‘Primary insomnia’ refers to difficulty falling asleep or staying asleep that is not due to any of the specific causes of insomnia discussed above.
Primary insomnia
You don’t use substances, don’t suffer from a medical or psychiatric condition, and don’t work shifts or in an international consulting firm, but you still have enormous difficulty sleeping properly. You may not be able to fall asleep, you may wake up every so often during the night or at half past four in the morning after which you can no longer fall asleep, or all of this together. You may also feel that the sleep you are getting is not relaxing or refreshing.
As a result, you feel sleepy all day and suffer from concentration problems, lethargy, irritability and reduced motivation. Because you haven’t gotten enough sleep at night, you may unintentionally fall asleep during the day, often while doing mind-numbing work or during a boring meeting. This can be dangerous if you have to drive, operate machinery or do anything else that requires you to remain alert.
Primary insomnia often starts with poor sleeping habits. The most likely causes of harm are an irregular sleep pattern, working or studying late at night, frequent or prolonged naps during the day or sleeping in excessively late.
Sleep problems quickly become worse during periods of social, medical, psychological or work stress. Insomnia tends to become self-perpetuating due to the negative conditioning that comes from all the tossing and turning that goes on in your bed. You worry so much about not being able to sleep that sleeping becomes a complete impossibility. The harder you try to fall asleep, the less you will be able to forget your worries. Your own bed becomes the last place in the world where you can fall asleep.
Instead, you doze off in front of the television or with a book in a comfortable chair. Then you wake up after midnight to go to bed, but you don’t sleep a wink for the rest of the night because you worry about whether you will be able to fall asleep.
You sleep better in hotels you visit while traveling or in the guest room of your own home.
Diagnosis according to DSM IV
According to the diagnostic manual, you have primary insomnia if the following occurs:
- You have difficulty falling asleep or staying asleep or you feel that you are not sleeping well.
- For at least a month, this has led to fatigue and daytime sleepiness severe enough to interfere with your daily functioning. All other causes for the sleep problem have been considered and ruled out.
- The insomnia is not the result of a medical condition or a substance, not a side effect of any drug, and not a symptom of a psychiatric disorder such as depression.
