Primary Insomnia (A Comprehensive Guide)

In this guide, we are going to comprehensively overview the potential contributing factors of primary, its symptoms, treatment options, and self-help techniques.

Primary Insomnia is a condition in which the person is unable to sleep or have low quality sleep.

This sleep disorder is not an outcome of medical or mental health conditions, genetics, environmental causes, or any other such afflictions. 

The principal complaint with Primary Insomnia is the inability to maintain or even initiate the sleep.

Even non-restorative sleep is associated with this condition.

If you or someone you know is showing these signs for at least one month, then you or they might have primary insomnia. 

Primary Insomnia VS Secondary Insomnia: 

When it comes to insomnia, there are two categories primary insomnia and secondary insomnia.

Do not confuse primary and secondary insomnia as the different stages of sleeplessness.

While the symptoms for both of them might be the same, the cause is different. 

Primary Insomnia:

As mentioned earlier, this type of insomnia is not associated with any mental, physical, or environmental causes. 

Secondary Insomnia:

Unlike the first type of insomnia, secondary insomnia is a state of sleepless that is a direct result of any physical or mental health condition.

Physical and psychological health isn’t the only factor, but certain afflictions or addictions also trigger the problem.

The leading causes of this condition include:

  • Health Conditions like asthma, arthritis, malignant growth, acid reflux, chronic pain, lower backaches, or allergies. 
  • Psychotic causes – depression, anxiety, Parkinson’s disease, or stress.
  • Other causes might include excessive alcohol consumption, drug abuse (unprescribed medication use), excessive drug (marijuana or other illegal drugs), or poor lifestyle habits. 

Cause Of Primary Insomnia:

The triggers or causes of this sleeping problem are divided into three major categories: Psychophysiological reasons, Idiopathic Insomnia and Sleep state misperception.

Below is the explanation for all the potential factors of primary insomnia:

1. Psychophysiological Cause:

Psychophysiological cause or insomnia is the result of anxiety and tension caused by prolonged stress conditions.

This sleeplessness begins in persons with a history of adequate sleeping. 

The sleeping problem develops gradually and slowly, starting with the awakening in the middle of sleep.

Such persons develop a poor sleep routine as their sleep cycle gets associated with arousal and frustration.

But this is not a permanent trigger. It has been observed that people get back to their regular sleep routine, once the stress decrease.

And it is because bad sleep habits are not reinforced in those people.

However, in some rare cases, even when the stress is subsided, the sleeping problem continues, sometimes even for the.

By the time the stress subdues, the bad sleeping habits have already been reinforced. It is when the bad habits are reinforced in the persons.

2. Idiopathic Insomnia:

Another leading cause of primary sleeplessness is the Idiopathic Insomnia. The term idiopathic is used for the reasons that are not known.

There are no visual signs for this insomnia, and it could become a lifelong problem in most people.

The trigger for this problem is the malfunction of a brain area that is responsible for the sleep and wakefulness cycles.

There is no reasonable explanation for this abnormality of the neurological control.

Idiopathic insomnia begins in childhood. Moreover, sleep in such persons is also associated with arousal. 

3. Sleep State Misperception:

In this situation, the person reports the issues of sleeplessness, while having a perfect sleep quality and duration.

Such persons don’t show any signs or symptoms of sleep disturbance, such as daytime sleepiness.

Their condition is often described as “sleep hypochondriasis.” 

Symptoms of Primary Insomnia 

Like other illnesses, there are also specific symptoms associated with Primary Insomnia.

The possible signs and symptoms for this sleeping condition include: 

  1. Difficulty to sleep and/or to stay awake.
  2. Inconsistent sleep routine and sleep quality, it means that having a good sleep one night after many nights of difficult or no sleep. 
  3. Daytime sleepiness. 
  4. Inability to perform routine.
  5. Lack of concentration and compromised focus at work or school.
  6. Memorization problems. 
  7. Eye redness.
  8. Constant irritability, mood swings, and fatigue.
  9. Thinking and worrying about sleep.

In addition to these general symptoms or signs, there are sure signs which are associated with the specific causes of primary sleep problems. 

