“Primary” means that the insomnia is not associated with another mental or physical disorder.1 Primary insomnia is a summary term that includes psychophysiological insomnia (excessive worrying about sleep), paradoxical insomnia (perceived insomnia despite sufficient sleep), idiopathic insomnia, inadequate sleep hygiene, and behavioral insomnia of childhood. There are at least 5 pathways that may lead to primary insomnia:
- Psychological issues that constitute the level of a psychiatric disease;
- Learning and conditioning factors (psychophysiological insomnia);
- Poor sleep hygiene and other maladaptive behaviors;
- Discrepancies between subjective and objective measures of sleep (paradoxical insomnia);
- Neurological and/or neurochemical imbalances in the sleep-wake system that do not constitute a classifiable neurological disorder (idiopathic insomnia).
- Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association; 2000.