Baseer Maroof, LCSW · Raleigh, NC · Adults 21+
What insomnia is
A bad night is not insomnia. A pattern that costs you during the day, despite a fair shot at sleep, is.
In short
- Insomnia disorder: trouble falling asleep, staying asleep or waking too early, with daytime distress or impairment.
- It counts when it happens at least 3 nights a week for at least 3 months, despite adequate opportunity to sleep.
- Short-term (acute) insomnia is common after stress and often fades. Chronic insomnia usually needs treatment.
- About a third of adults have symptoms; about 6–10% meet full criteria.
The diagnosis (DSM-5-TR)
Paraphrased. A clinician makes the diagnosis.
The complaint
Dissatisfied with sleep amount or quality, with one or more of: trouble falling asleep, trouble staying asleep (frequent waking or trouble getting back to sleep), or waking early and not getting back to sleep.
The cost
It causes real distress or gets in the way of work, school, relationships or other parts of life. Tiredness, low energy, mood, focus and mistakes are common.
The timing
At least 3 nights a week, for at least 3 months.
The opportunity
It happens even though there’s adequate opportunity to sleep. Someone working doubles with five hours in bed has a schedule problem, not insomnia.
The exclusions
It isn’t better explained by another sleep disorder (like apnea), and isn’t only due to a substance or medication. It can, and often does, exist alongside anxiety, depression or medical conditions, and still gets its own treatment.
Criteria paraphrased from DSM-5 as summarized by AHRQ (2015).
Acute vs chronic
DSM-5-TR specifiers
- Episodic: symptoms for at least 1 month but less than 3.
- Persistent: 3 months or longer.
- Recurrent: two or more episodes within a year.
ICD-11
The WHO’s ICD-11 splits it into 7A00 Chronic insomnia and 7A01 Short-term insomnia. Same idea: frequency and duration separate a rough patch from an established pattern.
Why the line matters
A few bad weeks after a loss or a hard stretch is normal. The question is whether sleep comes back as the stress eases, or whether the coping takes over. That’s the 3P model. See it move →
How common it is
Ohayon 2002 review; StatPearls; AHRQ 2015.
Who gets it more
Every way of counting it shows higher rates in women than men. Symptoms become more common with age. And insomnia is closely tied to depression: people with insomnia are more likely to have it, and persistent insomnia predicts new episodes. (Ohayon 2002)
What it isn’t
Not enough time in bed
If you sleep well whenever you get the chance, the fix is the schedule.
A night owl body clock
Can’t fall asleep until 2 a.m. but sleep fine if allowed to sleep until 10? That may be a delayed body clock rather than insomnia. Worth naming to a clinician.
Sleep apnea or restless legs
They can look like insomnia and need different care. When to see a doctor →
Sources
All sources, linked4 references⌄
- Brasure M, et al. (2015). Management of Insomnia Disorder. AHRQ Comparative Effectiveness Review No. 159, Introduction (DSM-5 criteria; 6–10% meet criteria). www.ncbi.nlm.nih.gov/books/NBK343490/
- World Health Organization. ICD-11 for Mortality and Morbidity Statistics: 7A00 Chronic insomnia; 7A01 Short-term insomnia. icd.who.int/browse/2024-01/mms/en#323148092
- Ohayon MM (2002). Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 6(2):97–111. doi.org/10.1053/smrv.2002.0186
- McNamara S, Spurling BC, Bollu PC. Chronic Insomnia. StatPearls (NCBI Bookshelf). www.ncbi.nlm.nih.gov/books/NBK526136/
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