Causes of Primary insomnia
List of causes of Primary insomnia
Following is a list of causes or underlying conditions
(see also Misdiagnosis of underlying causes of Primary insomnia)
that could possibly cause Primary insomnia includes:
- Chronic pain, especially neuropathic pain
- Primary sleep disorders (eg, sleep apnea, periodic limb movements, restless legs syndrome)
- Dyspnea from any cause
- Pregnancy
- Drug use or withdrawal Mood disorders
- Anxiety disorders (eg, generalized anxiety, panic attacks, obsessive-compulsive disorder)
- Substance abuse
- Major life stressors and/or events
- Environmental causes
- Noise
- Jet lag or shift work
- Bedroom too hot or cold
Primary insomnia Causes: Book Excerpts
Related information on causes of Primary insomnia:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Primary insomnia may be found in:
Causes of Primary insomnia: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Primary insomnia.
Insomnia:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Unnecessary concern about deviation from “normal” sleeping patterns
-
Acute, transient insomnia (<4 weeks)
–Situational stress (most common)
–Acute illness or injury
–Medications or drugs (e.g., cocaine)
–Change in sleep environment or hours - Chronic insomnia (>4 weeks)
–Difficulty falling asleep: May be due to poor sleep hygiene, conditioned insomnia (initial acute insomnia progresses to chronic due to maladaptive distorted sleep cognitions), medications (e.g., sedatives, decongestants, oral contraceptive use, antidepressants, bronchodilators), drugs (including over-the-counter and herbal preparations, alcohol, nicotine, illicit drugs), and caffeine (e.g., coffee, soda, medications)
–Difficulty staying asleep: May be due to sleep apnea, medications and drugs (e.g., alcohol), depression, anxiety, dementia, psychosis, mania, post-traumatic stress disorder, and various medical conditions (e.g., COPD, asthma, CHF, angina, GERD, peptic ulcer disease, IBD, BPH, UTI, pregnancy, uremia, diabetes mellitus, hyperthyroidism, menopause, pain, pruritus, seizures)
-
RLS
–“Creepy-crawly” unpleasant sensations in
the legs and/or feet
–Temporarily relieved by moving limbs
-
Periodic limb movement disorder
–Arms and/or legs jerk during sleep
–May be a primary disorder or secondary to uremia, neuropathy, or iron deficiency
–Often in the elderly
–Often occurs with restless legs syndrome
Narcolepsy
REM-behavior disorder
–Rare, mostly in elderly
–Thrashing or seemingly purposeful
behaviors during sleep
Prion fatal familial insomnia
>
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Insomnia:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Alcohol withdrawal syndrome
Abrupt cessation of alcohol intake after long-term use causes insomnia that may persist for up to 2 years
Other early effects of this acute syndrome include excessive diaphoresis, tachycardia, hypertension, tremors, restlessness, irritability, a headache, nausea, flushing, and nightmares. Progression to delirium tremens produces confusion, disorientation, paranoia, delusions, hallucinations, and seizures.
Generalized anxiety disorder
Anxiety can cause chronic insomnia as well as symptoms of tension, such as fatigue and restlessness; signs of autonomic hyperactivity, such as diaphoresis, dyspepsia, and high resting pulse and respiratory rates; and signs of apprehension.
Mood (affective) disorders
Depression commonly causes chronic insomnia with difficulty falling asleep, waking and being unable to fall back to sleep, or waking early in the morning
Related findings include dysphoria (a primary symptom), decreased appetite with weight loss or increased appetite with weight gain, and psychomotor agitation or retardation. The patient experiences loss of interest in his usual activities, feelings of worthlessness and guilt, fatigue, difficulty concentrating, indecisiveness, and recurrent thoughts of death.
Manic episodes produce a decreased need for sleep with an elevated mood and irritability. Related findings include increased energy and activity, fast speech, speeding thoughts, inflated self-esteem, easy distractibility, and involvement in high-risk activities such as reckless driving.
Nocturnal myoclonus
With nocturnal myoclonus, a seizure disorder, involuntary and fleeting muscle jerks of the legs occur every 20 to 40 seconds, disturbing sleep.
Sleep apnea syndrome
Apneic periods begin with the onset of sleep, continue for 10 to 90 seconds, and end with a series of gasps and arousal
With central sleep apnea, respiratory movement ceases for the apneic period; with obstructive sleep apnea, upper airway obstruction blocks incoming air, although breathing movements continue. Some patients display both types of apnea. Repeated possibly hundreds of times during the night, this cycle alternates with bradycardia and tachycardia. Associated findings include a morning headache, daytime fatigue, hypertension, ankle edema, and personality changes, such as hostility, paranoia, and agitated depression.
Thyrotoxicosis
Difficulty falling asleep and then sleeping for only a brief period is one of the characteristic symptoms of thyrotoxicosis
Cardiopulmonary features include dyspnea, tachycardia, palpitations, and an atrial or a ventricular gallop. Other findings include weight loss despite increased appetite, diarrhea, tremors, nervousness, diaphoresis, hypersensitivity to heat, an enlarged thyroid, and exophthalmos.
