Fast Five Quiz: Insomnia Types and Causes

Primary insomnia is sleeplessness that is not attributable to a medical, psychiatric, or environmental cause. The DSM-5 diagnostic criteria for primary insomnia are as follows:

A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one or more of the following symptoms:
- Difficulty initiating sleep
  - In children, this may manifest as difficulty initiating sleep without caregiver intervention
- Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings
  - In children, this may manifest as difficulty returning to sleep without caregiver intervention
- Early-morning awakening with inability to return to sleep
The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning
The sleep difficulty occurs at least 3 nights per week
The sleep difficulty is present for at least 3 months
The sleep difficulty occurs despite adequate opportunity for sleep
The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (eg, narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia)
The insomnia is not attributable to the physiologic effects of a substance (eg, a drug of abuse, a medication)
Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia

The key to making a diagnosis of primary insomnia is the exclusion of all common causes of insomnia. This includes excluding medical causes of insomnia (eg, chronic pain, especially neuropathic pain), psychiatric and/or psychological causes (eg, anxiety disorders), and drug use or withdrawal. In addition, clinicians should rule out environmental causes of insomnia as well as other medical conditions, including obstructive sleep apnea-hypopnea syndrome, hyperthyroidism, and parasomnias.

Learn more about the DSM-5 criteria for insomnia.

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Stephen Soreff. Fast Five Quiz: Insomnia Types and Causes - Medscape - Jul 15, 2020.

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