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Primary Insomnia Causes, Treatment & Link to Depression

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Primary insomnia means your sleep problems aren’t linked to other health conditions. Secondary insomnia is when symptoms arise from a primary medical illness, mental disorders, or other sleep disorders. Continue to read more about primary insomnia.

By We Level Up FL Treatment Center | Editor Yamilla Francese | Clinically Reviewed By Lauren Barry, LMFT, MCAP, QS, Director of Quality Assurance | Editorial Policy | Research Policy | Last Updated: December 29, 2022

Individuals suffering from primary insomnia are twice as likely to develop depression versus people without sleep disorders. Chronic primary insomnia, defined as sleep problems not associated with other health conditions, may increase a person’s risk for depression later in life.

Depression and sleep problems are closely linked. People with insomnia may have a 1000% increased risk of developing depression compared to those who sleep well. Moreover, among people with depression, 75% have trouble falling asleep or staying asleep. 

What is Primary Insomnia?

Primary insomnia is relatively prevalent. Primary insomnia is difficulty initiating sleep (sleep onset insomnia), difficulty maintaining sleep (mid-sleep awakening, early morning awakening), or chronic nonrestorative sleep, which persists longer than three weeks despite having an adequate opportunity for rest and results in impaired daytime functioning. [1]

Primary Insomnia ICD 10

Primary insomnia is a medical classification listed by WHO in ICD-10 under mental, behavioral, and neurodevelopmental disorders. According to them, the primary insomnia symptoms are behavioral syndromes associated with physiological disturbances and physical factors. [2]

 International Classification of Diseases 10th Revision (ICD-10)  is the foundation for identifying health trends and is the international standard for reporting diseases and health conditions.

The VA disability rating for primary insomnia could be like mental disorders, ranging from 0% to 100% disability rating. Generally, insomnia is rarely an isolated medical or mental illness but rather a symptom of another disease to be investigated by a person and their medical doctors. In other people, insomnia can result from a person’s lifestyle or work schedule.

Primary insomnia is rarely an isolated medical or mental illness but rather a symptom of another disease to be investigated by a person and their medical doctors. In other people, insomnia can result from a person's lifestyle or work schedule.
Primary insomnia is rarely an isolated medical or mental illness but rather a symptom of another disease to be investigated by a person and their medical doctors. In other people, insomnia can result from a person’s lifestyle or work schedule.

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Primary Insomnia Statistics

Approximately 30% to 40% of adults in the United States report insomnia symptoms at some point in a given year. Short-term insomnia has an estimated prevalence of 9.5% in the United States, but about 1 in 5 short-term insomnia transitions to chronic insomnia, which can persist for years.


30%

Chronic insomnia is highly prevalent and affects approximately 30% of the general population.

Source: NCBI

30%

Insomnia is the most common sleep disorder, with 30% of adults experiencing short-term insomnia. About 10% of people have long-lasting insomnia.

Source: NIMH

50%

Insomnia symptoms occur in 33% to 50% of the adult population, while Chronic Insomnia disorder associated with distress or impairment is estimated at 10% to 15%.

Source: CDC


What is the Primary Cause of Insomnia?

Facts Sheet

Comorbid medical disorders, psychiatric disorders, and working night or rotating shifts represent significant insomnia risks. It is important to recognize that these factors do not independently cause insomnia; instead, they are precipitants in individuals predisposed to this disorder. Chronic illnesses are a significant risk for insomnia. It is estimated that most people with insomnia (approximately 75%–90%) have an increased risk for comorbid medical disorders, such as conditions causing hypoxemia and dyspnea, gastroesophageal reflux disease, pain conditions, and neurodegenerative diseases. [3]


Primary insomnia is most often tied to the following:

  • Stress-related to significant life events, like a job loss or change, the death of a loved one, divorce, or moving.
  • Things around you, like noise, light, or temperature
  • Changes to your sleep schedule, like jet lag, a new shift at work, or bad habits you picked up when you had other sleep problems
  • Your genes. Research has found that a tendency for insomnia may run in families.

Secondary causes of insomnia include:

  • Psychiatric disorders like depression and anxiety
  • Medications for colds, allergies, depression, high blood pressure, and asthma.
  • Pain or discomfort at night
  • Caffeine, tobacco, or alcohol abuse, as well as substance abuse.
  • Hyperthyroidism and other endocrine problems
  • Other sleep disorders, like sleep apnea or restless legs syndrome
  • Pregnancy
  • Alzheimer’s disease and different types of dementia
  • ADHD
  • PMS and menopause

What are the Signs and Symptoms of Primary Insomnia?

