Insomnia - psychophysiological (learned)
Key points
- Primary insomnia is difficulty getting to sleep or staying asleep, or experiencing nonrefreshing sleep for at least 1 month.
- Primary insomnia is the most common sleep disorder.
- Primary insomnia is often characterized by both difficulty falling asleep and by repeated awakenings.
- Clinical history (including all current medication and recreational drug use) and physical exam are usually sufficient to make the diagnosis.
Alternative names
Primary Insomnia; Chronic insomnia
Definition
Primary insomnia is difficulty getting to sleep or staying asleep, or experiencing nonrefreshing sleep for at least 1 month. The term primary indicates that the insomnia is not caused by any known physical or mental condition.
Causes, incidence, and risk factors
There are numerous causes and risk factors. Primary insomnia is the most common sleep disorder. Everyday anxiety and stress, coffee, and alcohol are the most common culprits.
About 25% of elderly people and about 15% of the general population suffer from insomnia, but this includes all types of insomnia. Secondary insomnia may be caused by depression or other mental and physical illnesses.
Symptoms
Primary insomnia is often characterized by both difficulty falling asleep and by repeated awakenings. People often feel fatigued the next day. People who suffer from this are generally preoccupied with getting enough sleep. The more they try to sleep, the greater the sense of frustration and distress and the more elusive sleep becomes.
Signs and tests
Clinical history (including all current medication and recreational drug use) and physical exam are usually sufficient to make the diagnosis. Polysomnography, an overnight sleep study, can be helpful to rule out other types of sleep disorders (such as breathing-related sleeping disorder).
Depression is a very common cause of secondary insomnia and it should be ruled out before primary insomnia is diagnosed. Often, insomnia is the symptom for which people with depression seek medical attention.
Depression includes more than 2 weeks of the following features: low mood or inability to feel pleasure in usually pleasurable things, a feeling of slowness or sluggishness of movement, or a feeling of agitation, irritability, anxiety, feelings of low self-worth or suicidal thoughts. Sleep can be too much, too little, unrefreshing or interrupted, especially with early morning wakening and inability to fall back asleep. Changes in appetite include eating too much or too little.
If you have insomnia, report any of these other symptoms to your health care provider so that you may be screened for depression. Antidepressant medications often solve insomnia problems related to depression, but some also cause sleep problems. If this occurs, medications may need to be adjusted.
Treatment
Nonspecific measures to induce sleep (sleep hygiene):
- Using the bed only for sleep and sex
Written and revised by
David Cohen, M.D.
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