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Understanding insomnia disorder beyond its subtypes: Psychological profiles of insomnia

Vanda Clemente¹, Daniel Ruivo Marques², Ana Allen Gomes³

¹Local Health Unit of Coimbra, Hospital and University Centre of Coimbra, Sleep Medicine Centre, Coimbra, Portugal; University of Coimbra, Faculty of Psychology and Educational Sciences, Coimbra, Portugal; University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal; University of Coimbra, Laboratory of Chronopsychology and Cognitive Systems (ChronCogLab), Coimbra, Portugal.

|November 4, 2025

Abstract

Objectives/Background:

Identifying subtypes or phenotypes of insomnia remains a remarkable challenge. Study 1 aimed to examine how two diagnosis-derived subtypes of Insomnia Disorder (ID) - ID alone and ID comorbid with mental disorders (anxiety or depression) - may be differentiated by sleep and non-sleep variables. The primary objective of Study 2 was to identify distinct psychological profiles of insomnia.

Methods:

A sample of 208 patients with ID (Mean age=48.73±13.56 years; 60.6% women) was assessed through a semi-structured interview based on ICSD-3-TR/DSM-5 diagnostic criteria. Participants completed self-reported instruments measuring sleep-related variables (insomnia severity, somatic/emotional and cognitive sleep activation, dysfunctional sleep beliefs regarding consequences/helplessness, and medication/hopelessness) and psychological variables (perfectionism and emotional disturbance). Additionally, they filled in a sleep diary for at least seven days.

Results:

Multivariate and univariate analyses of covariance, controlling for sex and age, revealed that patients with ID comorbid exhibited higher scores on sleep-related variables, except for insomnia severity, as well as increased socially prescribed perfectionism and emotional disturbance, than those with ID alone. Using Latent Profile Analysis, four well-defined psychological profiles of insomnia were identified: (i) standalone insomnia (18.3%); (ii) major insomnia with an overactive and worried mind (22.1%); (iii) major insomnia with emotional disturbance (21.6%); and (iv) insomnia with perfectionism (38.0%).

Conclusion:

Differences across insomnia subtypes are better explained by emotional/somatic and cognitive activation (hyperarousal), dysfunctional sleep beliefs, perfectionism and emotional disturbance, rather than by insomnia severity, sleep features or daytime sleepiness. These sleep-related and psychological factors enable the identification of distinct psychological profiles of insomnia, which might guide more tailored interventions.

Keywords:

insomnia disorder insomnia subtypes latent profile analysis mental comorbidity

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