We usually say that we suffer from insomnia when we have sleep problems.But did you know that there are different types of insomnia? It is indeed so. There is not one type but several. And each of them requires a different treatment. We will endeavor in this article to explain the different types of insomnia and the recommended treatment in each case.Deepen.
Insomnia is one of the most common reasons for consultation in primary health care. It is also one of the symptoms shared by virtually all psychological disorders.
Like other common problems in our society (such as anxiety or depression),many people use the term insomnia incorrectly.For example, having trouble sleeping for a day or two is not insomnia. Being very stressed and not being able to sleep properly would not identify with this sleep disorder either. In the latter case, it would be more the result of being subjected to a stress process whose insomnia would be a symptom.
As we can see,some specifications are essential to understand this problem, evaluate it and design the treatment. Let's look at each of these aspects below.
- 1 What is insomnia?
- 2 Insomnia of conciliation or initiation
- 3 Treatment of insomnia of conciliation or initiation
- 4 Insomnia of maintenance or fragmented sleep
- 5 Treatment of maintenance insomnia or fragmented sleep
- 6 Late insomnia or early awakening
- 7 Treatment of late insomnia or early awakening
- 8 Insomnia: personal ghosts that do not let you sleep
What is insomnia?
Insomnia is formally referred to as primary insomnia, a sleep disorder in which appear the following characteristics:
- The person experiences, for at least four weeks, a persistent difficulty sleeping.
- The difficulty can be felt at the beginning of the sleep, during the maintenance, the finalization or the fact of the sensation of restless sleep (to sleep but not to rest).
- There is no organic cause (traumatic brain injury, dementia, stroke) or medical / physiological cause that may explain insomnia (use of drugs, drugs, insomnia-causing disease).
- There is no such thing as a psychological disorder such as anxiety or depression. In such cases we would be diagnosed with an anxiety disorder or other disorder (with insomnia symptoms related to another DSM-5 mental disorder).
So there are three types of insomnia, depending on when the person has difficulty sleeping:
- Insomnia of conciliation or initiation
- Insomnia of maintenance or fragmented sleep
- Late insomnia or early awakening
It is therefore necessary to fulfill the diagnostic criteria described above to be able to say that we suffer from insomnia (strictly speaking).If we have another disorder or problem that causes insomnia, simply treating the sleep disorder will not end the problem.The main disorder should be diagnosed and treated to end sleep problems. We will dive below into the three types of existing insomnia.
Insomnia of conciliation or initiation
This is the most common and known of the three types of insomnia.It is the inability to sleep when we go to bed. In other words, we have a problem finding sleep. Insomnia of conciliation generally corroborates the maxim "we sleep as we live". In other words, if we spend the day stressed or worried, it is very difficult for the mind to disconnect and enterstandby.
Insomnia of conciliation answers in most cases to a state of psychological malaise, responsible for the difficulty to fall asleep.We may also have problems starting to sleep when changes occur in the usual schedule of our routine or in hours of exposure to sunlight.
"Finish each day before starting the next and put a solid wall of sleep in between."-Ralph Waldo Emerson-
Treatment of insomnia of conciliation or initiation
The recommended treatment for conciliation insomnia has several phases. What we call sleep hygiene is done first and foremost. This approach is used because the person often acquires, with the development of insomnia, habits that are not healthy and that further aggravate his situation. The first guidelines are to develop correct habits and break the association: go to bed → do not sleep → early anxiety not to sleep.
If sleep hygiene guidelines are not enough, then different techniques or tasks are prescribed to break the association between bedtime and the inability to sleep, as well as the discomfort that generates.The psychologist designs a specific task for each case and each person. He also sets up a series of therapeutic goals that seek to generate changes in his daily life.
It is however necessary to remember that all the therapeutic approaches that we mentioned aim at the insomnia of conciliation as primary trouble.In other words, these are treatments and approaches that are designed in the event that other types of insomnia or psychological disorders such as anxiety, depression, obsessive-compulsive disorder or disorder are excluded. bipolar.
In addition, it may be necessary to resort to medication if the person can not sleep despite the use of psychological techniques.The best options for conciliation insomnia are the non-bezodiazeine sleep inducers.These drugs work quickly and for a short time. They have no anxiolytic or residual effect the next day. For example, zolpidem, zaleplon or zopiclone.
The pharmacological treatment of insomnia should always be prescribed and supervised by a doctor.The latter decides which drug is the most appropriate and how long it should be taken.
"It seems that insomnia is different for everyone, just like everyday life and aspirations."-F. Scott Fitzgerald-
Insomnia of maintenance or fragmented sleep
It is difficult to stay asleep all night in the case of maintenance insomnia.In other words, the person is able to fall asleep, but experiences frequent and prolonged nocturnal awakenings that tend to occur especially in the middle of the night. When this happens, the negative consequences are very visible. We have the feeling of not having a restful sleep.
hein such a case, it is essential to exclude the organic or physiological causes responsible for the problem.For example, hormonal problems that cause the person to wake up. The waking up in the middle of the night is very frequent when there is a dysfunction of the thyroid gland or, in the case of the women, when they know irregularities in their hormonal cycle.
Treatment of maintenance insomnia or fragmented sleep
We must first address the medical causes of maintenance insomnia or fragmented sleep if we find them.Once these causes have been controlled or excluded, treatment of this type of insomnia will involve all techniques used in conciliatory insomnia, along with pharmacological treatment.
In this case, the recommended drug would be a benzodiazepine. They act all night long, which is necessaryto keep the person asleep throughout this period.
There is, however, no effective psychological treatment to date that allows for an immediate reduction in the number of nocturnal awakenings.The work of a psychologist is however fundamental in this type of case.
Most people who suffer from insomnia of maintenance or fragmented sleep also have psychological problems such as anxiety disorders or major depressive disorders.The first thing that is therefore sought in the short term is that the person manages to sleep properly, so that she can then work, through psychotherapy, all the psychological aspects that are the cause of this type of insomnia.
Late insomnia or early awakening
In the last type of insomnia, the person is able to fall asleep and does not wake up during the night. She can not sleep all the hours she needs.For example, we put the alarm clock at 7:00 and we woke up at 5:00 without being able to go back to sleep. That makes us tired the rest of the day. It can also cause a feeling of anxiety or anxiety.
This type of insomnia is largely associated with problems such as depression or stress at work. TheDepression actually causes a series of changes in sleep cycles that cause the person to wake up too early and fail to go back to sleep.In addition, the existence of a large workload often causes the person to wake up and the impossibility of going back to sleep.
Treatment of late insomnia or early awakening
The treatment of late insomnia consists ofa combination of pharmacological treatment to prevent the person from waking up early and psychological treatment to manage the emotions that cause an early awakening.
The psychological approach is similar to that used in the other two types of insomnia. However, it is essential here to make an intervention to manage stress and emotions related to awakening.
It is also very important, although it seems strange, to get up if we wake up early and do not go back to sleep.This is important because increasing fatigue is one of the best cures for insomnia. Also because we break the association between being in bed and the feeling of anxiety caused by not being able to sleep.
Whereas in the case of insomnia of conciliation the treatment of first choice is psychological, in the case of the two other types of insomnia (of maintenance or late) it is advisable to combine the pharmacological approach and the psychological approach.