15 Types of Insomnia — Causes and Treatments

Expert Verified ByExpert Verified By: Janet K. Kennedy, PhD. and Annie Schlecht, MOTR/L, CIMI
Table of Contents

Insomnia sounds simple. It’s just the inability to fall asleep, right? Well, not exactly. Insomnia may also be the inability to fall asleep, stay asleep, or fall back to sleep after waking. A person suffering from insomnia might experience one form of it, two, or all three. Insomnia may disturb sleep for a brief period of time or chronically, possibly leading to long-term sleep debt.

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Insomnia is by far the world’s most common sleep disorder (1), and its effects are potentially serious and far-reaching. Particularly when insomnia becomes chronic, it can adversely affect relationships, social life, work performance, and mental and physical health, and have a detrimental impact on quality of life.

Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t be taken as medical advice, and it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately.

Effects of insomnia typically include fatigue, lack of attention span, poor memory, decreased productivity, depression or irritability, anger, poor decision-making, low motivation, and memory issues.

Causes of insomnia symptoms include:

  • Stress
  • Other medical conditions such as obesity, asthma, dementia, and Parkinson’s disease
  • Chronic pain or itching
  • Other sleep disorders such as restless leg syndrome and sleep apnea
  • Medications, particularly those with a stimulant effect
  • Mood disorders such as depression and anxiety
  • Lifestyle and environmental factors, like poor sleep hygiene or a new baby

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Causes of insomnia disorder, or chronic insomnia, include:

  • A conditioned negative response to bedtime, the attempt to sleep, and the sleeping environment
  • Hyperarousal of the nervous system
  • Head injuries and other medical conditions

As many as a third of adults suffer from one or more types of insomnia at some point in their lives. Insomnia symptoms are more common in older adults, and are particularly prevalent in people under stress, pregnant women, (2) and those suffering from mental illness.

Insomnia Fact: SOL, or Sleep Onset Latency, is the period of time it takes to transition from being fully awake to being asleep.

Insomnia Symptoms or Insomnia Disorder?

Though insomnia may appear to be a relatively straightforward disorder, it is actually quite complex. Insomnia can come and go throughout life depending on health, family and employment circumstances, and levels of stress. Insomnia may take a number of forms, some brief and relatively manageable, others chronic and more challenging to treat.

Symptoms of insomnia are usually related to a life event or circumstance, and tend to resolve by themselves without treatment. Insomnia disorder is persistent insomnia lasting three months or longer, and is often a conditioned negative response to sleep or the sleeping environment.

Most types of insomnia refer to insomnia symptoms associated with particular triggers, not the chronic insomnia characteristic of insomnia disorder.

Though the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition does not distinguish between causes of insomnia, it can be helpful to break the disorder into sub-types to understand how it might be experienced by sufferers. Some of these sub-types refer to the duration of symptoms, while others refer to medical, developmental, psychological, or other causes.

Transient Insomnia

Transient insomnia is a period of difficulty with sleep lasting less than one week. The relatively brief duration of transient insomnia distinguishes it from other, more protracted types of the disorder. (3)

Transient insomnia usually resolves without treatment. Symptoms may range from inability to fall asleep to daytime sleepiness to waking early in the morning. Causes include:

  • Jet lag
  • Stress
  • Anxiety
  • Medication side effects
  • Short-term illness, such as a cold or flu virus

Acute Insomnia

Acute insomnia is a relatively brief period of insomnia symptoms, typically lasting less than one month. A diagnosis of acute insomnia typically requires sleep disruption at least three nights each week. (4) Acute insomnia can often be attributed to:

  • A significant life event such as a move or job change
  • Stress
  • Travel
  • Adjustment to a higher altitude
  • Pregnancy, particularly the third trimester
  • Illness or pain, such as that occurring after surgery

Short-Term Insomnia

Short-term insomnia is a period of insomnia symptoms lasting less than three months. It may occur in as many as twenty percent of people. Common causes of this type of insomnia include:

  • A traumatic event such as a death in the family or divorce (5)
  • A move to a new home or location
  • Financial concerns
  • An illness or medical condition
  • Employment difficulties
  • Birth of a baby

Insomnia Fact: Fatal familial insomnia is a rare and fatal genetic brain disorder characterized by rapidly worsening insomnia and autonomic nervous system dysfunction, such as sweating and rapid heart rate

Chronic Insomnia, or Insomnia Disorder

Chronic insomnia refers to a longer-term pattern of problematic sleeping. (6) Chronic insomnia may develop from the anxiety of short-term or acute insomnia, and become a lifelong issue.

