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Insomnia: Definition, Symptoms, Causes, Diagnosis, Treatment and Prevention

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What Is Insomnia?


Insomnia may be a disorder during which you've got trouble falling and/or staying asleep.

The condition are often short-term (acute) or can last an extended time (chronic). it's going to also come and go.

Acute insomnia lasts from 1 night to a couple of weeks. Insomnia is chronic when it happens a minimum of 3 nights every week for 3 months or more.

Types of Insomnia


There are two types of insomnia: primary and secondary.

  • Primary insomnia: This means your sleep problems aren’t linked to any other health condition or problem.

  • Secondary insomnia: This means you have trouble sleeping because of a health condition (like asthma, depression, arthritis, cancer, or heartburn); pain; medication; or substance use (like alcohol).



Insomnia Causes


Causes of primary insomnia include:

  • Stress related to big life events, like a job loss or change, the death of a loved one, divorce, or moving

  • Things around you like noise, light, or temperature

  • Changes to your sleep schedule like jet lag, a new shift at work, or bad habits you picked up when you had other sleep problems


Causes of secondary insomnia include:

  • Mental health issues like depression and anxiety

  • Medications for colds, allergies, depression, high blood pressure, and asthma

  • Pain or discomfort at night

  • Caffeine, tobacco, or alcohol use

  • Hyperthyroidism and other endocrine problems

  • Other sleep disorders, like sleep apnea or restless legs syndrome



Insomnia Risk Factors


Insomnia affects women more than men and older people more than younger ones. Young and middle-age African Americans also have a higher risk.

Other risk factors include:

  • Long-term illness

  • Mental health issues

  • Working night shifts or shifts that rotate







Understanding Insomnia -- Symptoms


Insomnia Symptoms


Symptoms of insomnia include:

  • Sleepiness during the day

  • Fatigue

  • Grumpiness

  • Problems with concentration or memory




What Are the Symptoms of Insomnia?


Insomnia itself is often a symptom of another problem. Symptoms include:

  • Trouble falling asleep

  • Failure to sleep through the night

  • Waking up earlier than usual

  • Daytime sleepiness

  • Reduced ability to concentrate

  • Irritability



Call Your Doctor About Insomnia If:



  • You experience disturbed sleep for more than a month without apparent cause, never seem to get enough sleep, or fall asleep without warning during the day; you may need a referral to a sleep disorders specialist to monitor your sleep patterns and test for an underlying sleep disorder.

  • Your significant other notices that you seem to stop breathing briefly during the night, often associated with severe snoring.; this could be a sign of sleep apnea.

  • Your insomnia is associated with a life-changing event, such as the loss of a job or a loved one; you may benefit from taking sleep medication for a brief period.

  • Your sleep medication is no longer effective, or you have been taking medication for more than a few nights without success







Diagnosing Insomnia


Your doctor will do a physical exam and ask about your medical history and sleep history.

They might tell you to keep a sleep diary for a week or two, keeping track of your sleep patterns and how you feel during the day. They may talk to your bed partner about how much and how well you’re sleeping. You might also have special tests at a sleep center.

Sleep disorder tests are often used to diagnose insomnia. A doctor will likely perform a physical exam and take a medical and sleep history to determine the cause of the sleep problem. Further tests may be required.


How Your Doctor Diagnoses Insomnia


During the exam, your doctor will seek to identify any medical or psychological illness that may be contributing to your insomnia. For example, you may be asked about chronic snoring and recent weight gain, which might suggest sleep apnea as the cause of insomnia. You will also likely be asked questions to see if you are suffering from anxiety, depression or other conditions that may keep you from getting a good night’s sleep.


Tests Used to Diagnose Insomnia



  • Sleep diary: Tracking your sleep patterns may help your doctor reach a diagnosis.

  • Epworth Sleepiness Scale: a validated questionnaire that is used to assess daytime sleepiness.

  • Polysomnogram: a test measuring activity during sleep.

