Insomnia is classified as an Intrinsic Dyssomnia. Dyssomnias are disorders that cause either difficulty innitiating or maintaining sleep, or they can cause excessive sleep. Dyssomnias are divided into 3 groups: Intrinsic sleep disorders, extrinsic sleep disorders, and circadian rythm disorders. In this post we are going to discuss intrinsic sleep disorders, or specifically insomnia.

Intrinsic sleep disorders are those that originate within the mind, or body. Insomnia is an intrinsic dyssomnia that causes problems with sleep initiation, and or sleep maintenance. Insomnia can affect your sleep in 3 different ways:

Initial insomnia-Trouble falling asleep.

Terminal insomnia- This is when a person awakens early and has trouble going back to sleep. This does not usually have any effect on initial sleep.

Maintenance insomnia- people whom are affected in this way usually have no problem falling asleep, but in maintaning sleep. They will wake up and fall asleep several times throughout the night.

There are 3 medical types of insomnia.

1-Psychophysiological insomnia- People with this disorder react to situations that are pshychologically stressful with bodily tension or or other physical complaints(upset stomach, headache), and they learn to associate certain things(i.e. going to bed) with emotions that preventsleep(fear of going to sleep). People with this disorder typically have a focused absorbtion on their sleep problems, which itself interferes with sleep. I see this in the labe quite a bit. Pts will come in with complaints of insomnia or restless sleep. Due to the pt being away from their stressful home lives(i.e. kids, bills, or work) they sleep very well in a lab setting.

2-Sleep state misperception-This disorder involves an honest complaint of insomnia or excessive sleepiness when there is no objective evidence that sleep is disturbed or lacking. People in the middle or late adulthood can develop this disorder because they are not able to as long or as well as they could in their earlier years. Sleep/wake perception when you are lying in a dark room with no clock can be very askewed. This is one of the many reasons for the morning questionairre after a sleep study.

3-Idiopathic Insomnia- A lifelong inability to get adequate sleep that has no OBSERVABLE cause. We can only assume that this is due to an abnormality of the sleep-wake control systems in the brain. It may be due to a problem in the sleep-inducing systems, or hyperactivity in the arousal systems. I personally have never encountered this disorder in a pt.

Everything that I have read and been told leads me to understand insomnia as a symptom of something else rather than an actual diagnosis. Meaning that the only way to cure insomnia is to find the cause and treat it, For some this could be as easy as tweaking your sleep hygiene or sleep environment. Psychiatric therapy may be needed to help eliminate symptoms. Others may have to take a sleep aid for a brief time. WARNING. If you take a sleep aid to help and do not see results in 2-4 weeks consult you PCP, and maybe start looking at other options. Sleep aids can eventually become a learned response required by your body to sleep, as well as affecting your body's arousal response to apnea.

Infromation was taken from "The Promise Of Sleep"Dr. Dement, "Guide To Sleep Medicine Technology"Steven Lennok RPSGT, and "The Essentials of Polysomnography vol II" Spriggs.