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The definition of chronic insomnia is insomnia that lasts longer than three months, for three or more nights each week. Chronic insomnia affects around ten percent of American adults. (7)

When insomnia symptoms become chronic, they are typically triggered by:

  • A conditioned negative response to the attempt to sleep and/or the sleeping environment
  • Head injuries and certain medical conditions (8)
  • Hyperarousal of the sympathetic nervous system, leading to excess release of stress hormones such as cortisol (9)

Due to its duration, chronic insomnia may have wide-ranging health effects such as diminished alertness, greater risk of occupational injury, cognitive and memory impairment, and mood changes. Work and relationships may be impacted, and quality of life reduced.

Adjustment Insomnia

Adjustment insomnia describes a period of insomnia symptoms linked to a life event. Stress, anxiety, or lack of familiarity are frequent underlying factors. The terms “adjustment insomnia” and “acute insomnia” are sometimes used interchangeably, as causes may be similar.

Approximately 20% of people experience adjustment insomnia each year. The symptoms typically resolve when the sufferer learns to cope with the triggering issue, which may be positive or negative. Common causes include:

  • Starting at a new job or school
  • Bereavement
  • Moving to a new home
  • Marriage or divorce
  • Birth or adoption of a child or pet

Drug or Substance-Induced Insomnia

This type of insomnia refers most often to sleeping difficulties caused by medications or recreational drug use. The most frequent offender is caffeine, but sleep can also be adversely affected by alcohol, cold medications, opioids, ADHD treatments, and cannabis.

Though cannabis may help some users fall asleep, it reduces the time spent in REM sleep, cuts down on dreaming, and may markedly increase alertness. (10) In addition, insomnia symptoms are common during withdrawal from habitual cannabis use. Stimulants such as cocaine and amphetamines may decrease REM and slow wave sleep and damage the circadian rhythm, in some cases permanently affecting a user’s ability to sleep.

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Drugs and medications may lead directly to disrupted sleep, or induce other bothersome disorders such as:

  • Sleep-eating
  • Nightmare disorder
  • Parasomnias such as sleep paralysis and exploding head syndrome (11)
  • Restless leg syndrome
  • REM sleep behavior disorder

Some drug users begin a damaging cycle of taking stimulant drugs to remain awake and sedative drugs to sleep. Users may also experience rebound and withdrawal insomnia once they stop using drugs. Abusers of alcohol and opiates are particularly susceptible to these types of insomnia symptoms, which can be part of a larger withdrawal syndrome and persist for weeks.

Nicotine, both smoked and vaporized, is a powerful vasoconstrictor and common cause of sleep disruptions. (12) In addition, nicotine raises the risk of sleep apnea, another sleep disorder that may contribute to insomnia. Quitting nicotine can trigger insomnia symptoms, as well. This is because nicotine is both a stimulant and mood-modulator, which means it can have a calming effect on users. (13)

Prednisone, a steroid commonly used to treat inflammation and pain, is known to cause such side effects as restlessness and disturbed sleep. Inhaled drugs for asthma and other respiratory conditions are common culprits, as well.

Alcohol is one of the most common causes of middle insomnia, which refers to waking during the night and being unable to get back to sleep. When alcohol’s depressant effects on the central nervous system wear off, typically several hours after going to bed, users may wake up and find returning to sleep difficult. (14)

Insomnia Fact: Snoring affects ninety million Americans, and is a primary cause of interrupted sleep 

Comorbid Insomnia

Comorbid insomnia occurs along with another illness or disorder. The most common conditions that trigger comorbid insomnia symptoms are psychiatric issues such as anxiety, depression, and bipolar disorder. Comorbid insomnia may also occur as a result of medical conditions that cause chronic pain, including:

  • Arthritis
  • Cancer
  • Shingles
  • Injury from gunshot wounds
  • Migraine headaches
  • Fibromyalgia and other autoimmune diseases

Neurologic disorders such as dementia may disrupt both the central nervous system and circadian rhythms and cause sleep difficulties. The pain and nausea of migraines may also cause insufficient sleep. (15) Those with Tourette’s Syndrome or other movement disorders may experience tics during all stages of sleep, and experience insomnia symptoms as a result. (16)

Insomnia symptoms can also become an issue at end of life due to multiple factors including pain, medications such as steroids, a noisy hospital environment, depression, or anxiety. Common terminal illnesses such as cancer and end-stage renal disease may require treatments that prevent refreshing or undisturbed sleep. (17)

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Onset, Middle, and Late Insomnia describe the time of night when insomnia symptoms occur. Insomnia sufferers may experience one, two, or all three stages, no matter what the cause of their symptoms. 

