Insomnia

Adjustment insomnia

This type is also called as acute insomnia or short-term insomnia, disturbs your sleep and usually occurs because of stress. The sleep problem ends when the source of stress is gone or when you adapt to the stress. The stress does not always come from a negative experience. It has been observed that even something positive can make you too excited and not sleep well.

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Behavioural insomnia in children

This condition occurs when children don't go to bed on time unless a parent or guardian enforces a bedtime. If the children are made to go to bed at a specified time, then they tend to fall asleep at a normal hour. If they are not given strict bedtimes, then they may linger awake for hours at night.

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Idiopathic insomnia

Idiopathic insomnia is a lifelong sleep disorder that starts during infancy or childhood and continues into adulthood. This insomnia cannot be explained by other causes. It is not a result of any of the following.

• Other sleep disorders
• Medical problems
• Psychiatric disorders
• Stressful events
• Medication use
• Other behaviors

It may result from an imbalance in your body, such as an overactive awakening system and/or an underactive sleep system, but the true cause of this disorder is still unclear. Insomnia due to a drug or substance. This type of insomnia is directly related to the use of any of the following substances:

• Medication
• Caffeine
• Alcohol
• A food item

Your sleep is disrupted by your use of the any of the above substances. It may come as a surprise to you but this type of sleep problem may also occur when you stop using a substance.

Insomnia due to a medical condition

This type of insomnia is caused as a result of certain mental health disorders. Insomnia is a symptom of mental disorders. The course and severity of insomnia are directly linked to that of the mental health disorder, but this particular type of insomnia is a separate focus of treatment. This insomnia is a disorder only if it is severe enough to require separate treatment.

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Insomnia nonorganic, unspecified

This type of insomnia suggests that known substances and other physical causes of insomnia have been ruled out. This means that the cause of insomnia is most likely due to an underlying mental health disorder, psychological factor, or sleep-disruptive behaviours. This particular type may be predicted by doctors on a temporary basis while further evaluation and testing are being conducted. It is the name unspecified used when a person with insomnia does not meet the criteria for another type of insomnia.

Insomnia organic, unspecified

This type of insomnia is caused by a medical disorder, physical condition, or substance exposure. But the specific cause remains unclear. Further testing is required to discover the exact cause. The name may be used on a temporary basis while further evaluation and testing are completed.

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Paradoxical insomnia

Paradoxical insomnia is a complaint of severe insomnia. It occurs without objective evidence of any sleep disturbance. Daytime side effects of insomnia vary in severity, but they tend to be far less severe than one would expect given the state of the condition. People with this disorder often report little or no sleep for one or more nights. They also describe having an intense awareness of the external environment or internal processes consistent with being awake. This awareness suggests a state of hyperarousal. A key feature which can be highlighted is an overestimation of the time it takes them to fall asleep. They also underestimate their total sleep time.

Psychophysiological insomnia

This type of insomnia is associated with excessive worrying, specifically focused on not being able to sleep. Insomnia may begin suddenly following an event or develop slowly over many years.

People with this sleep disorder worry too much about their insomnia and about being tired the next day. As a result, they learn to become tense and anxious as bedtime approaches. They may have racing thoughts that all relate to insomnia and trying to fall asleep. As they worry about falling asleep, they become more and tenser, which makes it less likely that they will be able to fall asleep

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The definition of insomnia is “habitual sleeplessness or the inability to sleep.” Most of us in today's fast-paced life struggle to get a good night’s sleep, but insomnia is different because it’s an ongoing condition that causes sleep disruptions despite someone having the chance to get good sleep (for example, you can’t stay asleep even though you lay in bed for many hours at night).

Impairment of daytime functioning is the defining and the most common symptom of insomnia. There are many signs and symptoms that are associated with insomnia:

• Difficulty falling asleep at night.
• Waking during the night.
• Waking earlier than desired.
• Still feeling tired after a night's sleep.
• Daytime fatigue or sleepiness.
• Irritability, depression, or anxiety.
• Poor concentration and focus.
• Being uncoordinated, an increase in errors or accidents.
• Tension headaches (feels like a tight band around head).
• Difficulty socializing.
• Gastrointestinal symptoms.
• Worrying about sleeping.

