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Primary and Secondary Insomnias are very common sleep disorders that keep you awake night after night and can lead to sleep deprivation. Insomnia has numerous forms, causes and treatments.

Insomnia is the perception of inadequate or poor-quality sleep. It can be due to problems falling asleep, early wakening, frequent awakening during the night, un-refreshing sleep, or a combination of these. Contrary to some popular beliefs, insomnia cannot be defined by the total amount of sleep one gets or how long it takes a person to fall asleep. Individuals can vary in their need for sleep and in the time required to fall asleep. What constitutes a refreshing night's sleep for one might be called insomnia for another. Nearly everyone suffers.

Insomnia is a common sleep disorder that keeps you awake for nights and can lead to sleep deprivation. About 15% of the general population suffers from insomnia, but this includes all types of insomnia. Secondary insomnia may be caused mental or physical illnesses.

Insomnia can be particularly devastating because it often leads to a "vicious cycle" of daytime behaviors that worsen the condition. Persons without adequate sleep experience tiredness, lack of energy, and concentration problems, which they may attempt to combat by excessive caffeine intake or nicotine use. Insomniacs may be "too tired" to exercise and take afternoon naps, both of which reduce the ability to fall asleep the following night.

Transient insomnia lasts from one night to a few weeks. Having episodes of transient insomnia that come and go is intermittent insomnia.

Chronic, or long-term, insomnia lasts a month or more and occurs most nights. Insomnia is more likely to occur in females, and significantly worsen, especially if left untreated, in midlife for both men and women. Making matters worse, persons who have a history of depression or anxiety related disorders commonly have a comorbid sleep disorder requiring immediate treatment with psychotherapy and prescription medications considerations. Anyone can be affected.

Primary insomnia is difficulty getting to sleep or staying asleep, or experiencing nonrefreshing sleep for at least one month. The term primary indicates that the insomnia is not caused by any known physical or mental condition.

Alternative Names: psychophysiological (learned insomnia); chronic insomnia 

Insomnia Symptoms:

  • Difficulty getting to sleep and staying asleep for a month
  • Waking up tired
  • Morning headaches
  • Difficulty concentrating
  • Irritability
  • Bloodshot eyes
  • Daytime sleepiness

Lots of things can cause a sleepless night like, for example, stress, worry, or anxiety (see your Psychiatric ARNP for new treatment options for these associated conditions, which may require prompt professional psychiatric attention). "I've got to get some sleep." It is likely that we have all felt this way when under major stress. Sleep disturbances are one of the most common symptoms of stress and can be difficult to control. The most common of these disturbances is stress-induced insomnia.

Remember, Primary Insomnia is a disorder not a symptom of a known underlying disorder or problem, and does have numerous causes and risk factors. Everyday anxiety and stress, coffee, and alcohol are the most common culprits.

Alternatively, Insomnia, or Secondary Insomnia, is often not a disease in itself but a symptom of some underlying problem:

  • Stress or anxiety, lying awake worrying.
  • Depression either causes insomnia or causes a need to sleep long hours in an attempt to get away from what is causing the depression; also, while depression can cause insomnia, the reverse is also true--insomnia can cause depression.
  • Chronic sleep related disorders like sleep apnea, and diabetes, kidney disease, arthritis.
  • Medications for other problems can cause insomnia.
  • Poor eating habits like eating large meals too near bedtime.
  • Caffeine, nicotine and alcohol (caffeine and nicotine are stimulants, and alcohol disrupts your sleep patterns).
  • Lack of exercise.

Diagnostic Methods:

  • Personal observation. Watching how long and how deeply one sleeps. This can be done by a room mate or by one's own observations to an extent.
  • PKeeping a sleep diary. Writing down how long you seem to be sleeping, where you sleep, if the sleep was deep, broken by dreams, etc.

Treatment and Management

Transient and intermittent insomnias are particularly related to lifestyle factors such as increased or unmanageable stress, noise, or environmental changes. Short-term insomnia may also occur as a side effect of certain medications. Chronic insomnia is more serious and may be caused by or related to a variety of mental and physical problems including depression, substance abuse, heart or kidney disease, arthritis, chronic pain, and many others.


While sedative medications may be prescribed for insomnia, over-the-counter insomnia remedies are usually not recommended. Try to identify and reduce behaviors that worsen the insomnia or try learning relaxation techniques. In persons suffering from chronic insomnia, a thorough medical examination should be carried out to diagnose any underlying problems that may be causing the insomnia.

Treat any underlying causes
If you suffer from a disease or disorder that is causing the insomnia, that must be treated first.  For example, a significant number of mood disorders and other psychiatric conditions include sleep disorder symptoms and would be best treated by psychotherapy and/or psychiatric medication, in addition to prescription sleep aid medications as directed. Other methods include reduction of stress or anxiety, taking prescribed medication for sleep, relaxation techniques (meditation, hypnosis, soft/relaxing music), and improving your healthy lifestyle.  It also helps to keep regular hours, cut back on caffeine, reduce smoking, and limit alcohol consumption.


Make sure the bedroom and bed are comfortable places to be.  Many clients do report improved sleep by employing any combination of the following eleven interventions:

1. Make your bedroom an inviting place to be. Clear the clutter and invest in some quality sheets or comforter in a soothing color. Create a welcoming environment with flowers, photos, pictures, candles - whatever makes you feel content and relaxed. Open a window during the day, if possible, to expose the room to fresh air.

2. Use the bed for sleeping and sex - only. Therapists often use "reconditioning" as part of a treatment plan for insomnia. With this method, people are "reconditioned" to associate the bed with sleep. Avoid use of the bed for watching TV, eating, working, or any other activities.

3. Ban work-related or self-instructional reading at or immediately before bedtime.

4. Establish a regular sleep-wake cycle. Your body will learn to set its internal clock to your schedule and will eventually respond to internal cues to become sleepy at a given time and to awaken at a given time. A good way to begin this is by getting up at the same time every morning - yes, even on weekends.

5. Don't nap. No matter how tempting it may be that afternoon nap can wreck your body's internal sleep-wake clock and make falling asleep that night even harder. "Extra" sleep on weekends can also throw off your sleep schedule and worsen midweek insomnia.

6. Don't consume caffeinated beverages in the evening. Remember that eating chocolates and drinking cocoa also are sources of caffeine. Ideally, no caffeine after 4 or 5 p.m. is a good rule to follow.

7. Don't drink alcohol 2-3 hours before going to bed. Excessive amounts of alcohol at any time can also disrupt sleep patterns and lead to un-refreshing sleep. Many experts advise those suffering from chronic sleep disorders to abstain from alcohol entirely.

8. Fit in some exercise during the day. Exercise not only improves mood, but also heightens our ability to fall asleep and sleep well. But don't exercise strenuously right before bedtime.

9. Eat light meals in the evening. Eating heavily in the evening or just prior to bed can also disrupt your sleep cycle.

10. Don't smoke in the evening. Nicotine can also keep you from falling asleep and cause insomnia.

11. Do be sure you have the right bed and mattress for your needs. The wrong mattress can sometimes lead to sleep disturbances and musculoskeletal problems. If you have been using an "antique" mattress, an upgrade might be the solution to your sleep problems.



Contact Rainier Professional Psychiatry