Insomnia or sleeplessness is a common sleep disorder. It is the inability to fall asleep, remain asleep, or feel refreshed by sleep. Acute and transient during periods of stress, insomnia may become chronic, causing constant fatigue, extreme anxiety as bedtime approaches, and psychiatric disorders.
Physiologic causes of insomnia include jet lag, arguing, and lack of exercise. Pathophysiologic causes range from medical and psychiatric disorders to pain, adverse effects of a drug, and idiopathic factors. Complaints of insomnia are subjective and require close investigation; for example, the patient may mistakenly attribute his fatigue from an organic cause, such as anemia, to insomnia.
HIGH RISK GROUPS FOR INSOMNIA
1. Travelers
2. Shift workers with frequent changing of shifts
3. Seniors
4. Adolescents or young adult students
5. Pregnant women
6. Women in menopause
7. People who use abuse drugs
8. Alcoholics
MEDICAL CAUSES OF INSOMNIA
1. Generalized anxiety disorder
2. Alcohol withdrawal syndrome
3. Mood (affective) disorders
4. Sleep apnea syndrome
5. Pain
6. Pruritus
7. Nocturnal myoclonus
8. Thyrotoxicosis
9. Drugs : Use of, abuse of, or withdrawal from sedatives or hypnotics may produce insomnia.
10. Chronic obstructive pulmonary disease (COPD)
SYMPTOMS
1. Some people with insomnia may complain of difficulty falling asleep or waking up frequently during the night. The problem may begin with stress. Then, as you begin to associate the bed with your inability to sleep, the problem may become chronic.
2. Poor concentration and focus
3. Difficulty with memory
4. Impaired motor coordination (being uncoordinated)
5. Irritability and impaired social interaction
TREATMENT
The main focus of treatment for insomnia should be directed towards finding the cause. Once a cause is identified, it is important to manage and control the underlying problem, as this alone may eliminate the insomnia all together. Treating the symptoms of insomnia without addressing the main cause is rarely successful.
1. Non-Medical treatment and Behavioral Therapy :-
- 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.
- Keep a regular sleep and awakening schedule.
- Do not drink alcohol, tea, coffee, soft drinks.
- Adjust the environment in the room (lights, temperature, noise, etc.)
- Do not watch TV, read, eat, or worry in bed. Your bed should be used only for sleep and sexual activity.
- Avoid large meals and excessive fluids before bedtime.
2. Medical Treatment :-
There are numerous prescription medications to treat insomnia. Generally, it is advised that they should not be used as the only therapy and that treatment is more successful if combined with non-medical therapies.
- Benzodiazepine sedatives e.g. temazepam, flurazepam, clonazepam.
- Nonbenzodiazepine sedatives e.g. eszopiclone, zaleplon.
- Some antidepressants e.g. amitriptyline, trazodone.
- Antihistamines e.g. diphenhydramine, doxylamine.
- Ramelteon (Rozerem)
- Melatonin
PREVENTION
General recommendations for prevention of insomnia include the following :
1. Control your environment :- avoid light, noise, and excessive temperatures.
2. Establish a bedtime routine
3. Avoid large meals, excessive fluid intake, and strenuous exercise before bedtime.
4. If you do not fall asleep within 20 to 30 minutes, try a relaxing activity such as listening to soothing music or reading.
Physiologic causes of insomnia include jet lag, arguing, and lack of exercise. Pathophysiologic causes range from medical and psychiatric disorders to pain, adverse effects of a drug, and idiopathic factors. Complaints of insomnia are subjective and require close investigation; for example, the patient may mistakenly attribute his fatigue from an organic cause, such as anemia, to insomnia.
HIGH RISK GROUPS FOR INSOMNIA
1. Travelers
2. Shift workers with frequent changing of shifts
3. Seniors
4. Adolescents or young adult students
5. Pregnant women
6. Women in menopause
7. People who use abuse drugs
8. Alcoholics
MEDICAL CAUSES OF INSOMNIA
1. Generalized anxiety disorder
2. Alcohol withdrawal syndrome
3. Mood (affective) disorders
4. Sleep apnea syndrome
5. Pain
6. Pruritus
7. Nocturnal myoclonus
8. Thyrotoxicosis
9. Drugs : Use of, abuse of, or withdrawal from sedatives or hypnotics may produce insomnia.
10. Chronic obstructive pulmonary disease (COPD)
SYMPTOMS
1. Some people with insomnia may complain of difficulty falling asleep or waking up frequently during the night. The problem may begin with stress. Then, as you begin to associate the bed with your inability to sleep, the problem may become chronic.
2. Poor concentration and focus
3. Difficulty with memory
4. Impaired motor coordination (being uncoordinated)
5. Irritability and impaired social interaction
TREATMENT
The main focus of treatment for insomnia should be directed towards finding the cause. Once a cause is identified, it is important to manage and control the underlying problem, as this alone may eliminate the insomnia all together. Treating the symptoms of insomnia without addressing the main cause is rarely successful.
1. Non-Medical treatment and Behavioral Therapy :-
- 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.
- Keep a regular sleep and awakening schedule.
- Do not drink alcohol, tea, coffee, soft drinks.
- Adjust the environment in the room (lights, temperature, noise, etc.)
- Do not watch TV, read, eat, or worry in bed. Your bed should be used only for sleep and sexual activity.
- Avoid large meals and excessive fluids before bedtime.
2. Medical Treatment :-
There are numerous prescription medications to treat insomnia. Generally, it is advised that they should not be used as the only therapy and that treatment is more successful if combined with non-medical therapies.
- Benzodiazepine sedatives e.g. temazepam, flurazepam, clonazepam.
- Nonbenzodiazepine sedatives e.g. eszopiclone, zaleplon.
- Some antidepressants e.g. amitriptyline, trazodone.
- Antihistamines e.g. diphenhydramine, doxylamine.
- Ramelteon (Rozerem)
- Melatonin
PREVENTION
General recommendations for prevention of insomnia include the following :
1. Control your environment :- avoid light, noise, and excessive temperatures.
2. Establish a bedtime routine
3. Avoid large meals, excessive fluid intake, and strenuous exercise before bedtime.
4. If you do not fall asleep within 20 to 30 minutes, try a relaxing activity such as listening to soothing music or reading.
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