Symptoms For Psychophysiological Cause:

  • The variation of sleep disturbance from mild to severe.
  • Frequent sleep awakening cycles during the night. 
  • Inability to sleep again after the awakening.
  • Dissatisfaction.
  • Constant denial problem.
  • A feeling that one could sleep anywhere other than their bedroom. 

Symptoms For Idiopathic Cause:

  • Difficulty in concentrating or paying attention.
  • Hyperactivity.
  • Emotional problems with denial. 
  • Atypical reactions to medications such as insensitivity or hypersensitivity.

Diagnostic Aspects of Primary Insomnia 

The preliminary medical tests and exams involve clinical interviews.

These are conducted to confirm that the patient is experiencing primary insomnia, not because of some other medical or psychiatric conditions.

In these clinical interviews, the health care professional asks the patient about his/her sleep pattern, duration, and sleeping habits. 

Furthermore, the patients are also required to maintain a regular sleep log, to track the quality and duration of night’s sleep.

Once the health care physician suspects that sleep deprivation in the patient is not because of any other ailment, then proceed to further diagnostic tests. 

There are two tests to rule out and evaluate the causes of insomnia; Polysomnography and Multiple Sleep Latency Test.

Polysomnography (overnight sleep study test)

It is used to study sleep disorders by observing the patient’s night sleep within a hospital or a sleep center.

The health care professionals find the sleep stages and sleep cycles throughout the night.

In this test, not just the night sleep patterns but also the blood oxygen levels, brain waves, breathing, heart rate, and leg and eye movements during sleep are recorded.

The purpose of this test is to the potential causes and triggers of insomnia and not the routine evaluation of the sleeping disorder.

The diagnosis for idiopathic and psychophysiological insomnia indicates increased sleep latency.

Moreover, extended and increased number of awakenings and reduced sleep efficiency is also observed. 

On the other hand, in the case of sleep state misperception, sleep latency (15 to 20 minutes), sleep duration (6.5 hours), and the number of awakenings, as well as the arousals, are perfectly average. 

Multiple sleep latency test

Another test to study sleep disorders, especially insomnia involves Multiple sleep latency tests.

Sleep latency in a person is observed during the daytime while the person is sleeping in a quiet room.

The diagnosis of this test shows that persons with sleep state misperception show standard daytime patterns, which is complete wakefulness. 

The patients show no sign of either increased or decreased sleep latency. In the case of idiopathic insomnia, the patients fall asleep very easily during days but unable to reach REM sleep stage during the trial. 

Other than Insomnia (psychological disorder), there are other neurological disorders that are associated with sleeping or waking up, such as Narcolepsy.

Treatment With Medication:

The treatment of insomnia is possible through medication. Different categories of medicines could be used to treat insomnia.

The famous drugs to treat insomnia are hypnotics. When it comes to hypnotics, there two different categories of these drugs, the long-term hypnotics and short-term hypnotics. 

The long-term hypnotics such as Quazepam (Doral), Lorazepam (Ativan), Temazepam (Restoril), while the short-term hypnotics include Triazolam (Halcion), Zaleplon(Sonata) or Zolpidem (Ambien).

Another drug that is used to treat insomnia is known as the Belsomra (suvorexant) – the orexin antagonist.

This medicine decreases the brain activity level and induces transitional sleep. 

Other than hypnotics and antagonist drugs; in some cases, antidepressants and melatonin stimulators are also used to treat the sleeplessness condition. 

Whether you are using hypnotics, antidepressants, or melatonin stimulators, you must take medication only if prescribed by your doctor.

Furthermore, do not overdose or skip your prescribed dosage.

When taking medications for insomnia, keep in mind:

  1. Go for the lowest effective medication dose.
  2. Use medication 2 to 3 nights every week.
  3. Do not use the medication for the long-term.
  4. Slowly discontinue the use of medication, with the consultation of your health care professional.
  5. Use drugs that would minimize daytime sedation.
  6. Take medicine at least 30-60 minutes before going to bed. 

Side Effects and Precautions:

  • The patients may experience amnesia.
  • Some people may experience mild to severe withdrawal effects.
  • Insomnia rebound may occur in some cases.
  • The old age group should not use long-term hypnotics and other medications.
  • No medication for insomnia should be taken during pregnancy. 
  • If you have obstructive sleep apnea, don’t use any medication. 
  • People with substance abuse should avoid the use of these drugs.
  • People using hypnotics or Belsomra (suvorexant), must take 7 hours of peaceful sleep. 
  •  Regular checkup is required in the case of pulmonary, renal, or hepatic disease or older people.

