OVERVIEW

What is transient insomnia disorder?

Transient insomnia disorder, also known as acute insomnia disorder, refers to difficulty sleeping at night lasting less than 3 months.

Similar to chronic insomnia disorder, it involves subjective dissatisfaction with sleep and daytime negative experiences related to sleep difficulties (such as fatigue, mood instability, difficulty concentrating, etc.), significantly impacting daily life, work, study, and other aspects.

How common is transient insomnia disorder?

The exact incidence of transient insomnia disorder remains unclear. Estimates suggest that the annual occurrence rate among adults is approximately 15%–20%. In the general population, about 30%–35% experience transient insomnia.

Similar to chronic insomnia disorder, transient insomnia is relatively more common among women and older adults.

Which department should be consulted for transient insomnia disorder?

The departments for treating transient insomnia disorder are generally the same as those for chronic insomnia disorder.

In well-equipped areas, a sleep specialty clinic is the first choice. In areas without sleep specialty clinics but with accessible psychiatric or psychosomatic medicine services, psychiatric or psychosomatic medicine departments may be considered. In special cases, neurology or even general internal medicine departments can also be options.

SYMPTOMS

What are the manifestations of transient insomnia disorder?

The clinical characteristics of transient insomnia disorder are generally similar to those of chronic insomnia disorder, primarily involving sleep difficulties and related daytime symptoms. The main difference between the two lies in the duration of insomnia symptoms.

• Difficulty falling asleep: The time taken to fall asleep after going to bed exceeds 20–30 minutes; early awakening, waking up more than 30 minutes earlier than usual. These two symptoms may occur independently or simultaneously and may be accompanied by complaints of poor sleep quality and lack of restorative sleep.

• Daytime complaints of negative symptoms related to sleep difficulties: fatigue, decreased energy, difficulty concentrating, impaired memory, irritability, low mood, or emotional instability.

• Daytime sleepiness is common, but most patients still struggle to fall asleep even when given the opportunity to sleep.

• The frequency of episodes may vary, but there is often excessive worry, anxiety, and tension about sleep difficulties. Sleep difficulties and related daytime symptoms last for less than 3 months.

CAUSES

What are the causes of transient insomnia disorder?

Similar to chronic insomnia disorder, the exact etiology and pathological mechanisms of transient insomnia disorder are not yet fully understood. It may be related to factors such as genetics, neurobiology, sleep-wake regulation, as well as individual behavioral and cognitive patterns.

Which factors are likely to contribute to insomnia?

• Unsuitable sleep environment, such as temperature, light, humidity, noise, etc.;

• Poor sleep hygiene habits, such as staying up late, late-night snacking or excessive drinking, engaging in non-sleep-related activities in bed (e.g., using a phone, reading, watching TV, overthinking), and other habits detrimental to sleep;

• Changes in sleep-wake circadian rhythms, such as night shifts, overtime work, or jet lag, which are usually adaptable in the short term;

• Stressful events (e.g., marital or family conflicts, career advancement) and related emotional issues like anxiety or depression;

• Cognitive and behavioral patterns regarding sleep, such as excessive worry about "what if I can't sleep well" or "I must sleep well";

• Certain physical illnesses, mental disorders, or medication factors, such as heart failure, emphysema, hyperthyroidism, gastrointestinal discomfort, physical pain, depression, mania, substance abuse and dependence, aminophylline, etc.

DIAGNOSIS

How is transient insomnia disorder diagnosed?

The diagnosis of transient insomnia disorder requires meeting the following criteria:

• At least one of the following sleep difficulty symptoms must be present:

1. Difficulty falling asleep;
2. Difficulty maintaining sleep;
3. Early morning awakening;
4. Subjective resistance to going to bed at the intended bedtime;
5. Difficulty sleeping without the presence of parents or caregivers.

Among these, items 4 and 5 are more common in children or elderly individuals requiring care (e.g., dementia).

• At least one of the following daytime symptoms related to sleep difficulties must be present:

1. Fatigue;
2. Difficulty concentrating or impaired memory;
3. Reduced physical energy or stamina;
4. Emotional irritability, agitation, impulsivity, or instability;
5. Daytime sleepiness;
6. Worry or dissatisfaction about sleep;
7. Significant negative impact on daily life, work, or study.

The duration of sleep difficulties and daytime symptoms is < 3 months. The frequency may be < 3 times per week but is accompanied by excessive focus on or anxiety about the insomnia symptoms themselves.

The sleep difficulties are not directly and solely caused by insufficient sleep opportunity (e.g., night shifts leading to inadequate nighttime sleep), unfavorable sleep environment (e.g., dangerous conditions, extreme temperatures), physical illness, mental disorders, or other factors, nor do they meet the characteristics of other sleep disorders.

