Insomnia is a sleep disorder that is characterized by difficulty falling and/or staying asleep. symptoms : • People with insomnia have one or more of the following symptoms: • Difficulty falling asleep. • Waking up often during the night and having trouble going back to sleep. • Waking up too early in the morning. • Feeling tired upon waking.

1. INSOMNIA
Presented by
M. Tejashree
Pharm D 4yr YR

2.  DEFINATION : Insomnia is a sleep disorder that is
characterized by difficulty falling and/or staying asleep.
 symptoms :
• People with insomnia have one or more of the following
symptoms:
• Difficulty falling asleep.
• Waking up often during the night and having trouble going
back to sleep.
• Waking up too early in the morning.
• Feeling tired upon waking.

4.  Acute insomnia:
• A brief episode of difficulty sleeping. Acute insomnia is
usually caused by a life event, such as a stressful change
in a person's job, receiving bad news, or travel. Often
acute insomnia resolves without any treatment.
 Chronic insomnia:
• A long-term pattern of difficulty sleeping. Insomnia is
usually considered chronic if a person has trouble falling
asleep or staying asleep at least three nights per week
for three months or longer. Some people with chronic
insomnia have a long- standing history of difficulty
sleeping. Chronic insomnia has many causes.

5.  Onset insomnia: Difficulty falling asleep at the beginning
of the night.
 Comorbid insomnia: • Insomnia that occurs with another
condition. Psychiatric symptoms — such as anxiety and
depression — are known to be associated with changes in
sleep. Certain medical conditions can either cause
insomnia or make a person uncomfortable at night (as in
the case of arthritis or back pain, which may make it hard
to sleep.
 Maintenance insomnia:
• The inability to stay asleep. People with maintenance
insomnia wake up during the night and have difficulty
returning to sleep.

7. CAUSES
Stress and anxiety
• Some people develop insomnia after a stressful event, such as
a bereavement, problems at work or financial difficulties.
• The problem can continue long after the event has passed
because they start to associate going to bed with being
awake. This develops into an anxiety about sleep itself.
• Having more general worries, for example about work, family or
health, are also likely to keep you awake at night. These can
cause your mind to start racing while you lie in bed, which can
be made worse by also worrying about not being able to sleep.
A poor sleep routine and sleeping environment
• You may struggle to get a good night's sleep if you go to bed at
inconsistent times, nap during the day, or don't 'wind down'
before going to bed.
• A poor sleeping environment can also contribute to insomnia,
for instance an uncomfortable bed, or a bedroom that's too
bright, noisy, hot or cold.

8. Lifestyle factors
• Drinking alcohol before going to bed, and taking certain
recreational drugs can affect your sleep, as can stimulants
such as nicotine (found in cigarettes) and caffeine (found in
tea, coffee and energy drinks). These should be avoided in
the evenings.
• Changes to your sleeping patterns can also contribute to
insomnia, for example because of shiftwork or changing
time zone after a long-haul flight (jet lag).
Mental health conditions
• Underlying mental health problems can often affect a
person's sleeping patterns, including.
• 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.

9. Physical health conditions :
• Insomnia can also be caused by underlying physical
conditions, including:
• heart conditions – such as angina or heart failure.
• respiratory conditions –such as chronic obstructive
pulmonary disease (COPD) or asthma.
• neurological conditions –such as Alzheimer's disease or
Parkinson's disease.
• hormonal problems – such as an overactive thyroid.
• joint or muscle problems – such as arthritis.
• problems with the genital or urinary organs –such as
urinary incontinence or an enlarged prostate.
• sleep disorders – such as such as snoring and sleep
apnea, restless legs syndrome, narcolepsy, night terrors
and sleepwalking.
• long-term pain

10. Medication:
• Some prescriptions or over-the-counter medications can
cause insomnia as a side effect. These include:
• certain antidepressants.
• epilepsy medicines.
• medicines for high blood pressure –such as beta-
blockers.
• steroid medication.
• non-steroidal anti-inflammatory drugs (NSAIDs).
• stimulant medicines used to treat attention deficit
hyperactivity disorder (ADHD) or narcolepsy.
• some medicines used to treat asthma –such as
salbutamol, salmeterol and theophylline.

12. Hyper arousal
Sleep
initiation
problem
Insomnia
Sleep
maintenanc
e problems
Nonrestorative
sleep
PATHOPHYSIOLOGY

13. Life stress
Problem
solving
Rumination
and worry
Physiologic
arousal Cognitive
arousal
Acute insomnia
Chronic insomnia
Sleep initiation
problems
Sleep
maintenance
problems
Nonrestorative
sleep
Insomnia

14. TREATMENT
 Treat the underlying cause. In both primary insomnia (where no
cause is identifi able)and insomnia due to other causes,
management includes introducing good sleep hygiene and
medications for short period, if required.
 Sleep hygiene
 Set a schedule: Go to bed at a set time each night and get up
at the same time each morning.
 Avoid day time naps.
 Limit daily in bedtime to the usual amount present before the
sleep disturbance.
 Avoid large meals near bedtime; eat at regular times daily. No
stimulant medication or food beverages (caffeine, nicotine,
alcohol, etc.) especially in the evenings.

15.  Mild to moderate physical exercise in the morning.
 Relax before going to bed: a warm bath, reading, or
another relaxing routine can make it easier to fall sleep.
Avoid evening stimulation: substitute television by radio.
 Don’t lie in bed awake: If you can’t get to sleep, don’t just
lie in bed. Do something else, like reading, watching
television, or listening to music, until you feel tired.
 Practice evening relaxation routines, such as progressive
muscular relaxation or meditation.
 Maintain comfortable sleeping conditions: avoid extreme
temperatures.

17.  Pharmacological
 Tab. Diazepam 5-10 mg or Tab. Lorazepam 1-2 mg, or
Clonazepam 0.25-0.5 mg at bedtime.
Or
Tab. Zolpidem 5-10 mg at bedtime.
 Precautions
 Medication to be given ½-1 hour before the usual time of
going to bed.
 Medications should be prescribed at the lower dose for a
period of 5-7 days.
 Benzodiazepines have risk of abuse potential if taken for
more than 4-5 weeks.
 Zolpidem has also dependence potential and, therefore,
long-term use should be discouraged.

18. PATIENT EDUCATION
 Stress on basic principles of sleep hygiene as above.
 Patient to avoid exceeding the prescribed dose and
should not take medicines beyond the prescribed period.
 Sometimes these drugs can lead to sedation during
daytime. In such case, reduce the dose to half and
contact the doctor.
 Diazepam and nitrazepam carry risk of dependence.

19. THANK YOU