  • Actigraphy: a test to assess sleep-wake patterns over time. Actigraphs are small, wrist-worn devices (about the size of a wristwatch) that measure movement.

  • Mental Health Exam: Because insomnia may be a symptom of depression, anxiety, or another mental health disorder, a mental status exam, mental health history, and basic psychological evaluations may be part of your initial assessment.






Understanding Insomnia -- Treatment


Acute insomnia may not need treatment.

If it’s hard for you to do everyday activities because you’re tired, your doctor may prescribe sleeping pills for a short time. Medicines that work quickly but briefly can help you avoid problems like drowsiness the next day.

Don’t use over-the-counter sleeping pills for insomnia. They might have side effects, and they tend to work less well over time.

For chronic insomnia, you’ll need treatment for the conditions or health problems that are keeping you awake. Your doctor might also suggest behavioral therapy. This can help you change the things you do that make insomnia worse and learn what you can do to promote sleep.



What Is the Treatment for Insomnia?


Treatment for insomnia may involve nonmedical therapy, such as developing better sleep habits or psychotherapy, and sometimes medications. If a medical condition like diabetes or menopause is causing your insomnia, treating those conditions may help. If insomnia is a side effect of a medication, changing the medication or its timing or reducing the dose may help. Always talk to your health care provider before making changes to any medications you are taking.

Short-term insomnia, often caused by travel or stress, usually improves once the stress is removed or after your body has adjusted to the new schedule. Short-term use of over-the-counter sleep remedies may help. Chronic insomnia, which disrupts sleep for extended periods of time, may call for a thorough physical exam, alteration of some lifestyle habits, medical treatment, and, perhaps, psychotherapy to identify a hidden cause. It is most important to treat any problem that is producing insomnia symptoms. Just treating insomnia symptoms without dealing with the main cause will not be helpful.

Sleep Medications

Benzodiazepine sedatives such as triazolam (Halcion), estazolam, lorazepam (Ativan), temazepam (Restoril), flurazepam, and quazepam (Doral) and non-benzodiazepine sedatives such as zolpidem (Ambien, Intermezzo), eszopiclone (Lunesta), and zaleplon (Sonata) are drugs that can help induce sleep. However, these medicines may be addictive with extended use. Also they can be dangerous if you take them with alcohol or other drugs that depress the central nervous system. They can cause morning sleepiness, although side effects are generally less severe with the non-benzodiazepines. A prescription oral spray called Zolpimist, which contains Ambien's active ingredient, can be used for short-term treatment of insomnia.

Belsomra (suvorexant) is the first approved orexin receptor antagonist. Orexins are chemicals that are involved in regulating the sleep-wake cycle and play a role in keeping people awake. Belsomra alters the action of orexin in the brain.

Doxepin (Silenor) is approved for treating people who have trouble staying asleep. Silenor may help with sleep maintenance by blocking histamine receptors. Do not take this drug unless you are able to get a full seven or eight hours of sleep. Dosage is based on your medical condition, age, and response to therapy.


Antidepressant drugs may be used in people with depression to help with sleep. They are not approved for the treatment of insomnia. These may cause daytime sleepiness or other side effects.

Ramelteon (Rozerem) is an insomnia medication that works differently than the other sedative medications. It is less likely to cause morning sleepiness or to be addictive.

Over-the-counter sleep drugs usually contain an antihistamine. Antihistamines are often used for allergies, but they have a side effect of drowsiness. These medications may cause daytime sleepiness and dry mouth along with other side effects.

Relaxation

Many poor sleepers simply need help relaxing. If you're a habitual insomniac and trying to get to sleep just makes you more anxious and awake, try these alternative choices to help reduce your worry about sleep while relaxing your body and mind. If the root cause of insomnia is stress, any treatment must address the problem of stress in your life.

