Unifying Concepts

ICSD Revised Classification of Adult Insomnia

Primary Insomnia

  • Idiopathic insomnia: Insomnia arising in infancy or childhood with a persistent, unremitting course
  • Psychophysiologic insomnia: Insomnia due to a maladaptive conditioned response in which the patient  learns to associate the bed environment with heightened arousal rather than sleep; onset often associated with an event causing acute insomnia, with the sleep disturbance persisting despite resolution of the precipitating factor
  • Paradoxical insomnia (sleep-state misperception): Insomnia characterized by a marked mismatch between the patient’s description of sleep duration and objective polysomnographic findings

Secondary Insomnia

  • Adjustment insomnia: Insomnia associated with active psychosocial stressors
  • Inadequate sleep hygiene: Insomnia associated with lifestyle habits that impair sleep
  • Insomnia due to a psychiatric disorder: Insomnia due to an active psychiatric disorder, such as anxiety or depression
  • Insomnia due to a medical condition: Insomnia due to a condition such as the restless leg’s syndrome, chronic pain, nocturnal cough or dyspnea, or hot flashes
  • Insomnia due to a drug or substance: Insomnia due to consumption or discontinuation of medication, drugs of abuse, alcohol, or caffeine


  1. The international classification of sleep disorders, revised: diagnostic and coding manual. Rochester, Minn.: American Sleep Disorders Association, 1997.
  2. Silber M. Chronic Insomnia. N Engl J Med 2005;353(8):803-810 [Medline]


Created: Aug 30, 2005

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