In the medical setting, we separate insomnia into two categories, acute and chronic. Acute insomnia is something that is very recent and might be related to a stressful event like an illness or a divorce. In this scenario, the person might try over-the-counter medications or go see their primary care doctor but eventually, the insomnia resolves.
In other cases, the insomnia persists and evolves and here is where having a comprehensive assessment by a board-certified sleep doctor make a difference. At this point, the person has been living with insomnia for several months or years and we call that chronic insomnia. The root causes might include behavioral changes that are being used to cope with insomnia, circadian rhythm sleep wake disorders, sleep disordered breathing, and/or medical/psychiatric factors like anxiety or depression, etc.
In most cases, there is more than one contributing factor and here is where a well-seasoned clinician can shine. During initial consultations, my main goal is to assess and prioritize which factors are of the most significance. Oftentimes that involves collecting more data with sleep diaries, actigraphy, and/or diagnostic sleep testing.
Therapeutic strategies are customized to the specific case.