What tests are needed to diagnose transient insomnia disorder?

Similar to chronic insomnia disorder, the diagnosis of transient insomnia disorder is primarily based on detailed sleep history and sleep-wake rhythm information provided by the patient and informants. At the same time, it is necessary to differentiate insomnia caused by physical illnesses, mental disorders, medications, or other reasons.

Therefore, in addition to a detailed physical and psychiatric examination, blood tests, imaging studies, electrocardiograms (ECG), electroencephalograms (EEG), psychological assessments, and other auxiliary tests may be necessary, depending on the suspected underlying conditions.

What conditions should transient insomnia disorder be distinguished from?

Transient insomnia disorder shares many features with chronic insomnia disorder. The main difference is that transient insomnia lasts < 3 months and does not meet the frequency criterion of occurring > 3 times per week.

If an individual voluntarily chooses "sleep difficulties" at night due to work or jet lag and must sleep during the day, this should not be diagnosed as transient insomnia disorder.

TREATMENT

How to treat transient insomnia disorder?

Similar to chronic insomnia disorder, the treatment of transient insomnia disorder mainly includes pharmacotherapy and cognitive behavioral therapy.

Pharmacotherapy may have better short-term efficacy than cognitive behavioral therapy. Combining pharmacotherapy with cognitive behavioral therapy can yield even better results. The formulation of a specific treatment plan should follow individualized principles and comprehensive considerations. For details, please refer to the treatment section under "Chronic Insomnia Disorder."

Can transient insomnia disorder resolve on its own without treatment?

For transient insomnia disorder that meets diagnostic criteria, active treatment is recommended, including short-term pharmacotherapy combined with self-adjustment of sleep mentality and behavior.

Even if pharmacotherapy is not preferred, actively receiving cognitive behavioral sleep counseling, adjusting sleep mentality, limiting time in bed, and cultivating healthy sleep behavior patterns are effective self-treatment strategies.

DIET & LIFESTYLE

What should patients with transient insomnia disorder pay attention to in daily life?

• Mindset: Avoid excessive focus and anxiety about sleep insomnia, such as thoughts like "What should I do if I can't sleep again tonight?" or "I must find a way to sleep well tonight." Such worries often lead to increased tension and concern, creating a vicious cycle where the more you focus on falling asleep, the harder it becomes.

• Cultivate good sleep hygiene habits:

• Create a conducive sleep environment: thick curtains, slightly cool temperature, quiet surroundings, appropriate humidity, etc.;

• Engage in moderate outdoor activities after work or daily life to break a sweat, which benefits sleep, but avoid intense exercise within 2 hours before bedtime;

• Avoid daytime naps as much as possible; even if you nap, keep it under 30 minutes;

• Wake up at a fixed time every day, regardless of how well you slept, including weekends and holidays;

• Find ways to relax before bed: music, walking, yoga, calligraphy, leisurely strolls, movies, deep breathing, relaxation exercises, etc.—specific methods vary by individual. A warm glass of milk, a foot soak, or a warm bath before bed may also help;

• Avoid consuming tea, coffee, or similar beverages after 4 PM (don’t overlook the caffeine in cola or chocolate);

• Avoid being overly full, hungry, or drinking too much water before bed, and strictly resist the temptation of alcohol or other substances for sleep.

What should I do when I can't sleep?

When you can't sleep, leave the bed and bedroom. Do something else that relaxes you while waiting for sleepiness.

If you can't fall asleep within 20–30 minutes in bed, get out of bed and the bedroom and engage in relaxing activities, such as listening to soothing music or reading a light book. Return to bed only when sleepiness comes.

If you still can't fall asleep after another 20–30 minutes, repeat the steps above. Consistently practicing this method for over 4 weeks may yield noticeable results.

Strictly limit the time spent in bed while awake to reinforce the natural association in your mind: the bed is only for sleep and intimacy.

PREVENTION

Can transient insomnia disorder be prevented?

Yes, it can be prevented by maintaining good lifestyle habits and a healthy mindset. For specific details, please refer to the "Lifestyle Considerations" section above.

How to prevent transient insomnia disorder from developing into chronic insomnia disorder?

Correct misconceptions about sleep and adopt healthy habits:

• Maintain a consistent bedtime and wake-up time, and avoid sleeping in on weekends.
• Limit naps to 30–40 minutes.
• Avoid caffeine-containing foods and drinks like tea and coffee.
• Exercise regularly.
• Get plenty of sunlight during the day.
• Seek professional help promptly, including psychiatrists or psychologists.