Symptoms and Signs of Primary Insomnia

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 12/3/2021

Doctor's Notes on Primary Insomnia

Primary insomnia is sleeplessness, insufficient sleep, or the perception of poor-quality sleep not caused by medical or psychiatric diseases, conditions, genetics, illnesses, or environmental causes (such as drug abuse, medication, or shift-work). Insomnia can be classified as primary, which is caused by either psychological factors, sleep state misperception, or is idiopathic (no known cause). When insomnia is caused by another disease, condition, or illness it is considered secondary insomnia

Symptoms of primary insomnia may range from mild to severe and include

  • difficulty falling asleep,
  • frequent awakenings in the night, and
  • an inability to sleep well anywhere else but in one’s own bedroom.

Symptoms that may accompany insomnia include

  • difficulties with attention or concentration,
  • hyperactivity,
  • hypersensitivity or insensitivity to medications,
  • tension,
  • dissatisfaction, and
  • repression (denial or minimization) of emotional problems.

What Is the Treatment for Primary Insomnia?

Evaluating sleep habits is important in the management of insomnia. Treatment of underlying sleep disorders and in some instances, changing sleep habits may correct the problem without the need for medications. Good sleep habits (also referred to as good sleep hygiene) should include: 

  • Regular sleep times
  • A comfortable bed and quiet room at a comfortable temperature
  • A darkened room
  • Regular exercise, but not close to bedtime or late in the evening 
  • A bedroom that is not used for work, watching television, or other activities not related to sleep other than sex
  • Avoidance of stimulants (for example, caffeine or tobacco), alcohol, and large meals close to bedtime (avoid 2 to 4 hours before bedtime if possible) 
  • Many people watch television before falling asleep. TV can be a very stimulating medium and needs to be closely evaluated if it adds to a person's insomnia.
  • Relaxation techniques such as breathing exercises or yoga 
  • No naps during the day
  • Try drinking warm milk before bed
    • It is high in the amino acid tryptophan, which helps induce sleep

Medications are widely used to treat insomnia. Common medications used for insomnia may include: 

Must Read Articles:


Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.