When we break down the Latin roots of the word Insomnia, we get a literal translation of “without sleep disease.” “In” means “not,” “somnus” is sleep, and “ia” is commonly used in the names of diseases. And though the insomnia definition in psychology and healthcare practice is more nuanced, at its core insomnia is the experience of being without sleep and the cascading consequences of what that means.
The definition of insomnia
Here’s the basic definition of insomnia: a condition in which someone lives without enough hours of sleep, or quality sleep, despite ample opportunity. In terms of a diagnosis, this lack of sleep must also cause distress and impairment in your life.
People often think of insomnia as difficulty falling asleep (sleep-onset insomnia), but difficulty sleeping can happen at any stage of sleep. The most common experience is having trouble staying asleep (sleep maintenance insomnia), which includes experiencing frequent or prolonged awakenings throughout the night.
You may also awaken in the early morning (late insomnia) before your body is rested and have trouble falling back asleep.
One of the most important things to know about insomnia is that it occurs during sleep time, but the impact continues throughout the day. Plus, it’s strongly associated with other health conditions—and can lead to significant difficulties functioning in at least one key area of life, such as social life, work, or school.
The American Psychiatric Association classifies insomnia as a sleep disorder. It is not the only sleep disorder, but it’s the most common one. One-third of adults in the US report insomnia symptoms, while 6 – 10% meet the criteria for insomnia disorder.
In both the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, and International Classification of Diseases, or ICD 10, for insomnia disorder, symptoms include:
- One or more of the following:
- Difficulty falling asleep
- Frequent wake-ups, with difficulty falling back asleep
- Waking up early morning without being able to fall back asleep
The DSM-5 also includes the following criteria:
- Significant distress or challenges functioning in essential areas of life, such as social life, work, school, or daily activities.
- Difficulty sleeping occurs at least 3 times per week, despite adequate opportunity for sleep.
If we define insomnia using the DSM-5’s criteria, someone may have difficulty sleeping but won’t receive an insomnia disorder diagnosis unless lack of sleep causes distress or impairment.
Insomnia can be episodic, recurrent, or persistent. Episodic means the difficulties sleeping last at least 1 month, but less than three. Recurrent means that episodes of insomnia re-occur at least twice within a year. Persistent insomnia means it is lasting more than three months.
One might also experience situational or acute insomnia, lasting a few weeks, often corresponding to a specific stressor or change.
Not all sleep issues are insomnia
We are a chronically underslept nation. Even though health experts recommend 8 hours of sleep, 1 in 5 Americans gets fewer than 6.
Any obstacles you face to getting the rest your body needs are worth addressing. But not all sleep obstacles fit the criteria for insomnia, meaning there are some instances where lack of sleep is not attributable to this particular condition.
This distinction can be important because understanding what’s happening may help you better identify the best path forward.
Sleep issues are not considered insomnia disorder if:
- They’re explained by the use of a substance, such as a drug or medication
- They’re due to another sleep-wake disorder such as narcolepsy, a breathing-related disorder such as sleep apnea, a parasomnia such as night terrors or sleepwalking, or a circadian rhythm sleep-wake disorder such as not being able to sleep due to disruptive shift work.
Other reasons can explain regularly getting less sleep than the recommended 7-8 hours. For example, some folks are “short sleepers,” meaning they feel rested after less sleep than average.
Others may have a chronotype mismatch. A night owl may have a hard time finding their sleep rhythm in a work schedule best suited to a morning lark.
As far as an insomnia definition when it comes to diagnosis in the US, your symptoms will only be considered insomnia when accompanied by significant distress or impairment.
What does insomnia mean?
Professor Matt Walker, a neuroscientist at UC Berkeley, explains that “sleep is the Swiss army knife of health. When sleep is deficient, there is sickness and disease. And when sleep is abundant, there is vitality and health.”
On the one hand, insomnia can take an immense toll on health, wellbeing, and productivity. On the other hand, improving sleep quality and duration can have an immensely positive impact.
