4. INSOMNIA:
Difficulty falling asleep, staying asleep, or early awakening despite the
opportunity for sleep that is associated with impaired daytime
functioning and occurs at least 3/wk for at least one month.
Most common sleep problem for which patients see a physician.
Diagnosis:- 3 months of symptoms leading to significant decrease in
quality and quantity of sleep and affecting daily functioning.
5. STATISTICS
Roughly, 1 in 3 adults worldwide have insomnia symptoms, and about 10%
of adults meet the criteria for insomnia disorder.
6. TYPES
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 longstanding history of difficulty sleeping. Chronic
insomnia has many causes.
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
1. 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.
2. 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.
• 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. 3. 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 shift work or
changing time zone after a long-haul flight (jet lag).
4. 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. 5. 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.
10. 6. 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.
11.
12.
13. • Benzodiazepines: Alprazolam, Clonazepam.
They have abuse potential. Can lead to dependence it used for longer time. Alprazolam is short acting and has
much more abuse potential than clonazepam longer acting. Best way is to avoid Benzodiazepines.
• 2 class drugs: Zolpidem, zaleplon (shortest acting),(Eszopiclone longest acting).
• Melatonin.
• Ramelteon/ Tasimelteon: melatonin receptor agonists.
• DORAS: Dual acting orexin receptor antagonists.
Example: Suvorexant, Lemborexant, Almorexant.
• Antidepressants : mirtazapine, Trazadone, tricyclic antidepressants.
• Antipsychotics / Quetiapine.
• Psychological management :
Sleep hygiene principle : maintaining a consistent sleep-wake schedule.
TREATMENT:
