Insomnia (sleeplessness) is characterized by a difficulty to initiate or maintain sleep not due to time constraints, resulting in daytime impairment, which may include sleepiness, fatigue, as well as cognitive problems (e.g., impaired memory and concentration). If you have been suffering from insomnia for at least 3 months, you would be diagnosed with Chronic Insomnia Disorder, which is a persistent form of insomnia. Now, if you believe that you have “never slept well,” we could further narrow your diagnosis to a primary insomnia known as Idiopathic Insomnia. It is primary because it is not caused by a secondary medical condition.
Marcel Proust, one the greatest novelists of all times, is said to have suffered from this form of insomnia.
Do you suffer from idiopathic insomnia?
If you’re suffering from idiopathic insomnia, you have probably had to deal with lifelong sleep difficulties with no periods of sustained remission, starting in childhood, and gradually becoming worse. Most likely, you do not remember any precipitating event or inciting factors. In fact, there may have been none; the condition might simply run in your family.
Often, nothing seems to help.
What is idiopathic insomnia?
Sleep scientists have limited understanding of this condition. One theory which attempts to explain it is known as the Two-Factor Model, proposed by Bonnet and Arand in 1997. The two factors are:
- Basal Arousal Level – What is your normal level of arousal relative to others? (The level of arousal reflects your level of wakefulness and alertness.) Is your basal arousal level lower of higher than that of others?
- Sleep Requirement – How much sleep do you require relative to others? Do you require a shorter or longer sleep than most other people?
Arising from different combinations of these factors are 4 distinct conditions:
- People who have a low basal arousal level and a short sleep requirement may suffer from excessive daytime sleepiness.
- People who have a low basal arousal level and a long sleep requirement may suffer from idiopathic hypersomnolence, characterized by excessive daytime sleepiness even after 7 hours or more of quality sleep.
- People who have a high basal arousal level and a long sleep requirement may suffer from paradoxical insomnia, characterized by complaints regarding sleep that are not supported by objective measures which show adequate sleep, and without the level of daytime impairment expected.
- People who have a high basal arousal level and a short sleep requirement may suffer from psychophysiological insomnia or idiopathic insomnia.
Long story short, according to the Two-Factor Theory, idiopathic insomnia characterizes people who do not require much sleep, while having a high basal arousal level. Since they are very aroused normally, they find it difficult to fall asleep. When sleep deprivation finally overrides the overactive arousal system, sleep comes, but not for long due to the short sleep requirement of the individual’s sleep system.
Sufferers of psychophysiological insomnia may try to fall asleep when sleep is not required, and fail, making them worry about not getting enough sleep, which in turn can prevent sleep when it is needed. As such it is a “learned” insomnia. (They just don’t need much sleep and when they don’t, they are highly aroused. They simply can’t fall asleep, and shouldn’t try to sleep, unless they are very tired.)
Like psychophysiological insomniacs, people with idiopathic insomnia also exhibit a heightened state of arousal, however changing the environment does not improve sleep like it does for psychophysiological insomniacs. And the condition is life-long, and not learned.
According to the neurological approach, there is a some dysfunction in sleep-wake center in the brain of idiopathic insomniacs. In particular, there may be hyperactivity in the wake center or hypoactivity in the sleep center.
Why does idiopathic insomnia happen?
How and why does basal arousal comes (and continues) to be elevated?
Currently, science has no answer to these questions, however there are two likely possibilities:
- Since a significant family history can be identified among people who suffer from idiopathic insomnia, it suggests it may be a genetic condition. This option is in tune with the Two-Factor Model. Perhaps there’s a genetic spectrum of sleep requirement and basal arousal levels. Where you are located on these continua, and the resulting sleep patterns, may be inherited from your parents.
- A trauma experienced in childhood (e.g., a history of abuse) may underlie this condition. When this is the case, the condition may also be thought of secondary insomnia resulting from PTSD, or post-traumatic stress disorder. Alternatively, it can be that PTSD was the primary condition at first, while insomnia was secondary, but through conditioning it eventually became a psychophysiological primary insomnia. In other words, and I’m just speculating here, idiopathic insomnia could be childhood onset psychophysiological insomnia caused by PTSD.
Treatment of idiopathic insomnia
I will start by stating what is not a useful treatment approach: Benzodiazepines and other sleeping pills should not be administered long-term for the treatment of idiopathic insomnia.
The first stage in the treatment of idiopathic insomnia should be to rule out PTSD.
What is Post-Traumatic Stress Disorder?
When a person is exposed to an event involving serious harm, death, or sexual violence, he may become afflicted with this disorder.
Insomnia is a common symptom of PTSD.
Another PTSD symptom is distress whenever one recollects or is reminded of the precipitating event. “Flashbacks” may be experienced in both waking life and dreams, involving images and thoughts. Nightmares and disturbing dreams are common, the awakening from which usually involves fear, even panic.
If PTSD is the reason for insomnia, it must be treated first. Clients facing nightmares should seek treatment with a qualified psychotherapist. Helpful techniques include lucid dreaming therapy, which can help transform nightmares into insightful and empowering lucid dreams. Image rehearsal therapy and cognitive-behavioral therapies may also be effective.
When PTSD is ruled out, idiopathic insomnia is treated like other primary insomnia disorders: with a combination of cognitive-behavioral strategies, including stimulus-control therapy, sleep-restriction therapy, relaxation, as well as lifestyle modification and improving sleep hygiene.
Herbs can provide a safe and efficient alternative for pharmaceutical drugs.
Learn more about treatments for insomnia.
Kryger, Meir H.; Roth, Thomas; Dement, William C.. Principles and Practice of Sleep Medicine E-Book. Elsevier Health Sciences. Kindle Edition.
Westerman, David, E., The Concise Sleep Medicine Handbook: Essential Knowledge for the Boards & Beyond. (5th ed.) GSSD Publishers, LLC.