We thought insomnia was just not being able to sleep. Now we know that there are five different disorders

insomnia is for many people a serious problem with which they deal daily, both day and night, and whose treatment is always based on three pillars: sleep hygienecognitive-behavioral therapy or hypnotic drugs. However, Sometimes what is useful for one person is useless for another.. Something that we now know is because there is not just one type of insomnia, but five.

The study. With Spanish origin and published in the Journal of Sleep Research confirms what many specialists were suspecting: insomnia is not a unique disorder. As Francesa Cañellas, from the Son Espases University Hospital, points out, research has proven that there are five different subtypes of insomniaa finding that promises to revolutionize the way we treat sleep problems.

Its evolution. The first hypothesis that was raised about the variability of insomnia comes from 2019, when some dutch researchers They already saw that this disorder had five faces. The problem is that these differences had to be proven according to the personality traits and biography of each of the patients.

That is exactly what the Spanish team has done. Financed by the Spanish Sleep Society (SES), the study has analyzed data from eight sleep units in Spain using the Insomnia Types Questionnaire (ITQ). Using the patients’ responses in these questionnaires and the data obtained from each one’s sleep, it has been seen that these five profiles are true. Although the problem is that the most severe type is the most common.

The different types. The interesting thing about this study is that it does not classify insomnia by the number of hours spent sleeping, but by personality traits or level of distress. Based on this, the classification proposed is the following:

• Type 1: a very complex group, since their peculiarity is that they have high anguish within them. In this way, they are patients with high levels of neuroticismtension and depression.
• Type 2: patients who have moderate distress, but who can respond to positive stimuli. In this way, they are able to overcome the problem thanks to cognitive-behavioral therapy, which is the usual standard treatment.
• Type 3: in this case the patients do not feel much anxiety, but they do have a great insensitivity to pleasure, which is known as anhedonia. This is a problem, because being emotionally flat, conventional treatments are not very effective.
• Type 4 and 5: They are the mildest forms, since they are due to specific problems in the life of each patient that increase their level of stress but without a psychological burden behind them.

The bad news. Although it has been possible to classify insomnia into different types, the reality is that 82% of patients belong to subtypes 1 and 3. These are the ones that respond the worst to treatments and that cause greater psychological damage to people.

Logically, these are the people who most frequently go to medical consultations and sleep units because They literally can’t take it anymoresince it is unlikely that a sleeping pill will solve your problem. In fact, the study highlights that these two groups are the ones with the highest consumption of hypnotics and anxiolytics, often with poor results.

A precision medicine. The importance of this work lies in the fact that there is no effective standard treatment for insomnia. In this way, if a type 2 patient receives psychological therapy they will do wonderfully, but for a type 3 patient this treatment will do almost nothing. Likewise, type 1 may require a psychiatric approach to treat underlying anxiety and then treat the insomnia problem.

With all this, we seek to stop treating the disease in isolation, and conceive that it will be associated with a person who has a specific biography and a personality that may require different care.

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