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Insomnia

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Insomnia
SpecialtyNeurology, psychiatry, neuroscience, psychology Edit this on Wikidata
This article is about the sleeping disorder. For other uses, see Insomnia (disambiguation).

Insomnia is a sleep disorder characterized by an inability to sleep and/or inability to remain asleep for a reasonable period. Insomniacs typically complain of being unable to close their eyes or "rest their mind" for more than a few minutes at a time. Both organic and nonorganic insomnia constitute a sleep disorder.[1][2] It is often caused by fear, stress, anxiety, medications, herbs, caffeine, depression, Bipolar disorder or sometimes for no apparent reason. An overactive mind or physical pain may also be causes. Finding the underlying cause of insomnia is usually necessary to cure it.

Types of insomnia

Insomnia, Tacuinum sanitatis casanatensis (XIV century)

Three types of insomnia exist: transient, acute, and chronic

  1. Transient insomnia lasts from one night to a few weeks but it seems longer. Most people occasionally suffer from transient insomnia due to such causes as jet lag or short-term anxiety. If this form of insomnia continues to occur from time to time, the insomnia is classified as intermittent.
  2. Acute insomnia is the inability to consistently sleep well for a period of between three weeks to six months.
  3. Chronic insomnia is regarded as the most serious; persists almost nightly for at least a month.

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 any of this, 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.[citation needed] Urination produces strong signals to the brain to wake up.[citation needed] Nocturnal polyuria can be nephrogenic (related to kidney disease) or it may be due to prostate enlargement or hormonal influences.[citation needed] 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.[citation needed] Excessive thirst or the use of diuretics can also cause these symptoms.[citation needed]

How much sleep is needed?

Some people get an average of 8 to 10 hours of sleep, and always feel tired, drowsy, low on energy, and complain about “poor sleep”, or “sleep deprivation”, and try to compensate by sleeping even longer. In reality, they are sleeping too much, and decreasing the “quality” of their sleep as well as their energy levels.

The most important fact about sleep is that Quality counts, not Quantity.

Children Sleep problems

Signs that a child has a problem with sleep might include the following:

• The parent spends too much time “helping” your child fall asleep.

• The child wakes up many times during the night.

• The child’s behavior and mood are affected by poor sleep.

• The parent loses sleep as a result of the child’s sleeping patterns.The child’s poor sleep hurts the parents relationship with the child.

• The child constantly tosses and turns during sleep.

Most sleep problems in children can be corrected quickly once detected. Talking with other parents and with the doctor will help. For more rare or severe problems, consult a sleep specialist.

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.

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 non-benzodiazepine drugs can also cause physical dependence which manifests in withdrawal symptoms if the drug is not carefully titrated down.

Many insomniacs rely on sleeping tablets and other sedatives to get rest. The most commonly used class of hypnotics prescribed for insomnia are the benzodiazepines. This includes drugs such as temazepam, diazepam, lorazepam, flurazepam, nitrazepam and midazolam. These medications can be addictive, especially after taking them over long periods of time.

Recent research has shown that cognitive behavior therapy can be more effective than medication in controlling insomnia [1]. In this therapy, patients are taught improved sleep habits and relieved of counter-productive assumptions about sleep.

Non-benzodiazepine prescription drugs, including Ambien and Lunesta, have a cleaner side effect profile than the older benzodiazepines; however, there are controversies over whether these non-benzodiazepine drugs are superior to benzodiazepines. These drugs appear to cause both psychological dependence and physical dependence, and can also cause the same memory and cognitive disturbances as the benzodiazepines along with morning sedation.

Melatonin has proved effective for some insomniacs in regulating the sleep/waking cycle, but lacks definitive data regarding efficacy in the treatment of insomnia.

Melatonin agonists, including Ramelteon (Rozerem), seem to lack the potential for abuse and dependence. This class of drugs has a relatively mild side effect profile and lower likelihood of causing morning sedation.

The antihistamine diphenhydramine is widely used in nonprescription sleep aids, with a 50 mg recommended dose mandated by the FDA. In the United Kingdom, Australia, New Zealand, South Africa, and other countries, a 50 to 100 mg recommended dose is permitted. While it is available over the counter, the effectiveness of these agents may decrease over time and the incidence of next-day sedation is higher than for most of the newer prescription drugs. Dependence does not seem to be an issue with this class of drugs.[citation needed]

Some antidepressants such as mirtazapine, trazodone and doxepin have a sedative effect, and are prescribed off label to treat insomnia. The major drawback of these drugs is that they have antihistaminergic, anticholinergic and antiadrenergic properties which can lead to many side effects. Some also alter sleep architecture.

Low doses of atypical antipsychotics such as quetiapine (Seroquel) are also prescribed for their sedative effect but the danger of neurological and cognitive side effects make these drugs a poor choice to treat insomnia.[citation needed]

Some insomniacs use herbs such as valerian, chamomile, lavender, hops, and passion-flower. Valerian has undergone the most studies[citation needed] and appears to be modestly effective[citation needed].

Alcohol may have sedative properties, but the REM sleep suppressing effects of the drug prevent restful, quality sleep.[citation needed] Middle-of-the-night awakenings due to polyuria or other effects from alcohol consumption are common, and hangovers can also lead to morning grogginess.

Marijuana has been known to act as a sleep-aid.

