Sleep disorders
Sleep-maintenance insomnia
This is the form that demands the most care in differential diagnosis: very often a sleep-related breathing disorder is hiding behind it, not insomnia.
What it is
Sleep arrives normally but is interrupted once or more during the night, with difficulty returning to sleep that exceeds 20–30 minutes.
Brief awakenings are normal and happen to everyone. The problem is not the awakening itself, but the inability to get back to sleep — and the tension that comes with it.
It is the form of insomnia most often linked to organic causes: sleep apnoea, restless legs syndrome, nocturia, chronic pain, hormonal changes of menopause.
How it shows up
- One or more awakenings every night
- More than 20–30 minutes to fall back asleep
- A sense that sleep is «broken» and unrefreshing
- Waking with a choking sensation, palpitations or a dry mouth
- Snoring or breathing pauses reported by a partner
How it is treated
- 01
Differential diagnosis first: where the history points to respiratory or movement causes, a sleep study comes before anything else.
- 02
When it is insomnia, stimulus control applies to night-time awakenings too: you do not stay in bed awake, waiting.
- 03
Compressing time in bed so that sleep becomes continuous before it is extended in duration.
- 04
Managing middle-of-the-night catastrophising — the thought that «that's it, I won't sleep again», which by itself keeps the brain awake.
Important
If there is loud snoring, witnessed breathing pauses, morning headache or marked daytime sleepiness, a sleep study is needed before any behavioural intervention.
Let's find out whether this is what is happening to you.