Primary insomnia

“Insomnia is defined as repeated difficulty with the initiation, duration, maintenance, or

quality of sleep that occurs despite adequate time and opportunity for sleep that results in

some form of daytime impairment.”

Insomnia can be categorized in numerous ways. One way to classify insomnia is in three

categories based on duration.

1. Transient insomnia is often self-limited and usually lasts no longer than 7 days;

2. Short-term insomnia lasts for 1 to 3 weeks; and

3. Chronic insomnia lasts longer than 3 weeks.

Chronic insomnia is usually associated with medical, psychiatric, psychological, or

substance-use disorders. Insomnia also can be classified as primary or secondary.

1. Primary insomnia is not caused by a health problem; it is a sleep disturbance that

cannot be attributed to a medical, psychiatric, or environmental cause.

2. Secondary insomnia, on the other hand, is caused by an underlying medical

condition or a medication.

Etiology

In the late 1980s, Spielman created a model of insomnia in terms of predisposing,

precipitating, and perpetuating factors.

 

Predisposing factors

Genetic and neurobiological factors likely determine a person’s risk of developing

insomnia in the context of a precipitating factor (psychosocial, medical, or psychiatric).

Exogenous (outside, environmental) influences such as caffeine, light, and stress.

Mutation or polymorphism in Circadian clock genes (Clock, Per2) regulate the

circadian rhythm.

A faulty mutation, gene encoding the GABA

Polymorphisms (chemical compound with different forms) in the serotonin

receptor transporter gene that modulate the ability to handle stress and is an

important neurotransmitter for arousal mechanisms.

Antagonism (a neutral interaction that diminishes the substance’s individual

effect) of the 5-HT2 receptor promotes slow wave sleep.

Increased brain arousal.

higher day and night body temperatures,

higher urinary cortisol and

higher adrenaline secretion,

Precipitating factors

 

A number of factors can trigger insomnia in vulnerable individuals. These factors include

depression,

anxiety,

sleep-wake schedule changes,

medications,

other sleep disorders, and

Medical conditions.

In addition, positive or negative family, work-related, and health events are common

insomnia precipitants.

Perpetuating factors

 

Insomnia is generally accepted to be perpetuated by cognitive and behavioral

mechanisms.

Cognitive mechanisms include misconceptions about normal sleep requirements and

excessive worry about the consequences of the daytime effects of inadequate sleep. These

dysfunctional beliefs often produce sleep disruptive behaviors, which in turn reduces

natural homeostatic drive to sleep at habitual bedtime. Learned sleep-preventing

associations are characterized by over concern about inability to fall asleep.

Consequently, these patients develop conditioned arousal to stimuli that would normally

be associated with sleep (i.e., heightened anxiety and ruminations about going to

sleep). A cycle then develops in which the more the patients strive to sleep, the more

agitated they become, and the less they are able to fall asleep. The individual also has

ruminative thoughts or clock watching as he tries to fall asleep.

OR

For primary insomnia the most common causes are

Stress,

Anxiety,

Environmental noise,

Extreme temperatures,

A change in environment,

Sleeping or waking schedules,

Jet lag, and

Side effect of some medicines. 

Caffeine use,

Alcohol use,

Substance abuse

Excitement,

Nighttime shift work,

Anger,

Grief,

Worry,

Smoking,

Sleeping area distractions, and

Having the wrong mattress. 

Secondary insomnia is most often chronic and is usually associated with some underlying

physical or mental disorder. 

Depression

Bipolar disorder,

Night urination,

Chronic pain,

Duodenal ulcers,

Arthritis,

Heart failure,

Lung disorders,

Kidney disorders,

Asthma,

Clinical depression,

Mania,

Schizophrenia, and

Other sleep disorders like sleep apnea.  

Symptoms

Difficulty falling asleep on most nights

Feeling tired during the day or falling asleep during the day

Not feeling refreshed when you wake up

Waking up several times during sleep

Treatment

There are two basic therapies for the treatment of individuals’ suffering from

insomnia i.e.

Relaxation therapy

Cognitive behavioral therapy

Several medicines are also prescribed for insomnia

Triazolam

Temazepam

Flurazepam