Breathing exercises can promote relaxation. Here's a routine you can do anywhere, anytime:

  1. Exhale completely through your mouth.

  2. Inhale through your nose to a count of four.

  3. Hold your breath for a count of seven.

  4. Exhale through your mouth for a count of eight.

  5. Repeat the cycle three times.


Exercise

Moderate exercise can help you sleep better and give you more energy while awake. Aim for a 20- to 30-minute routine three or four times a week. Tailor the workout to your physical condition, and exercise in the morning or afternoon, not close to bedtime.Check with your doctor about how much and what type of exercise is right for you.

Mind/Body Medicine

Meditation, yoga, and biofeedback may reduce tension and promote better sleep. Visualization or guided imagery, during which you hold a peaceful image in your mind before bedtime, can also be an effective path to relaxation. You can learn these techniques from an instructor, online sites, a how-to book, or an instructional tape.

Good Sleep Habits

Be sure your bedroom is quiet and dark. Eye shades may help since light comes in even through closed eyelids.


Both children and adults may have trouble sleeping if they are overstimulated by activity or watching television just before bedtime. A quarter hour of quiet conversation, light reading, or soft music before going to sleep may make all the difference. Also, these steps are important:

  • Try to keep a regular sleep schedule.

  • Avoid heavy meals, smoking, alcohol, or caffeine near bedtime.

  • Keep the bedroom reserved for sleep and sex only.


If you wake up at night and can't go back to sleep, remain quiet and relaxed. Even normal sleep can be punctuated by periods of restlessness or even waking. Be patient; sleep usually returns. Remember, a few nights of poor sleep do no long-term harm. Even if you toss and turn trying to get to sleep, you are probably getting more periods of sleep than you think.



Insomnia Complications


Our bodies and brains need sleep so they can repair themselves. It’s also crucial for learning and keeping memories. If insomnia is keeping you awake, you could have:

  • A higher risk of health problems like high blood pressure, obesity, and depression

  • A higher risk of falling, if you’re an older woman

  • Trouble focusing

  • Anxiety

  • Grumpiness

  • Slow reaction time that can lead to a car crash







Insomnia Prevention


Good sleep habits, also called sleep hygiene, can help you beat insomnia. Here are some tips:

  • Go to sleep at the same time each night, and get up at the same time each morning. Try not to take naps during the day, because they may make you less sleepy at night.

  • Don’t use phones or e-books before bed. Their light can make it harder to fall asleep.

  • Avoid caffeine, nicotine, and alcohol late in the day. Caffeine and nicotine are stimulants and can keep you from falling asleep. Alcohol can make you wake up in the middle of the night and hurt your sleep quality.

  • Get regular exercise. Try not to work out close to bedtime, because it may make it hard to fall asleep. Experts suggest exercising at least 3 to 4 hours before bed.

  • Don't eat a heavy meal late in the day. But a light snack before bedtime may help you sleep.

  • Make your bedroom comfortable: dark, quiet, and not too warm or too cold. If light is a problem, use a sleeping mask. To cover up sounds, try earplugs, a fan, or a white noise machine.

  • Follow a routine to relax before bed. Read a book, listen to music, or take a bath.

  • Don’t use your bed for anything other than sleep and sex.

  • If you can't fall asleep and aren’t drowsy, get up and do something calming, like reading until you feel sleepy.

  • If you tend to lie awake and worry about things, make a to-do list before you go to bed. This may help you put your concerns aside for the night.



Alternative Treatments for Insomnia


Alternative therapy encompasses a variety of disciplines that include everything from diet and exercise to mental conditioning and lifestyle changes. Examples of alternative therapies include acupuncture, guided imagery, yoga, hypnosis, biofeedback, aromatherapy, relaxation, herbal remedies, massage, and many others.

Complementary medicine is essentially alternative medicine that is taken along with conventional treatments.


Alternative Therapies for Insomnia


Herbal supplements are purported to help treat insomnia. A look:

  • Valerian root. Some studies have suggested that the root of valerian (Valeriana officinalis) may help with the onset of sleep and with sleep maintenance. However, more research is needed before a final conclusion can be made about the safety and effectiveness of valerian for insomnia. It's possible that it can interfere with some medications. It also has side effects and is not safe in small children or during pregnancy.

