INSOMNIA

Sleeplessness, known medically as, "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 falling asleep
• 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.

Types

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 fatigue.

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.

Causes

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 surroundings),
• 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),
• Obesity,
• Acid reflux,
• Hyperthyroidism,
• Urinary problems (frequent urination, urinary incontinence),
• Chronic pain,
• Fibromyalgia,
• Parkinson's disease, or
• Dementia.

Common psychiatric problems can be responsible for insomnia including:

• Depression,
• Psychosis,
• Mania,
• Anxiety, or
• Post-traumatic stress disorder (PTSD).

Some common physiologic conditions can lead to insomnia such as:

• Menopause,
• Menstrual cycle,
• Pregnancy,
• Fever, or
• Pain.

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 morning.
• A disruptive bed partner with loud snoring or periodic leg movements also may impair your ability to get a good night's sleep.

Symptoms

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,
• anxiety,
• poor social function,
• headaches, and
• increased errors and mistakes.

Diagnosis

 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.

Treatment

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, noise, etc.)
• Do not go to bed with your worries; try to resolve them before going to bed.

• 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 bedroom.
• Get up at the same time every morning to avoid over-sleeping.