Onset Insomnia

Onset insomnia describes difficulty with falling asleep at the beginning of the night, or the point of what’s termed “sleep onset.” This type of insomnia is quite common, and is characterized as a delay in sleep that lasts more than thirty minutes.

Causes of onset insomnia may include stress, consumption of alcohol or caffeine, poor sleep hygiene such as electronics usage before bed, and illness. The disorder is particularly associated with anxiety and stress. It may be temporary, acute, or chronic, and occur alone or along with middle and/or late insomnia.

Middle Insomnia

Middle Insomnia, also known as maintenance insomnia, refers to difficulty staying asleep. Sufferers may wake once or more often during the night and have trouble getting back to sleep. Middle insomnia is often associated with alcohol use, disorders that cause chronic pain, and babies who awaken for middle-of-the-night feedings.

One common cause of middle insomnia is menopause. (18) Because estrogen assists the functioning of essential neurotransmitters involved with sleep, declining levels of this hormone may disturb circadian rhythms. Hot flashes and shifting hormones may disrupt sleep, while life transitions and career pressures may contribute to insomnia, as well. Perimenopause, which occurs in the years before menopause, may also be a period of sleep difficulties due to changing levels of estrogen and progesterone.

Middle insomnia may occur in conjunction with other sleep disorders such as restless leg syndrome or sleep apnea. These disorders can disrupt sleep repeatedly, in some cases up to ninety times each night. REM sleep behavior disorder, in which the normal muscle paralysis of REM sleep is absent, may cause frequent awakening due to the physical acting out of dreams.

Insomnia Fact: Researchers have found a 25% jump in heart attacks after Daylight Saving Time begins in the spring, an increase they attribute to lost sleep

Late Insomnia

If you’ve ever awakened too early and been unable to go back to sleep, you may have experienced late insomnia. Late insomnia, also termed sleep offset or terminal insomnia, often occurs between 2 and 4 am. Sufferers may feel that while it’s too early to get up, it’s too late for them to take sufficient time to go back to sleep. (19)

A diagnosis of late insomnia usually requires waking thirty minutes early or more at least three days each week. This type of insomnia is a common symptom of clinical depression. Other culprits include:

  • Low blood sugar or hunger
  • Changes in room temperature
  • Allergies
  • Emotional stress or grief
  • Noise or light

Conditioned, or Psychophysiological Insomnia

Also called “learned insomnia,” this type of sleep disorder occurs when insomnia becomes a conditioned response to going to bed. This conditioned response is frequently an underlying mechanism behind chronic insomnia. Many sufferers experience a precipitating event that causes insomnia symptoms, but once the trigger is removed, the insomnia remains.

Conditioned insomnia is more common in women, and may occur in conjunction with health anxiety. Normal preparations for sleep such as tooth-brushing and showering may induce a conditioned response of fear or anxiety, which can be worsened by the release of the stress hormone cortisol. Insufficient sleep may become a habit, along with the fear of being unable to sleep. The cycle may continue for weeks or years unless diagnosed and treated.

Recent research into conditioned insomnia reveals possible evidence of nervous system hyperarousal. Hyperarousal may represent an exaggerated stress response that persists during sleep, resulting in elevated blood pressure and increased emotional reactivity, or tendency to worry. An exaggerated stress response may not be the result of conditioned insomnia, but a cause of it. Hyperarousal, stress, and insomnia may become a vicious circle of symptoms and bodily responses, worsening both anxiety and sleep difficulties. (20)

Insomnia Fact: Sleep deprivation lowers the pain threshold, making lack of sleep painful in more ways than one

Behavioral Insomnia Of Childhood

Behavioral insomnia may begin when a child is not given a specific and strict bedtime. Children who suffer from this sleep disorder are typically under five years old. They do not learn regular sleep habits and routines, and as a result may struggle with getting to or staying asleep. Needing to sleep with a parent may be another common trigger. These types of symptoms can last into adulthood, and may affect the potential for good sleeping habits for a lifetime.

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Most children between three and five years old require about 12 hours of sleep, plus naps. Children with this form of insomnia may get much less than this, leading to other symptoms of insomnia such as daytime sleepiness, hyperactivity, and aggression.

In addition, untreated behavioral insomnia may lead to issues beyond sleep, including diminished performance at school and temper tantrums. Inconsistent bedtimes may compound the problem of behavioral insomnia by disturbing a child’s circadian rhythm. As many as 25% of children may experience behavioral insomnia during their first five years of life. (21)

Childhood behavioral insomnia is divided into two types: limit-setting and sleep-onset association. Both types of childhood behavioral insomnia involve anxiety around the idea of going to sleep. They are similar to conditioned insomnia, but occur in children.

