerned about your sleep issues and insomnia struggles, Dr. Roth suggests you first reach out to your primary care doctor. “Ask if there is a sleep specialist you can be referred to so you can have a thorough examination for sleep disorders like insomnia, sleep apnea, or circadian rhythm disorders,” says Dr. Roth. “The people who provide CBTI are usually psychologists or licensed clinical social workers. The website for theSociety of Behavioral Sleep Medicine(SBSM) has a list of providers by state and country who can provide CBTI.” She also adds that the recent COVID pandemic could also be a cause for insomnia. But help is available. “The pandemic has affected sleep more than ever—for lots of different reasons. In particular, I am seeing more people come for help who have long COVID or post-COVID syndrome,” she notes. “It’s a consequence of COVID that we don’t know much about yet and has many possible reasons for happening. But the good news is that even though many long COVID symptoms are difficult to treat, it seems like CBTI still works very well.” Next up: Do Weighted Blankets Work for Insomnia?
Sources
Dr. Alicia Roth, PhD, of Cleveland Clinic’s Sleep Disorders CenterW. Christopher Winter, MD, neurologist and author of The Sleep Solution: Why Your Sleep Is Broke and How to Fix It
