Insomnia is a sleep disorder characterized by difficulty initiating and/or maintaining sleep. Insomnia plagues one in three American adults. Sufferers may experience the following:

  • Sleep is nonrestorative
  • Difficulty initiating sleep
  • Difficulty maintaining sleep
  • Poor quality of sleep
  • Final awakening occurs much earlier than desired
  • Daytime complaints such as fatigue, sleepiness, mood disturbance, cognitive difficulties that lead to social and/or occupational impairment

Terms such as “nonrestorative” or “poor quality” are used when sleep is subjectively shallow and un-refreshing despite being apparently normal in length and continuity. You can be tired and grumpy even if you don’t have insomnia. You may be worn-out from staying up too late at night. This does not mean that you have insomnia. Many people are sleepy during the day simply because they went to bed too late the night before. They don’t have a sleep disorder; they just didn’t get enough sleep. Everyone has an occasional night of bad sleep. For most people insomnia lasts only a few days and goes away without treatment. But stress or depression can cause a higher level of insomnia that may last for several weeks. This kind of insomnia may not go away on its own.

The following is a brief description of the more common insomnias.

Primary insomnia occurs when poor sleep arises from conditioned aversion to the bedroom or from subclinical emotional, cognitive, and/or physiologic turmoil. This means that if a person is having sleep problems that are not directly associated with any other health condition or problem the cause is primary insomnia.

Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition (like asthma, depression, arthritis, cancer, or heartburn); pain; medication they are taking; or a substance they are using (like alcohol). These external agents or disease processes are commonly implicated in sleep disturbance. Many sleep disorders cause insomnia.

Acute insomnia is short term and can last from one night to a few weeks. Causes of acute insomnia can include:

  • Significant life stress
  • Emotional or physical discomfort
  • Environmental factors that interfere with sleep
  • Some medications
  • Interferences in normal sleep schedule.

Chronic insomnia is when a person has insomnia at least three nights a week for a month or longer. Causes of Chronic insomnia include:

  • Depression and/or anxiety
  • Chronic stress
  • Pain or discomfort at night

Inadequate sleep hygiene is the result of bad sleep habits. These habits keep your sleep from being refreshing. They can also keep someone from feeling alert during the day. These activities are all things that people should be able to control. The following can be associated with bad sleep practices:

  • Alcohol may make and individual sleepy but is more likely to wake a person up during the night.
  • Drinking coffee, colas or tea that contain caffeine can make a person more alert.
  • The nicotine in a cigarette can “keep the edge” during the day. This “edge” is not always gone by the time it’s time to go to sleep.
  • Worry
  • Physical exercise right before bed
  • Irregular bedtimes and rise times
  • Naps late in the day
  • Noise, light, and a warm room

Many cases of insomnia will respond to changes that people can make on their own. One can often sleep better by simply following the practices of good sleep hygiene. With that said, because insomnia may arise from myriad causes, patients who present with insomnia complaints require a comprehensive assessment to determine appropriate diagnoses and treatment needs.


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