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             Comorbid insomnia, sometimes known as secondary insomnia, refers to sleeping problems associated with medical or psychiatric issues.

Restless leg syndrome, arthritis, back pain, and obstructive sleep apnea are examples of medical issues that can be connected to sleep problems.

Psychiatric issues associated with insomnia include depression, bipolar disorder, and substance abuse disorders.

According to the American Academy of Sleep Medicine, surveys suggest that approximately 2-3% of the general population has insomnia due to medical or psychiatric conditions.  This percentage represents a relatively small minority of all people with sleeping problems.  However, determining whether or not there are any accompanying issues to be addressed is one of the most important reasons to see your doctor before starting the STS.

In order to successfully treat comorbid forms of insomnia, the associated medical or psychiatric issues must be addressed with a health care professional.


            How primary insomnia may evolve in normal sleepers      

The vast majority of us experience a short term problem with sleeping at some point in our lives.  This typically results from a stressful experience – a problem with a relationship, loss of a loved one, jobs, money, health, or a host of other everyday problems we all face.

For most people, short-term insomnia diminishes over time as the problem is either resolved or we adapt to it in some way.  Sleep disturbances fade away completely and our natural sleep system recovers back to normal functioning.

However, for some of us, short term insomnia can evolve into a primary concern about sleeping independent of the problem that originally caused it.  In other words, worry about sleep replaces the original source of stress.  Sleep itself becomes the stressor.  When that happens, insomnia can be perpetuated by a near constant stream of worry.  This is how short term insomnia evolves into primary insomnia for many otherwise normal people. 

When worry about sleep becomes excessive, a number of unintended consequences may occur.  Many hours at night are spent awake and frustrated; so bed time understandably begins to be associated with dread.  Thoughts like “Oh no, here we go again, another night of tossing and turning” become automatically connected, subconsciously, with the idea of sleeping.  Just the sight of bed triggers worry.  The thought of sleeping becomes a concern, a source of stress.

Once worry about sleep becomes a problem in and of itself, many people inadvertently respond in ways that only worsen their ability to get a good night’s sleep.

Such common counterproductive behaviors include:

  • Drinking alcohol before bed to get drowsy.
  • Cutting back or eliminating exercise due to fatigue from sleeplessness.
  • Trying to force sleep and instead lying awake tossing and turning in frustration.
  • Compulsively checking the clock, hour after hour, night after night, to see how much time it’s taking to fall asleep, or fall back asleep, and feeling all the worse because of it.
  • Spending more time in bed, especially on weekends, trying to catch up on lost sleep.