Sunday, February 6, 2011
Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions: "Do you experience difficulty sleeping?" or "Do you have difficulty falling or staying asleep?
Thus, insomnia is most often thought of as both a sign and a symptom that can accompany several sleep, medical, and psychiatric disorders, characterized by persistent difficulty falling asleep and/or staying asleep or sleep of poor quality. Insomnia is typically followed by functional impairment while awake. One definition of insomnia is "difficulties initiating and/or maintaining sleep, or nonrestorative sleep, associated with impairments of daytime functioning or marked distress for more than 1 month.
Insomnia can be grouped into primary and secondary, or comorbid, insomnia.Primary insomnia is a sleep disorder 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. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe depression, or by 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. It can be caused by another disorder, or it can be a primary disorder. Its effects can vary according to its causes. They might include muscular fatigue, hallucinations, and/or mental fatigue; but people with chronic insomnia often show increased alertness. Some people that live with this disorder see things as if they are happening in slow motion, wherein moving objects seem to blend together. Can cause double vision.
Patterns of insomnia
Sleep-onset insomnia is 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 or waking too early in the morning: middle-of-the-night insomnia and terminal insomnia. The former may be a symptom of pain disorders or medical illness; the latter is often a characteristic of clinical depression.
Causes of Insomnia
Causes of acute insomnia can include:
* Significant life stress (job loss or change, death of a loved one, divorce, moving).
* Emotional or physical discomfort.
* Environmental factors like noise, light, or extreme temperatures (hot or cold) that interfere with sleep.
* Some medications (for example those used to treat colds, allergies, depression, high blood pressure, and asthma) may interfere with sleep.
* Interferences in normal sleep schedule (jet lag or switching from a day to night shift, for example).
Causes of chronic insomnia include:
* Depression and/or anxiety.
* Chronic stress.
* Pain or discomfort at night.
Treatment for Insomnia
Acute insomnia may not require treatment. Mild insomnia often can be prevented or cured by practicing good sleep habits (see below). If your insomnia makes it hard for you to function during the day because you are sleepy and tired, your health care provider may prescribe sleeping pills for a limited time. Rapid onset, short-acting drugs can help you avoid effects such as drowsiness the following day. Avoid using over-the-counter sleeping pills for insomnia since they may have undesired side effects and tend to lose their effectiveness over time.
Treatment for chronic insomnia includes first treating any underlying conditions or health problems that are causing the insomnia. If insomnia continues, your health care provider may suggest behavioral therapy. Behavioral approaches help you to change behaviors that may worsen insomnia and to learn new behaviors to promote sleep. Techniques such as relaxation exercises, sleep restriction therapy, and reconditioning may be useful.