Other causes
Drugs
Use of, abuse of, or withdrawal from sedatives or hypnotics may produce insomnia
CNS stimulants — including amphetamines, theophylline derivatives, pseudoephedrine, phenylpropanolamine, cocaine, and caffeinated beverages — may also produce insomnia.
Herb alert
Herbal remedies, such as ginseng and green tea, can also cause insomnia.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Insomnia:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Alcohol withdrawal syndrome
Abrupt cessation of alcohol intake after long-term use causes insomnia that may persist for up to 2 years. Other early effects of this acute syndrome include excessive diaphoresis, tachycardia, hypertension, tremors, restlessness, irritability, headache, nausea, flushing, and nightmares. Progression to delirium tremens produces confusion, disorientation, paranoia, delusions, hallucinations, and seizures.
Generalized anxiety disorder
Anxiety can cause chronic insomnia as well as symptoms of tension, such as fatigue and restlessness; signs of autonomic hyperactivity, such as diaphoresis, dyspepsia, and high resting pulse and respiratory rates; and signs of apprehension.
Mood (affective) disorders
Depression commonly causes chronic insomnia with difficulty falling asleep, waking and being unable to fall back to sleep, or waking early in the morning. Related findings include dysphoria (a primary symptom), decreased appetite with weight loss or increased appetite with weight gain, and psychomotor agitation or retardation. The patient experiences loss of interest in his usual activities, feelings of worthlessness and guilt, fatigue, difficulty concentrating, indecisiveness, and recurrent thoughts of death.
Manic episodes produce a decreased need for sleep with an elevated mood and irritability. Related findings include increased energy and activity, fast speech, speeding thoughts, inflated self-esteem, easy distractibility, and involvement in high-risk activities such as reckless driving.
Nocturnal myoclonus
With this seizure disorder, involuntary and fleeting muscle jerks of the legs occur every 20 to 40 seconds, disturbing sleep.
Pain
Almost any condition that causes pain can cause insomnia. Related findings reflect the specific cause.
Pheochromocytoma
This rare disorder causes paroxysms of acute hypermetabolic activity, which can prevent or interrupt sleep. Its cardinal sign is severe hypertension, which may be sustained between attacks. Other effects include headache, palpitations, and anxiety.
Pruritus
Localized skin infections and systemic disorders, such as liver failure, can cause pruritus, resulting in insomnia.
Sleep apnea syndrome
Apneic periods begin with the onset of sleep, continue for 10 to 90 seconds, and end with a series of gasps and arousal. With central sleep apnea, respiratory movement ceases for the apneic period; with obstructive sleep apnea, upper airway obstruction blocks incoming air, although breathing movements continue. Some patients display both types of apnea. Repeated possibly hundreds of times during the night, this cycle alternates with bradycardia and tachycardia. Associated findings include morning headache, daytime fatigue, hypertension, ankle edema, and personality changes, such as hostility, paranoia, and agitated depression.
Thyrotoxicosis
Difficulty falling asleep and then sleeping for only a brief period is one of the characteristic symptoms of this disorder. Cardiopulmonary features include dyspnea, tachycardia, palpitations, and atrial or ventricular gallop. Other findings include weight loss despite increased appetite, diarrhea, tremors, nervousness, diaphoresis, hypersensitivity to heat, an enlarged thyroid, and exophthalmos.
Other causes
Drugs
Use of, abuse of, or withdrawal from sedatives or hypnotics may produce insomnia. CNS stimulants—including amphetamines, theophylline derivatives, pseudoephedrine, cocaine, and caffeinated beverages—may also produce insomnia.
Herb Alert
Herbal remedies, such as ginseng and green tea, can also cause insomnia.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Insomnia:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Alcohol withdrawal syndrome
Abrupt cessation of alcohol intake after long-term use causes insomnia that may persist for up to 2 years. Other early effects of this acute syndrome include excessive diaphoresis, tachycardia, hypertension, tremors, restlessness, irritability, headache, nausea, flushing, and nightmares. Progression to delirium tremens produces confusion, disorientation, paranoia, delusions, hallucinations, and seizures.
Depression
Depression commonly causes chronic insomnia with difficulty falling asleep, waking and being unable to fall back to sleep, or waking early in the morning. Related findings include dysphoria (a primary symptom), decreased appetite with weight loss or increased appetite with weight gain, and psychomotor agitation or retardation. The patient experiences loss of interest in his usual activities, feelings of worthlessness and guilt, fatigue, difficulty concentrating, indecisiveness, and recurrent thoughts of death.
Generalized anxiety disorder
Anxiety can cause chronic insomnia as well as symptoms of tension, such as fatigue and restlessness; signs of autonomic hyperactivity, such as diaphoresis, dyspepsia, and high resting pulse and respiratory rates; and signs of apprehension.
