Introduction

Although people often think of insomnia as a general sleep problem, it is important understand the difference between acute insomnia and chronic insomnia. Understanding which category you fall into is essential in deciding how to approach the problem and whether treatment may be necessary.

Before we discuss acute and chronic insomnia in more detail, let’s first dive into what the symptoms of insomnia actually are.

The symptoms of insomnia

The symptoms of insomnia include: difficulty falling asleep, staying asleep, and/or waking up too early at least three times a week.

  • Difficulty falling asleep. Generally, an average of 30 minutes or more would be moving into insomnia territory. Good sleepers usually take between 10 to 30 minutes to fall asleep.
  • Difficulty maintaining sleep. Contrary to popular belief, good sleepers don’t sleep throughout the night. There are usually brief awakenings throughout, but they are able to fall back asleep pretty quick (within a few minutes). On the other hand, insomnia territory would be waking up 30 minutes or more in the middle of the night
  • Waking up too early. If you are naturally a morning bird and sleep around 9 to 10pm and wake up around 4:30am, then this is not what waking up too early means. That’s just your natural biological clock at work. However, if you typically fall asleep around midnight and sometimes wake up at 4:30am, then this might be more indicative of waking up too early.

Insomnia is a 24-hour problem meaning that it also affects our day. Symptoms of insomnia during the daytime include:

  • Feelings of fatigue/exhaustion
  • Memory problems
  • Concentration difficulties
  • Mood difficulties and irritability
  • Many more

What is acute insomnia?

Acute insomnia includes the above symptoms but the main difference between acute and chronic insomnia is duration. Acute insomnia usually lasts between 1 to 3 months.

Importantly, acute insomnia can be considered a response to stress. Acute insomnia is actually a fairly normal phenomenon because life happens and sometimes our sleep gets worse because of it. This can be because of both positive events (e.g., planning a wedding; having a baby) or negative events (losing a romantic relationship, a close one passing away). When stressors in our life happens, our sleep gets worse for a period of time. Usually what happens is that once we have overcome the stressor, our sleep gets better. That is acute insomnia.

The tricky part is when our sleep problems continue despite the stressor resolving – this is when we move into the disordered category of chronic insomnia. But why does this happen?

What is chronic insomnia?

According to the DSM-5, insomnia becomes chronic when you have experienced sleep problems for more than three months. Typically, the sleep problem has taken life on its own and is no longer the result of a stressor.  

This is primarily because people with chronic insomnia begin to really worry about their sleep (and the fact that they are not getting enough) and focus on symptoms of perceived sleep deprivation, such as feeling exhausted or having difficulty concentrating. Because of this, they begin to engage in behaviours that counterproductively impact their ability to produce high-quality sleep.

For example, they may have a thought such as “I’m worried I’m not going to get enough sleep and my next day will be terrible”. Because of this, they may try to catch-up on sleep by going to bed early, sleeping in, taking naps, or cancel plans to get more rest. Unfortunately, these behaviours actually reduce our ability to get deep sleep. These behaviours maintain our insomnia.

Below, I provide an outline of a model of how insomnia develops and is later maintained.

The 3P Model of insomnia

Model of insomnia

The 3P model proposed by Spielman et al. (1987) explains how insomnia first develops because of a stressor (precipitating factor). For some, the sleep gets better after the stressor ends. However, for others the sleep problems continue because of perpetuating factors. For example, they may engage in behaviours that that affect our sleep drive or their worry about not getting enough sleep may create an association between the bed and wakefulness.

How do I treat acute vs chronic insomnia?

For acute insomnia, it’s important to recognize that sleep may not be optimal because of an on-going stressor. And that’s okay – it’s a normal (perhaps even adaptive) response to stress. Knowing that your sleep will get better once your exam ends or the wedding planning is done may be relieving to know in and of itself.

Keeping to optimal sleep behaviours (e.g., a consistent schedule, keeping active throughout the day, and using the bed for sleep) can also be helpful to support general sleep health. What’s important is to ensure that our thoughts and behaviours about sleep don’t trap us in a vicious cycle of sleep disturbances after the stressor is over. We don’t want to make acute insomnia become chronic.

For people with chronic insomnia, cognitive behavioural therapy for insomnia is the treatment gold standard. This is because cognitive behavioural therapy targets the causes of insomnia. It may be helpful to check if there are healthcare professionals in your area who can provide CBT if you are interested in learning more about the treatment.

Medication may be another option for chronic insomnia – however, it is best to discuss this with your medical provider.

Here’s a post for information on the potential benefits and costs of CBT vs medication.  

Best wishes,

P

Featured photo credits: Lukas Blazek on Unsplash