Saturday, July 4, 2009

What Is Insomnia ?


Insomnia is a sleep disorder. Sleep is a state of consciousnesses, which gives your body time to rest and build up your strength. It is characterized by an inability to sleep and/or inability to remain asleep for a reasonable period. Insomnia affects all age groups. Among older adults, insomnia affects women more often than men. The incidence increases with age. Insomnia can be a symptom of physical disorders, although for most of us it's the result of tension, stress and anxiety -- and of course the more anxious we get about our insomnia, the worse it gets. It is often caused by fear, stress, anxiety, medications, herbs, caffeine, depression, bipolar disorder or sometimes for no apparent reason. An overactive mind or physical pain may also be causes. Insomnia may be classified by how long the symptoms are present.

Transient insomnia usually is due to situational changes such as travel and stressful events. It lasts for less than a week or until the stressful event is resolved. Short-term insomnia lasts for 1-3 weeks, and long-term insomnia (chronic insomnia) continues for more than 3 weeks. Chronic insomnia often results from depression or substance abuse. It is important to know that nearly everyone has problems sleeping at some time or other and it is thought that a third of people in the UK have bouts of insomnia. Newborn babies can sleep for 16 hours a day, while children of school age need an average of 10 hours. Adults usually need, on average, 7 to 9 hours sleep a night. As we get older, it’s normal to need less sleep. Most people over 70 need less than 6 hours sleep per night, and they tend to be light sleepers.

According to the United States Department of Health and Human Services in the year 2007, approximately 64 million Americans regularly suffer from insomnia each year. Insomnia is 1.4 times more common in women than in men.


Types of insomnia

Transient insomnia lasts from days to weeks. 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.
Acute insomnia is the inability to consistently sleep well for a period of between three weeks to six months.
Chronic insomnia lasts for years at a time. 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 sleepiness, 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 though they were happening in slow motion, whereas moving objects seem to blend together. Can cause double vision.


Patterns of insomnia

The pattern of insomnia often is related to the etiology. Insomnia affects 1 in 3 people.

Onset insomnia - difficulty falling asleep at the beginning of the night, often associated with anxiety disorders.
Middle-of-the-Night Insomnia - Insomnia characterized by difficulty returning to sleep after awakening in the middle of the night or waking too early in the morning. Also referred to as nocturnal awakenings. Encompasses middle and terminal insomnia.
Middle insomnia - waking during the middle of the night, difficulty maintaining sleep. Often associated with pain disorders or medical illness.
Terminal (or late) insomnia - early morning waking. Often a characteristic of clinical depression.


Causes

Psychoactive drugs or stimulants, including certain medications, herbs, caffeine, cocaine, ephedrine, amphetamines, methylphenidate, MDMA, methamphetamine and modafinil
Fluoroquinolone antibiotic drugs, see Fluoroquinolone toxicity, associated with more severe and chronic types of insomnia
Hormone shifts such as those that precede menstruation and those during menopause
Life problems like fear, stress, anxiety, emotional or mental tension, work problems, financial stress, unsatisfactory sex life
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, can cause an inability to sleep at some times of the day and excessive sleepiness at other times of the day. Jet lag is seen in people who travel through multiple time zones, as the time relative to the rising and setting of the sun no longer coincides with the body's internal concept of it. The insomnia experienced by shift workers is also a circadian rhythm sleep disorder.
Estrogen is considered to play a significant role in women’s mental health (including insomnia). A conceptual model of how estrogen affects mood was suggested by Douma et al. 2005 based on their extensive literature review relating activity of endogenous, bio-identical and synthetic estrogen with mood and well-being. They concluded the sudden estrogen withdrawal, fluctuating estrogen, and periods of sustained estrogen low levels correlated with significant mood lowering. Clinical recovery from depression postpartum, perimenopause, and postmenopause was shown to be effective after levels of estrogen were stabilized and/or restored.
Certain neurological disorders, brain lesions, or a history of traumatic brain injury
Medical conditions such as hyperthyroidism and rheumatoid arthritis
Abuse of over-the counter or prescription sleep aids can produce rebound insomnia
Poor sleep hygiene, e.g., noise
Parasomnia, which includes a number of disruptive sleep events including nightmares, sleepwalking, violent behavior while sleeping, and REM behavior disorder, in which a person moves his/her physical body in response to events within his/her dreams
A rare genetic condition can cause a prion-based, permanent and eventually fatal form of insomnia called fatal familial insomnia
Parasites can cause intestinal disturbances while sleeping.[citation needed]

Sleep studies using polysomnography have suggested that people who have insomnia with sleep disruption have elevated nighttime levels of circulating cortisol and adrenocorticotropic hormone They also have an elevated metabolic rate, which does not occur in people who do not have insomnia but whose sleep is intentionally disrupted during a sleep study. Studies of brain metabolism using positron emission tomography (PET) scans indicate that people with insomnia have higher metabolic rates by night and by day. The question remains whether these changes are the causes or consequences of long-term insomnia.

Insomnia can be common after the loss of a loved one, even years or decades after the death, if they have not gone through the grieving process. Overall, symptoms and the degree of their severity affect each individual differently depending on their mental health, physical condition, and attitude or personality.

A common misperception is that the amount of sleep required decreases as a person ages. The ability to sleep for long periods, rather than the need for sleep, appears to be lost as people get older. Some elderly insomniacs toss and turn in bed and occasionally fall off the bed at night, diminishing the amount of sleep they receive.


Epidemiology

The National Sleep Foundation's 2002 Sleep in America poll showed that 58% of adults in the U.S. experienced symptoms of insomnia a few nights a week or more.Although insomnia was the most common sleep problem among about one half of older adults (48%), they were less likely to experience frequent symptoms of insomnia than their younger counterparts (45% vs. 62%), and their symptoms were more likely to be associated with medical conditions, according to the 2003 poll of adults between the ages of 55 and 84.


Diagnosis

Specialists in sleep medicine are qualified to diagnose the many different sleep disorders. Patients with various disorders including delayed sleep phase syndrome are often mis-diagnosed with insomnia.If a you has trouble getting to sleep, but has normal sleep pattern once asleep, a circadian rhythm disorder is a likely cause.


Sleep duration and mortality

A survey of 1.1 million residents in America found that those who reported sleeping about 7 hours per night had the lowest rates of mortality, whereas those who slept for fewer than 6 hours or more than 8 hours had higher mortality rates. Getting 8.5 or more hours of sleep per night increased the mortality rate by 15%. Severe insomnia - sleeping less than 3.5 hours in women and 4.5 hours in men - also led to a 15% increase in mortality. However, most of the increase in mortality from severe insomnia was discounted after controlling for comorbid disorders. After controlling for sleep duration and insomnia, use of sleeping pills was also found to be associated with an increased mortality rate. The lowest mortality was seen in individuals who slept between six and a half and seven and a half hours per night. Even sleeping only 4.5 hours per night is associated with very little increase in mortality. Thus mild to moderate insomnia for most people may actually increase longevity and severe insomnia has only a very small effect on mortality. As long as a patient refrains from using sleeping pills there is little to no increase in mortality associated with insomnia but there does appear to be an increase in longevity. This is reassuring for patients with insomnia in that despite the sometimes unpleasantness of insomnia, insomnia itself appears to be associated with increased longevity. It is unclear why sleeping longer than 7.5 hours is associated with excess mortality.


Treatment for insomnia

In many cases, insomnia is caused by another disease, side effects from medications or a psychological problem. It is important to identify or rule out medical and psychological before deciding on the treatment for the insomnia. Attention to sleep hygiene is an important first line treatment strategy and should be tried before any pharmacological approach is considered.

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