Primary insomnia doesn’t really exist, does it? Isn’t insomnia always secondary to something else?

Circadin.com May 28, 2018
It is common to assume that insomnia is a symptom of, or secondary to, other causes. Often this is the case, and proper treatment is then based on identifying the underlying cause. Primary insomnia does indeed exist, however, and is defined in ICD-10 and DSM-IV as sleeplessness that is not attributable to a medical, psychiatric or environmental cause54 55. It could be argued that a psychological conditioning process, due to a medical or psychosocial stressor, precedes the development of insomnia. However, due to conditioning, the insomnia may persist even if the original stressor has been resolved. For example, a person losing their job could become anxious and develop insomnia; the person spends more time in bed; the bed becomes associated with the stress of trying to and failing to sleep; this conditioning remains even after resolving the job situation. When other causes of insomnia are ruled out, primary insomnia is characterised by either trouble falling or staying asleep or non-refreshing sleep. Insomnia can exists with various comorbidities, hypertension, diabetes, etc., which are not considered to impair sleep41.

It is important to differentiate between these characteristics, as the appropriate treatment might differ. It is often overlooked that non-refreshing (poor quality) sleep is independent of the number of hours spent asleep. A person may spend the ‘normal’ 7–8 hours in bed asleep, but still wake up feeling unrefreshed. This insomnia is important to treat, as it is linked to fatigue, low daytime performance, depression and anxiety. Circadin® is approved for the treatment of insomnia characterised by poor Quality of Sleep1. Circadin® also improves sleep latency1 30 34. These features, together with its favorable safety profile, relative to BZDs and ‘z’-drugs 8 , should place Circadin® as a first-choice treatment of primary insomnia.

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