Sleep Onset Insomnia: Causes, Tests, & Treatments

By A Member of the Lina Team (Licensed Psychologist, PsyD)

What is sleep onset insomnia?

Insomnia can be categorized into three main types: initial insomnia, middle insomnia, and terminal insomnia. Initial insomnia, or sleep onset insomnia, describes the condition of difficulty falling asleep at bedtime.

What are the causes of sleep onset insomnia?

Sleep onset insomnia can have a number of causes. It is not uncommon for individuals to experience brief periods of sleep onset insomnia due to transient life stressors (e.g. jet lag, worry about an upcoming event, pain from an injury). For those who suffer from chronic sleep onset insomnia, they may be experiencing a comorbid mental or physical condition like an anxiety disorder, mood disorder, post-traumatic stress disorder, chronic pain, a cardiac or respiratory disorder, or a neurodegenerative condition. The introduction to the section on Sleep-Wake disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) notes that when it comes to insomnia disorders, “coexisting clinical conditions are the rule, not the exception.”

Of note, sleep onset insomnia is more common among young adults, while middle and terminal insomnia is more common among middle and older adults. For young children who experience sleep-onset insomnia, this may be due to a lack of consistent bed-time routines or the need to learn how to fall asleep without the presence of a parent in the room.

What are the common symptoms of sleep onset insomnia?

Sleep onset insomnia is commonly accompanied by anxiety or worry around bed-time as well as tiredness during the daytime. Chronic sleep difficulties may also result in irritability, difficulties of attention and concentration, and the development of further emotional and health difficulties such as depressive symptoms and heightened stress.

Is there a sleep onset insomnia test to diagnose if you have sleep onset insomnia?

The simplest way to test for sleep onset insomnia, is to measure your average sleep latency – or length of time it takes to fall asleep after turning out the lights. A healthy sleep latency is typically about ten to twenty minutes. If an individual is consistently awake for longer than twenty minutes trying to fall asleep, sleep onset insomnia may be present. A sleep study conducted by medical professionals is a more sophisticated way to diagnose sleep-wake disorders, including sleep-onset insomnia.

Is there a connection between sleep onset insomnia and ADHD?

Yes, there is a connection between ADHD and sleep onset insomnia. ADHD symptoms can cause disruptions in the sleep-wake cycle due to hyperactivity during the day, dysregulated circadian rhythm, or racing thoughts around bed-time. Individuals with ADHD are thus at increased odds of experiencing sleep onset insomnia.

Is there a connection between sleep onset insomnia and anxiety?

Yes, there is a connection between sleep onset insomnia and anxiety. Insomnia, especially sleep-onset insomnia, is a common symptom of anxiety disorders like generalized anxiety disorder (GAD). Anxiety disorders are often characterized by persistent worry thoughts and activation of the sympathetic nervous system (the body’s fight or flight system) which disrupt peaceful sleep. Conversely, individuals who suffer from sleep onset insomnia may consequently develop heightened anxiety, particularly around bed-time.

Are there any sleep onset insomnia natural treatments without medicines?

The most common natural treatment to aid sleep onset insomnia is a melatonin supplement. Melatonin is a naturally occurring hormone in the human body that regulates the sleep-wake cycle. Additionally, some individuals benefit from using blue-light filters on their screens several hours before bed in order to mitigate the rousing effect of blue light on our body’s circadian rhythm.

What are the best sleep onset insomnia treatments?

Prescription treatments that effectively treat insomnia include Eszopiclone (Lunesta), Lemborexant (Dayvigo), Ramelteon (Rozerem), and Zolpidem (Ambien). These medications work through various physiological channels like blocking histamine receptors, suppressing the central nervous system, or actively targeting the sleep-wake cycle. While prescription medications can be highly effective in relieving sleep-onset insomnia, they may cause side effects such as grogginess. A medical professional can provide the information needed for an individual to find the best fit for their symptoms.

Other effective treatment options for sleep onset insomnia include psychotherapy such as cognitive behavioral therapy for insomnia (CBT-I), an evidence-based treatment that trains individuals in strategies to maximize sleep efficiency, recondition mental associations with bed and bedtime, and develop cognitive tools to manage sleep-interfering thoughts. For those who suffer from sleep-onset insomnia due to other mental conditions (like PTSD or bipolar disorder), psychotherapies to treat those conditions can help to improve sleep as well. Several over-the-counter antihistamine medications such as Benadryl can cause drowsiness and induce sleep.

Remember, sleep onset insomnia is treatable. If you struggle with sleep onset insomnia, reach out to your provider to discuss the treatment that will be best for you!