Definition:Insomnia is a sleeping disorder characterized by persistent difficulty falling asleep or staying asleep despite the opportunity. It is typically followed by functional impairment while awake. Insomniacs have been known to complain about being unable to close their eyes or “rest their mind” for more than a few minutes at a time. Both organic and non-organic insomnia constitute a sleep disorder.
According to the U.S. Department of Health and Human Services, approximately 60 million Americans suffer from insomnia each year. Insomnia tends to increase with age and affects about 40 percent of women and 30 percent of men.
Types of Insomnia:
At least three types of insomnia exist: transient, acute, and chronic.
Transient insomnia lasts from days to weeks. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, or by stress. Its consequences – sleepiness and impaired psychomotor performance – are similar to those of sleep deprivation. If this form of insomnia continues to occur from time to time, the insomnia is classified as intermittent.
Acute insomnia is the inability to consistently sleep well for a period of between three weeks to six months.
Chronic insomnia lasts from months to years. It can be caused by another disorder, or it can be a primary disorder. Its effects can vary according to its causes. They might include sleepiness, muscular fatigue, and/or mental fatigue; but people with chronic insomnia often show increased alertness.
Insomnia can be caused by:
*Psychoactive drugs or stimulants, including certain medication, herbs, caffeine, cocaine, ephedrine, amphetamines,
* methylphenidate, MDMA, methamphetamine and modafinil
*Hormone shifts such as those that precede menstruation and those during menopause
*Psychological problems like fear, stress, anxiety, emotional or mental tension, work problems, financial stress,
*unsatisfactory sex life
*Mental Disorders such as clinical depression, bipolar disorder, general anxiety disorder
*Disturbances of the circadian rhythm, such as shift work and jet lag can cause an inability to sleep at some times of the day and excessive sleepiness at other times of the day. Jet lag is seen in people who travel through multiple time zones, as the time relative to the rising and setting of the sun no longer coincides with the body’s internal concept of it. The insomnia experienced by shift workers is also a circadian rhythm sleep disorder.
*Certain neurological disorders, brain lesions, or a history of traumatic brain injury
*Medical conditions such as Hyperthyroidism and Wilson’s syndrome
*Abuse of over-the counter or prescription sleep aids can produce rebound insomnia
*Poor sleep hygiene
*Parasomnia, which includes a number of disruptive sleep events including nightmares, sleepwalking, violent behavior while sleeping, and REM behavior disorder, in which a person moves his/her physical body in response to events within his/her dreams
*A rare genetic condition can cause a prion-based, permanent and eventually fatal form of insomnia called fatal familial insomnia.
A common misperception is that the amount of sleep a person requires decreases as he or she ages. The ability to sleep for long periods, rather than the need for sleep, appears to be lost as people get older. Some elderly insomniacs toss and turn in bed and occasionally fall off the bed at night, diminishing the amount of sleep they receive.
An overactive mind or physical pain may also be causes. Finding the underlying cause of insomnia is usually necessary to cure it. Insomnia can be common after the loss of a loved one, even years or decades after the death, if they have not gone through the grieving process.
Patients with delayed sleep phase syndrome are often mis-diagnosed with insomnia. If the patient has trouble getting to sleep, but has normal sleep architecture once asleep, a circadian rhythm disorder is a more likely cause.
Insomnia Versus Poor Sleep Quality
Poor sleep quality can occur as a result of sleep apnea or major depression. Poor sleep quality is caused by the individual not reaching stage 4 or delta sleep which has restorative properties. There are, however, people who are unable to achieve stage 4 sleep due to brain damage who still lead perfectly normal lives.
Sleep apnea is a condition that occurs when a sleeping person’s breathing is interrupted, thus interrupting the normal sleep cycle. With the obstructive form of the condition, some part of the sleeper’s respiratory tract loses muscle tone and partially collapses. People with obstructive sleep apnea often do not remember awakening or having difficulty breathing, but they complain of excessive sleepiness during the day. Central sleep apnea interrupts the normal breathing stimulus of the central nervous system, and the individual must actually wake up to resume breathing. This form of apnea is often related to a cerebral vascular condition, congestive heart failure, and premature aging.
Major depression leads to alterations in the function of the hypothalamus and pituitary causing excessive release of cortisol which can lead to poor sleep quality.
Nocturnal polyuria or excessive nighttime urination can be very disturbing to sleep. Nocturnal polyuria can be nephrogenic (related to kidney disease) or it may be due to prostate enlargement or hormonal influences. Deficiencies in vasopressin, which is either caused by a pituitary problem or by insensitivity of the kidney to the effects of vasopressin, can lead to nocturnal polyuria. Excessive thirst or the use of diuretics can also cause these symptoms.
Treatment for Insomnia:
In many cases, insomnia is caused by another disease or psychological problem. In this case, medical or psychological help may be useful.
Many insomniacs rely on sleeping tablets and other sedatives to get rest. All sedative drugs have the potential of causing psychological dependence where the individual cannot psychologically accept that they can sleep without drugs. Certain classes of sedatives such as benzodiazepines and newer nonbenzodiazepine drugs can also cause physical dependence which manifests in withdrawal symptoms if the drug is not carefully titrated down.
In comparing the options, a systematic review found that benzodiazepines and nonbenzodiazepines have similar efficacy which was insignificantly more than for antidepressants. Benzodiazepines had an insignificant tendency for more adverse drug reactions.
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