Even just one night of poor sleep can lead to an unpleasant experience the next day: grogginess, having trouble concentrating, or feeling grumpier than usual. If you have multiple nights of poor sleep in a week, you may be experiencing acute insomnia, and significant worry about sleep may start to creep in.
How Is Acute Insomnia Defined?
Acute insomnia involves having difficulty falling asleep at least three nights per week for a period lasting anywhere between three days and three months. At the three-month mark, insomnia is considered chronic rather than acute and could be diagnosed as an insomnia disorder based on the standards laid out in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). At any given time, around 10% of individuals in the United States experience acute insomnia, and approximately one-third of Americans experience a period of acute insomnia in any given year.
Why Does Acute Insomnia Occur?
Sleep is a dynamic, complex, multi-system process, so a whole range of events and issues can lead to difficulty sleeping. A major schedule change, such as working the late shift or overnight, can lead to major sleep issues due to disruptions in circadian rhythms and the sleep-wake cycle. Similarly, experiencing jet lag after crossing time zones, having a baby that is up at all hours of the night, or contracting a new illness or injury can all lead to short-term disruptions in sleep.
Stress also has a strong impact on sleep. The classic stress response, which involves activation of the hypothalamic-pituitary-adrenal (HPA) axis, impacts the sleep-wake cycle. Sometimes an initial stress response stems from a life event, such as a job layoff, the breakup of a relationship, or an upcoming high-stakes exam. These stressors can lead to physiological hyperarousal, such as the “fight-or-flight response.” It is difficult to fall asleep when your heart or mind is racing. Over the course of several nights or weeks, difficulty sleeping itself can become a stressor, ironically causing even further sleep disturbance.
Can Acute Insomnia Be Treated Without Medications?
Cognitive behavioral therapy for insomnia (CBT-I) is considered the first-line treatment for insomnia disorder by the American Academy of Sleep Medicine (AASM). Although CBT-I is typically recommended only for folks who have crossed the three-month threshold into chronic insomnia, there is evidence that it may also provide benefit for short-term sleep difficulties. One randomized controlled trial found that a single-session version of CBT-I provided significant improvement for individuals with acute insomnia, with 60% of those in the CBT-I group achieving remission within one month, compared with only 15% in the control group.
CBT-I does not require medication, but it does involve more than traditional sleep hygiene. The treatment combines behavioral components, such as refraining from activities other than sleep in bed, with cognitive components, such as changing your upsetting or self-defeating thoughts about sleep. If you are suffering from acute insomnia, here are five behavioral strategies from CBT-I that may help you shift the tide back to your normal, pre-insomnia sleep pattern.
- Keep to a regular morning wake-up time. We sleep best on a set schedule because it allows our bodies to sync with our natural circadian rhythms. Although many people try to go to bed at the same time each night, we can’t actually control when we fall asleep. One of the best ways to regulate circadian rhythm is to wake up at the same time each morning, regardless of how well you slept the night before.
- Cut out naps (unless needed for safety purposes). Naps might feel like a clever way to get more sleep in, but they weaken the sleep drive, or our daily need for sleep. Taking an afternoon nap might make it harder for you to fall or stay asleep the next night. However, if you tend to doze or fall asleep during the day, a thirty-minute power nap may be an important safety precaution before driving or operating heavy machinery.
- Give yourself at least an hour-long buffer before bed. Calming activities can lower stress levels and signal to your body that sleep is approaching. At least an hour before your typical bedtime, shift towards soothing, calming, or low-energy activities. These could include reading, a nighttime skincare routine, listening to a podcast or audiobook, taking a warm bath, or stretching.
- Wait until you are actually sleepy before getting into bed. If you get in bed while wired, you are unlikely to fall asleep quickly. The process of tossing and turning can increase your stress levels or, worse, lead you to start associating the bed with wakefulness. Signs of sleepiness include yawning, heavy eyelids, or even nodding off. If your bedtime comes around and you aren’t sleepy yet, it is better to engage in calming activities until sleepiness sets in rather than trying to “force” sleep.
- Get out of bed if you have been lying awake for more than 20 (or so) minutes. Spending long stretches of time in bed without sleeping can create a mental association between the bed and wakefulness, which could increase your risk for developing chronic insomnia. Before you go to bed tonight, identify a comfortable area in your home where you can sit and engage in a quiet activity if you have trouble sleeping. For example, set out a book of crossword puzzles on a couch with a soft blanket and access to lamplight. If you can’t sleep, go to that spot and engage in another activity until you feel sleepy. Then get back in bed, better prepared to drift off.
