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Annette (Gbemudu) Ogbru, PharmD, MBA

Annette (Gbemudu) Ogbru, PharmD, MBA

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Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Insomnia is usually a transient or short-term condition (lasting less than 3 months). In some cases insomnia can become chronic (more than 6 months).

Transient insomnia specifically lasts up to 1 week and is associated with acute situational stress factors such as a job interview or exam. It usually resolves once the person has adjusted to stress factor, or it is no longer a concern. It can however reemerge when new or similar stressors occur. Causes of short-term (acute) insomnia are typically related to more significant or persistent stress sources, which may be environmental factors such as too much noise, light, temperature extremes, or an uncomfortable bed ,or situational factors including relationship concerns or losses (for example, death of a family member).

Causes of chronic insomnia are more variable and are associated with underlying causes which include the following:

Medical disorders

• Chronic pain
• Severe emphysema
• Menopause
• Chronic kidney disease (especially if undergoing dialysis)
• Chronic fatigue syndrome
• Fibromyalgia

Neurologic disorders

• Parkinson's disease
• Other movement disorders
• Cluster headaches

Psychiatric disorders

• Depression
• Schizophrenia
• Anxiety disorders

Drug-related insomnia

• Stimulants (for example, caffeine)
• Alcohol
• Addictive substance abuse or withdrawal (for example, attempting to quit smoking)
• Overuse of sedative-hypnotic drugs

• Restless leg syndrome (RLS) is characterized by the urge to move the legs usually accompanied by an uncomfortable sensation in the legs such a crawling, burning, aching or cramping sensations. RLS often occurs at night while sitting and relaxing, and the sensation and the urge to move is often relieved by movement.
• Periodic limb movement disorder (PLMD) occurs during sleep and involves periodic movements of the lower legs, causing brief mini-awakenings (arousals from sleep). Severe cases can cause significant sleep interruption and insomnia.
• Sleep apnea is a less common cause of insomnia. This condition is associated with loud snoring and frequent brief awakenings during the night. Many factors, including abnormalities or altered anatomy of the structures in the nose or throat, may cause this condition.
• Circadian rhythm disorders (disruption of an individual's "biological clock") may occur when a person stays up later and sleeps later, then has difficulty returning to a more normal sleep schedule. People who work during the night ("graveyard shift") frequently have problems with insomnia. Insomnia due to jet lag is also a disruption of the normal Circadian rythym.

Primary insomnia

Primary insomnia may be diagnosed when all other disorders have been excluded. Primary insomnia is often referred to as psychophysiologic insomnia. This disorder often results from a period of stress in a person's life. Normally, this condition resolves over time, but for some, insomnia results in ongoing tension and an inability to sleep. Bad sleep habits develop, and the person begins to worry about his or her sleep, worsening the symptoms of insomnia. The bad habits must be "unlearned," and the person educated regarding good sleep hygiene practices.

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