Insomnia is defined as a difficulty falling asleep and/or maintaining sleep. Insomnia is a symptom and not a disorder. It is a common complaint that affects most Americans at some point in their life. The symptom of insomnia is associated with a variety of medical conditions and life experiences. These include physical, psychiatric and sleep disorders, a life crisis, anxiety, depression, stress, travel across time zones, the sleep environment, and certain medications. Your healthcare provider needs to determine the exact cause of your insomnia in order for you to receive the best treatment for it. An accurate diagnosis requires a medical and sleep history.

Specialized sleep studies may also be recommended. Primary insomnia is a specific disorder not simply a symptom of another problem. Three forms of primary insomnia are psychophysiological insomnia, sleep state misperception, and idiopathic insomnia.

Symptoms of Primary Insomnia

  • Psychophysiological insomnia is often called “behavioral” or “learned” insomnia. Approximately fifteen percent of all those with primary insomnia have psychophysiological insomnia. These individuals associate going to bed with emotions that prevent sleep, such as being afraid of falling asleep. Individuals with this disorder are often very worried about their sleep problems. This intense focus on the sleep problem is one of the things that interferes with their sleep.
  • Sleep state misperception is a primary insomnia that occurs when there is a complaint of insomnia or excessive sleepiness without proof of a sleep disturbance. Individuals with sleep state misperception sleep adequately but do not believe they do. They underestimate their total sleep time and overestimate the time it took them to fall asleep.
  • Idiopathic insomnia is also called “childhood onset insomnia.” It is a lifelong inability to obtain adequate amounts of sleep. Individuals with idiopathic insomnia can trace their insomnia back to childhood and have no history of mood or mental health disorders. Some researchers believe that this form of primary insomnia is due to a brain irregularity that controls the sleep-wake cycle.


Treatment of primary insomnia depends on the type you have.

Psychophysiological Insomnia

Treating psychophysiological insomnia often requires a trial and error approach. Treatment generally consists of sleep hygiene techniques, behavioral treatment and medications.

  • Sleep hygiene attempts to improve your sleep environment and sleep habits.
  • Behavioral treatments shift their focus on relaxation techniques, such as breathing techniques, meditation and stimulus control.
  • Medications are used one to two times each week to break the vicious non-sleep cycle. These medications or “sleep aids” should not be used nightly for more than a few weeks in most cases.

Sleep State Misperception

Treatment of sleep state misperception focuses upon helping you realize that you are actually sleeping more than you feared. Behavioral techniques are also a very important part of the treatment plan.

Idiopathic Insomnia

The use of several different types of medications offers the most successful treatment for idiopathic insomnia. In addition to medications, psychological treatment is often necessary.

What to DO

  • If you think you have Primary Insomnia, contact your healthcare provider.
  • Keep a sleep diary for at least one month. Include the time that you went to bed, how long it took you to fall asleep, when you woke up and when you got up for the day.
  • Use sleep hygiene techniques to improve your sleep habits and your sleep environment.
  • Find a support group.

What NOT to DO

  • Do not take sleep medications for longer than a three week period.
  • Do not drink alcohol.
  • Do not use over-the-counter remedies.
  • Do not operate a motor vehicle or heavy machinery until your sleepiness improves.

Things to Remember

  • Insomnia may be a symptom of another medical condition and not the problem itself.
  • Follow your healthcare providers treatment advice.

What We Have Learned

  1. Primary insomnia is a disorder and not a symptom.
    True or False
    The answer is TRUE
  2. Behavioral treatments are used in treating primary insomnia.
    True or False
    The answer is TRUE
  3. Idiopathic insomnia usually starts in adulthood.
    True or False
    The answer is FALSE

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