Insomia

Insomnia is a common symptom of many mental and physical disorders. Insomnia is generally seen as both a sign and a symptom that can accompany several sleep, medical, and psychiatric disorders characterized by a persistent difficulty falling asleep. As a result, you may get too little sleep or have poor-quality sleep. Insomnia is typically followed by functional impairment while awake. You may still feel tired when you wake up. Insomnia can occur at any age, but it is particularly common in the elderly. Insomnia is common among sleep disorders.

Definition

Insomnia is a term applied collectively to complaints involving the chronic inability to obtain adequate sleep. Three principle complaints commonly cited are -

a. Sleep Onset Insomnia (Early/ Initial Insomnia) - Difficulty in Falling asleep (taking longer than 30 min to fall asleep)
b. Frequent Nocturnal awakening - Waking up during the night/ Interrupted sleep. (Total awakening duration in more than 30 min)
c. Early morning awakening (Late Insomnia) - Waking up early in the morning and not being able to fall back asleep (less than 6.5 hours of total sleep)

Types of insomnia

Insomnia can be classified as acute, or chronic.

1.Acute insomnia:

It is the inability to sleep well for a period of less than a month. These types of insomnia occurs despite there is adequate opportunity and circumstances for sleep, and they must result in problems with daytime function. Acute insomnia is also known as short term insomnia or stress related insomnia.

2.Chronic insomnia:

It lasts for more than a month. People with high levels of stress hormones or shifts in the levels of cytokines are more likely to have chronic insomnia. Its effects can vary according to its causes. They might include muscular fatigue, hallucinations, and/or mental fatigue. Those people that live with this disorder have hallucinations and tend to see things as if they are happening in slow motion. Chronic insomnia can cause double vision.

It can be a primary disorder or it can be caused by another disorder.

Primary Chronic Insomnia - Sometimes chronic insomnia is the primary problem. This means that it is not caused by something else. Its cause is not well understood, but long-lasting stress, emotional upset, travel and shift work can be factors. Primary insomnia usually lasts more than one month.
Secondary Chronic Insomnia - Most cases of chronic insomnia are secondary. This means they are the symptom or side effect of some other problem, such as certain medical conditions, medicines, and other sleep disorders. Substances such as caffeine, tobacco, and alcohol can also be a cause.

Symptoms

Waking up early in the morning and not being able to get back to sleep
Waking up several times in the middle of night
Lying awake for a long time at night
daytime sleepiness
lack of energy
Feeling tired and not refreshed by sleep
feel anxious, depressed, or irritable
trouble focusing on tasks paying attention, learning, and remembering

example -

It could make you may feel drowsy while driving. This could cause you get into a car accident.

Risk Factor -

You are also at higher risk of insomnia if you:

Excessive stress
Depression or other emotional distress, such as divorce or death of a spouse
financial issues (lower salary)
Work at night or have frequent major shifts in your work hours
Travel long distances with time changes
Have an inactive or sedentary lifestyle

Causes -

Stressful events: If somebody experiences insomnia due to any stressful event. Like worrying about work, money or health, a loved one becoming ill or dying, and even noise and light are all causes of Stress and are likely to keep you awake at night.
Psychiatric problems: Underlying mental health problems can affect sleeping patterns. They include:

Mood disorders, such as depression or bipolar disorder.
Anxiety disorders, such as generalized anxiety, panic disorder or post-traumatic stress disorder
Psychotic disorders, such as schizophrenia

Medical Conditions: Insomnia can be caused by underlying:

Heart disease
Respiratory disease, such as chronic obstructive pulmonary disease or asthma
Neurological disease, such as Alzheimer's or Parkinson's disease
Hormonal problems, such as an overactive thyroid
Joint or muscle problems, such as arthritis
Sleep disorders, such as restless legs syndrome, narcolepsy or sleep apnoea.

Drinking too much caffeine (contained in tea, coffee, energy drinks) can also affect sleeping patterns.
Medications: Some medicines that are available over the counter can cause insomnia. These include:

Antidepressants
Epilepsy medicines
Medication for high blood pressure (hypertension), such as beta-blockers
Hormone replacement therapy
Non-steroidal anti-inflammatory drugs (NSAIDs)
Some medicines that are used to treat asthma, such as salbutamol, salmeterol and theophylline

Diagnosis

Sleep history: Doctor may ask the patient about his sleep history.
Medical history:

It is taken to enquire about his medical conditions, such as: Any new or ongoing health problem
Painful injuries or health conditions, such as arthritis
Any medicines taken, either over-the-counter or prescription

Symptoms or a history of depression, anxiety, or psychosis
Coping history with highly stressful life events, such as divorce or death
Sleep study. A sleep study measures how well you sleep and how your body responds to sleep problems.

Treatments for insomnia -

lifestyle changes, counseling, and medicines: Lifestyle changes, including good sleep habits, often help relieve acute (short-term) insomnia. These changes might make it easier for you to fall asleep and stay asleep.
Several medicines also can help relieve your insomnia and allow you to re-establish a regular sleep schedule
Cognitive and behavioral treatments: Cognitive behavioral treatments (CBT) aim to change unhelpful thoughts and behaviors that may be contributing to insomnia. CBT is usually recommended if someone had sleep problems for more than four weeks.
Stimulus-control therapy- which aims to help associate the bedroom with sleep and establish a consistent sleep/wake pattern
Sleep restriction therapy - The amount of time spent in bed to the actual amount of time spent asleep, creating mild sleep deprivation; sleep time is then increased as your sleeping improves
Relaxation training – This aims to reduce tension or minimize intrusive thoughts that may be interfering with sleep
Paradoxical intention –Try to stay awake and avoid any intention of falling asleep, it's only used if someone have trouble getting to sleep, but not maintaining sleep
Biofeedback – Sensors connected to a machine are placed on the body to measure responses, such as muscle tension and heart rate; the machine produces pictures or sounds to help control breathing and body responses.