NOT all insomniacs are the same, scientists have warned – as a new Spanish study identified five distinct types, each requiring different treatments.
The research, led by sleep specialist Francesca Cañellas of the Balearics’ Health Research Institute (IdISBa), confirmed that insomnia can be triggered by a range of factors, including stress, depression, and even childhood trauma.
Cañellas stressed that different types of insomnia respond to different treatments, and some approaches work better for certain patients than others.
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The discovery came as new data from Spain’s Society of Sleep (SES) warned that around 43% of Spaniards have experienced insomnia at some point in their lives – with chronic cases now affecting more than 5 million people nationwide.
Cañellas told El Pais: “[Insomnia] is a complex condition with multiple underlying causes, all leading to the common problem of poor sleep and impaired daytime functioning.”
Originally, the idea of five distinct insomnia subtypes came from Dutch researchers Tessa Blanken and Eus Van Someren, who proposed the classification in 2019 based on patients’ life history and personality traits.
But the new Spanish study was the first to confirm that the five subtypes also apply to patients seen in clinical practice.
According to the classification, the first subtype includes people with very high distress, severe insomnia, and high levels of depression.
Experts say these patients often need medical treatment for underlying mood disorders as well as sleep support.
The second subtype describes those with moderate distress whose insomnia is reactive to stress; they tend to respond well to a type of psychological support known as cognitive behavioural therapy for insomnia.
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The third subtype consists of people who are moderately distressed but do not respond well to standard treatments, often showing negative?tending personality traits and requiring more intensive, tailored care.
The fourth subtype includes patients with long-term insomnia linked to significant life events and childhood trauma; these sufferers often benefit from relaxation therapies and stress-coping techniques.
The fifth subtype also involves long-lasting insomnia with lower overall distress and links to life events.
Clinicians say these patients may improve with behavioural and stress-management interventions.
Cañellas said that about 82% of Spanish patients belong to subtypes one and three.
She said: “In [type one] patients, insomnia may be the first and most important symptom of depression. If the depression is not treated, the insomnia cannot improve.”
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“More often than in the other subtypes, these patients have been diagnosed at some point in their lives with anxiety or depressive disorders,” she added.
Type three patients may be even harder to treat, the researcher explained.
“They are people with a tendency toward negativity. They come to the sleep units a lot because worry just eats away at them,” she said.
Both groups tend to use more hypnotic drugs and often have a family history of insomnia or psychiatric disorders, Cañellas stressed.
“[But] we need to continue studying subtype three patients, who represent nearly half of those seen in sleep units and show the poorest response to different treatments,” she added.
The findings are likely to represent a breakthrough in how insomnia is treated, experts have said.
Javier Puertas, a clinical neurophysiologist and vice president of the Spanish Federation of Sleep Medicine Societies (Fesmes), told El Pais: “The results of the study allow us to slightly rethink the treatment paradigm. In other words, you cannot use the same approach for all people with insomnia; instead, treatments will need to be adjusted according to each insomnia subtype.”
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