According to The International Classification of Sleep Disorders, primary insomnia is a syndrome mainly composed of psychophysiological, paradoxical, and idiopathic sleeplessness. [4] Signs and symptoms of ICD 10 primary insomnia may include the following:

Psychophysiological Insomnia Symptoms

  • Sleep disturbance varies from mild to severe.
  • Sleeplessness may manifest as difficulty falling asleep or as frequent awakenings in the night.
  • Persons with insomnia often find they can sleep well anywhere except in their bedroom.
  • Persons with this type of insomnia tend to be more tense and dissatisfied than good sleepers. Emotionally, they are typically repressors (suppress their feelings), denying problems.

Paradoxical Insomnia Symptoms

  • Feeling aware of their surroundings at night.
  • Sleeping for only a few hours each night, if at all, despite objectively sleeping for long enough to avoid sleep deprivation symptoms

Idiopathic Insomnia Symptoms

  • Insomnia is long-standing, typically beginning in early childhood.
  • Persons with idiopathic insomnia often complain of attention, concentration, or hyperactivity difficulties.
  • Emotionally, persons with childhood-onset insomnia are often repressors, denying and minimizing emotional problems.
  • Individuals often show atypical reactions to medications, such as hypersensitivity or insensitivity.
  • Insomnia persists throughout life and can be aggravated by stress or tension.

Persons complain of insomnia subjectively, while sleep duration and quality are regular. They typically do not display daytime sleepiness or other signs of poor-quality sleep. These people may be described as having “sleep hypochondriasis.” People with hypochondria worry about their health, even when nothing is seriously wrong. They may subsequently develop anxiety and depression.

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How is Primary Insomnia Diagnosed?

Short-term insomnia may be caused by stress or changes in your schedule or environment. It can last for a few days or weeks. Chronic (long-term) insomnia occurs three or more nights a week, lasts more than three months, and cannot be fully explained by another health problem.

Effective pharmacologic and behavioral interventions to treat insomnia rely on accurate neurobehavioral and neurobiological information. Depending on your situation, the diagnosis of insomnia and the search for its cause may include the following:

  • Physical Exam. If the cause of insomnia is unknown, your doctor may do a physical exam to look for signs of medical problems related to insomnia. Occasionally, a blood test may be done to check for thyroid problems or other conditions associated with poor sleep.
  • Sleep Habits Review. In addition to asking you sleep-related questions, your doctor may have you complete a questionnaire to determine your sleep-wake pattern and your level of daytime sleepiness. You may also be asked to keep a sleep diary for a couple of weeks.
  • Sleep Study. If the cause of your insomnia isn’t clear, or you have signs of another sleep disorder, such as sleep apnea or restless legs syndrome, you may need to spend a night at a sleep center. Tests are done to monitor and record various body activities while you sleep, including brain waves, breathing, heartbeat, eye movements, and body movements.
Approximately 40% of adults with insomnia also have a diagnosable psychiatric disorder—most notably depression.
Approximately 40% of adults with insomnia also have a diagnosable psychiatric disorder—most notably depression.

Risk Groups

The significant risk factors for insomnia are advancing age, family history of insomnia, female sex, lifestyle, and stress or worrying. Insomnia is a common condition with several risk factors. Some are inherited, while others are the result of aging or lifestyle. Do any of these risk factors apply to you?

  • Advancing Age: The risk of insomnia increases as you age.
  • Family History of Insomnia: Your genetics can predispose you to insomnia and influence the depth of your sleep.
  • Sex: Women are more likely to have insomnia than men.
  • Lifestyle: Certain habits can increase the risk of insomnia. Some examples include taking long naps near bedtime, drinking excessive caffeine or alcohol or inhaling nicotine from smoking, and having an irregular sleep schedule.
  • Stress or Worry: stress and worry about sleep or daily life can raise the risk of insomnia. The vicious cycle of losing sleep and worrying about rest can cause insomnia to worsen.
  • Medical and Psychiatric Disorders: Medical disorders such as heart disease and psychiatric disorders such as depression and anxiety are often associated with insomnia.

Effects of Primary Insomnia

An ongoing lack of sleep has been closely associated with hypertension, heart attacks, strokes, obesity, diabetes, depression, anxiety, decreased brain function, memory loss, weakened immune system, lower fertility rates, and psychiatric disorders. The overall effects of primary insomnia may also include the following:

  • Fatigue
  • Moodiness
  • Irritability or anger
  • Daytime sleepiness
  • Anxiety about sleep
  • Lack of concentration
  • Poor Memory
  • Poor quality performance at school or work
  • Lack of motivation or energy
  • Headaches or tension
  • Upset stomach
  • Mistakes/accidents at work or while driving

Severe daytime sleepiness typically is an effect of sleep deprivation and is less common with insomnia. People with insomnia often underestimate the amount of sleep they get each night. They worry that their inability to sleep will affect their health and keep them from functioning well during the day. They can often perform well during the day despite feeling tired.

