Primary insomnia

Insomnia: When the Sandman Refuses to Come By

Primary insomnia

Insomnia is a very common sleep disorder characterized by being unable to fall asleep, unable to stay asleep, or a combination of both. Individuals with insomnia will either have extremely poor-quality sleep, or not even get enough at all. As a result, they don’t feel refreshed when they wake.

This condition can be short term- known as acute, or long-term- known as chronic. Acute is the most common type of insomnia, is typically referred to as primary insomnia and is typically brought on by stress at work, pressures within the family, or strenuous/traumatic events. Medical problems, medications or other substances do not cause this particular form of insomnia. Acute/Primary insomnia will last from a few days to a few weeks.

On the other hand, chronic insomnia is characterized by being unable to get proper sleep for one month or longer. Most of the time, chronic insomnia is secondary, meaning that it is the side effect or symptom of some other issue. Some of the things that can cause secondary insomnia are:

  • Medical conditions
  • Sleep disorders
  • Substances

Insomnia can result in sleepiness during the day and an overall lack of energy. In addition, it can cause you to feel irritable, depressed, or anxious.

If you are dealing with insomnia, you’ll most likely have some difficulties focusing on daily tasks, remembering, learning, and paying attention.

It is possible for insomnia to lead to other issues, such as when you feel drowsy while driving, you’re at a greater risk for being involved in an accident.

Outlook for Individuals with Insomnia

Taking the steps necessary to treat the underlying cause of secondary insomnia could improve or even solve the sleep difficulties- especially if treatment is found soon after it has started.

For example, if you believe that caffeine has caused you to experience insomnia, limiting your consumption of it could resolve your sleep problems.

In addition, making changes in your lifestyle, including creating better sleep habits, can help to resolve acute insomnia. On the other hand, if you have chronic insomnia, your physician could recommend taking medications or even cognitive-behavioral therapy.

Causes of Insomnia

As we have already mentioned, there are two types of insomnia: secondary and primary. Here are the causes of each of them:

Secondary Insomnia

This form of insomnia is typically the side effect/symptom of a larger problem. This form is typically a symptom of another medical disorder, another sleep disorder, or an emotional or neurological problem.

Emotional disorders that could result in insomnia include: anxiety, PTSD, and depression. Some of the neurological disorders that can result in insomnia are Parkinson’s and Alzheimer’s disease.

In addition, there are many other factors and disorders that can result in insomnia, including:

  • Conditions such as asthma & heart failure that make it difficult to breathe
  • Gastrointestinal disorders
  • Conditions causing ongoing pain such as headache disorders and arthritis
  • Stroke
  • Overactive thyroid
  • Menopause/hot flashes
  • Sleep disorders, including RLS
  • Sleep related breathing issues

Finally, secondary insomnia can also be a side effect of some types of medications. For example, some asthma and allergy medications can lead to insomnia. Beta blockers for heart issues can also result in insomnia.

There are some common substances that can lead to insomnia such as caffeine/stimulants, tobacco/nicotine products, and alcohol/other sedatives.

Primary Insomnia

On the other hand, as we’ve already said, primary insomnia is not due to another medical condition or substance use. It is a disorder in and of itself and the cause of it is not really understood. Primary insomnia typically lasts for at least one month.

There are many life changes that can cause primary insomnia, including emotional upset or major/long-term stress. Work schedules that cause a disruption in sleep and travel can also be a trigger for this condition.

Even when these issues are resolved, insomnia doesn’t always go away immediately. Difficulty with sleeping can continue because you have learned habits to deal with your lack of sleep, such as worrying about sleep, going to bed early, and taking naps during the day.

Researchers are looking for some clues as to whether there are some people that have a genetic predisposition to this disorder.

Who is At Risk?

As we already know, insomnia is a very common disorder. Women are affected by it more often than men. While insomnia can occur at any age, older adults are much more likely to have this condition than younger people.

Here is a list of those that might be at an increased risk of developing this condition:

  • Individuals under significant levels of stress
  • Individuals who are depressed or dealing with other emotional stress
  • Individuals with lower incomes
  • Individuals who frequently change shifts at work or work at night
  • Individuals who travel through several time changes
  • Individuals who have specific medical conditions or other sleep disorders
  • Individuals who are not active

Research has revealed that African Americans might be at a greater risk because they do take more time to fall asleep than Caucasians. In addition, they sleep lighter, take more naps, and basically just don’t sleep as well.

