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Primary Insomnia

Primary Insomnia, Causes, Signs & Symptoms, Diagnosis, Risks, Effects, & Treatment

What is primary insomnia?

Primary insomnia is relatively common. According to The International Classification of Sleep Disorders, primary insomnia is a syndrome mainly composed of psychophysiological insomnia, paradoxical insomnia, and idiopathic insomnia [1]. Primary insomnia is difficulty initiating sleep (sleep-onset insomnia), difficulty maintaining sleep (mid-sleep awakening, early morning awakening), or chronic non-restorative sleep, which persists longer than three weeks despite having an adequate opportunity for sleep and result in impaired daytime functioning.

The sleeplessness caused by primary insomnia can be frustrating for you at bedtime, and you can end up feeling tired or irritable throughout the day. Primary insomnia is relatively common, and sometimes it can resolve without treatment. But if you have persistent insomnia, you may need a diagnostic evaluation, including blood tests or an overnight sleep study to determine an underlying cause.

There are two types of insomnia – primary and secondary. 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 insomnia symptoms arise from a primary medical illness, mental disorders, or other sleep disorders. It may also arise from using, abusing, or exposure to certain substances.

primary insomnia
How do you cope with primary insomnia?

What is the primary cause of insomnia?

Primary causes of insomnia include:

  • Stress-related to big 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 other types of dementia
  • ADHD
  • PMS and menopause

What are the signs and symptoms of primary insomnia?

Signs and symptoms of primary insomnia may include:

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 that they can sleep well anywhere else but in their own bedroom.
  • Persons with this type of insomnia tend to be more tense and dissatisfied compared to good sleepers. Emotionally, they are typically repressors (suppress their feelings), denying problems.

Idiopathic insomnia symptoms

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

Sleep state misperception: Persons complain of insomnia subjectively, while sleep duration and quality are completely normal. They typically do not display daytime sleepiness or other signs of poor-quality sleep. These people may be described as having “sleep hypochondriasis.” They may subsequently develop anxiety and depression

How is primary insomnia diagnosed?

Depending on your situation, the diagnosis of insomnia and the search for its cause may include:

  • Physical exam. If the cause of insomnia is unknown, your doctor may do a physical exam to look for signs of medical problems that may be related to insomnia. Occasionally, a blood test may be done to check for thyroid problems or other conditions that may be 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 a variety of body activities while you sleep, including brain waves, breathing, heartbeat, eye movements and body movements.
primary insomnia
About 10 percent of adults have insomnia that is severe enough to cause daytime consequences

Risk Groups

  • A high rate of insomnia is seen in middle-aged and older adults. Although your individual sleep need does not change as you age, physical problems can make it more difficult to sleep well.
  • Women are more likely than men to develop insomnia.
  • People who have a medical or psychiatric illness, including depression, are at risk for insomnia.
  • People who use medications may experience insomnia as a side-effect.

Effects of Pimary Insomnia

  • 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. Often, however, they are able to perform well during the day despite feeling tired.

Complications of Primary Insomnia

You can develop a lot of 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. In addition, not getting enough sleep is associated with lowered immune system function, obesity, and heart disease.

Primary vs Secondary Insomnia

There are two types of insomnia: secondary insomnia and primary insomnia. Among these types of insomnia

Primary insomnia is the opposite of secondary insomnia, and means that your trouble sleeping is not directly related to some other 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 example, in the case where 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 for insomnia.

What is Secondary insomnia?

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

Primary Insomnia
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 that recognizes that sleeping problems often have a bidirectional relationship with other health issues. For example, 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 underlying 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 and toward a broader understanding of insomnia.

Primary Insomnia Treatment

Cognitive-behavioral therapy (CBT)

CBT can have beneficial effects that last well beyond the end of treatment. It involves combinations of the following therapies: 

  • 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 

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, which are typically prescribed for only short-term use. Newer sleeping pills are nonbenzodiazepines, which may pose fewer risks and may be effective for longer-term use.

Unapproved prescription drugs

Drugs from a variety of 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. 

Professional anxiety disorder treatment can become necessary if you or your loved one has primary insomnia. Contact us today at the We Level Up FL Treatment Facility to learn more. We provide utmost care with doctors and medical staff available 24/7 for life-changing and lasting recovery. We can help provide an enhanced opportunity to return to a fulfilling and productive life.

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[1] NCBI –