insomnia (redirected from Chronic insomnia)

Insomnia 

Definition

Insomnia is the inability to obtain an adequate amount or quality of sleep. The difficulty can be in falling asleep, remaining asleep, or both. People with insomnia do not feel refreshed when they wake up. Insomnia is a common symptom affecting millions of people that may be caused by many conditions, diseases, or circumstances.

Description

Sleep is essential for mental and physical restoration. It is a cycle with two separate states: rapid eye movement (REM), the stage in which most dreaming occurs; and non-REM (NREM). Four stages of sleep take place during NREM: stage I, when the person passes from relaxed wakefulness; stage II, an early stage of light sleep; stages III and IV, which are increasing degrees of deep sleep. Most stage IV sleep (also called delta sleep), occurs in the first several hours of sleep. A period of REM sleep normally follows a period of NREM sleep.

Insomnia is more common in women and older adults. People who are divorced, widowed, or separated are more likely to have the problem than those who are married, and it is more frequently reported by those with lower socioeconomic status. Short-term, or transient, insomnia is a common occurrence and usually lasts only a few days. Long-term, or chronic insomnia lasts more than three weeks and increases the risk for injuries in the home, at the workplace, and while driving because of daytime sleepiness and decreased concentration. Chronic insomnia can also lead to mood disorders like depression.

Causes and symptoms

Transient insomnia is often caused by a temporary situation in a person's life, such as an argument with a loved one, a brief medical illness, or jet lag. When the situation is resolved or the precipitating factor disappears, the condition goes away, usually without medical treatment.

Chronic insomnia usually has different causes, and there may be more than one. These include:

• A medical condition or its treatment, including sleep apnea
• Use of substances such as caffeine, alcohol, and nicotine
• Psychiatric conditions such as mood or anxiety disorders
• Stress, such as sadness caused by the loss of a loved one or a job
• Disturbed sleep cycles caused by a change in work shift
• Sleep-disordered breathing, such as snoring
• Periodic jerky leg movements (nocturnal myoclonus), which happen just as the individual is falling asleep
• Repeated nightmares or panic attacks during sleep.

Another cause is excessive worrying about whether or not a person will be able to go to sleep, which creates so much anxiety that the individual's bedtime rituals and behavior actually trigger insomnia. The more one worries about falling asleep, the harder it becomes. This is called psychophysiological insomnia.

Symptoms of insomnia

People who have insomnia do not start the day refreshed from a good night's sleep. They are tired. They may have difficulty falling asleep, and commonly lie in bed tossing and turning for hours. Or the individual may go to sleep without a problem but wakes in the early hours of the morning and is either unable to go back to sleep, or drifts into a restless unsatisfying sleep. This is a common symptom in the elderly and in those suffering from depression. 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.

Diagnosis

The diagnosis of insomnia is made by a physician based on the patient's reported signs and symptoms. 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, and any other information recommended by the physician. If the patient has a bed partner, information can be obtained about whether the patient snores or is restless during sleep. This, together with a medical history and physical examination, can help confirm the doctor's assessment.

A wide variety of healthcare professionals can recognize and treat insomnia, but when a patient with chronic insomnia does not respond to treatment, or the condition is not adequately explained by the patient's physical, emotional, or mental circumstances, then more extensive testing by a specialist in sleep disorders may be warranted.

Treatment

Treatment of insomnia includes alleviating any physical and emotional problems that are contributing to the condition and exploring changes in lifestyle that will improve the situation.

Changes in behavior

Patients can make changes in their daily routine that are simple and effective in treating their insomnia. They should go to bed only when sleepy and use the bedroom only for sleep. Other activities like reading, watching television, or snacking should take place somewhere else. If they are unable to go to sleep, they should go into another room and do something that is relaxing, like reading. Watching television should be avoided because it has an arousing effect. The person should return to bed only when they feel sleepy. Patients should set the alarm and get up every morning at the same time, no matter how much they have slept, to establish a regular sleep-wake pattern. Naps during the day should be avoided, but if absolutely necessary, than a 30 minute nap early in the afternoon may not interfere with sleep at night.

Another successful technique is called sleep-restriction therapy, which restricts the amount of time spent in bed to the actual time spent sleeping. This approach allows a slight sleep debt to build up, which increases the individual's ability to fall asleep and stay asleep. If a patient is sleeping five hours a night, the time in bed is limited to 5-5 1/2 hours. The time in bed is gradually increased in small segments, with the individual rising at the same time each morning; at least 85% of the time in bed must be spent sleeping.

