Researchers have identified 5 types of insomnia and suggest that certain treatments work better for different types.
Are you one of us? A tosser-and-turmer who spends too much of the night staring at the ceiling and counting sheep? If so, you're not alone. One out of 10 people suffer from the frustrating madness of chronic insomnia. As such, it is the second-most “prevalent and burdensome mental disorder,” according to the Netherlands Institute for Neuroscience, whose researchers have just published a groundbreaking study on the vexing condition.
What they discovered is that rather than a single problem with various nuances, it is actually five different disorders, which helps to explain why pinning down successful treatments has remained elusive for many sufferers.“While we have always considered insomnia to be one disorder, it actually represents five different disorders,” note the researchers, “Underlying brain mechanisms may be very different. For comparison: progress in our understanding of dementia was propelled once we realized that there are different kinds, such as Alzheimer-, vascular-, and frontal-temporal dementia.”
They also note that insomnia is a primary risk factor for depression. It can be a barrier to wellness and lead to other health issues as well. Yet is has remained an enigma. Gaining a better understanding of such a widespread problem – and getting a better handle on treating it – would be a valuable thing for us under-slept masses.
Insomnia has often been categorized by the complaint – for example, trouble falling asleep, or waking up in the night and not being able to fall back to sleep. Dr. Tessa Blanken and her colleagues looked beyond the complaints to examine the responses of thousands of volunteers from the Netherlands Sleep Registry, based on personality traits that are known to be rooted in brain structure and function. They identified five subtypes, and what they found was significant.
From the study, which has been published in The Lancet Psychiatry: “We found differences between the identified subtypes in developmental trajectories, response to treatment, the presence of an electroencephalogram biomarker, and the risk of depression that was up to five times different between groups, which indicated a clinical relevance of these subtypes.”
Curiously, people in the same groups experienced different sleep complaints, which supports the idea that the problems lie beyond the ways in which sleeplessness manifests itself. Here are the types:
Type 1s tended to have high levels of distressing traits such as neuroticism and feeling down or tense, and low levels of pleasant emotions and overall happiness.
People in this group had less emotional distress; their levels of pleasurable emotions and happiness were normal, and they had a “high sensitivity to reward.” This type responds well to talk therapy (including cognitive behavioral therapy (CBT). They also tend to experience improvements when prescribed medication.
Those in this category also had less distress, but experienced a lower sensitivity to reward. This type does not respond well to sleep-inducing drugs.
Type 4s experienced even lower levels of distress, but were vulnerable to severe and long-lasting insomnia in relation to stressful life events. This type does not respond well to talk therapy (including cognitive behavioral therapy (CBT), and tends to experience improvements when prescribed medication.
People in this group also had low levels of distress similar to Type 4, but their sleep problems were not related to stressful life events.
“The most concerning finding was that people in the Type 1 category are also at greatest risk for lifetime depression,” writes the Netherlands Institute for Neuroscience. “Addressing the underlying emotional issues is crucial for improving their sleep.”
In conclusion, the authors note that this kind of subtyping can help identify the underlying causes of insomnia, and the development of custom treatments. And importantly, can help identify patients with the highest risk of depression for inclusion in trials designed to prevent it.
See more on the study here: Insomnia disorder subtypes derived from life history and traits of affect and personality.