Insomnia

The medical term "insomnia" originates from Latin and is translated as "no sleep. "

Insomnia can be most generally described as a complaint of insufficient or inadequate sleep despite the opportunity for sleep. Although insomnia is common in our society, population-based and clinic-based epidemiologic studies have resulted in varying estimates of this public health problem, depending upon methodological tools and definitions employed.

What is insomnia? what causes it?

Insomnia is a problem that causes people to have trouble either fall asleep or stay asleep. It can cause you to be tired and sleepy during the daytime, and you may have difficulty paying attention at school or being alert at work. Insomnia sometimes lasts only several days, but other times the problem may continue for several weeks to months.

Insomnia can appear because of stress, relationship problems, an illness, death, or divorce. Other causes include the use of stimulants (such as caffeine), alcohol, bright lights, and shift work.

Classification of insomnia

Insomnia signs and symptoms

  • Restlessness when trying to fall asleep.
  • Brief sleep followed by wakefulness.
  • Normal sleep until very early in the morning (3 a.m. or 4 a.m.), then wakefulness (often with frightening thoughts).
  • Periods of sleeplessness, alternating with periods of excessive sleep or sleepiness at inconvenient times.

Although various definitions have been used to distinguish between acute and chronic insomnia, this disorder is sometimes classified as either primary or secondary (also referred to as "comorbid") insomnia, based on the presumed etiology. Comorbid insomnia has been suggested as the preferred terminology to minimize the perception that secondary insomnia may not require medical attention or treatment.

Most patients (approximately 80% - 85%) with the disorder present with comorbid insomnia. The underlying cause of insomnia must be fully investigated to avoid unnecessarily exposing patients with comorbid insomnia to sedative hypnotic agents and their adverse effects. The diagnosis of primary insomnia is typically considered only after all other secondary causes have been ruled out.

The duration of symptoms also has been used to distinguish between acute and chronic insomnia. Insomnia can be described as: transient/short-term (occurring 2-3 nights in a single week), short-term (occurring nightly for 1-4 weeks), intermittent (occurring episodically), and chronic. Because of the lack of consensus for a definition of chronic insomnia, diagnosis in clinical trials has been based on symptoms persisting for a minimum duration of 30 days to as long as 1 year.

Many medical, psychiatric, and sleep disorders, as well as their pharmacologic treatments, may contribute significantly to the emergence of symptoms of insomnia. Several commonly recognized medical causes of insomnia include pain disorders, cancer, chronic breathing disorders (e. g. , asthma, sleep apnea), cardiovascular diseases (e. g. , angina, arrhythmias, heart failure), gastrointestinal disorders (e. g. , reflux disease, ulcer disease), human immunodeficiency virus/acquired immunodeficiency syndrome, and neurologic diseases (e. g. , Parkinson's disease, Alzheimer's disease, seizure disorder).

Commonly seen psychiatric comorbidities include major depression, schizophrenia, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, generalized anxiety, substance abuse (including cigarette smoking, prescription and OTC drugs, caffeine, or alcohol), and dementia. Approximately 40% of patients with chronic insomnia have a corresponding psychiatric diagnosis of depression, anxiety, or substance abuse.

Finally, insomnia also can present as an adverse effect of pharmacotherapy. Several classes of medications (e. g. , anticonvulsants, bronchodilators, selective serotonin reuptake inhibitors, steroids, decongestants, stimulants) have been reported to cause insomnia.

Diagnosis of insomnia

The diagnosis of insomnia is usually based on the presence, duration, and severity of clinical symptoms; however a thorough medical history and physical examination also help to identify additional precipitating factors of insomnia. Specific diagnostic interventions should include an interview with the patient as well as the bed partner to accurately document the characteristics and patterns of the sleep disorder. Objective criteria used in clinical research to define insomnia include a delay of 30 minutes or more in sleep-onset latency, premature awakenings with less than 6. 5 hours of sleep, or a sleep efficiency ratio (time asleep:time in bed) below 85%.

Occasionally, if sleep apnea or other sleep disorder is suspected, an individual may be referred to a specialized sleep center where evaluative sleep studies (including multichannel polysomnography or actigraphy) will be performed. These technical measures can reveal abnormalities of relevant parameters of sleep architecture including changes in sleep stages (rapid eye movement [REM] and non-REM sleep) and the time in each stage.

Although transient insomnia is a short-lived phenomenon, 30% to 80% of patients with moderate to severe insomnia do not have symptom improvement over time. In many instances insomnia becomes a chronic condition, at times indistinguishable from comorbid medical or psychiatric conditions.

To best manage insomnia of any duration, a comprehensive assessment to evaluate pertinent risk factors and comorbidities should be undertaken by the primary health care provider.

How is Insomnia treated?

  • Sleep-inducing drugs may be prescribed for a short time if: Temporary insomnia is interfering with your daily activities; you have a medical disorder that regularly disturbs sleep; you need to establish regular sleep patterns.
  • Long-term use of sleep inducers may be counter productive or addictive. Don't use sleeping pills given to you by friends.

Medications

Ambien (Zolpidem), Soma (Carisoprodol), Ativan (Lorazepam), Klonopin (Clonazepam), Xanax (Alprazolam), Valium (Diazepam), Remeron (Mirtazapine), Desyrel (Trazodone)

Activity

  • Exercise regularly to create healthy fatigue, but not within 2 hours of going to bed.
  • Have sexual relations, if they are fulfilling and satisfying, before going to sleep.

Diet

No special diet, but don't eat within 3 hours of bedtime if indigestion has previously disturbed your sleep. Drinking a glass of warm milk before bedtime helps some people.

What can i do to help my insomnia?

Try these healthy habits to help you get a good night's sleep:

  • Do not go to bed unless you are sleepy.
  • If you are not asleep after 20 minutes, then get out of bed and find a relaxing activity in a different room before you try to sleep again in your bedroom.
  • Use rituals that help you relax each night before bed (such as taking a warm bath).
  • Get up at the same time every morning, even on holidays and weekends.
  • Avoid taking naps.
  • Avoid nicotine, alcohol, and caffeine before bedtime.
  • Use your bedroom only for sleep and sex; avoid eating, watching TV, talking on the phone, or using other electronic devices in bed.
  • Avoid strenuous exercise before bedtime.
  • Make your bedroom quiet, dark, and a bit cool.

Last updated 7 August 2011


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