Bharat Bista asked:


Insomnia is the most common sleep problem reported by adults. Approximately one-half of all adults have occasional sleep problems during the course of any year. Insomnia is characterized by the inability to fall asleep or to maintain sleep, usually due to an underlying condition or cause. Both men and women of all ages suffer from insomnia, but it is more common in females and older adults. Individuals suffering from insomnia may experience any or all of the following symptoms:



Difficulty falling asleep

Difficulty staying asleep

Waking too early in the morning



Typically, insomnia is associated with feelings of restlessness, irritability, anxiety, unrefreshing sleep, and daytime fatigue. Medical or psychiatric conditions that are sometimes associated with insomnia include depression, anxiety, substance abuse disorders, obstructive sleep apnea, restless legs syndrome, and chronic medical conditions. Medications and other substances, such as caffeine, alcohol, or nicotine, can also play an important role in the development or persistence of insomnia. Some commonly used medications, such as antidepressants, antihypertensive, antihistamines, and decongestants, have been known to cause insomnia and sleep disruption. Before discontinuing any medication, however, it is very important to discuss your concerns with your doctor first.

For most people with insomnia, the symptoms last a few days to weeks, and then resolve spontaneously. In many of these cases, the underlying cause of insomnia may be a transient life stress or change in the daily routine of an individual. However, for those who have chronic insomnia, lasting for three months or longer, the effects of poor sleep can take a significant toll on quality of life and general well-being. The effects of chronic insomnia include reduced quality of life, impaired social functioning, diminished work productivity, missed work days, impaired memory and concentration, and depression. In essence, chronic insomnia can deprive individuals of their ability to function both socially and professionally, which can then lead to increasing problems in these areas of life.

In addition to decreased job performance, insomnia is associated with increased absenteeism. People with insomnia are at increased risk for various kinds of accidents, both at work and while operating motor vehicles.

Managing Insomnia

Chronic insomnia is characterized by its chronicity. Thus, individuals with chronic insomnia can expect that the problem may be life-long. However, there are successful treatments available that can help to control the severity and to minimize the long-term effects of insomnia.

Scientific research has demonstrated that the most successful treatment protocol for chronic insomnia is a combination of medication and cognitive behavioral therapy (CBT). CBT is a series of behavioral interventions used to improve one’s ability to initiate and to maintain sleep. Specifically, CBT is a group of techniques that can be learned to help one sleep better. Generally, CBT is conducted in individual or small group formats, over a period of several weeks. As mentioned earlier, CBT is most successful in conjunction with medication for the treatment of chronic insomnia. However, treatment with medication is not required in every case.

So what exactly is CBT?

CBT encompasses several different techniques, which may be used all together or individually. These various techniques include sleep hygiene training, relaxation therapy, stimulus control therapy, sleep restriction, and cognitive therapy. Sleep hygiene training refers to re-learning habits that encourage and promote sleep. Maintenance of a quiet sleep environment may mean excluding a pet from the bedroom or getting a bed partner to seek help for a snoring problem. Relaxation therapy helps to reduce physiologic and cognitive arousal at bedtime. Some people may be unaware of how tension and stress affect their sleep. Stimulus control therapy works by limiting the presence of external stimuli or factors that may bring anxiety or stress into the bedroom environment. Implementation of this technique can help to establish the bedroom as a place to relax and unwind, away from the stresses of the world. Sleep restriction limits the amount of time spent lying awake in bed. This technique requires close oversight by a physician or psychologist, using sleep diaries, to ensure successful treatment. Cognitive therapy works to refute an individual’s thoughts about sleeplessness and the fear and anxiety related to these thoughts. Cognitive therapy has the potential to provide patients with good tools to deal with insomnia.

CBT is generally conducted by psychologists or physicians with specialized training in these techniques. Unfortunately, CBT for chronic insomnia is not readily available everywhere; however, by doing some research through internet resources or by contacting the National Sleep Foundation (www.sleepfoundation.org) or the American Academy of Sleep Medicine (www.aasmnet.org), you may be able to find someone in your area. At the Dallas Center for Sleep Disorders, we offer Insomnia Workshops with CBT for chronic insomnia. You can contact us for more information (www.dallas-sleep.com or 972-473-7300).

gladys906 asked:


Although we often ask ‘what causes insomnia’, it is important to understand that the causes will depend very much on whether you are suffering from primary or secondary insomnia.

