Insomnia is difficulty falling or staying asleep that interferes with daily life. It can be transient (less than a week), acute (less than a month), or chronic (over a month). Many factors can contribute to insomnia, including medical, psychiatric, and substance-related issues. Treatment involves both non-pharmacological options like cognitive behavioral therapy and relaxation techniques, as well as pharmacological options like benzodiazepines, but drugs should be used cautiously and for short durations. Proper sleep hygiene practices can also help manage insomnia symptoms.

1. Okwuo Ikechukwu (M.B.B.S Nig)
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3. -Insomnia is one of the most common health
concerns among adults.
-Insomnia causes sleep issues that interfere
with daily life and can be debilitating for
some people.
-Many factors contribute may contribute to
this pathology.
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4.  Insomnia is difficulty falling asleep or
staying asleep, even when a person has
the chance to do so.
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5. The predominant complaint is a global sleep dissatisfaction
with one or more of the following symptoms:
1. Difficulty initiating sleep (in children: without caregiver
intervention).
2. Difficulty maintaining sleep (e.g., frequent or prolonged
awakenings with difficulty returning to sleep) (in children:
without caregiver intervention).
3. Early morning awakening (e.g., premature awakening with
inability to return to sleep).
4. Resistance to going to bed (children).
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6. In addition…
• The sleep disturbance causes clinically
significant distress or impairment in social,
occupational, educational, academic,
behavioral, or other important areas of
functioning.
• The sleep difficulty occurs at least 3 nights per
week.
• The sleep difficulty occurs despite adequate
opportunity for sleep.
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8. • Increasing age
• Females: menstruation and menopause
• Psychiatric illness
• Medical co-morbidities
• Impaired social relationships
• Shift workers
• Long distance travelers.
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11.  Insomnia can be classified based on
duration into transient, acute, or chronic.
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12. • Transient insomnia lasts for less than a
week.
• It can be caused by another disorder, by
changes in the sleep environment, by the
timing of sleep, severe depression, or by
stress.
• Its consequences – sleepiness and
impaired psychomotor performance – are
similar to those of sleep deprivation.
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13. • It is the inability to consistently sleep well
for a period of less than a month.
• These problems occur despite 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.
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14. • Situational stress (e.g. occupational,
interpersonal, financial, academic,
medical, jet lag)
• Withdrawal from substances
• Environmental stressors (e.g. noise,
hospitalization)
• Death or illness of a loved one
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15. • Chronic insomnia lasts for longer than a
month.
• It can be caused by another disorder, or it can
be a primary disorder.
• People with high levels of stress hormones or
shifts in the levels of cytokines are more likely
than others to have chronic insomnia.
• Its effects include muscular weariness,
hallucinations, and/or mental fatigue.
• Chronic insomnia can cause double vision.
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16. • Primary sleep disorder
Idiopathic, central sleep apnea, restless
leg syndrome
• Psychiatric conditions:
Anxiety, depression, mania, schizophrenia
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17. -Medications and substances:
Anticholinergic agents,antidepressants
(SSRIs,bupropion, antiepileptics, nicotine ,
oral contraceptives, thyroid, ETOH withdrawal
-Medical disorders:
Cancer, chronic pain, congestive heart failure,
COPD, end-stage renal disease,
gastroesophageal reflux disease, HIV/AIDS,
hyperthyroidism, nocturia
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18. Pharmacological and non-pharmacological.
Non-pharmacological:
-Cognitive behavioural therapy
-Relaxation therapy
-Sleep hygiene
-Alternative therapy
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19. • Helps change incorrect beliefs and
attitudes about sleep (e.g., unrealistic
expectations, misconceptions amplifying
consequences of sleeplessness)
• Keeping regular bedtime and wake time
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20. • Tensing and relaxing different muscle
groups
• Breathing exercises
• Guided imagery meditation
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21. Before getting into bed:
• Establish a routine for bedtime
• Create a positive sleep environment
• Relax before getting into bed
• Avoid alcohol, smoking and caffeine for at
least a few hours before bedtime
• Do not go to bed unless you are sleepy
• Reduce exposure to electronics (e.g.,
smartphones, tablets) within one hour of
bedtime; it’s best to keep these out of the
bedroom
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22. While in bed –
• If you can’t fall asleep in 20 minutes, get
out of bed and do something relaxing until
you are sleepy
• Use your bed for sleep only
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23. In the morning and daytime:
• Wake up at the same time each morning,
even on weekends
• Avoid daytime naps
• Avoid caffeine, especially in the late
afternoon and evening
• Exercise regularly, but not within four hours
of bedtime
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24. • Acupuncture
• Yoga
• Meditation
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25. Guidelines for Prescribing Hypnotics
• Initiate hypnotic use while identifying and
addressing specific behaviours,
circumstances, and underlying disorders
contributing to insomnia
• Prescribe the lowest effective dose of the
hypnotic
• Prescribe hypnotics for short durations (two
to four weeks) and intermittently (duration
based on patient's return to an acceptable
sleep cycle)
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26. • Avoid hypnotic use or exercise caution if
patient has a history of substance abuse,
myasthenia gravis, respiratory impairment, or
acute CVA
• Watch for requests for escalating doses or
resistance to tapering or discontinuing
hypnotics
• Hypnotics should be discontinued gradually
(i.e., tapered); physician should be alert for
adverse effects (especially rebound insomnia)
and withdrawal phenomena
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27. Benzodiazepams, non-benzodiazepams,
barbiturates, antihistamines,
antidepressants
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