Nocturnal myoclonus
With nocturnal myoclonus, a seizure disorder, involuntary and fleeting muscle jerks of the legs occur every 20 to 40 seconds, disturbing sleep. The patient typically reports poor sleep and daytime somnolescence.
Pain
Almost any condition that causes pain can also cause insomnia. Related findings reflect the specific cause. Behavioral responses that may accompany pain include altered body position, moaning, grimacing, withdrawal, crying, restlessness, muscle twitching, and immobility. With mild or moderate pain the patient may have pallor, elevated blood pressure, dilated pupils, skeletal muscle tension, dyspnea, tachycardia, and diaphoresis. Severe, deep pain may produce pallor, decreased blood pressure, bradycardia, nausea and vomiting, weakness, dizziness, and loss of consciousness.
Pruritus
Localized skin infections and systemic disorders, such as liver failure, can cause pruritus, resulting in insomnia. The patient may report scratching as a way to relieve the itching.
Sleep apnea syndrome
Apneic periods begin with the onset of sleep, continue for 10 to 90 seconds, and end with a series of gasps and arousal. With central sleep apnea, respiratory movement ceases for the apneic period; with obstructive sleep apnea, upper airway obstruction blocks incoming air, although breathing movements continue. Repeated possibly hundreds of times during the night, this cycle alternates with bradycardia and tachycardia. Associated findings include morning headache, daytime fatigue, hypertension, ankle edema, and personality changes, such as hostility, paranoia, and agitated depression.
Thyrotoxicosis
Difficulty falling asleep and then sleeping for only a brief period is one of the characteristic symptoms of thyrotoxicosis. Cardiopulmonary features include dyspnea, tachycardia, palpitations, and atrial or ventricular gallop. Other findings include weight loss despite increased appetite, diarrhea, tremors, nervousness, diaphoresis, hypersensitivity to heat, an enlarged thyroid, and exophthalmos.
Other causes
Drugs
Use of, abuse of, or withdrawal from sedatives or hypnotics may produce insomnia. CNS stimulants—including amphetamines, theophylline derivatives, pseudoephedrine, phenylpropanolamine, cocaine, and caffeinated beverages—may also produce insomnia.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Insomnia:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Alcohol withdrawal syndrome.Abrupt cessation of alcohol intake after long-term use causes insomnia that may persist for up to 2 years. Other early effects of this acute syndrome include excessive diaphoresis, tachycardia, hypertension, tremors, restlessness, irritability, a headache, nausea, flushing, and nightmares. Progression to delirium tremens produces confusion, disorientation, paranoia, delusions, hallucinations, and seizures.
Generalized anxiety disorder.Anxiety can cause chronic insomnia as well as symptoms of tension, such as fatigue and restlessness; signs of autonomic hyperactivity, such as diaphoresis, dyspepsia, and high resting pulse and respiratory rates; and signs of apprehension.
Mood (affective) disorders.Depression commonly causes chronic insomnia with difficulty falling asleep, waking and being unable to fall back to sleep, or waking early in the morning. Related findings include dysphoria (a primary symptom), decreased appetite with weight loss or increased appetite with weight gain, and psychomotor agitation or retardation. The patient experiences loss of interest in his usual activities, feelings of worthlessness and guilt, fatigue, difficulty concentrating, indecisiveness, and recurrent thoughts of death.
Manic episodes produce a decreased need for sleep with an elevated mood and irritability. Related findings include increased energy and activity, fast speech, speeding thoughts, inflated self-esteem, easy distractibility, and involvement in high-risk activities such as reckless driving.
Nocturnal myoclonus (also known asperiodic limb movement disorder). With nocturnal myoclonus, a seizure disorder, involuntary and fleeting muscle jerks of the legs occur every 20 to 40 seconds, disturbing sleep.
Restless leg syndrome.With restless leg syndrome, uncomfortable sensations in the legs cause uncontrollable urges to move the limbs. Although movement brings relief, sleep is usually disrupted, causing insomnia, which may be severe.
Sleep apnea syndrome.With sleep apnea syndrome, apneic periods begin with the onset of sleep, continue for 10 to 90 seconds, and end with a series of gasps and arousal. With central sleep apnea, respiratory movement ceases for the apneic period; with obstructive sleep apnea, upper airway obstruction blocks incoming air, although breathing movements continue. Some patients display both types of apnea. Repeated possibly hundreds of times during the night, this cycle alternates with bradycardia and tachycardia. Associated findings include a morning headache, daytime fatigue, hypertension, ankle edema, and personality changes, such as hostility, paranoia, and agitated depression.
Other causes
Drugs.Use of, abuse of, or withdrawal from sedatives or hypnotics may produce insomnia. CNS stimulants—including amphetamines, theophylline derivatives, pseudoephedrine, cocaine, and caffeinated beverages—may also produce insomnia.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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