Primary insomnia is insomnia which does not have a specific medical or emotional root. For example, primary insomnia is insomnia that does not appear as a side-effect of medication or as a symptom of an emotional or medical disorder. In other words primary disorder can be linked directly to its cause and is a primary, rather than a secondary, result of that cause.

A good example of primary insomnia would be insomnia resulting from long-haul air travel. Here it is the shift in your body’s internal clock, which is a direct result of air travel, which causes your insomnia. Another good example is shift work insomnia in which you are asking your body to sleep when its internal clock says you should be awake and to work when your clock says you should be sleeping.

Secondary insomnia is often much more complex and can be caused by a whole variety of different things.

A common cause of secondary insomnia is an emotional disorder such as anxiety, depression or post-traumatic stress disorder. Other emotional disorders also giving rise to insomnia as a secondary symptom might include Parkinson’s and Alzheimer’s diseases.

There are also a number of common medical conditions which can give rise to insomnia including those with accompanying chronic pain, such as arthritis; those which affect breathing, such as asthma or certain heart problems and a range of general conditions including an overactive thyroid, gastrointestinal difficulties and heartburn.

Other sleep problems can themselves also give rise to insomnia and a good example of this would be restless leg syndrome.

Perhaps the commonest cause of secondary insomnia however is seen in the side-effects of a range of medications and in other chemical substances which we put into our bodies.

Medicines used to treat the common cold, asthma, allergies and heart conditions can often lead to insomnia. In addition, alcohol, caffeine and nicotine account for a substantial proportion of people suffering from insomnia.

Perhaps the most surprising cause of secondary insomnia however is to be found in sedatives – the common sleeping pill. Although sleeping pills can be very helpful in the short-term many people continue to take them for extended periods and unwittingly cause rather than cure their insomnia.

peterhutch asked:


 

Insomnia is a symptom of a sleeping disorder characterized by persistent difficulty falling asleep or staying asleep despite the opportunity. It is typically followed by functional impairment while awake. Insomniacs have been known to complain about being unable to close their eyes or “rest their mind” for more than a few minutes at a time. Both organic and non-organic insomnia constitute a sleep disorder.

Insomnia Causes

The most common psychological problems include anxiety, stress, and depression. In fact, insomnia may be an indicator of depression. Many people will have insomnia during the acute phases of a mental illness.

Many people have insomnia. People who have insomnia may not be able to fall asleep. They may wake up during the night and not be able to fall back asleep, or they may wake up too early in the morning.

Insomnia contributes to excessive daytime tiredness, which in turn may be responsible for accidents, recurrent infections, poor concentration, irritability, work and relationship problems and a general inability to cope.

Anxiety, a condition in which individuals feel increased tension, apprehension, and feelings of helplessness, fear, worry, and uncertainty. This may be due to the effects that other people at work have on us, financial worries, concerns over relationships outside work or numerous other causes.

Symptoms

Insomnia symptoms may include:

Difficulty falling asleep at night

Waking up during the night

Waking up too early

Daytime fatigue or sleepiness

Daytime irritability

It’s common for older adults to sleep less deeply and for less time than they did earlier in life, and to experience fragmented sleep. However, these normal changes in the sleep patterns of older adults do not mean that they should expect inadequate rest and to awaken feeling unrefreshed.8 Routine poor-quality sleep due to health problems, medication use, and major life changes can lead to chronic sleep problems.

Diagnosis of Insomnia

Surprisingly, a sleep study is not routinely recommended for those complaining of insomnia. The reason is that when a sleep study is performed in someone suffering from insomnia, it does not generally give any new information; it simply confirms that the patient is having trouble sleeping. The best way to find the cause for insomnia is by careful history taking. Assessment of recent onset insomnia should focus on acute personal and medical problems.

