Insomnia失眠 · Insomnia

Place · Level 3

腺苷 + SCN + HPA 三轴失调 · CBT-I A 级证据 · melatonin 是时钟信号不是安眠药· Z 药慎用

Insomnia types · ICSD-3

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失眠分型 · ICSD-3

Insomnia is any of three difficulties — falling asleep / staying asleep / waking too early — PLUS daytime functional impairment.

By duration:

Acute insomnia: < 3 months, usually with a trigger (stress / jet lag / illness)Chronic insomnia: ≥ 3 months / ≥ 3 nights per week / with daytime impairment → ICSD-3 diagnostic criteria30-35% of adults have occasional insomnia; 10-15% have chronic insomnia
By presentation:

Sleep-onset insomnia: > 30 minutes to fall asleep after going to bedSleep-maintenance insomnia: waking in the middle of the night and not getting back to sleep for > 30 minutesEarly morning awakening: waking ≥ 1 hour before the target wake time and unable to return to sleepNon-restorative sleep: 7-8 hours in bed but still tired
"I get 6 hours a night — is that insomnia?" Not necessarily — sleep need varies meaningfully between individuals:

Most adults need 7-9 hours, but a small subset (true "short sleepers", < 5%) do fine on 5-6 hoursThe judgment criterion: is there any daytime functional impairment (attention, reaction, mood, error rate)?No impairment + subjectively satisfied → 6 hours may be enough; impairment → you need more
Insomnia is one of the most badly-handled "symptoms" out there. Most people go straight to melatonin or an OTC sleep aid, but:

Z-drugs and benzodiazepines — the true sleep medications — carry serious long-term risks (falls, dementia, dependence)Melatonin is not a sleep aid; it is a clock signal. Wrong dose or timing makes it backfire.CBT-I (cognitive behavioral therapy for insomnia) is A-grade evidence, but adoption is low — most patients don't even know it exists
What this island is trying to do is upgrade the conversation from "what should I take" to "why can't I sleep + which levers actually work".

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本站提供科普与一般性建议，不替代医师诊断或处方；有症状或正在服药请咨询合格医师。 Educational content, not medical advice — consult a clinician for diagnosis or treatment.

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