Fast Five Quiz: Insomnia Types and Causes

Stephen Soreff, MD


July 15, 2020

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.


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