Unspecified Insomnia Disorder

Unspecified insomnia disorder, insomnia not due to a substance or known physiologic condition, is marked by chronic difficulties initiating or maintaining sleep or experiencing non-restorative sleep without an identifiable underlying cause. These sleep difficulties are persistent, typically occurring at least three nights per week for at least three months, and lead to significant distress or impairment in various aspects of life, such as work, social interactions, and overall well-being.

The condition is distinguished by the absence of specific medical, psychiatric, or environmental factors that are known to disrupt sleep. The American Psychiatric Association recognizes insomnia disorder as a condition that can significantly impair an individual's daytime functioning and overall quality of life, much like other sleep-wake conditions.  Below are the key signs and symptoms associated with this. 

• Taking a long time (more than 30 minutes) to fall asleep
• Lying awake for long periods before falling asleep
• Repeatedly failing to fall asleep at the desired bedtime
• Waking up frequently during the night
• Having difficulty falling back asleep after waking up
• Waking up too early in the morning and being unable to return to sleep
• Finding that sleep is not refreshing or of poor quality
• Waking up tired or not well-rested despite sleeping the recommended hours
• Experiencing light, fragmented, or shallow sleep without deep or REM stages
• Waking up too early (at least 30 minutes before the desired time)
• Being tired or low in energy during the day
• Experiencing mood disturbances, such as irritability, anxiety, or depression
• Having difficulty concentrating, remembering, or focusing on tasks
• Decreased performance at work or school due to sleep challenges 
• Avoiding or struggling to engage in recreational activities due to fatigue

Physical symptoms and behavioral signs of unspecified insomnia disorder

Physical and behavioral symptoms might include the following: 

• Becoming physically tense or uncomfortable when trying to sleep
• Experiencing headaches or body aches upon waking
• Gastrointestinal symptoms, such as an upset stomach or acid reflux, which are exacerbated by poor sleep
• Frequently checking the time during the night
• Developing rituals or behaviors associated with trying to initiate sleep, such as reading, watching TV, or using electronic devices in bed
• Altering one’s sleep schedule in an attempt to compensate for lost sleep, such as napping during the day or sleeping in on weekends

Unspecified insomnia disorder is unique because it is diagnosed when the insomnia is not attributable to a co-existing medical or psychiatric condition, another sleep disorder, medication side effects, or substance use—its cause is unidentified. Although medical conditions and mental disorders are two factors that can affect sleep, these are typically ruled out before a diagnosis of unspecified insomnia disorder is made. This is important to distinguish from primary insomnia, which is a sleep condition in its own right, not caused by other health issues.

However, several common risk factors may contribute to the development or exacerbation of this disorder. Note that these factors do not directly cause the condition, but they may increase an individual's susceptibility to experiencing insomnia.

Risk factors

Risk factors for this mental health condition may include the following: 

• Age: Insomnia is more common in older adults, although it can occur at any age.
• Gender: Women are often more likely to experience insomnia than men.
• Stress: Chronic or acute stress is a significant risk factor for insomnia.
• Family history: A history of insomnia in close family members may increase one’s risk.
• Mental health disorders: While psychiatric conditions do not directly cause unspecified insomnia disorder, individuals with a history of mental health challenges may be more susceptible to insomnia.
• Sleep-wake disorders: Sleep apnea, parasomnias, and restless legs syndrome can also contribute to the risk of insomnia.
• Irregular schedule: People with varying work hours or frequent travel may be more prone to insomnia disturbances in their circadian rhythm.

Potential causes of unspecified insomnia disorder

Other potential causes of this mental health condition include the following: 

• Significant life changes: Events like moving, starting a new job, or experiencing a significant loss (like the death of a loved one or a breakup) might incite episodes of insomnia.
• Environmental factors: Noise, light, temperature extremes, or an uncomfortable sleep environment can incite sleep difficulties.
• Behavioral factors: Engaging in stimulating activities close to bedtime, such as exercise, work, or screen time, can make it harder to fall asleep.

Unspecified insomnia disorder is a complex condition, and the relationship between these risk factors and the symptoms is not necessarily straightforward. The presence of one or more risk factors does not guarantee that an individual will develop insomnia, and some people with these risk factors do not have sleep problems.

Often, the primary goal of treatment for this condition is to improve sleep quality and duration, thereby enhancing daytime functioning and overall quality of life. Treatment approaches are often tailored to the individual, considering the severity of the sleep interruptions, medical history, and specific symptoms. Therapeutic interventions, medications, and self-care strategies are commonly employed.