Finally, sleep related breathing issues are more common in the African American population.

Signs and Symptoms of Insomnia

Signs and Symptoms of Insomnia

The primary symptom of insomnia is difficulty falling or staying asleep- which means that you end up with a lack of sleep. If you are dealing with insomnia, you may also experience the following:

  • Lying awake for a long time before being able to fall asleep
  • Sleep for short amounts of time
  • Are awake most of the night
  • Feel like you didn’t get any sleep at all
  • Wake up too early

Not getting enough sleep can also result in other symptoms: you are likely to wake up feeling tired or feel tired as the day goes on, or you wake up feeling like you didn’t get rest.

You are likely to have difficulty focusing even on your daily tasks. Insomnia can also lead to anxiousness, irritability, and depression.

Insomnia can also have an effect on your daily activities and result in some serious issues. You might feel drowsy when driving. You should know that driver sleepiness- unrelated to alcohol- is the cause of approximately 20 percent of serious car crashes. Older women suffering from this condition are more likely to fall and become injured.

If you have noticed that this condition is affecting your daily activities, speak with your physician. Getting the proper treatments can help you to avoid the symptoms and problems that are related to this condition.

Additionally, inferior sleep could be a symptom of other health issues- if your physician can find and treat these issues, your sleep and overall health will improve.

Diagnosing Insomnia

Your physician will diagnose your insomnia based upon your sleep history, medical history, and a full physical exam. He/she is also likely to recommend you undergo a sleep study- especially if the cause of your insomnia is unclear.

Sleep History

In order to get a clearer picture of your sleep issues, your physician will ask you for some details regarding your sleeping habits. Before you go to your appointment, give some thought to how to describe what you’re feeling- including:

  • How often do you have difficulty sleeping?
  • How long have you had this issue?
  • How long does it take you to fall asleep at night?
  • How often do you wake up during the night?
  • How long does it take you to fall back asleep?
  • Do you snore, or wake up feeling out of breath?
  • Do you feel refreshed when you wake up?
  • Do you feel tired during the day?
  • How often do you have difficulty staying awake during routine activities?
  • How often do you doze off during the day?

In order to figure out what could be causing or affecting your insomnia, your physician is also likely to ask the following:

  • Do you worry about falling asleep, getting enough sleep, or staying asleep?
  • Do you eat, drink, or take medications before going to bed at night?
  • What is your bedtime routine?
  • What is the noise level, temperature, and lighting like where you usually sleep?
  • What distractions are in your bedroom?

In order to assist your physician in diagnosing your condition, you should keep a sleep diary for one or two weeks. Take some time to write down when you go to sleep, when you wake up, and any naps you take during the day. Additionally, record how much sleep you get each night and how drowsy you feel during the day.

Medical History

In addition to asking about your sleep habits, your physician is also going to ask about your medical history, including:

  • Do you have any ongoing or new health problems?
  • Do you have painful injuries?
  • Do you have any painful health conditions?
  • Do you take any medications- whether OTC or prescription?
  • Do you have symptoms of anxiety, depression, or psychosis?
  • Do you have a history of anxiety, depression, or psychosis?
  • Are you dealing with any major stress at this time?

In addition, he/she may ask some questions about your work and/or leisure habits. He/she might ask you about your work routines, your exercise routines, caffeine use, tobacco use, alcohol use, and your long-distance travel habits. These answers could shed some light on what exactly is causing your condition.

Finally, your physician will ask about any ongoing or new work-related or personal issues or other stresses that may be present in your life. He/she will also ask if you have a family history of insomnia.

Physical Exam

In order to rule out other medical issues, your physician will want to perform a physical exam, including blood tests to rule out thyroid problems and other conditions that could result in insomnia.

Sleep Study

In addition to the above, your physician is also likely to recommend you undergo a sleep study, known as a PSG, or polysomnogram- especially if he/she believes that your insomnia is the result of an underlying sleep disorder.

When undergoing a PSG, you will stay overnight at a sleep center. This study will record your heart rate, eye movements, blood pressure, and brain activity through the night.

