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Abstract Insomnia is the most common sleep complaint. Insomnia is not a disease but a symptom arising from multiple environmental, medical, and mental disorders. Insomnia can be transient, short-term, or chronic in its presentation. Degenerative and vascular diseases involving the central nervous system (CNS) may impair sleep either as a result of the brain lesion or because of illness-related personal discomfort. Chronic insomnia can be caused by neurological conditions characterized by movement disorders starting or persisting during sleep that hinder sleep onset and/or sleep continuity. Three specific neurological conditions, Fatal familial insomnia, a human prion disease, Morvan’s chorea, an autoimmune limbic encephalopathy, and Delirium tremens, the well-known alcohol or benzodiazepine withdrawal syndrome, share a common clinical phenotype characterized by an inability to sleep associated with motor and autonomic activation. Agrypnia excitata (AE) is the term which aptly defines this generalized overactivation syndrome, whose pathogenetic mechanism consists in an intralimbic disconnection releasing the hypothalamus and brainstem reticular formation from corticolimbic control. Keywords:  Insomnia, Degenerative diseases, Movement disorders, Fatal familial insomnia, Morvan’s chorea, Delirium tremens, Agrypnia excitata

Introduction Poor sleep quality is the most common sleep complaint. Insomnia is when sleep is insufficient, inadequate or nonrestorative. Its prevalence varies considerably depending on the definition adopted. Epidemiologic evidence concludes that while one-fourth to one-third of the general population report transient or occasional difficulty falling and/or staying asleep, about 10% of the adult population present chronic complaints and seek help for insomnia [1, 2]. Increasing age

From: Clinical Handbook of Insomnia, Current Clinical Neurology Edited by: H.P. Attarian and C. Schuman, DOI 10.1007/978-1-60327-042-7_16, © Springer Science+Business Media, LLC 2003, 2010

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and female sex are the most important risk factors for chronic insomnia [1, 3]. The inadequate identification and treatment of insomnia has significant medical and public health implications. Chronic insomnia impairs occupational performance and quality of life [4]. Objective sleep measures, EEG activity, and physiological findings suggest that insomnia is not a state of sleep loss, but a disorder of hyperarousal present during both night and daytime [4, 5]. Several psychological and physiological factors such as the association with other medical complaints and/or psychological symptoms, particularly anxiousruminative personality traits, worry and depression can contribute to the onset and perpetuation of insomnia. Stressful life events (difficulties in interpersonal relationships, family discord, problems at work and financial troubles) may also determine poor sleep quality. Insomnia is not always a specific illness or disease but can often represent a symptom or consequence of other primary disorder