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Complications of Primary Insomnia

Insomnia can affect your memory and concentration. Chronic insomnia raises your risk of high blood pressure, coronary heart disease, diabetes, and cancer. [5] You can develop anxiety and distress because you aren’t sleeping. This anxiety is usually more severe at bedtime or in the middle of the night, but you might also notice that you worry about your insomnia during the day.

Over time, persistent insomnia and chronic lack of sleep can lead to depression and predispose you to health complications. Furthermore, not getting enough sleep is associated with lowered immune system function, obesity, and heart disease.

Primary vs Secondary Insomnia

There are two main types of insomnia. These are primary and secondary insomnia.

  • Primary insomnia definition is the opposite of secondary insomnia and means that your trouble sleeping is not directly related to another underlying issue. While these terms are convenient and, in many cases, clear-cut, it’s also easy to see that the line can become blurred. For instance, when both insomnia and depression are present, the question becomes, “Which comes first?”
  • Secondary insomnia means that you have insomnia as a direct result or symptom of something else, such as a health condition, medication, pain, substance abuse, etc. For example, depression can be an underlying cause of insomnia.

Chronic Primary Insomnia

Chronic insomnia is highly prevalent and affects approximately 30% of the general population. Insomnia impairs cognitive and physical functioning and is associated with a wide range of impaired daytime functions across several emotional, social, and physical domains. People with persistent sleep disturbances are more prone to accidents than good sleepers. They have higher rates of work absenteeism, diminished job performance, decreased quality of life, and increased health care utilization.

Various risk factors associated with the increased prevalence of chronic insomnia include older age, female gender, and comorbid medical and psychiatric conditions. Approximately 40% of adults with insomnia also have a diagnosable psychiatric disorder—most notably depression. A comorbid psychiatric disorder such as depression or anxiety may be a consequence of—as well as a risk factor for—disrupted sleep. [6]

What is Secondary Insomnia?

In the past, sleeping problems were sometimes labeled as comorbid or secondary insomnia. This meant that insomnia was believed to arise due to other conditions such as anxiety, depression, sleep apnea, gastroesophageal reflux disease (GERD), or physical pain.

Primary insomnia is associated more often with a psychiatric disorder, such as depression, than with any other medical condition.
Primary insomnia is associated more often with a psychiatric disorder, such as depression, than with any other medical condition.

Contemporary research has generated a deeper understanding of insomnia, recognizing that sleeping problems often have a bidirectional relationship with other health issues. For instance, while anxiety may contribute to insomnia, insomnia may trigger or exacerbate anxiety as well. Furthermore, insomnia triggered by another condition does not always go away even after that issue is resolved.

Because of the complexity of these relationships, it becomes difficult to classify insomnia as strictly comorbid or secondary. Similarly, multiple contributing factors make identifying a single cause of insomnia challenging for many patients. For these reasons, insomnia classification systems used in sleep medicine have moved away from this terminology of primary insomnia vs secondary insomnia and toward a broader understanding of insomnia.

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Primary Insomnia Treatment

The kind of insomnia you have and the underlying cause will determine the treatment your doctor will recommend. The condition typically improves when treating the underlying medical or psychological cause. According to research, combining medical and non-medical therapies yields better results than utilizing each alone.

Common treatments for insomnia include:

