Primary insomnia is a condition where there is a problem with obtaining a restful night's sleep, without any known cause. In secondary insomnia, which is more common, causes can range from medical conditions, which can be either mental or physical illnesses, to noisy surroundings and consumption of substances such as caffeine. The diagnosis of primary insomnia is made after all of these kinds of reasons for sleeplessness have been ruled out. Fortunately, although the cause remains unknown, primary insomnia can still be treated.
Insomnia is a common problem, with sleep disturbances affecting many people at some time in their lives, often due to factors such as stress. Both primary and secondary insomnia have similar negative effects on the lives of sufferers. While sleepless nights may be worrying and unpleasant, the subsequent daytime fatigue can be a greater problem, interfering with normal functioning in social situations and reducing performance in the workplace. It can also be dangerous on occasion, resulting in accidents while driving, when operating machinery, or when carrying out other tasks where errors can have serious consequences. Primary insomnia is less common than secondary insomnia and accounts for less than a third of all cases of insomnia.
It is thought that there are three broad categories of primary insomnia: psychophysiological, idiopathic and paradoxical. The psychophysiological form of the condition is thought to occur after sleep has been disrupted for a short period, perhaps by stress, and the person learns to become tense about sleep. This leads to a vicious circle where preparing for sleep causes anxiety that prevents sleep from occurring. In idiopathic primary insomnia, lack of sleep is lifelong, beginning in childhood. The paradoxical form of the disorder involves sufferers being convinced they have a sleep problem, even though the evidence suggests they are actually obtaining adequate amounts of sleep and they are not tired during the day.
There is a range of options for primary insomnia treatment, with the focus on achieving a better quality of sleep and improving functioning during the day. Medication is one possibility, and this can take the form of prescription drugs such as hypnotics, commonly called sleeping tablets, or non-prescription alternatives such as antihistamines. These cause drowsiness as a side effect but can have other negative effects, including blurred vision. Melatonin and certain herbal preparations have been found to be helpful in some cases. Psychological treatments concentrate on changing the thoughts and behaviors associated with sleep, and learning relaxation techniques; these methods are sometimes combined with the use of drugs in the initial stages of treatment.
