Health Encyclopedia

Primary Insomnia

Definition

Primary insomnia is difficulty getting to sleep or staying asleep, or having non-refreshing sleep for at least 1 month without any known physical or mental condition.

Alternative Names

Insomnia - psychophysiological (learned); Chronic insomnia

Causes, incidence, and risk factors

Insomnia is caused by many different things. The most common causes of insomnia are:

Alcohol
Anxiety
Coffee
Stress

About 25% of elderly people and about 10% of people in general have insomnia.

Secondary insomnia is insomnia caused by a medical condition. Depression is a very common cause of secondary insomnia. Often, insomnia is the symptom for which people with depression seek medical help.

Symptoms

Difficulty falling asleep
Feeling tired
Waking up several times during sleep

People who have primary insomnia tend to keep thinking about getting enough sleep. The more they try to sleep, the greater the sense of frustration and distress, and the more difficult sleep becomes.

Signs and tests

Your health care provider will do a physical exam and ask you questions about your current medications, drug use, and medical history. Usually, these are the only methods needed to diagnose insomnia.

Polysomnography, an overnight sleep study, can help rule out other types of sleep disorders (such as sleep apnea).

Treatment

The following tips can help improve sleep. This is called sleep hygiene.

Avoid caffeine, alcohol, or nicotine before bed
Don't take daytime naps
Eat at regular times each day (avoid large meals near bedtime)
Exercise early in the day
Get out of bed if you are not asleep after 5-10 minutes and do something else (going to another room may help reduce your anxiety about falling asleep)
Go to bed at the same time every night
Keep comfortable sleeping conditions
Remove the anxiety that comes with trying to sleep by reassuring yourself that you will sleep or by distracting yourself
Use the bed only for sleep and sex
Practice evening relaxation routines such as muscle relaxation or meditation

If you follow these recommendations and still have insomnia, your doctor may prescribe medications such as benzodiazepines.

Expectations (prognosis)

You should be able to sleep if you practice good sleep hygiene. See a doctor if you have chronic insomnia that does not improve.

It is important to remember that your health is not at risk if you do not get 6-8 hours of sleep every day. Different people have different sleep requirements. Some do fine on 4 hours of sleep a night, while others only thrive if they get 10-11 hours.

Sleep requirements also change with age. Listen to your body's sleep signals and don't try to sleep more or less than is refreshing for you.

Complications

Daytime sleepiness is the most common complication, though there is some evidence that lack of sleep can also lower your immune system's ability to fight infections. Sleep deprivation is also a common cause of auto accidents -- if you are driving and feel sleepy, take a break.

Calling your health care provider

Call your doctor if chronic insomnia has become a problem.

References

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders; 2003: 1207-1210.

Rakel P, ed. Conn’s Current Therapy 2005. 57th ed. Philadelphia, Pa: WB Saunders; 2005:34-39.

Review Date:2/6/2008
Reviewed By:Christos Ballas, M.D., Attending Psychiatrist, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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