Criteria for Primary Insomnia
Primary insomnia is sleeplessness that is not attributable to a medical, psychiatric, or environmental cause the main criterion is that the sleep disturbance (or associated daytime fatigue) causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Treatment Goals and Considerations
The pathophysiology of primary insomnia is not well understood. In addition, essential features assist in diagnosis. The focus of management is on symptoms.  However, findings have strengthened the evidence that primary insomnia may be linked with mood disorders and are associated with hypothalamic-pituitary-adrenal (HPA) axis over activity and excess secretion of corticotropin-releasing factor (CRF), adrenocorticotropin-releasing hormone, and cortisol. The goal of insomnia management is to improve sleep quality and maintenance and limit daytime impairments. [2,3,4] Inpatient care is not usually required for primary insomnia unless significant medical or psychiatric comorbidity exists. Sleep disturbance is a reliable indicator of psychological and/or physical ill health. A report of disturbed sleep from the patient signals the need for further evaluation and close monitoring.
Incidence in the United States
Primary insomnia is diagnosed in approximately 15-25% of patients with insomnia who are referred to sleep disorder centers following exclusion of other predisposing conditions. However, the true incidence is not known. Primary insomnia is estimated to occur in 25% of all patients with chronic insomnia. Whether the consequences associated with chronic insomnia outweigh the costs of treatment remains debatable. Despite that, various health-related associations with chronic insomnia have been noted. Poor health and decreased activity occur in persons with chronic insomnia. Moreover, insomnia is the best predictor of the future development of depression. An increased risk of mortality is...