In addition, the test will record the amount of oxygen that is in your blood, chest movements, snoring, and how much air is flowing through your nose when you breathe. The chest movements will indicate whether or not you are making an effort to breathe.

Treating Insomnia

In most cases, changes in lifestyle can help to relieve the problem of acute insomnia. These changes should help you to fall asleep and stay asleep easier.

CBT, or cognitive-behavioral therapy, could be helpful in relieving the anxiety related to ongoing insomnia. When you’re anxious about sleeping, that tends to aggravate the condition of insomnia.

There are some medications that can help to relieve the problem of insomnia and help you to get back into a regular sleep routine. However, if your insomnia is due to another problem, you must try to treat that underlying cause if possible.

Changes in Lifestyle

If you are experiencing insomnia, you should avoid those things that can cause or aggravate the condition, including:

  • Stimulants: tobacco, caffeine, and others- the effects of these can last for up to eight hours
  • Specific OTC and even prescription medications can cause disruptions in sleep- speak with your physicians about alternative treatments that don’t
  • Alcohol: sure, an alcoholic beverage may be helpful for falling asleep- but it’s a lighter sleep, so you’re more likely to wake up during the night

Try creating some bedtime habits that will help you fall asleep and stay asleep. Create a routine that you will do every night to help you wind down and relax before going to bed. You can read a book, listen to music, or even take a hot bath/shower.

You should be getting adequate amounts of exercise, but not right before bed. You should hit the gym five or six hours before you go to bed and avoid eating heavy meals or drinking before bed.

Make sure your sleep environment is conducive to your sleep. Try to avoid bright lights while preparing for bed and limit distractions such as computer, television, phone, and even pets. Be sure that the temperature is cool and comfortable and that it is dark and quiet.

Try going to sleep at the same time every night and waking up at the same time every morning- even on the weekends. If at all possible, avoid working night shifts, alternating shifts, and anything else that may cause a disruption in your sleep schedule.

Cognitive- Behavioral Therapy (CBT)

Cognitive-Behavioral Therapy is used to target the actions/thoughts that cause disruptions in your sleep. It is used to encourage good sleep habits and relieved sleep related anxiety.

CBT replaces sleep anxiety with a more positive thought process that links your bed to sleeping. In addition, this therapy will provide you with tips about what to do when you can’t fall asleep within a reasonable amount of time.

This treatment might involve speaking with a therapist either in group sessions or one on one sessions to help you process your feelings/thoughts about sleep.

You may be encouraged to describe the thoughts in your mind through how they sound, feel, and look. The whole goal of this is to get your mind to slow down long enough for you to sleep.

Finally, this method of treatment says to limit the amount of time you spend in bed awake. This means that you’ll have to set up a sleep schedule. To start with, you’ll be limiting the total amount of time that you’re in bed to the amount of time that you’re typically sleeping.

In the beginning, you’re likely to feel even more tired because some of that time you’re in bed will be spent fighting difficulty falling asleep. However, the point is so that the tiredness you feel will help you fall asleep better the next night. Eventually, you will find yourself able to get a full night’s sleep.

In order for CBT to be fully successful, it is likely that you will need to see a therapist skilled in this approach for two to three months. CBT works very well for those who have chronic insomnia and is often a better choice than medication.

For individuals with major depression, CBT along with antidepressants are promising treatments.

Medications for Insomnia

Medications for Insomnia

Prescription Medications

Many times, prescription medications are used for treating insomnia- some for short term and some for long term use. Discuss with your physician the benefits as well as the side effects of these medications.

There are some medications that may help you fall asleep, but will make you feel groggy the next morning.

Some of the rare side effects include: eating, walking, and driving while asleep. If you experience side effects of a particular medication or it is not working well for you, let your physician know- there may be something else that they can try.

Keep in mind that some medications can be habit forming- ask your physician about both the benefits and the risks of prescription medications.

Over-The-Counter Medications

There are some OTC medications that claim to treat this condition, including L-tryptophan, valerian root, melatonin, and more.

Keep in mind that the FDA does not regulate any of the natural products and most of the food supplements, so the dose and purity can vary. It is not understood how well these products work or how safe they are.

Some of the OTC medications contain antihistamines and though they may help you sleep, you should discuss them with your physician first.


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