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The term insomnia signi es a chronic inability to sleep despite adequate opportunity to do so; it is used popularly to indicate any impairment in the duration, depth, or restorative properties of sleep There may be dif culty in falling asleep or remaining asleep, awakening may come too early, or a combination of these complaints may be made Precision as to what constitutes insomnia is impossible at the present time because of our uncertainty as to the exact amounts of sleep required and the role of sleep in the economy of the human body All that can be said is that some form of sleeplessness is a frequent complaint (20 to 40 percent of the population) and is more prominent in the elderly and in women Only a small proportion of persons who perceive their sleep to be inadequate seek professional help or use sleeping pills (Mellinger et al) Two general classes of insomnia can be recognized one in which there appears to be a primary abnormality of the normal sleep mechanism and another in which the sleep disturbance is secondary to a medical or psychologic disorder Polygraphic studies have de ned yet another subgroup pseudoinsomniacs who actually sleep enough but who perceive their sleep time to be shortened Primary Insomnia This term should be reserved for the condition in which nocturnal sleep is disturbed for prolonged periods and none of the symptoms of neurosis, depression, or other psychiatric or medical diseases can be invoked to explain the sleep disturbance In some of the patients, like those described by Hauri and Olmstead, the disorder is lifelong Unlike the rare individuals who seem to be satis ed with 4 h or even less of sleep a night, insomniacs suffer the effects of partial sleep deprivation and resort to all manner of drugs and various techniques to induce or maintain sleep Their lives come to revolve around sleep to such an extent that they have been called sleep pedants or sleep hypochondriacs Although statements of insomniacs are often not to be trusted, Rechtschaffen and Monroe have con rmed that most of them do indeed sleep for shorter periods, move and awaken more often, spend less time in stage 4 sleep than normal persons, and show a heightened physiologic arousal Personality inventories have disclosed a high incidence of psychologic disturbances in this group, but whether these are cause or effect is not clear Although victims of insomnia, regardless of the cause, tend to exaggerate the amount of sleep lost, primary insomnia should be recognized as an entity and not passed off as a neurotic quirk Secondary or Situational Insomnia This type of insomnia, which is usually transitory, can often be ascribed to pain or some other recognizable bodily disorder, such as drug or alcohol abuse or, most commonly, to anxiety, worry, or depression Of the medical disorders conducive to abnormal wakefulness, certain ones stand out pain in the joints or in the spine, abdominal discomfort.

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