Medication

Medication may sometimes be used to aid in sleep difficulties. Medications prescribed by healthcare professionals may include: 

• Prescription sleep aids: Zolpidem, eszopiclone, ramelteon, and other related sleep medications may be prescribed for short-term use. These medications are generally not recommended for long-term use and have serious side effects and interact with other medications and substances. 
• Antidepressants: Some antidepressants, such as trazodone, are used to treat insomnia.
• Over-the-counter sleep aids: Some people may find relief using OTC sleep aids containing antihistamines, but healthcare professionals may not recommend them for long-term use due to potential side effects.
• Dietary Supplements: Other sleep supplements such as melatonin are essentially unregulated and should be used with caution. 

Other treatment options

Other treatment options for this condition might include the following: 

• Light therapy: Exposure to bright light for a specified amount of time, often in the morning, may help reset the body's internal clock and improve sleep.
• Sleep restriction and compression: These therapies limit the time spent in bed to the actual time spent sleeping, often increasing sleep efficiency.

Self-care

Self-care can be a significant part of reducing insomnia and other sleep symptoms. Below are a few suggestions: 

• Sleep hygiene: Sleep hygiene can be fundamental for anyone struggling with insomnia. Sleep hygiene often includes maintaining a consistent sleep schedule, creating a relaxing bedtime routine, keeping the sleep environment comfortable and conducive to sleep, and avoiding caffeine and heavy meals close to bedtime.
• Exercise: Regular physical activity, particularly aerobic exercise, can significantly improve the quality and duration of sleep. However, avoid vigorous exercise close to bedtime, as it may keep you awake. 
• Mindfulness⁴ and stress-reducing practices: Engaging in mindfulness meditation, yoga, or other relaxation practices may reduce stress and improve sleep.

Individuals with this condition can work closely with healthcare professionals to develop a comprehensive and personalized treatment plan. Regular follow-up appointments are often necessary to monitor progress and adjust the treatment plan.

Therapy, particularly cognitive-behavioral therapy for insomnia, is often a highly effective treatment for this condition. CBT-I is a structured program that helps individuals identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep.

Unlike sleeping pills, CBT-I helps individuals overcome the underlying causes of their sleep problems. For those interested in exploring therapy options from the comfort of their own home, online platforms like BetterHelp offer a way to connect with licensed therapists from home via phone, video, or live chat sessions. 

In addition to therapy, several reputable resources exist for individuals seeking more information or support for insomnia. Government health agencies, such as the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), offer evidence-based information on insomnia and other sleep disorders. 

The American Academy of Sleep Medicine (AASM) and the Sleep Research Society are professional organizations providing resources for healthcare professionals and the public. Support groups, either in-person or online, can also be beneficial. They offer a space for individuals with sleep conditions to share their experiences, learn from others, and receive emotional support. The National Sleep Foundation is a non-profit organization providing educational resources, supporting research, and advocating for policies improving sleep health.

The availability of specific resources may vary based on location, so ensure that any resource or support group you consider is reputable and evidence-based.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

Emerging research on insomnia sheds light on its complex relationship with various health conditions. Insomnia is a symptom and contributes to the risk and maintenance of comorbid conditions, including mental health conditions and chronic pain. A significant shift in understanding has led to a change in diagnostic classification, emphasizing the value of treating insomnia as a standalone condition rather than solely as a symptom of associated comorbidities, as discussed in a study published in the Wiley Online Library.

In terms of treatment, cognitive-behavioral therapy for insomnia has emerged as the recommended first-line treatment for insomnia symptoms, including those of unspecified insomnia disorder. CBT-I is a brief, multicomponent treatment that aims to reduce acute and chronic hyperarousal and align the circadian rhythm with the sleep-wake cycle.

Recent clinical research demonstrates that CBT-I is effective in various formats and can optimize health outcomes for coexisting conditions, such as improving adherence to treatments for obstructive sleep apnea (OSA) and enhancing antidepressant response for individuals with depression, as highlighted in a study published by NCBI.

Below are several statistics on unspecified insomnia disorder and other sleep conditions: 

• Approximately 30% to 35% of the global population experiences insomnia symptoms, while the prevalence of insomnia disorder ranges from 3.9% to 22.1%, depending on the diagnostic criteria used. This wide variance in prevalence rates is due to the use of different classification systems defined by various professional bodies.
• People with insomnia are ten times as likely to have clinical depression and 17 times as likely to have clinical anxiety compared to those without the condition, as highlighted in a study published by NCBI.
• Approximately 50% of older adults complain of difficulty falling asleep. Insomnia, including difficulties falling asleep and waking up too early, is reported by 15% to 20% of people aged 65 and over, as outlined in the Neuropsychiatry Journal. 
• Cognitive-behavioral therapy for insomnia is effective in treating chronic insomnia. According to the Neuropsychiatry Journal, about 75% of insomnia patients experience significantly improved sleep after CBT-I treatment.