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What is Insomnia ?
Insomnia refers to the inability to
get sufficient or adequate amount of sleep. It is characterized
by poor quality of sleep and the difficulty may be either in
initiating or in maintaining sleep or both. Insomnia is a sleep
disorder in which there is difficulty in sleeping and/or
remaining asleep for a reasonable period of time at night. In
patients of insomnia, sleep is broken by frequent awakening and
therefore not refreshing or restorative. Insomnia is not a
disease but the sensation of daytime fatigue and impaired
performance caused by insufficient sleep. Sleep deprivation, and
the daytime sleepiness that follows, is increasingly recognized
as a cause of mood disruption and contributor to industrial
errors and motor vehicle crashes. Insomnia is not defined by the
number of hours of sleep, but rather by an individuals ability
to sleep long enough to feel healthy and alert during the day.
Insomnia is a disturbance in sleep that makes sleep seem
inadequate or unrefreshing.
Types of Insomnia
Insomnia can be classified as transient, intermittent, and
chronic insomnia. Insomnia is also characterized as primary or
secondary insomnia.
Transient insomnia It is also known as short term insomnia.
Disturbed sleeping pattern lasting from a single night to a few
weeks is referred to as transient insomnia.
Intermittent insomnia If episodes of transient insomnia occur
from time to time, the insomnia is said to be intermittent.
Chronic insomnia Insomnia is considered to be chronic if it
occurs constantly and lasts a month or more.
Insomnia is also characterized as primary or secondary chronic
insomnia depending on its cause.
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Primary chronic insomnia Primary
insomnia is a sleep disturbance that occurs without any specific
underlying condition.
Secondary chronic insomnia Secondary insomnia is a sleep
disturbance caused by a specific physical or psychological
condition. Secondary insomnia is more common than primary
insomnia. Multiple conditions can result in secondary insomnia.
Symptoms
of Insomnia
Signs and symptoms of insomnia may include:
Difficulty in falling asleep at night, and people commonly lie
in bed tossing and turning for hours.
Awakening during sleep and having trouble getting back to
sleep, that there is difficulty in maintaining continuous sleep. |
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Sometimes people with insomnia
wakes in the early hours of the morning and either there are
unable to go back to sleep, or they drift into a restless.
Sometimes sleep patterns are reversed and the individual has
difficulty staying awake during the day and takes frequent naps.
The sleep at night is fitful and frequently interrupted.
Daytime irritability, drowsiness, anxiety, and/or
nonproductive ness.
Poor concentration and focus.
Difficulty with memory.
Impaired motor coordination.
Impaired social interaction.
Sleeplessness is also common during pregnancy, especially in
the later weeks.
Causes
of Insomnia
Insomnia affects all age groups. Among older adults, insomnia
affects women more often than men. The incidence increases with
age.
Transient/Short term insomnia: A reaction to change or stress is
one of the most common causes of short-term and transient
insomnia. Short-term insomnia can be linked to events and
factors that are often temporary, such as:
Stress A temporary stress (conflict or environmental change)
such as starting a new job; an upcoming test at school; a family
or marriage problem; financial difficulties; a death in the
family; or moving to a new house or city can be a cause of
insomnia.
Change in the environment or work schedule such as working a
late or early shift.
Jet lag. Air travel across time zones often causes brief bouts
of insomnia.
Medications. Insomnia can be a side effect of various
medications.
Overuse of caffeine and nicotine- Excess caffeine is known to
disrupt sleep. Nicotine at times, may cause insomnia. However,
quitting smoking can also cause transient insomnia.
Environmental noise, extreme temperatures, or a change in a
person's surrounding environment.
Fluctuations in female hormones play a major role in insomnia
in women over their lifetimes. Such insomnia is most often
temporary.
Chronic Insomnia: Chronic insomnia is more complex and results
from a combination of factors. Chronic insomnia most often
follows transient insomnia. Some of the factors leading to
chronic insomnia includes:
Psychological
Depression. Sleep abnormalities are an integral part of
depressive disorders, with more than 90% of depressed patients
experiencing insomnia.
Anxiety, a condition in which individuals feel increased
tension, apprehension, and feelings of helplessness, fear,
worry, and uncertainty due to financial worries, work load,
strained relationships.
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Physical
Decreased melatonin, the hormone that controls sleep, as a
person ages.
Medical conditions such as allergies, arthritis, asthma, heart
disease, high blood pressure, hyperthyroidism, parkinsons
disease.
Genetics. Problems with insomnia do seem to run in some
families, although researchers have yet to identify how genetics
play a role.
Other sleep disorders including sleep apnea (in which one
temporarily stops breathing during sleep) and periodic leg and
arm movements during sleep.
Secondary insomnia mostly refers to insomnia caused by a
psychiatric disorder (most often depression) or a medical
disorder (most often chronic pain). Secondary insomnia may occur
as a result of medication side effects. Antidepressant, high
blood pressure and corticosteroid medications, can cause
sleeping difficulties as a side effect.
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Diagnosis of Insomnia
Diagnosing sleep disturbance and its cause is the most important
step in restoring healthy sleep. The diagnosis of insomnia is
made by a physician based on the patient's reported signs and
symptoms. The two most characteristic features of this disorder
are- excessive daytime tiredness, and memory and concentration
trouble. These two features are enough to call for sleep help.
It can be useful for the patient to keep a daily record for two
weeks of sleep patterns, food intake, use of alcohol,
medications, exercise. This together with a medical history and
physical examination can help the doctor confirm it as a case of
insomnia.
Treatment of Insomnia
The doctor may recommend relaxation techniques, changes in diet
and exercise, and a regular sleep routine.
Progressive Muscle Relaxation (PMR) PMR is a set of
exercises that can be used to reduce anxiety and stress at
bedtime.
Diaphragmatic breathing is a good way to keep the mind away
from stressful or anxious thoughts.
Daily exercise helps release excess anger and frustration.
Avoidance of daytime naps, and stimulating activities before
going to bed.
Dietary items to be avoided include drinks that contain
caffeine such as coffee, tea and colas, chocolate (which
contains a stimulant), and alcohol, which initially makes a
person sleepy but a few hours later can have the opposite
effect.
Sleep restriction technique may help obtain a normal sleep. In
this technique, a person only allowed to get a few hours sleep a
night; over time the hours of sleep are increased until a more
normal night's sleep is achieved.
Bright-light therapy is useful for people with a miss-set
internal clock. Exposure to bright light or light therapy is
one method to set the clock right.
In some cases medications may help patients sleep. Medications
given for insomnia include sedatives, tranquilizers, and
antianxiety drugs. Most of these medicines fall into a class of
drugs known as benzodiazepines, eg, Dalmane (flurazepam).
Halcion (triazolam). A newer class of drugs known as
"non-benzodiazepine, benzodiazepine receptor agonists" is now
widely used, eg, Zolpidem (Ambien), Zaleplon (Sonata). If the
insomnia is related to depression, then an antidepressant
medication may be helpful. Antidepressant medications most
commonly used include trazodone (Desyrel), amitriptyline (Elavil),
and doxepin (Sinequan).
One of the most recent "natural" remedies for insomnia has
been melatonin(hormone involved in the regulation of sleep and
wakefulness), which can be obtained at most health food stores.
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Article Contributed By: Shaonli
Dasgupta
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