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Is It Really Sleep-Onset Insomnia?

Last updated: April 2022

Is it really sleep-onset insomnia...?

Difficulty falling asleep, staying asleep, or waking early – or some combination of all 3 – are characteristics of insomnia. However, insomnia comes in many flavors.

What is sleep-onset insomnia?

Sleep-onset insomnia is the insomnia flavor defined by having trouble falling asleep. Sleep-onset insomnia is very common and is the most prevalent form of insomnia in my sleep therapy clinic. When people have difficulty falling asleep, they will often – very naturally – think will that they have this particular kind of insomnia.

What makes sleep-onset insomnia worse?

It's not unheard of for somebody with this kind of insomnia to take several hours to fall asleep. Though typically, a person may complain of difficulties for a couple of hours, some may not fall asleep until 2 AM or later in the morning.

The usual things people often do to catch a bit more sleep, such as lying in bed later in the morning, can actually make sleep-onset insomnia worse by reducing the sleep drive they need to get to sleep in a reasonable time more consistently. Waking irregularly also can disrupt a person's circadian rhythm – the biological timing of when they sleep.

How do I know if I really have sleep-onset insomnia?

However, having difficulty falling asleep may not be sleep-onset insomnia. This sleep initiation challenge could represent a natural variation in the timing of their circadian rhythm, particularly if it is a longstanding part of their sleeping issues.

Delayed sleeping phase syndrome/disorder is when someone is a 'night owl' – those who would fall asleep in the small hours of the night and find it difficult to wake in the morning. Think teenagers. Teens and young adults often will experience a circadian rhythm shift as a natural consequence of changes in their brains as they age. Often the circadian rhythm will shift and return to the more common type – but not always.1

Sleep-onset insomnia or circadian rhythm change?

So, how could you know if it's one or the other? Sleep-onset insomnia or a circadian rhythm change? A professional assessment would be advised; however, a few guidelines can help differentiate between them.

Sleep-onset insomnia

Someone with sleep-onset insomnia may look like this: You may have normally fallen asleep late in the evening and woke at 6 or 7 AM with no problems, and have always tended to feel energetic, sharp, and creative during the day. Then, the sleeping problems started. If your difficulty falling asleep has coincided with a stressful or exciting time and your overall sleeping problems – but didn't exist before – it's more likely to be sleep-onset insomnia.

Circadian rhythm variation

Someone with a natural variation in their circadian rhythm may look like this: You always were a 'night owl' and were more creative and energetic later in the day/evening and had a lot of trouble in the 'morning hours' when forced to wake up. On weekends and holidays, when you don't have to wake up, your sleep is naturally from the small hours of the morning to the late hours of the morning. It may be more challenging right now after a stressful event; however, this was always more your norm. If this is your story, you might want a careful assessment to differentiate your situation from sleep-onset insomnia because no insomnia treatment is going to address the circadian component of the sleeping issue.

Historical patterns can offer a clue

Now, someone with a delayed phase can also have sleep-onset insomnia. And often, people with longstanding insomnia can develop circadian rhythm issues – which is why careful assessment is needed.

Sleep-onset insomnia is not defined by any actual time a person falls asleep. It's about having a hard time falling asleep at whatever time is normal for that person. Looking at historical sleeping patterns can definitely lend a clue to what may be contributing to having a hard time falling asleep.

Do you have a hard time falling asleep? Have you ever had an assessment to see if it's insomnia or a circadian rhythm variation? I'd be interested to know your experience!

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Insomnia.Sleep-Disorders.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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