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Insomnia can be caused by physical and psychological factors. There is sometimes an underlying medical condition that causes chronic insomnia, while transient insomnia may be due to a recent event or occurrence. Insomnia is commonly caused by:

• Disruptions in circadian rhythm due to reasons such as jet lag, job shift changes, high altitudes, environmental noise, extreme heat or cold.
• Psychological issues such as bipolar disorder, depression, anxiety disorders, or psychotic disorders.
• Medical conditions chronic pain, chronic fatigue syndrome, congestive heart failure, angina, acid-reflux disease, chronic obstructive pulmonary disease, asthma, sleep apnea, Parkinson's and Alzheimer's disease, hyperthyroidism, arthritis, brain lesions, tumours, stroke.
• Hormones such as estrogen, hormone shifts during menstruation.
• Other factors external factors such as sleeping next to a snoring partner, parasites, genetic conditions, overactive mind and pregnancy.
• Insomnia caused by stress and lifestyle factors

Common situational and stress factors leading to acute or adjustment insomnia may include:

• Physical discomfort (hot, cold, lighting, noise, unfamiliar surroundings)
• Working different shifts
• Stressful life situations (divorce or separation, a death of a loved one, losing a job, preparing for an examination)
• Illicit drug use
• Cigarette smoking
• Caffeine intake prior to going to bed
• Alcohol intoxication or withdrawal
• Certain medication

Risk Factors

• Insomnia can affect people of any age; it is more common in adult females than adult males. It can undermine school and work performance, as well as contributing to obesity, anxiety, depression, irritability, concentration problems, memory problems, poor immune system function, and reduced reaction time.
• Some people are more likely to experience insomnia. These include: travellers, particularly through multiple time zones
• shift workers with frequent changes in shifts (day vs. night)
• the elderly.
• users of illegal drugs.
• adolescent or young adult students.
• pregnant women.
• menopausal women.
• those with mental health disorders.

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Best way to prevent getting insomnia is to improve your "sleep hygiene". Improving sleep hygiene consists of the following strategies:

• Sleep as much as possible to feel rested, then get out of bed (do not over-sleep).
• Maintain a regular sleep schedule. Go to bed and wake up at the same time daily.
• Do not force yourself to sleep.
• Do not drink caffeinated beverages or other stimulants in the afternoon or evening.
• Do not drink alcohol prior to going to bed.
• Do not smoke, especially in the evening.
• Adjust the bedroom environment to induce sleep.
• Avoid watching television in bed and for 30 minutes before bed.
• Do not go to bed hungry, but avoid foods that may cause reflux.
• Resolve stress and anxiety before going to bed.
• Exercise regularly, but not 4-5 hours prior to bedtime.
• Using relaxation techniques: Examples include meditation and muscle relaxation.
• Stimulus control therapy only goes to bed when sleepy. Avoid watching TV, reading, eating, or worrying in bed. Set an alarm for the same time every morning (even weekends) and avoid long daytime naps.
• Sleep restriction: Sleep restriction refers to another non-medical behavioural therapy for insomnia which involves limiting the time spent in bed for sleeping only. Decreasing the time spent in bed and partially depriving the body of sleep can increase tiredness, ready for the next night.
• Many people aren’t aware that they suffer from low potassium or have signs of a magnesium deficiency, as both are crucial nutrients you need to help your body feel relaxed so you can sleep.