Some traditional remedies for insomnia have included drinking warm milk before bedtime, taking a warm bath in the evening; exercising vigorously for half an hour in the afternoon, eating a large lunch and then having only a light evening meal at least three hours before bed, avoiding mentally stimulating activities in the evening hours, and making sure to get up early in the morning and to retire to bed at a reasonable hour.

Pomegranates are also believed to help insomniacs sleep.

Warm milk contains high levels of tryptophan, a natural sedative. Using aromatherapy, including jasmine oil, lavender oil, Mahabhringaraj and other relaxing essential oils, may also help induce a state of restfulness. Adding honey to warm milk helps the body to absorb the tryptophan more quickly.[citation needed] Tryptophan absorption is normally inhibited or deterred by other amino acids but in the presence of sugar tryptophan is absorbed more quickly. [citation needed] Horlicks[2] has been shown to help.[citation needed]

Many believe that listening to slow paced music will help insomniacs fall asleep. This theory is being studied by professor Jedediah Fajman at the University of Illinois.

The more relaxed a person is, the greater the likelihood of getting a good night's sleep. Relaxation techniques such as meditation have been shown to help people sleep. Such techniques can lower stress levels from both the mind and body, which leads to a deeper, more restful sleep.[citation needed]

The dangers of Sleeping Pills

The following information points out some important reasons why sleeping pills should not be considered.

• Those who use sleeping pills have significantly higher mortality rates than those who do not

• Sleeping pills (even the newer generations) do little or nothing to improve chronic insomnia and cause long-term chemical dependency

• Sleeping pills reduce brain cell activity during the day, affecting short-term memory as well as causing a hangover effect

• Sleeping pills accentuate the GABA neurotransmitter, which keeps the nerve cells in the lung tissue from firing. This is why an overdose of sleeping pills will cause asphyxiation and over 1000 overdose related deaths each year

• GABA actuation is also responsible for impaired physical ability. Each year, thousands of traffic deaths, accidents and falls (especially in the elderly) are attributed to sleeping pills

• Sleep Apnea Patients should never take sleeping pills. Sleeping pills increase the pauses and length of pause in breathing. Someone with sleep apnea could suffer brain or ocular damage from the lack of oxygen or even death

• Anyone over the age of 40 should be cautioned against sleeping pills, and anyone over the age of 65 should never take sleeping pills. Studies show that almost all people over 40 have some symptoms of sleep apnea, and anyone over 65 would be clinically diagnosed with sleep apnea

• Sleeping pills create a hypnotic dependency similar to alcohol and lower inhibitions and fear of pain or consequences. This is one reason why sleeping pills contribute to accidents and why chronic sleeping pill users are less likely to worry or take care of themselves

• Sleeping pills are highly addictive. Sleeping pills are similar to barbiturates and are extremely difficult to stop using

• Although sleeping pills do not improve daytime functioning, people still prefer taking them because of the barbiturate feel-good effect they produce. As with many addictive drugs, they may not be helpful, but the patient feels good when taking them.

Alternative approaches

Traditional Chinese medicine has included treatment for insomnia. A typical approach may utilize acupuncture, dietary and lifestyle analysis, herbology and other techniques, with the goal of resolving the problem at a subtle level. Although these methods have not been scientifically proven, some insomniacs report that these remedies are sufficient to break the insomnia cycle without the need for sedatives and sleeping tablets[citation needed].

In the Buddhist tradition, people suffering from insomnia or nightmares may be advised to meditate on "loving-kindness", or metta. This practice of generating a feeling of love and goodwill is claimed to have a soothing and calming effect on the mind and body[3]. This is claimed to stem partly from the creation of relaxing positive thoughts and feelings, and partly from the pacification of negative ones. In the Mettā Sutta, Siddhartha Gautama, the Buddha, tells the gathered monks that easeful sleep is one benefit of this form of meditation.

There are a number of alternative cures for this disorder that are marketed. Often, a combination of dietary and lifestyle changes is claimed to be the most helpful approach. However, it should be noted the reason they are considered "alternative" medical treatments is the lack of empirical evidence to back up such claims. There are always studies going on to either confirm or deny the effectiveness of such medicine, but in many cases even if no effect is shown to exist in a treatment, proponents will still believe in their effectiveness.

Statistics for insomnia

According to the U.S. Department of Health and Human Services, approximately 60 million Americans suffer from insomnia each year.[4] Insomnia tends to increase with age and affects about 40 percent of women and 30 percent of men [5]. The average American gets 7 hours of sleep, instead of the 8 to 10 hours recommended by doctors. Children however are recommended more than 8 hours.

Movies

Books

Songs

Music Producers

See also

Insomnia - Electric President

References

Jacobs, PhD, Gregg (September 27, 2004). "Cognitive Behavior Therapy and Pharmacotherapy for Insomnia: A Randomized Controlled Trial and Direct Comparison". Archives of Internal Medicine. 164 (17): 1888–1896. {{cite journal}}: Check |authorlink= value (help); External link in |authorlink= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

  1. ^ http://www3.who.int/icd/currentversion/fr-icd.htm?gf50.htm+f510
  2. ^ http://www3.who.int/icd/currentversion/fr-icd.htm?gg40.htm+g47
  3. ^ Lutz, A., Greischar, L.L., Rawlings, N.B., Ricard, M., and Davidson, R.(2004). Long-term meditators self-induce high-amplitude gamma synchrony during mental practice. Proc. Natl. Acad. Sci. USA 101,16369–16373.
  4. ^ http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm
  5. ^ http://www.womenshealth.gov/faq/insomnia.htm
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