Treatment

The treatment of insomnia depends on its cause and severity. If insomnia results from another disorder, treatment of that disorder may improve sleep. For most people who have insomnia, some simple changes in lifestyle, such as following a regular sleep schedule and avoiding caffeine after lunch time, can improve sleep.

In addition to daytime tiredness or fatigue, chronic insomnia can be associated with a complaint of compromised intellectual function, mood disturbance, or an increase in physical complaints (e.g., headaches and gastrointestinal problems). Beyond these outcomes, there is now considerable evidence that individuals with chronic insomnia have an increased risk of psychiatric illness (especially major depressive disorder) and substance abuse and there is mounting evidence that insomnia is associated with absenteeism from work, higher health care costs, and reduced quality of life.

Cognitive Behavior Therapy

Cognitive behavior therapy helps patients change thoughts and behaviors that interfere with sleep. Treatment methods are often used in combination for increased effect.

 

You may find that if you are unable to fall asleep or wake up in the night, you spend a lot of time in bed trying unsuccessfully to sleep. If so, you may benefit from a sleep restriction program that initially allows only a few hours of sleep during the night. Gradually this time is increased until a normal sleep period is achieved.

 

Antihistamines

 

Diphenhydramine (for example, Sominex, Nytol) and doxylamine (for example, Unisom) are antihistamines that are currently marketed as OTC sleep aids. Diphenhydramine is the only agent that is considered to be safe and effective by the Food and Drug Administration. The safety and effectiveness of doxylamine has not been evaluated adequately for FDA approval.

John mathew asked:

Insomnia is a condition in which you have trouble falling or staying asleep. Some people with insomnia may fall asleep easily but wake up too soon. Other people may have the opposite problem, or they have trouble with both falling asleep and staying asleep. The end result is poor-quality sleep that doesn’t leave you feeling refreshed when you wake up.

Insomnia can affect any person, of any age, at any time in their life. While insomnia is often a fleeting or “transient” condition, many people experience chronic insomnia. When left untreated, insomnia can have many dramatic effects on the body, including physical, psychological and emotional.

Types of Insomnia

There are different classifications of insomnia: transient, intermittent, and chronic. Transient insomnia is short term insomnia. It can last from a single night to a few weeks. Intermittent Insomnia is insomnia that occurs on and off. Chronic insomnia is insomnia that occurs constantly, usually most nights and lasts for a month or more.

Symptoms

Insomnia symptoms can vary and may be different from person to person. Insomnia is a medical condition characterized by the inability to sleep. People who suffer from insomnia typically have a hard time falling asleep; they lie in bed for hours in frustration, tossing and turning. Because of the poor quality of sleep they are getting, insomniacs are tired for most of the day.

The following symptoms indicate possible insomnia:

•    difficulty falling asleep at night

•    inability to get adequate sleep at night

•    feeling tired after sleep

•    waking up at early hours

•    waking up through the night.

Causes

You might be surprised at the vast range of factors that can cause sleep problems. Health and lifestyle issues such as stress, illness, or sleep environment might be at play. Or you might have a sleep disorder that interferes with the quality of your sleep. Whatever the cause or causes of your insomnia, there are effective solutions.

Insomnia stems from 4 main causes:

1.    Psychological

2.    Lifestyle

3.    Environmental

4.    Insomnia as a secondary illness

Treatment

Treatment of insomnia often depends on the cause. If insomnia is a secondary condition or symptom to another problem, healthcare professionals prefer to treat the primary condition whether it be depression, long term anxiety, or a medical condition that is leaving the patient awake at night. Some antidepressants, such as SSRI’s, can cause insomnia, however, others have a sedating effect. These include: Elavil, mirtazapine, trazodone and doxepin.

The antidepressant trazodone (Desyrel) also may help with insomnia. Over-the-counter sleep aids contain antihistamines that can induce drowsiness. They’re OK for occasional sleepless nights, but they, too, often lose their effectiveness the more you take them. Many sleeping pills contain diphenhydramine, which can cause difficulty ********* and a drowsy feeling in the daytime.