Insomnia is a symptom of any of several sleep
disorders. Insomnia can involve:
- Difficulty falling asleep
- Difficulty staying asleep (that is, waking up many times
during the night), without necessarily having had any difficulty
- Waking up too early in the morning
- Not feeling refreshed after a night's sleep
Insomnia is not defined by a specific
number of hours of sleep that one gets, since individuals vary widely
in their sleep needs and practices.
Most adults have experienced insomnia or sleeplessness at one time or
another in their lives. An estimated 30%-50% of the general population
is affected by insomnia, and 10% have chronic insomnia.
Insomnia affects people of all ages including children, although it is
more common in adults and its frequency increases with age. In general,
women are affected more frequently than men.
There are three types of insomnia:
- Transient, or mild, insomnia - sleep difficulties that last
for a few days; there is little or no evidence of impairment of
functioning during the day.
- Short-term, or moderate, insomnia - sleep difficulties that
last for less than a month that mildly affects functioning during the
day, together with feelings of irritability and fatigue.
- Chronic, or severe, insomnia - sleep difficulties that last
for more than a month that severely impairs functioning during the day,
and cause strong feelings of restlessness, irritability, anxiety, and
It is important to make a distinction
between insomnia and other similar terminology; short duration sleep
and sleep deprivation.
- Short duration sleep may be normal in some individuals who
may require less time for sleep without feeling daytime impairment, the
central symptom in the definition of insomnia.
- In insomnia, adequate time and opportunity for sleep is
available, whereas in sleep deprivation, lack of sleep is due to lack
of opportunity or time to sleep because of voluntary or intentional
avoidance of sleep.
Those causes responsible for the transient insomnia are-
- Jet lag- Air travel across time zones often causes brief
bouts of insomnia.
- Physical discomfort (hot, cold, lighting, noise, unfamiliar
- Working different shifts,
- Stressful life situations (divorce or separation, 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, or
- Certain medications.
Those causes responsible for chronic
insomnia are usually psychological or physiological conditions-
- Breathing problems from chronic heart or lung disease
(asthma, chronic obstructive pulmonary disease (COPD),
- Congestive heart failure,
- Obstructive sleep apnea),
- Acid reflux,
- Urinary problems (frequent urination, urinary
- Chronic pain,
- Parkinson's disease, or
Common psychiatric problems can be
responsible for insomnia including:
- Anxiety, or
- Posttraumatic stress disorder (PTSD).
Some common physiologic conditions can
lead to insomnia such as:
- Menstrual cycle,
- Fever, or
Other causes of insomnia may be related
to sleep disorders including:
- Sleep walking,
- Sleep apnea,
- Restless leg syndrome (creeping sensations in the leg
during sleep, relieved by leg movement),
- Periodic limb movement disorder (involuntary repeated leg
movement during sleep),
Other causes of insomnia
- Common stimulants associated with poor sleep include
caffeine and nicotine. You should consider not only restricting
caffeine and nicotine use in the hours immediately before bedtime but
also limiting your total daily intake.
- People often use alcohol to help induce sleep, as a
nightcap. However, it is a poor choice. Alcohol is associated with
sleep disruption and creates a sense of nonrefreshed sleep in the
- A disruptive bed partner with loud snoring or periodic leg
movements also may impair your ability to get a good night's sleep.
Impairment of daytime functioning is the defining and the most common
symptom of insomnia.
Other common symptoms include:
- daytime fatigue,
- daytime sleepiness,
- mood changes,
- poor attention and concentration,
- lack of energy,
- poor social function,
- headaches, and
- increased errors and mistakes.
Evaluation and diagnosis of insomnia may start with a thorough medical
and psychiatric patient history taken by the physician.
A general physical examination to assess for any abnormal findings is
also important, including assessment of mental status and neurological
function; heart, lung and abdominal exam; ear, nose and throat exam;
and measurement of the neck circumference and waist size. Assessment of
routine medications and use of any illegal drugs, alcohol, tobacco, or
caffeine is also an important part of the medical history. Any
laboratory or blood work pertinent to these conditions can also be a
part of the assessment along with the sleep history of the patient.
Polysomnography is a test that is done in sleep centers if conditions
such as sleep apnea are suspected.
Actigraphy is another technique to assess sleep-wake patterns over
time. Actigraphs are small, wrist-worn devices (about the size of a
wristwatch) that measure movement. They contain a microprocessor and
on-board memory and can provide objective data on daytime activity.
1. Sleep hygiene-
Sleep hygiene is one of the components of behavioral therapy for
insomnia. Several simple steps can be taken to improve a patient's
sleep quality and quantity. These steps include:
- Sleep as much as you need to feel rested; do not oversleep.
- Exercise regularly at least 20 minutes daily, ideally 4-5
hours before your bedtime.
- Avoid forcing yourself to sleep.
- Keep a regular sleep and awakening schedule.
- Do not drink caffeinated beverages
- Do not smoke, especially in the evening.
- Do not go to bed hungry.
- Adjust the environment in the room (lights, temperature,
- Do not go to bed with your worries; try to resolve them
before going to bed.
2. Relaxation Therapy-
Relaxation therapy involves measures such as meditation and muscle
relaxation or dimming the lights and playing soothing music prior to
going to bed.
3. Stimulus control-
Stimulus control refers to techniques used to help with initiating
sleep. These techniques are used to induce an environment in the
bedroom that promotes sleep. Some simple steps include:
- Use the bed only for having sex and sleeping, not working,
reading, watching TV, eating, or other mentally stimulating activities.
- Go to bed only when you feel ready to sleep.
- Turn off the lights and all the noise in and around the
- Get up at the same time every morning to avoid
4. Sleep restriction- it refers another
non-medical behavioral therapy for insomnia which involves limiting the
time spent in bed for sleeping only.
5. Sleeping pills are often antihistamines. Antihistamines are
generally taken for allergies, but also make you feel very sleepy.
Sedatives like, Barbiturates, Benzodiazepines, Imidazopyridine, and
Antihistamines. Unfortunately, the use of these medications can lead to
unwanted side effects, such as allergic reactions, excessive drowsiness
during waking hours, and complex sleep behaviors, such as sleep-eating,
sleep-walking and even sleep-driving.
6. Homoeopathy- Homeopathy treats the person as a whole. It means that
homeopathic treatment focuses on the patient as a person, as well as
his pathological condition. The homeopathic medicines are selected
after a full individualizing examination and case-analysis.
Professional homeopaths do not generally prescribe remedies to treat
symptoms individually, as the symptoms are considered to be only the
outward sign that your vital force is struggling to overcome disease.
Instead a remedy is prescribed for the whole person. Accurate
prescribing is essential to the success of homeopathy.
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