At home, sounds of rain or cars outside wake her from sleep. Her current sleep pattern is that she tosses and turns for hours before falling asleep, sometimes wakes up during the night around 4 AM, and generally falls back asleep until her alarm clock wakes her at 6:30 AM. This is not related to stress, as she says she had always been even tempered and ambitious, and she isn’t prone to anxiety.
She recalls being tired in the mornings when she was a child, during her teenage years, and throughout her adult years. Although she is in good health, she reports that she has had trouble falling asleep for as long as she can remember. 1Ī 42-year-old woman complains that she isn’t sleeping well at night. 3 Medications commonly used for the treatment of primary insomnia include benzodiazepines, antihistamines, and melatonin ( Table). Non-medical therapies include counseling, cognitive behavioral therapy, biofeedback, avoiding naps or inconsistencies in sleep schedule, managing caffeine and alcohol intake, and avoiding stimulation from factors like bright lights before sleep. Treatments for primary insomnia include lifestyle modification, therapy, and prescription medications. 3 A sleep study would not be expected to show any abnormalities in SSM. A sleep study may show delayed sleep latency, sleep fragmentation, decreased sleep efficiency, and reduced total sleep time in patients who have idiopathic primary insomnia.
These symptoms are not usually present in SSM. Daytime symptoms can include restlessness, feeling tired, falling asleep easily during waking hours, trouble concentrating, moodiness, and sadness. People who have primary insomnia may be very concerned about the causes and effects of not getting enough sleep, and anxiety about sleep can exacerbate the insomnia.Ī diagnostic work-up of insomnia includes a medical history, physical examination, and diagnostic tests. Symptoms can also include 1 or more episodes of waking up during the night, often for less than an hour in total. An individual affected by the condition can have trouble sleeping, may toss and turn in bed, or may get up from bed at night. The frequency of sleep symptoms can vary-primary insomnia can occur occasionally or frequently, and it can affect someone for just 1 night at a time or for many nights in a row. Someone who has had episodes of idiopathic insomniacan also experience worsening symptoms when dealing with mild stress or can experience SSM during phases of adequate sleep. Idiopathic insomnia is truly without any identifiable contributory factor, while stress-related insomnia can be characterized by mild stress, such as rumination or other thoughts throughout the night. Primary insomnia has 3 subtypes: idiopathic, stress-related, and SSM. SSM is believed to affect 9% to 50% of the adult population, and it is more common among people who also have bouts of primary insomnia. With paradoxical insomnia, a person feels that they are experiencing insomnia, although they are getting enough sleep and don’t experience daytime signs of sleep deprivation. And people who have a history of primary insomnia may also have episodes of sleep state misperception (SSM), also known as paradoxical insomnia. Primary idiopathic insomnia occurs without any identifiable cause and in the absence of anxiety.
This type of insomnia is usually idiopathic, although it can be impacted by mild to moderate stress. 1 Primary insomnia is a type of chronic insomnia as defined by the ICSD-III, and it tends to persist or recur for many years throughout a person’s life, often beginning during childhood.
Primary insomnia is diagnosed using DSM-5 and the International Classification of Sleep Disorders, 3rd Edition (ICSD-III) classification criteria. The sleep problems of primary insomnia are not associated with lifestyle habits or a medical or psychiatric cause. Primary insomnia is a decreased ability to fall asleep and/or stay asleep, with resulting daytime effects of sleep deprivation, such as fatigue, dozing off, and irritability.
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