Insomnia

Insomnia
Insomnia
Specialty	Neurology, psychiatry, neuroscience, psychology

Insomnia is characterized by an inability to sleep and/or 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 or caffeine. An overactive mind or physical pain may also be causes. Finding the underlying cause of insomnia is usually necessary to cure it.

Classifying Insomnia

Medical Insomnia is classed as not being able to sleep (or sleeping for less than 4 hours at a time) for 14 hours straight. Deliberately staying awake does not constitute insomnia.

Types of insomnia

Three different types of insomnia exist. Insomnia may be classified as transient, acute (short-term), and chronic. Insomnia lasting from one night to a few weeks is referred to as transient. This is generally the case for most people, as one often suffers from jet lag or short-term anxiety. If this form of insomnia continues to occur from time to time, the insomnia is classified to be intermittent. Acute insomnia is the inability to consistently sleep well for a period of three weeks to six months. However, after this time, the person does not experience insomniatic episodes. Insomnia is considered to be chronic, the most serious, if it persists almost nightly for at least a month, and sometimes longer.

Common causes of insomnia

A person can have primary or secondary insomnia. Primary insomnia is sleeplessness that is not attributable to a medical or environmental cause. Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition, an example of which would be generalized anxiety disorder.

Some of the most common causes of insomnia are:

Circadian rhythm sleep disorders cause insomnia at some times of the day and excessive sleepiness at other times of the day. Common circadian rhythm sleep disorders include jet lag and delayed sleep phase syndrome. Jet lag is seen in people who travel through multiple time zones, as the time relative to the rising and falling 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.

Parasomnia includes a number of disorders of arousal or 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. These conditions can often be treated successfully through medical intervention or through the use of a sleep specialist.

Gastroesophageal Reflux Disease causes repeated awakenings during the night due to unpleasant sensations resulting from stomach acid flowing upward into the throat while asleep.

Mania or Hypomania in bipolar disorder can cause difficulty falling asleep. A person going through a manic or hypomanic episode may feel a reduced need for sleep. Sleep deprivation can worsen a manic episode, or cause hypomania to develop into mania.

Pain can produce insomnia and finding effective ways to treat pain can provide relief. A common misperception is that the amount of sleep one 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. ^[3]

Insomnia is a common side-effect of some medications, and it can also be caused by stress, emotional upheaval, physical or mental illness, dietary allergy and poor sleep hygiene. Insomnia is a major symptom of mania in people with bipolar disorder, and it can also be a sign of hyper-thyroidism, depression, or other ailments with stimulating effects.

In addition, a rare genetic condition can cause a prion-based, permanent and eventually fatal form of insomnia called Fatal Familial Insomnia.

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 is very restorative.

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 nightime urination can be very disturbing to sleep. Urination produces strong signals to the brain to wake up. Noctural 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 both lead to noctural 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. All sedative drugs have the potential of causing psychological dependence where the individual can't 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 carfully 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, nitrazepam and midazolam. These medications can be addictive, especially after taking them over long periods of time.

Non-benzodiazepine prescription drugs, including Ambien and Lunesta, are quickly replacing benzodiazepines as a first-line treatment for insomnia. There are controversies over whether these non-benzodiazepine drugs are superior to benzodiazpines. These drugs appear to cause both psychological and physical dependence, and can also cause the same memory and cognitive disturbances as the benzodiazepines along with morning sedation.

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 antihsitaminergic, anticholinergic and antiadrenergic properties which can lead to many side effects.

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.

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

Alcohol may have sedative properties, but the REM suppressing effects of the drug prevent restful, quality sleep. Hangovers can also lead to morning grogginess.

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 be able to help insomniacs sleep.

Traditional Chinese medicine has included treatment for insomnia throughout its history. 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]}. Warm milk contains high levels of tryptophan, a natural sedative. Using aromatherapy, including lavender oil and other relaxing essential oils, may also help induce a state of restfulness. Melatonin has proved effective for some insomniacs, mostly in regulating the sleep/waking cycle.

The more relaxed a person is, the greater the likelihood of getting a good night's sleep. Relaxation techniques such as meditation have been proven 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]}

Helpful advice:

Avoid all stimulating substances/activities such as caffeine and exercise before bedtime.

Avoid distractions in the bedroom including excessive light and noise, television, alarm clocks, etc.

Avoid stressful thoughts and feelings before bedtime and while attempting to fall asleep.

Combat worries and preoccupations about the day ahead by tending to plans and schedules before bedtime.

Background noise, such as a fan or soft rhythmic music, can serve to ease some individuals into sleep.

Alternative approaches

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^[4]. 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 currently 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 each year suffer from insomnia.^{[citation needed]} Insomnia tends to increase with age and affects about 40 percent of women and 30 percent of men ^[5].

References

External links

[1] ttp://www3.who.int/icd/currentversion/fr-icd.htm?gf50.htm+f510

[2] ttp://www3.who.int/icd/currentversion/fr-icd.htm?gg40.htm+g47

[3] ttp://www.aafp.org/afp/991001ap/1431.html

[4] 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.

[5] ttp://www.womenshealth.gov/faq/insomnia.htm

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