Evaluation and diagnosis of insomnia may start with a thorough medical and psychiatric patient history taken by the doctor or other healthcare professional. A doctor will perform an examination on the patient to assess for any abnormal findings as well. Portions of the exam may include:

• Assessment of mental status and neurological function
• Heart, lung and abdominal exam
• Ear, nose and throat exam
• Measurement of the neck circumference and waist size.
• Questions about any routine medications you are currently taking, and use of any illegal drugs, alcohol, tobacco, or caffeine.
• Laboratory or blood work pertinent to these conditions can also be a part of the assessment.
• Sleep patterns: The patient's family members and bed partners also need to be interviewed to ask about the patient's sleep patterns, snoring, or movements during sleep.
• Sleep habits: Specific questions regarding sleep habits and patterns are also a vital part of the assessment. A sleep history focuses on the below mentioned points.
  • Duration of sleep
  • Time of sleep
  • Time to fall asleep
  • Number and duration of awakenings
  • Time of final awakening in the morning
  • Time and length of any daytime naps
  • The typical sleep environment
• Sleep logs or diaries: Sleep logs or diaries may be used for this purpose to record these parameters on a daily basis for more accurate assessment of your sleep patterns.
• Sleep history: Sleep history also typically includes questions about possible symptoms associated with insomnia. You may be asked about daytime functioning, fatigue, concentration and attention problems, naps, and other common symptoms of the condition.

Diagnostic tests

• Polysomnography is a test that is done in sleep centres if medical conditions such as sleep apnea are suspected. In this test, the person will be required to spend a full night at the sleep centre while being monitored for heart rate, brain waves, respiration, movements, oxygen levels, and other parameters while they are sleeping. The data is then analyzed by a specially trained physician to diagnose or rule out sleep apnea or other disorders of sleep.
• Actigraphy: An actigraph is a motion detector that senses the person's movements during sleep and wakefulness. This test may be useful in cases of primary insomnia disorder, circadian rhythm disorder, or sleep state misconception.

Good sleep hygiene, including avoiding electronics before bed, can help treat insomnia. Some types of insomnia resolve when the underlying cause is treated or wears off. In general, insomnia treatment focuses on determining the cause. For example, if insomnia is related to a transient stressful situation, such as jet lag or an upcoming examination, it will then be cured when the situation resolves. Once identified, this underlying cause can be properly treated or corrected.

The treatment of insomnia depends largely on the cause of the problem. The treatment of insomnia can be divided into two therapies

• Non-medical or behavioural approaches
• Medical therapy: The main classes of medications used to treat insomnia are the sedatives and hypnotics, such as the benzodiazepines, non-benzodiazepine sedatives and antidepressant medications.

Several medications in the benzodiazepine class have been used successfully for the treatment of insomnia, and the most common ones include:

• quazepam (Doral),
• triazolam (Halcion),
• estazolam (ProSom).
• temazepam (Restoril).
• flurazepam (Dalmane).
• lorazepam (Ativan).

Non-benzodiazepine sedatives are also used commonly for the treatment of insomnia and include most of the newer drugs. Some of the most common ones are:

• zaleplon (Sonata),
• zolpidem (Ambien or Ambien CR), and
• eszopiclone (Lunesta).

Some anti-depressants trazodone (Desyrel amitriptyline (Elavil, Endep) or doxepin (Sinequan, Adapin)) can be used effectively to treat insomnia in patients who also may suffer from depression. Some anti-psychotics have been used to treat insomnia, although their routine use for this purpose is generally not recommended.

A doctor or sleep specialist is the best person to discuss these different medications and to decide which one may be the best for each specific individual. Many of these drugs have a potential for abuse and addiction and need to be used with caution. Several of these medications can not be taken without the supervision of the prescribing doctor. Both approaches are necessary to successfully treat the problem, and combinations of these approaches may be more effective than either approach alone.

According to the American Association of Retired Persons (AARP), the following medications can cause insomnia in some patients which causes complications:

• corticosteroids
• statins
• alpha blockers
• beta blockers
• SSRI antidepressants
• ACE inhibitors
• ARBs (angiotensin II-receptor blockers)
• cholinesterase inhibitors
• second generation (non-sedating) H1 agonists
• glucosamine/chondroitin