Drug therapy

Medications given for insomnia include sedatives, tranquilizers, and antianxiety drugs. All require a doctor's prescription and may become habit-forming. They can lose effectiveness over time and can reduce alertness during the day. The medications should be taken two to four times daily for approximately three to four weeks, though this will vary with the physician and patient. If the insomnia is related to depression, then an antidepressant medication may be helpful. Over-the-counter drugs such as antihistamines are not very effective in bringing about sleep and can affect the quality of sleep.

Other measures

Relaxing before going to bed will help a person fall asleep faster. Learning to substitute pleasant thoughts for unpleasant ones (imagery training) is a technique that can be very helpful in reducing worry. Another effective measure is the use of audiotapes which combine the sounds of nature with soft relaxing music. These, alone or in combination with other relaxation techniques, can safely promote sleepiness.

Changes in diet and exercise routines can also have a have a beneficial effect. 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. Maintaining a comfortable bedroom temperature, reducing noise and eliminating light are also helpful. Regularly scheduled morning or afternoon exercise can relax the body. This should be done 3-4 times a week and be sufficient to produce a light sweat.

Alternative treatments

Many alternative treatments are effective in treating both the symptom of insomnia and its underlying causes. Incorporating relaxation techniques into bedtime rituals will help a person go to sleep faster, as well as improve the quality of sleep. These methods include meditation, massage, breathing exercises, and a warm bath, scented with rose, lavender (Lavendula officinalis), marjoram, or chamomile (Matricaria recutita). Eating a healthy diet rich in calcium, magnesium, and the B vitamins is also beneficial. A high protein snack like yogurt before going to bed is recommended, or a cup of herb tea made with chamomile, hops (Humulus lupulus), passionflower (Passiflora incarnata), or St John's Wort (Hypericum perforatum) to encourage relaxation. Acupuncture and biofeedback have also proven useful.

Prevention

Prevention of insomnia centers around promotion of a healthy lifestyle. A balance of rest, recreation and exercise in combination with stress management, regular physical examinations, and a healthy diet can do much to reduce the risk.

Resources

Organizations

American Sleep Disorders Association. 1610 14th St. NW, Ste. 300, Rochester, MN 55901. (507) 287-6006. http://www.asda.org.

Other

"What to Do When You Can't Sleep." The Virtual Hospital Page. University of Iowa. http://www.vh.org.

Key terms

Biofeedback — A training technique that enables an individual to gain some element of control over involuntary body functions.

Mood disorder — A group of mental disorders involving a disturbance of mood, along with either a full or partial excesseively happy (manic) or extremely sad (depressive) syndrome not caused by any other physical or mental disorder. Mood refers to a prolonged emotion.

Sleep apnea — A condition in which a person stops breathing while asleep. These periods can last up to a minute or more, and can occur many times each hour. In order to start breathing again, the person must become semi-awake. The episodes are not remembered, but the following day the client feels tired and sleepy. If severe, sleep apnea can cause other medical problems.

Sleep disorder — Any condition that interferes with sleep. At least 84 have been identified, according to the American Sleep Disorders Association.

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insomnia /in·som·nia/ (-som´ne-ah) inability to sleep; abnormal wakefulness.insom´niacinsom´nic

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fatal familial insomnia  an inherited prion disease affecting primarily the thalamus and characterized by progressive insomnia, hallucinations, stupor, and coma ending in death; autonomic and motor disturbances are also present.

primary insomnia  a dyssomnia characterized by persistent difficulty initiating or maintaining sleep or by persistently nonrestorative sleep; not due to any other condition.

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in·som·ni·a (n-smn-)

n.

Chronic inability to fall asleep or remain asleep for an adequate length of time.

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insomnia,

[insom′nē·ə]

Etymology: L, in, not, somnus, sleep

chronic inability to sleep or to remain asleep throughout the night; wakefulness; sleeplessness. Insomnia may be the symptom of a psychiatric disorder. Formerly called agrypnia.

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insomnia,

n sleeplessness; may be short- or long-term; has a variety of causes, including some psychiatric disorders.

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insomnia,

n the chronic inability to sleep or remain asleep throughout the night.