Limit-setting insomnia often involves defiance by the child of specific bedtimes or bedtime routines. Children may try to delay going to bed using such methods as crying, asking to go the bathroom, or requesting food or water. (22)

The sleep-onset form of this disorder involves a negative association with bedtime. The negative association may begin when a pleasurable activity such as game-playing or television-watching is stopped because the child must go to sleep. The child may have become used to rocking, singing, story-time, or sleeping with a parent, and may be reluctant to go to sleep or remain in bed alone if these routines change.

Sleep-onset disorder might be more than a matter of sleep-related anxiety or bedtime routine. This type of childhood insomnia is sometimes associated with common behavioral issues such as attention deficit/hyperactivity disorder.

Idiopathic Insomnia

Idiopathic insomnia is a term used to describe insomnia with no apparent cause, such as a medical or psychological condition. However, recent research has found that this type of insomnia likely does have a cause: hyperarousal of the central nervous system. This could be due to a dysregulated response to stress by the body, which may remain in a hypervigilant state and continue to release stress hormones such as cortisol, making sleep more difficult. Metabolic rate, heart rate, and body temperature may rise, as well, contributing to insufficient sleep. (23)

In some individuals, stress may activate emotional regulatory centers involved in sleep, such as the amygdala. Sleep studies have shown insomnia of all types in people with hyperaroused central nervous systems. These continued responses to stress, even in sleep, may be the cause of insomnia cases once considered idiopathic, or “of no known cause.”

Paradoxical Insomnia

Also called pseudo-insomnia, paradoxical insomnia refers to a complaint of severe or chronic insomnia which is not objectively occurring. The key feature of this disorder is overestimation by the sufferer of how long it takes to fall asleep, or exaggerated periods of wakefulness. Those who complain of the disorder also tend to underestimate actual time spent asleep.

Sleep studies of paradoxical insomnia sufferers reveal normal sleep/wake patterns. Onset and efficiency of sleep are usually within normal limits, as well. Though sufferers may claim that they get very little sleep or spend hours lying awake, they are not as sleep-deprived as they claim to feel.

Unsurprisingly, physical effects of paradoxical insomnia are not as severe as they are in other types of insomnia. Psychological effects, however, can be profound, resulting in anxiety, repeated visits to doctors, and multiple rounds of sleep testing. (24)

Sleep Hygiene Insomnia

This refers to insomnia caused by poor sleep hygiene. This may mean having a bedroom which is too warm, cold, or uncomfortable. It might refer to unproductive sleep habits, such as using electronics just before trying to sleep, drinking coffee or alcohol in the evening, or having a poor bedtime routine. Sleep hygiene insomnia is one of the most common forms of insomnia, and one of the most treatable.

Sleep hygiene insomnia may be the result of one poor sleep habit, or many. An inconsistent bedtime may be enough to disrupt circadian rhythms and cause sleep hygiene insomnia. A new pet or baby can interrupt or delay sleep, as can external noise and bright light.

Sleep hygiene insomnia has become more prevalent with the increasing presence of electronics in homes and bedrooms. Bright light throughout the evening may increase the chance of experiencing insomnia, even later at night, and even if other aspects of sleep hygiene are followed. (25)

Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t be taken as medical advice, and it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately.

Treatments for Insomnia

Treatment for insomnia falls into three broad categories: sleep hygiene, therapy, and medication. A doctor may suggest one or more forms of treatment, depending on the diagnosed cause of the disorder, age of the patient, or underlying medical condition.

Cognitive Behavioral Therapy, or CBT-I

One of the most effective chronic insomnia treatments is reducing the number of hours spent in bed. This type of treatment is part of the Cognitive Behavior Therapy protocol for chronic insomnia, which includes:

SO_15StagesInsomniGraphics8_Sleep-Restriction 15 Types of Insomnia — Causes and Treatments1. Sleep restriction. Sleep restriction requires limiting the time spent in bed to the number of hours typically spent asleep. For example, if you usually spend eight hours in bed but lie awake for two, sleep restriction therapy might require you to go to bed at midnight and get up at 6 am. Going to bed later is usually recommended during this type of treatment, rather than getting up earlier than your normal time.

Though it may seem to compound the problem of insomnia, sleep restriction therapy increases sleep efficiency and cuts down on waking during the night. Once someone undergoing training is sleeping well for six hours without waking, 15-minute blocks may be added to the time spent in bed, increasing gradually until the person feels rested during the day.

