Primary insomnia, its etiology, precipitating factors, perpetuating factors and treatment are summarized in this document

1. Primary insomnia
“Insomnia is defined as repeated difficulty with the initiation, duration, maintenance, or
quality of sleep that occurs despite adequate time and opportunity for sleep that results in
some form of daytime impairment.”
Insomnia can be categorized in numerous ways. One way to classify insomnia is in three
categories based on duration.
1. Transient insomnia is often self-limited and usually lasts no longer than 7 days;
2. Short-term insomnia lasts for 1 to 3 weeks; and
3. Chronic insomnia lasts longer than 3 weeks.
Chronic insomnia is usually associated with medical, psychiatric, psychological, or
substance-use disorders. Insomnia also can be classified as primary or secondary.
1. Primary insomnia is not caused by a health problem; it is a sleep disturbance that
cannot be attributed to a medical, psychiatric, or environmental cause.
2. Secondary insomnia, on the other hand, is caused by an underlying medical
condition or a medication.
Etiology
In the late 1980s, Spielman created a model of insomnia in terms of predisposing,
precipitating, and perpetuating factors.
Predisposing factors
Genetic and neurobiological factors likely determine a person’s risk of developing
insomnia in the context of a precipitating factor (psychosocial, medical, or psychiatric).
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Exogenous (outside, environmental) influences such as caffeine, light, and stress.

2. •
Mutation or polymorphism in Circadian clock genes (Clock, Per2) regulate the
circadian rhythm.
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A faulty mutation, gene encoding the GABA
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Polymorphisms (chemical compound with different forms) in the serotonin
receptor transporter gene that modulate the ability to handle stress and is an
important neurotransmitter for arousal mechanisms.
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Antagonism (a neutral interaction that diminishes the substance’s individual
effect) of the 5-HT2 receptor promotes slow wave sleep.
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Increased brain arousal.
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higher day and night body temperatures,
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higher urinary cortisol and
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higher adrenaline secretion,
Precipitating factors
A number of factors can trigger insomnia in vulnerable individuals. These factors include
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depression,
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anxiety,
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sleep-wake schedule changes,
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medications,
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other sleep disorders, and

3. •
Medical conditions.
In addition, positive or negative family, work-related, and health events are common
insomnia precipitants.
Perpetuating factors
Insomnia is generally accepted to be perpetuated by cognitive and behavioral
mechanisms.
Cognitive mechanisms include misconceptions about normal sleep requirements and
excessive worry about the consequences of the daytime effects of inadequate sleep. These
dysfunctional beliefs often produce sleep disruptive behaviors, which in turn reduces
natural homeostatic drive to sleep at habitual bedtime. Learned sleep-preventing
associations are characterized by over concern about inability to fall asleep.
Consequently, these patients develop conditioned arousal to stimuli that would normally
be associated with sleep (i.e., heightened anxiety and ruminations about going to
sleep). A cycle then develops in which the more the patients strive to sleep, the more
agitated they become, and the less they are able to fall asleep. The individual also has
ruminative thoughts or clock watching as he tries to fall asleep.
OR
For primary insomnia the most common causes are
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Stress,
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Anxiety,
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Environmental noise,
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Extreme temperatures,

4. •
A change in environment,
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Sleeping or waking schedules,
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Jet lag, and
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Side effect of some medicines.
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Caffeine use,
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Alcohol use,
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Substance abuse
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Excitement,
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Nighttime shift work,
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Anger,
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Grief,
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Worry,
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Smoking,
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Sleeping area distractions, and
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Having the wrong mattress.
Secondary insomnia is most often chronic and is usually associated with some underlying
physical or mental disorder.
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Depression
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Bipolar disorder,
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Night urination,

5. •
Chronic pain,
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Duodenal ulcers,
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Arthritis,
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Heart failure,
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Lung disorders,
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Kidney disorders,
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Asthma,
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Clinical depression,
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Mania,
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Schizophrenia, and
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Other sleep disorders like sleep apnea.
Symptoms
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Difficulty falling asleep on most nights
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Feeling tired during the day or falling asleep during the day
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Not feeling refreshed when you wake up
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Waking up several times during sleep
Treatment
There are two basic therapies for the treatment of individuals’ suffering from
insomnia i.e.
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Relaxation therapy
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Cognitive behavioral therapy
Several medicines are also prescribed for insomnia

6. •
Triazolam
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Temazepam
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Flurazepam

7. •
Triazolam
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Temazepam
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Flurazepam