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insomnia

Sleep disorders The perceived or actual inability to sleep one's usual amount of time; a condition characterized by any combination of difficulty with falling asleep, staying asleep, intermittent wakefulness, and early-morning awakening; episodes may be transient, short-term–lasting 2 to 3 wks, or chronic Triggers Illness, depression, anxiety, stress, poor sleep environment, caffeine, abuse of alcohol, heavy smoking, physical discomfort, daytime napping, medical conditions, poor sleep habits–eg, early bedtime, excessive time awake in bed Examples Psychophysiologic–learned insomnia, delayed sleep phase syndrome, hypnotic dependent sleep disorder, stimulant dependent sleep disorder. See Circadian rhythm, Conditioned insomnia, Familial fatal insomnia, Jet lag, Pseudoinsomnia, Rebound insomnia, REM sleep, Sleep disorder, Sleep-onset insomnia.

Insomnia

Chronologic classification

• Transient–eg, 'jet lag'; does not require treatment

• Short term < 3 weeks in duration, due to travel to high altitudes, grieving loss of loved one, hospitalization, pain

• Long term > 3 weeks in duration, eg related to medical, neurologic or psychiatric disorders or addiction

Etiology

• Pharmacologic Due to coffee, nicotine, alcohol

• Rebound (withdrawal) Related to abrupt discontinuation of hypnotic drugs

• Delayed sleep phase Due to shift work, chronic pain, sleep apnea and restless leg syndrome

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Patient discussion about Chronic insomnia.

Q. Are medications always needed in a case of insomnia? I've been suffering from insomnia for about a month now- for the first time in my life though. It did start in a few hard days in which I had a lot on my mind. Back then I thought I just have to wait for those issues to be solved and over and I'd be sleeping like a beauty. Guess what- I still find myself lying in bed for hours every night and waking up in the middle of the night after I finally fall asleep. Is there a way to help me sleep without starting to take all kinds of chemicals??

A. What helps me:From 2 hours before bedtime I do not eat any sweets nor any form of sugar,nor anything high in protein,if I am hungry I'll eat 1 slice of brown bread with cheese.Then 1 hour before bedtime I"ll eat 3/4 cup real plain Yoghurt+a bit of honey as sweetener+ I"ll take 2 tabs. 500 mg. each of Calcium + each 250 mg.magnesium + Vit. D in it
1/2 hour before bedtime I disslve in 8 oz of hot water 2 American size teasp. of honey, then I add 1 bag of "Lemon Yerba Mate" herbtea(Traditional Medicinals" brand,steep /squeeze it,drink it hot, it's quite a pleasant taste or also good for me is "sleepytime"herbal tea,(Celestial brand)Taken the same way + Honey.I buy both at Walmart.While and after drinkingthe tea,I read something educational to take my mind of the daily happenings.I do not watch any violent shows on T.V from 3 hours before bedtime.
Have to make sure my feet are warm

Q. How to deal with sleeping problems? I wonder if anyone could help me. Here's the thing: I’ve been in school break for two months now and that means i usually go to bed at about 2 am, and I usually wake up with an alarm clock at 11 for breakfast then lunch immediately after breakfast. My problem is that I have problems sleeping, I usually stay an hour or two in bed trying to get some sleep.

A. I have been taking 5 mg. of ambien every night for 12 years. It has been a miracle drug for me. My bedtime is between 11:00 and 12:00 PM. I take my "pill" about 15 minutes before turning TV off and sleep really well until 7:00 or 8:00 AM. Never have side effects.

Q. Any other treatment for sleeplessness problem than Melatonin??? 33 years male having acute sleeping problem awake until 08:00-09:00am. Taking Melatonin failed.

A. Belladonna. [Bell]
The sleepless conditions calling for Belladonna are due to congestion; sleep is extremely restless, as a rule it is interrupted by talking, startings, muscular jerkings and spasmodic motions; frightful images appear on closing the eyes and the patient therefore dreads sleep. Children awake from sleep frightened. The dreams found under Belladonna are frightful ones, and they constantly awaken the patient. It is probably our best remedy for insomnia due to cerebral hyperaemia; that is, it will be most often indicated, also after morphine which produces cerebral hyperaemia of a passive variety. Aconite comes in here, too, but with Aconite there is intense anxiety and restlessness, fear of disaster or death. Cuprum, Stramonium and Zincum have the symptom that the patient is aroused from sleep frightened. For the complete list: http://www.hpathy.com/diseases/insomnia-sleeplessness-treatment-cure.asp Hope this helps.