The occasional night of inadequate sleep, or jet lag, could result in daytime sleepiness. Perhaps counterintuitively, sleepiness is not the most common impact of insomnia. More often, it’s symptoms like:
- Difficulty with attention, concentration, and memory
- Difficulty performing simple manual skills
- Intense or rapidly changing moods
It’s easy to see how consequences like mood swings and difficulty doing basic tasks, or remembering essential items, can make it challenging to thrive.
Complications and consequences
Persistent insomnia can contribute to long-term complications, including the following.
Higher risk of accidents
Those with insomnia have been shown to have a 2.5 – 4.5 times greater risk of being in an accident.
Work issues like increased absenteeism or productivity
People with insomnia are more likely than those with depression to experience symptoms of pain, and those with severe insomnia experience higher levels of physical pain, emotional pain, and mental health conditions than those with chronic heart failure.
Reduced quality of life
Insomnia can be a significant obstacle to vitality, calmness, connection. It can keep you from having the energy for the things you truly want to do.
Comorbidity with other mental health conditions
Insomnia often co-occurs with other mental health disorders such as depression, anxiety, or bipolar disorder. In medical practice, over 40% of patients with insomnia have a co-occurring mental health condition. In fact, you may experience anxiety about insomnia.
It also commonly accompanies health conditions such as diabetes, heart disease, arthritis, fibromyalgia, and other types of chronic pain. Sleep disturbances can also be related to the natural process of aging.
The medical and mental health risks are bi-directional. Having another condition makes it more likely one will develop insomnia. And insomnia increases the risk of developing other mental health issues.
If you have insomnia based on the medical definition, or regularly have trouble sleeping and wonder if you might have a sleep condition, talk to your medical provider. Many people respond positively to behavioral changes, such as sleep hygiene. Others may need a non-habit-forming medication to help with sleep.
Start with sleep hygiene. It addresses some of the most common behavioral causes of insomnia and can help you get the most out of your hours of rest. Sleep hygiene includes things like:
- Optimizing your space for sleep
- Ensuring it is dark, quiet, and neither too cold nor too warm.
- Use your bed only for sleep or sex
- Go to bed at the same time every night
- Wake up at the same time every morning, including weekends
- Avoid caffeine after lunch
- Stay away from screens in the hours before bedtime
Sleep hygiene isn’t exactly a treatment. It’s more of a way to minimize any loss of quality sleep due to sleep conditions or behaviors. Even if it doesn’t cure insomnia disorder, it can reduce symptoms and set you up for success with other treatments.
Cognitive behavioral therapy is highly effective for insomnia. You can reach out to a practitioner or start with a free app from the VA called CBT-i Coach.
If these changes don’t have an impact or if you’re ready to try a medication for insomnia, talk to your medical provider about short-term medication for sleep. Medications can help you find a healthy sleep rhythm. But for long-lasting, sustainable change, use meds while simultaneously working on the behavioral changes that set you up for restful sleep.
Non-habit-forming medications for sleep include trazodone and hydroxyzine. Some people also find melatonin useful, though it’s not indicated for every type of insomnia disorder.
- The definition of insomnia is a health condition where one experiences difficulty sleeping despite ample opportunity and an adequate environment for sleep.
- Over 30% of adults in the US have insomnia symptoms, while an estimated 10-16% have a diagnosable insomnia disorder.
- Insomnia is characterized not just by sleeplessness but also by significant distress or challenges in functioning due to lack of sleep.
- There are many effective ways to address insomnia, including sleep hygiene, cognitive behavioral therapy, and medical intervention.
- The American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
- Roth (2007). Insomnia: definition, prevalence, etiology, and consequences. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978319/
- Walker (2018). Why We Sleep. Penguin Books: Westminster, London, England.
- Harvard Health Publishing (2019). Insomnia: What is it? https://www.health.harvard.edu/a_to_z/insomnia-a-to-z
- Harvard Health Publishing (N.D). Sleep. https://www.health.harvard.edu/topics/sleep