15  IDIOPATHIC INSOMNIA

This is one of the possibilities from Step E.

15a. Definition and Description

For some people, insomnia is a basic condition of existence. It can go back for as long as they can remember, possibly to infancy or early childhood. For them, it has always been a condition of life. There is no identifiable beginning or precipitating event.

Many experts (Manber and Ong, p.114; Morin, p. 36) consider this to be one of a group of primary insomnias, so named because they are not connected with another source of insomnia nor caused by another issue, such as a psychological disorder, medication, etc.

Because the sources in childhood are difficult to unravel in retrospect, it is possible that an apparently uncaused issue had roots that are now unclear Reite, Weissberg and Ruddy (74) suggest that this may be a form of early conditioned insomnia or long-term low-level anxiety. In any case, it can create a condition of long-term hyperarousal that interferes with sleeping.

The International Classification of Sleep Disorders (ICSD) (2014, p. 20) lists idiopathic insomnia as a kind of chronic disorder but rejects the idea of primary and secondary sources of insomnia. This is because when there are two or more possible sources of insomnia, it is often difficult to determine which is primary. Also, a secondary source may eventually sustain the problem in the absence of the precipitating or primary source.

According to the ICSD (p. 27) the actual source of this disorder is likely to be either genetic or congenital problems with the person’s arousal system or sleep-inducing system or both.

15b. Treatment

Patients with this issue have had a lifetime to learn to cope with it and may underplay its impact (Morin, 36). They are also likely to have other issues with attention, concentration, motivation and memory that should be addressed.

It is possible that a person has more than one contributor to sleep difficulty. If a person appears to have idiopathic insomnia, we can try a variety of treatments to see whether some relief can be obtained there.

If no reasonable treatment is helpful, a person may need long-term medical management for relief Reite, Weissberg and Ruddy, p.74.