  • Chamomile is another commonly used herb for the treatment of insomnia. More research is needed, however, to see if it is effective. The FDA considers chamomile to be safe and the herb has no known adverse effects. You should not take it, though, if you are sensitive to ragweed or chrysanthemums or other members of the Compositae family such as daisies or sunflowers. You could develop contact allergies if you are.

  • Other herbs promoted as effective sleep remedies include passionflower, hops, and lemon balm. These still need to be studied to determine their safety and effectiveness.


Clinical studies to evaluate the effectiveness and safety of herbs are scarce. More information is required before these herbs can be recommended as a first line of treatment against insomnia.

Since herbal supplements can interact with certain medications, always inform your health care provider if you are using any herbal supplements.

Melatonin

Melatonin is a hormone that is made by a gland in the brain in humans and produced in animals as well as plants. Although the effects of melatonin are complex and poorly understood, it plays a critical role in the regulation of the sleep-wake cycle and other circadian rhythms. Melatonin has been studied as a possible treatment for circadian rhythm disorders, and may be helpful in decreasing sleep disturbances caused by jet lag. Studies are mixed, but it may help with falling asleep more quickly and help with insomnia.


Melatonin needs to be taken at the right time of day in the right dose to be effective, but how much to take is poorly understood. The amount of melatonin in over-the-counter supplements can raise the level in the body up to 20 times normal. Adverse effects of melatonin are minimal, but long-term studies examining efficacy and toxicity of melatonin supplements are needed.

Acupuncture

Acupuncture is often used in traditional Chinese medicine for the treatment of insomnia. This procedure involves the insertion of very fine needles (sometimes in combination with electrical stimulus or with heat produced by burning specific herbs) into the skin at specific acupuncture points in order to influence the functioning of the body. The results of recent studies have shown acupuncture improved sleep quality in people with insomnia. However, additional research is required before the effectiveness of acupuncture is proved conclusively for the relief of insomnia.

Relaxation and meditation or mindfulness

Increased muscle tension and intrusive thoughts can interfere with sleep. Therefore, it is not surprising that techniques aimed at relaxing muscles (progressive muscle relaxation and biofeedback) and quieting the mind (meditation) have been found to be effective treatments for insomnia. Most people can learn these techniques, but it usually takes several weeks before they can sufficiently master them well enough to help ease insomnia. There is a growing body of evidence that supports the value of meditation in treating insomnia. Several studies show that regular meditation practice, either alone or as a part of yoga practice, results in higher blood levels of melatonin, an important regulator of sleep.

Exercise

Regular exercise deepens sleep in young adults with or without sleep disorders. In addition, several studies show that exercise can improve sleep in older adults. Recent studies show that even the low-to-moderate tai chi and certain yoga practices enhance sleep quality in older persons and cancer patients with sleep problems, respectively. Although consistent exercise has been shown to improve sleep quality, most experts advise exercising at least three to four hours before bedtime to avoid interference with sleep.



Points to Consider About Alternative Therapy


Alternative therapies are not FDA approved and not always benign. By definition, alternative therapies are not generally accepted standard of care practice in the U.S. As mentioned, some herbal therapies can interact with other medications you may be taking. Consider the following points before starting alternative therapy.

  • Always talk to your doctor before trying an alternative approach and be sure to tell all your doctors what alternative treatments you are using.

  • If you experience side effects such as nausea, vomiting, rapid heartbeat, anxiety, diarrhea, or skin rashes, stop taking the herbal product and notify your doctor immediately.

  • Avoid preparations made with more than one herb.

  • Beware of commercial claims of what herbal products can do. Look for scientific-based sources of information.

  • Select brands carefully. Only purchase brands that list the herb's common and scientific name, the name and address of the manufacturer, a batch and lot number, expiration date, dosage guidelines, and potential side effects.





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