When insomnia becomes chronic

In clinical terms, insomnia means trouble getting to sleep or staying asleep even when you have enough time and a suitable place to sleep, and it affects how you feel or cope the next day.

Having enough time matters. Clinicians call this adequate opportunity for sleep. Someone whose schedule allows only five hours in bed may be short of sleep without having insomnia. Both can cause tiredness, but they call for different approaches.

Clinicians also look at how long the problem has lasted:

• Short-term insomnia lasts less than three months. It often follows a clear trigger, such as an illness, a loss or a big change at work or home, and may settle once the trigger passes.
• Chronic insomnia occurs on at least three nights a week and has continued for three months or more.

Insomnia is common. Estimates vary, but the International Classification of Sleep Disorders, a manual used by sleep clinicians, suggests that about 10 percent of adults have chronic insomnia and many more have shorter spells of poor sleep.

How insomnia can affect your day

Clinicians ask about your days as well as your nights. Next-day problems caused by poor sleep are called daytime impairment, and they are part of how insomnia is defined. They may include:

• Tiredness or low energy
• Difficulty concentrating or remembering things
• Irritability, low mood or feeling on edge
• More mistakes than usual at work or at home
• Spending much of the day thinking or worrying about sleep

Many people with insomnia feel exhausted through the day yet still cannot nap. Some describe feeling tired but wired: the body stays alert even when you want to rest.

If you sleep six hours and feel well during the day, that alone may not mean you have insomnia. Strong daytime sleepiness, such as dozing off in conversation, is less typical of insomnia and can point to other sleep conditions, so it is worth mentioning to a clinician.

Conditions that can look like insomnia

During an evaluation, a clinician checks for other conditions that can disturb sleep or occur alongside insomnia. Only a clinical assessment can show which apply to you.

• Sleep apnea. Breathing stops and starts during sleep, often with loud snoring, gasping or choking. Sleep apnea and insomnia often occur together. We treat insomnia and, when needed, coordinate referrals to partners who treat sleep apnea. Our page Do You Need a Sleep Study? lists the signs that may call for testing.
• Restless legs syndrome. An uncomfortable urge to move the legs, usually in the evening or when resting, that eases with movement. It needs its own assessment.
• Body clock problems. Your body clock, or circadian rhythm, sets the times you feel sleepy and alert. Night shifts, rotating shifts or a naturally late body clock can make it hard to sleep when you need to. This is a timing problem, though it can overlap with insomnia.
• Anxiety and depression. Worry and low mood can disturb sleep, and poor sleep can make both harder to manage. Our anxiety therapy page describes how our clinicians treat worry alongside sleep problems.
• Medicines, alcohol and caffeine. Some prescriptions, over-the-counter products, alcohol and caffeine can affect sleep. Tell your clinician about everything you take. Any change to a prescribed medicine should be managed by the prescriber.

Getting help for insomnia in Virginia

Consider talking to a clinician if poor sleep happens on most nights, has lasted several weeks or is affecting your work, mood or relationships. You do not have to wait until it has lasted three months, and no referral is required.

Our insomnia test can be a useful starting point. It takes about two minutes, and you can share the score at your appointment.

Your first appointment is an evaluation of about 50 minutes with a Virginia-licensed clinician. You discuss your sleep, your health and what you have already tried, and decide together whether CBT-I is a good fit. The how it works page describes each step.

Most patients see Virginia-licensed clinicians by video, and a limited number of clinicians also see patients in person; availability is confirmed at booking. You must be physically in Virginia during your appointments.

Insurance plans we accept in Virginia include Aetna, Anthem Blue Cross Blue Shield, Cigna / Evernorth, Medicare, Sentara / Optima Health, UnitedHealthcare / Optum, UnitedHealthcare Medicare Advantage and Veterans Affairs Community Care Network. Coverage varies by plan, so our team verifies your benefits before your first visit. Self-pay rates are listed on our pricing page.