During the diagnostic process, doctors further classify insomnia according to its origin or cause so they can recommend the appropriate therapy.
The classifications are primary and secondary insomnia.
Primary insomnia All sleeplessness not due to a medical, psychiatric, neurological or environmental cause is called primary insomnia, meaning the insomnia itself is the medical condition and isn't just a symptom of something else.
This can be further classified as either conditioned insomnia, sleep state misperception or idiopathic insomnia.
Conditioned insomnia results when a person who is suffering from ongoing stress develops poor sleep habits that condition him to sleep poorly.
Such patients develop a vicious cycle of self-defeating bedtime behavior.
After a few sleepless nights, they begin to associate their bedrooms with not being able to sleep.
The closer they get to bedtime the more anxious they become and the more they focus on their sleeplessness.
They fear they'll never be able to get to sleep, and eventually their anxiety and frustration actually make that fear a self-fulfilling prophecy.
Interestingly, these people can fall asleep on the couch, sleep better in hotel rooms and sleep well in sleep labs.
This is because: oThey're not in contact with the cue they have conditioned themselves to associate with sleeplessness-their bed and bedroom oThey're not trying to sleep oTheir self-defeating bedtime behaviors are inhibited in locations they don't associate with sleeplessness Sleep state misperception results from the mistaken belief that you're awake when you're really asleep.
Like most people, you may assume that the brain switches off when you sleep and you become unconscious.
You know you slept because you can't remember anything from when you fell asleep until you woke up.
However, your brain is not "off" when you sleep.
It can be in a very active state.
Dreams occur, among other things.
Recordings of their brain activity in a sleep lab show these people are getting a full night's sleep, but swear they toss and turn all night and didn't sleep a wink.
Idiopathic insomnia refers to a condition in which a person has had trouble sleeping for most of his life, but there is no apparent or readily identifiable cause for the insomnia.
It's less common than behavioral insomnia.
Because the condition starts in childhood and tends to run in families, many researchers believe that some undetected brain abnormality may be to blame.
secondary insomnia Here, a medical problem such as sleep apnea or restless leg syndrome, or emotional problem like depression, causes the insomnia.
The sleeplessness is considered a symptom and not medical condition.
If insomnia is secondary, your doctor should try to determine what's causing it and treat it directly.
Treating only the symptom without considering the cause can lead to a therapeutic misadventure.
For example: consider a cardiac ischemia patient with chest pain who goes to the emergency room.
If a doctor treats the symptom of pain but doesn't address the cause of pain, the disease can progress unabated.
Or a person with sleep-maintenance insomnia caused by sleep apnea (interruptions in nighttime breathing) if the person's doctor prescribed a sleeping pill just to treat the insomnia the person's undiagnosed apnea will get worse because: oSleeping pills usually suppress breathing oSleeping pills usually increase airway collapsibility by relaxing the muscles in the throat, tongue and soft pallet.
oSleeping pills raise the arousal threshold so the person's apnea episodes get longer and longer Anything from depression to arthritis, headache or indigestion can cause secondary insomnia.
Emotional problems, plus almost anything that causes physical pain or discomfort, can produce secondary insomnia as a symptom.
Treatment of the underlying problem can often resolve the insomnia as well.