Insomnia is sign as well as symptom that can accompany several sleeps, medical and psychiatric disorders, characterized by persistent difficulty falling asleep and/or staying asleep or sleep of poor quality It is defined as sleeping difficulties as termed by individual's report. This disorder can be demonstrated by polysomnographic evidence of disturbed sleep. Insomnia can be grouped into primary and secondary, or comorbid Primary insomnia: not attributable to a medical, psychiatric, or environmental cause A diagnosis will usually differentiate between: • insomnia as secondary to another condition, • primary insomnia co-morbid with one or more conditions, or • free-standing primary insomnia Types of insomnia Insomnia can be classified as transient, acute, or chronic. 1. Transient insomnia lasts for less than a week. • Underlying another disorder • changes in the sleep environment • change in timing of sleep • severe depression • stress Its consequences - sleepiness and impaired psychomotor performance - are similar to those of sleep deprivation. 2. Acute insomnia is the inability to consistently sleep well for a period of less than a month. 3. Chronic insomnia lasts for longer than a month. • Underling another disorder • Primary disorder. Its effects can vary according to its causes. • muscular fatigue • hallucinations • mental fatigue • Often show increased alertness. • see things as if they are happening in slow motion • moving objects seem to blend together • Can cause double vision. Various Patterns of insomnia Sleep-onset insomnia -difficulty falling asleep at the beginning of the night, often a symptom of anxiety disorders or the delayed sleep phase disorder. Nocturnal awakenings are characterized by difficulty returning to sleep after awakening in the middle of the night Waking too early in the morning: middle-of-the-night insomnia (pain disorders or medical illness) and terminal insomnia (clinical depression). Poor sleep quality caused by the individual not reaching stage 3 or delta sleep which has restorative properties • restless legs • sleep apnea • Major depression • Nocturnal polyuria.(excessive urination at night) Major depression leads to alterations in the function of the hypothalamic-pituitary-adrenal axis, causing excessive release of cortisol which can lead to poor sleep quality.
The following are some of the symptoms of Insomnia: Causes • Use of psychoactive drugs or stimulants, including certain medications, herbs, caffeine, nicotine, cocaine, amphetamines, methylphenidate, MDMA and modafinil • Use of fluoroquinolone antibiotic drugs • Restless Legs Syndrome • Periodic limb movement disorder (PLMD • Pain • Hormone shifts • Life events such as fear, stress, anxiety, emotional or mental tension, work problems, financial stress, birth of a child and bereavement. • Mental disorders such as bipolar disorder, clinical depression, generalized anxiety disorder, post traumatic stress disorder, schizophrenia, or obsessive compulsive disorder. • Disturbances of the circadian rhythm, such as shift work and jet lag • Certain neurological disorders, brain lesions, or a history of traumatic brain injury • Hyperthyroidism and rheumatoid arthritis. • Abuse of over-the counter or prescription • Poor sleep hygiene, e.g., noise • Parasomnias which include : nightmares, sleepwalking, night terrors, violent behavior while sleeping • REM behavior disorder: physical body moves in response to events within dreams. • Physical exercise. Exercise-induced insomnia is common in athletes, causing prolonged sleep onset latency.
• Identify or rule out medical and psychological causes to decide the treatment management • Maintain sleep hygiene . • Pharmacological treatments have been used mainly to reduce symptoms in acute insomnia; their role in the management of chronic insomnia remains unclear. • stimulus control • behavioral interventions • sleep-restriction therapy • paradoxical intention • patient education and relaxation therapy. EEG biofeedback has demonstrated effectiveness in the treatment of insomnia with improvements in duration as well as quality of sleep.