2. Relaxation training. Relaxation training teaches insomnia sufferers to use a combination of meditation techniques, guided imagery, and breathing exercises to prepare the body for sleep. Biofeedback helps patients learn to control the body’s normally involuntary bodily processes, such as heart rate, blood pressure, and muscle tension. This combination of techniques helps to relax the body, calm the mind, and make falling asleep easier. 

3. Cognitive Restructuring. This aspect of the protocol involves challenging negative beliefs about sleep, and replacing fearful associations with positive thinking. Worrying may be relegated to a particular time of day so the evening and just before bed become times of relaxation. Insomnia patients in cognitive behavior therapy learn to manage stress and control the over-active thought process that may lead to sleep difficulties.

4. Stimulus control training. This helps chronic insomnia sufferers reduce negative associations with sleep and the bedroom environment. (26) Training essentials include:

  • Lying down in bed only when sleepy
  • Using the bed only for sleep and sex
  • Getting up after 20 minutes if you can’t fall asleep, returning to bed only when sleepy and repeating if necessary
  • Getting up at the same time every morning
  • Foregoing naps

This type of therapy protocol can train the brain to associate a particular environment and time of night with sleep, and break the conditioning that causes delayed, fragmented, or low-quality sleep.

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Another avenue of therapy is called paradoxical intention, a type of treatment which involves remaining passively awake while not worrying about or attempting to sleep. This many help to decrease conditioned responses to bedtime, such as anxiety and restlessness.

A behavioral sleep medicine specialist may be helpful for children with behavioral insomnia. For paradoxical insomnia, therapy and reassurance can be effective in helping sufferers attain better and more restful sleep. (27)

Sleep Hygiene

Sleep hygiene refers to habits and routines surrounding your sleep habits. (28Good sleep hygiene may be one of the simplest and most effective remedies for mild insomnia symptoms. Good sleep hygiene essentials include:

  • Maintaining a regular sleep-wake schedule
  • Using the bed only for sleep and sex
  • Limiting daytime naps to one nap of thirty minutes or less
  • Exercising regularly to improve sleep quality
  • Avoiding blue light exposure from electronics and smartphones in the hours leading up to bed
  • Making sure the bedroom stays cool, dark, and quiet
  • Refraining from consumption of alcohol, caffeine, or heavy meals in the hours before bed

A healthy change in sleep habits can reset the body’s biological clock, train the brain to associate a particular environment and time of night with sleep, and eliminate disruptions that cause fragmented or low-quality sleep.


Medication may be an effective treatment for insomnia if used in a limited way and for a brief period under a doctor’s care. Most medical professionals do not recommend long-term use of insomnia medications, which may lose effectiveness over time as the body builds tolerance to the medications effects.

Some insomnia medications also have the potential for abuse, or for side effects such as daytime drowsiness, memory loss, dizziness, headache, or odd behaviors such as eating while asleep.

There are several classes of medications that treat insomnia (29), including:

  • Antidepressants
  • Hypnotics and sedatives
  • Antihistamines
  • Natural treatments and herbal remedies

Insurance coverage of medications may vary according to type of medication and insurer, and may be limited to a certain number of pills per week or month. Use of sleeping pills may also require the ability to get a full night’s sleep, as well as avoidance of alcohol, driving, and operating machinery.

Sleeping medications do not typically treat the underlying causes of insomnia, which may persist after medications are stopped.

Insomnia is a complex sleep disorder with myriad causes and symptoms. It is also one of the most treatable sleep disorders, and one of the most responsive to good sleep habits and hygiene. Most of us will experience at least one form of insomnia in our lifetimes, but with proper treatment and understanding of the disorder, insomnia doesn’t have to keep us awake at night.


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Rose is the Chief Research Officer at Sleepopolis, which allows her to indulge her twin passions for dense scientific studies and writing about health and wellness. An incurable night owl, she loves discovering the latest information about sleep and how to get (lots) more of it. She is a published novelist who has written everything from an article about cheese factories to clock-in instructions for assembly line workers in Belgium. One of her favorite parts of her job is connecting with the best sleep experts in the industry and utilizing their wealth of knowledge in the pieces she writes. She enjoys creating engaging articles that are chock full of information and make a difference in people’s lives. Her writing has been reviewed by The Boston Globe, Cosmopolitan, and the Associated Press, and received a starred review in Publishers Weekly. One of her proudest moments as a writer was when she learned that a corporate wellness manual she co-authored helped an office of forty people lose a collective one thousand pounds. When she isn’t musing about sleep, she’s usually at the gym, eating extremely spicy food, or wishing she were snowboarding in her native Colorado. Active though she is, she considers staying in bed until noon on Sundays to be important research.