  • Cognitive-behavioral therapy (CBT, a type of talk therapy) – Cognitive behavioral therapy can have beneficial effects that last well beyond the end of treatment. It involves combinations of the following:
    • Cognitive Therapy: Changing attitudes and beliefs that hinder your sleep
    • Relaxation Training: Relaxing your mind and body
    • Sleep Hygiene Training: Correcting bad habits that contribute to poor sleep
    • Sleep Restriction: Severely limiting and then gradually increasing your time in bed
    • Stimulus Control: Going to bed only when sleepy, waking at the same time daily, leaving the bed when unable to sleep, avoiding naps, using the bed only for sleep and sex 
  • Lifestyle Changes – You can help prevent insomnia by taking these precautions:
    • Avoid substances like caffeine, alcohol, and medications that can prevent quality sleep.
    • Follow the same sleep routine every night, including waking at the same time every day.
    • Get out of bed if it takes too long to fall asleep, then try again 15 minutes later.
    • Avoid napping.
    • Sleep in a cool, dark room.
    • Don’t use electronics or your phone in the bedroom.
    • Avoid eating, drinking, or exercising close to the time you want to fall asleep.
    • Learn relaxation and deep breathing techniques to help you relax.
    • Treat and maintain physical and psychological conditions.
    • Prescription medication to help you sleep
    • Over-the-counter sleep aids that contain antihistamines or diphenhydramine
    • Melatonin supplement (a lab-made form of the hormone melatonin)
  • Over-the-Counter Products – Most of these sleep aids contain antihistamines. They can help you sleep better, but they also may cause severe daytime sleepiness. Other products, including herbal supplements, have little evidence to support their effectiveness.
  • Prescription Sleeping Pills – Prescription hypnotics can improve sleep when supervised by a physician. The traditional sleeping pills are benzodiazepine receptor agonists, typically prescribed for only short-term use. Newer sleeping pills are nonbenzodiazepines, which may pose fewer risks and be effective for longer-term use.
  • Unapproved Prescription Drugs – Drugs from various classes have been used to treat insomnia without FDA approval. Antidepressants such as trazodone are commonly prescribed for insomnia. Others include anticonvulsants, antipsychotics, barbiturates and nonhypnotic benzodiazepines. Many of these medications involve a significant level of risk.

Your quality of life may suffer if you experience any sleeplessness. Feeling exhausted and grouchy throughout the day is typical when you don’t get enough sleep. Relationships at home and work can suffer from persistent irritability. Without enough sleep, your ability to think clearly can deteriorate, which increases your chance of getting into accidents.

The good news is that when the root of the issue is treated, insomnia frequently gets better. To begin developing a strategy to address your sleep issues, speak with a mental health professional. Your health, relationships, and general well-being may all benefit.

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Call us now for a free mental health assessment! In addition, for the substance abuse or dual diagnosis approach, our inpatient treatmentinpatient medical detox, and residential primary addiction treatment may be available at our affiliated facility. For more primary insomnia treatment resources, call us about your symptoms, and we can help you determine the cause and develop a treatment plan.

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3 Most Primary Insomnia Frequently Asked Questions

  1. What is the primary cause of insomnia?

    Common causes of chronic insomnia include stress. Concerns about work, school, health, finances, or family can keep your mind active at night, making it difficult to sleep. Stressful life events or trauma — such as the death or illness of a loved one, divorce, or a job loss — also may lead to insomnia.

  2. What is the main difference between primary and secondary insomnia?

    Primary insomnia is sleeplessness that cannot be attributed to an existing medical, psychiatric, or environmental cause (such as drug abuse or medications). Secondary insomnia is when symptoms arise from a primary medical illness, mental disorders, or other sleep disorders.

  3. What is the VA disability rating for primary insomnia?

    VA Disability for Insomnia has ratings that range from 0% to 100%, with breaks at 10%, 30%, 50%, and 70%. However, the VA usually treats Insomnia as a “symptom” of another mental health condition, such as Post Traumatic Stress Disorder (PTSD), Depression, or Anxiety.

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[1,4] Kayukawa Y, Kitajima T, Tomita S, Okada T. [Primary insomnia]. Nihon Rinsho. 2009 Aug;67(8):1494-500. Japanese. PMID: 19768930.

[2] International Classification of Diseases (ICD-10-CM/PCS) Transition – Background – Centers for Disease Control and Prevention (CDC)

[3,6] Roth T. Insomnia: definition, prevalence, etiology, and consequences. J Clin Sleep Med. 2007 Aug 15;3(5 Suppl): S7-10. PMID: 17824495; PMCID: PMC1978319.

[5] What Is Insomnia? – National Heart, Lung, and Blood Institute (NHLBI)

[7] Kaur H, Spurling BC, Bollu PC. Chronic Insomnia. [Updated 2022 Jul 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526136/

[8] Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: A review. EXCLI J. 2017 Jul 21;16:1057-1072. DOI: 10.17179/excli2017-480. PMID: 28900385; PMCID: PMC5579396.

[9] Schneiderman N, Ironson G, Siegel SD. Stress and health: psychological, behavioral, and biological determinants. Annu Rev Clin Psychol. 2005;1:607-28. DOI: 10.1146/annurev.clinpsy.1.102803.144141. PMID: 17716101; PMCID: PMC2568977.

[10] Woody G. The Challenge of Dual Diagnosis. Alcohol Health Res World. 1996;20(2):76-80. PMID: 31798155; PMCID: PMC6876494.