Treatment With Therapeutic Methods:

Medications aren’t the only solution for treating insomnia.

There are several therapeutic methods to restore regular sleep habits in a person suffering from sleeplessness.

Here is the list of all the effective therapies that are used to treat insomnia.

Behavioral Therapy:

It the most popular and common of all the therapies are. Behavioral therapy is a type of cognitive therapy.

It is helpful for people experiencing insomnia without any other psychotic, medical, or environmental problem.

In this therapy, the focus is on the sleep hygiene or habits of the person so that the good sleep habits could be restored.  

Paradoxical intention:

Another therapy to treat insomnia is known as the ‘paradoxical intention.’

In this method, the patient is persuaded to engage his/her most feared thoughts, such as fear of never being able to sleep again.

The purpose of this therapy is to eliminate the patient’s anxiety and tension.

And in doing so, the patient starts to sleep comfortably.

Stimulus Therapy:

in this sleep therapy, the association of sleep with one’s bed is restored.

Persons undergoing this therapy are recommended to be involved in any non-sleep activity when on the bed.

Plus, this therapy also prohibits daytime napping.

Sleep Restriction Therapy:

As the name of the therapy indicates, here the patient’s sleep is limited.

The therapists advise the persons to reduce their sleeping hours or hours in bed at night.

The sleeping hours are then gradually increased by 15 to 30 minutes, once the sleep habits show improvements.

Relaxation Therapy:

in this therapy, the person is taught to learn to control his/her tension and anxiety. different muscle relaxation and mind relaxation techniques are used in this therapy.

Different exercises, yoga, and meditation are used for muscle relaxation. moreover, a biofeedback training technique is also used in this method. 

No matter if you use medications or any kind of therapy to treat insomnia, the key factor is consistency and regularity.

It is very important to continue your medication and therapy until your healthcare professional advise you otherwise. 

Some Helpful Resources

  1. Say Good Night to Insomnia
  2. Insomnia Solved: A Self-Directed Cognitive Behavioral Therapy for Insomnia (CBTI) Program 
  3. Primary Care Sleep Medicine: A Practical Guide
  4. Sleepy or Sleepless: Clinical Approach to the Sleep Patient
  5. Handbook of Insomnia


Primary insomnia is a chronic condition and must be dealt with seriousness by seeking appropriate healthcare.

The overall outlook may be improved for primary insomnia patient if the person follows a carefully devised sleep schedule and sticks to it.

It is of great significance that the person suffering from Primary Insomnia, pays attention to the sleep requirements (that vary from individual to individual). 

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Weighted Blankets

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Sleep bands

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Frequently Asked Questions

Will insomnia go away on its own?

Insomnia will consistently leave without any other person; it can regardless have hazardous effects.

In case you have chronic insomnia, there are steps you can take to endeavour to decrease the symptoms.

Who is most affected by insomnia?

Insomnia is most likely seen to affect women more than men, and when it comes to age, so there is no specific age-gender in particular, but it affects the adults more. 

Can Insomnia Be Dangerous?

By knowing the fact that it is a sleeping disorder which is often left undiagnosed.

Yes! It can be dangerous if it is not taken seriously, because it can lead to severe consequences like heart failure, diabetes and others. 

How do you cure insomnia without pills?

Curing insomnia without pills is not a big challenge.

You have to follow some simple steps, which are: 1. Schedule a bedtime routine 2. Exercise daily 3 take a bath before bed 4. Expose yourself to natural light. 

Are 5 hours of sleep enough?

The maximum amount of sleep for which a human should go is for seven to eight hours. 

What happens if you only sleep for 3 hours?

By sleeping for 3 hours only can lead you to sleeping disorder, weight gain, dark circles, and other physical issues are some of the significant problems that are associated if you sleep for 3 hours only. 


  1. An Overview of Primary Insomnia
  2. Causes and Symptoms of Primary Insomnia
  3. Primary Insomnia: Treatments
  4. All about Primary Insomnia
  5. Primary Insomnia: Etiology, Symptoms
  6. Primary Insomnia: Treatment Options

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