What is insomnia?
To begin with, let’s tackle what might seem like the simplest question: what is insomnia? Essentially, it is an inability to sleep, but let’s explore how our scientific and medical understanding of it has evolved over time.
There are numerous definitions available online, and some even date back to the 1600s, marking its first recorded use. Related terms include agrypnotic and agrupnos, both meaning "lost in pursuit of sleep." For one definition, you can visit https://en.wikipedia.org/wiki/Insomnia, and for the full criteria, refer to the DSM-IV-TR Diagnostic Criteria for Primary Insomnia.
These sources provide definitions, but what does the medical and scientific community say in more detail? Let’s delve into the science behind it.
Why is science so important in understanding insomnia? Science plays a significant role because it aids not only in comprehending insomnia but also in treating it. While it isn’t the sole source of knowledge or treatment, it is certainly an essential part of the overall picture.
A brief history of its diagnosis is helpful here. In the 1980s, insomnia was considered merely a symptom rather than a primary disorder. It was seen as a sign of other issues, such as depression or other mental or physical disorders. Consequently, treatment typically focused on addressing the underlying disorder with the hope that insomnia would resolve on its own, or in cases where it was treated directly, hypnotics were used as a short-term solution. Chronic insomnia was only recognized as part of another psychological or physical illness.
On a personal note, this perspective likely contributed to the common responses we heard growing up when someone mentioned they couldn’t sleep, such as “What’s on your mind?” or “You must be depressed.” Naturally, if doctors, psychologists, and scientists viewed insomnia through that lens, that belief would have been reinforced in society by the media.
Around 2005, however, this viewpoint began to shift within the scientific community—a topic I’ve touched on in a previous blog post and one that is part of an ongoing series starting in 2016. In 2005, insomnia was reclassified from a mere symptom to a disorder in its own right. While it is often found in combination with other conditions, this change in classification was crucial. It acknowledged that chronic insomnia exists independently and merits its treatment, regardless of whether it is accompanied by another disorder.
This shift should have been a relief for those of us who had long struggled with insomnia, unsure whether our sleeplessness was a symptom of some hidden psychological or physiological issue simply because society kept telling us so. I remember often thinking, “I don’t feel depressed or ill, yet everyone insists there must be something wrong. Perhaps I just can’t see it.” As insomniacs, we are all too familiar with the internal dialogue of “Why can’t I sleep?” or “I hope I can get some sleep tonight,” which only serves to keep us awake in a vicious, spiraling cycle.
From 2005 onward, treatments began to focus on both the insomnia itself and any accompanying disorder, often finding that addressing the insomnia helped alleviate the other condition as well. By 2014, the DSM-IV-TR used a specific diagnostic criterion for insomnia, defining it as a predominant complaint of difficulty initiating or maintaining sleep, or nonrestorative sleep, persisting for at least one month. This development is significant because it not only established insomnia as a standalone disorder but also provided clear diagnostic criteria. This means that when you are diagnosed, it is taken seriously by healthcare professionals, which can lead to better treatment options. It also helps move us away from endless self-pity and despair, replacing it with the mindset of “I have insomnia—now, how am I going to live with it?” At Insomnia Life, we firmly believe that acceptance is key. Once you accept insomnia as part of your life, it shifts from being something that causes you suffering to something you learn to live with.
Now that we have explored how insomnia is diagnosed and what it means, in our next blog we will examine the causes and effects of insomnia. In fact, let’s take a deeper look at what insomnia truly is and consider the origins of this relatively new phenomenon.
Insomnia Disorder as Defined by the DSM-V is characterized as a “predominant complaint of dissatisfaction with sleep quantity or quality,” which is typically associated with difficulty falling asleep, staying asleep, or waking up too early and being unable to resume sleep. Additional aspects of the definition classify insomnia as a disorder in its own right, noting that it causes distress in various areas of life. For a diagnosis, sleep problems must occur more than three times a week over at least three months, and they should not be attributed to another disorder or medication.
