Insomnia
From Wikipedia, the free encyclopedia
| ICD-10 | F51.0, G47.0 |
|---|---|
| ICD-9 | 307.42, 307.41, 780.51, 780.52 |
Insomnia is characterized by an inability to sleep and/or inability to remain asleep for a reasonable period. Insomniacs typically complain of being unable to close their eyes or "rest their mind" for more than a few minutes at a time. Both organic and nonorganic insomnia constitute a sleep disorder.[1][2] It is often caused by fear, stress, anxiety, medications, herbs, caffeine, depression or sometimes for no apparent reason. An overactive mind or physical pain may also be causes. Finding the underlying cause of insomnia is usually necessary to cure it.
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[edit] Types of insomnia
Three different types of insomnia exist: transient, acute, and chronic
- Transient Insomnia lasts from one night to a few weeks but it seems longer. Most people occasionally suffer from transient insomnia due to such causes as jet lag or short-term anxiety. If this form of insomnia continues to occur from time to time, the insomnia is classified as intermittent.
- Acute Insomnia is the inability to consistently sleep well for a period of between three weeks to six months.
- Chronic Insomnia is regarded as the most serious; persists almost nightly for at least a month.
[edit] Insomnia versus poor sleep quality
Poor sleep quality can occur as a result of sleep apnea or major depression. Poor sleep quality is caused by the individual not reaching stage 4 or delta sleep which has restorative properties. There are, however, people who are unable to achieve stage 4 sleep due to brain damage that still lead perfectly normal lives.
- Sleep apnea is a condition that occurs when a sleeping person's breathing is interrupted, thus interrupting the normal sleep cycle. With the obstructive form of the condition, some part of the sleeper's respiratory tract loses muscle tone and partially collapses. People with obstructive sleep apnea often do not remember any of this, but they complain of excessive sleepiness during the day. Central sleep apnea interrupts the normal breathing stimulus of the central nervous system, and the individual must actually wake up to resume breathing. This form of apnea is often related to a cerebral vascular condition, congestive heart failure, and premature aging.
Major depression leads to alterations in the function of the hypothalamus and pituitary causing excessive release of cortisol which can lead to poor sleep quality.
Nocturnal polyuria or excessive nighttime urination can be very disturbing to sleep. Urination produces strong signals to the brain to wake up. Nocturnal polyuria can be nephrogenic (related to kidney disease) or it may be due to prostate enlargement or hormonal influences. Deficiencies in vasopressin, which is either caused by a pituitary problem or by insensitivity of the kidney to the effects of vasopressin, can lead to nocturnal polyuria. Excessive thirst or the use of diuretics can also cause these symptoms.
[edit] Treatment for insomnia
In many cases, insomnia is caused by another disease or psychological problem. In this case, medical or psychological help may be useful.
All sedative drugs have the potential of causing psychological dependence where the individual can't psychologically accept that they can sleep without drugs. Certain classes of sedatives such as benzodiazepines and newer non-benzodiazepine drugs can also cause physical dependence which manifests in withdrawal symptoms if the drug is not carefully titrated down.
Many insomniacs rely on sleeping tablets and other sedatives to get rest. The most commonly used class of hypnotics prescribed for insomnia are the benzodiazepines. This includes drugs such as temazepam, diazepam, lorazepam, flurazepam, nitrazepam and midazolam. These medications can be addictive, especially after taking them over long periods of time.
Recent research has shown that cognitive behavior therapy can be more effective than medication in controlling insomnia [1]. In this therapy, patients are taught improved sleep habits and relieved of counter-productive assumptions about sleep.
Non-benzodiazepine prescription drugs, including Ambien and Lunesta, have a cleaner side effect profile than the older benzodiazepines; however, there are controversies over whether these non-benzodiazepine drugs are superior to benzodiazepines. These drugs appear to cause both psychological dependence and physical dependence, and can also cause the same memory and cognitive disturbances as the benzodiazepines along with morning sedation.
Melatonin has proved effective for some insomniacs in regulating the sleep/waking cycle, but lacks definitive data regarding efficacy in the treatment of insomnia.
Melatonin agonists, including Ramelteon (Rozerem), seem to lack the potential for abuse and dependence. This class of drugs has a relatively mild side effect profile and lower likelihood of causing morning sedation.
The antihistamine diphenhydramine is widely used in nonprescription sleep aids, with a 50 mg recommended dose mandated by the FDA. In the United Kingdom, Australia, New Zealand, South Africa, and other countries, a 50 to 100 mg recommended dose is permitted. While it is available over the counter, the effectiveness of these agents may decrease over time and the incidence of next-day sedation is higher than for most of the newer prescription drugs. Dependence does not seem to be an issue with this class of drugs.[citation needed]
Some antidepressants such as mirtazapine, trazodone and doxepin have a sedative effect, and are prescribed off label to treat insomnia. The major drawback of these drugs is that they have antihistaminergic, anticholinergic and antiadrenergic properties which can lead to many side effects. Some also alter sleep architecture.
Low doses of atypical antipsychotics such as quetiapine (Seroquel) are also prescribed for their sedative effect but the danger of neurological and cognitive side effects make these drugs a poor choice to treat insomnia.
Some insomniacs use herbs such as valerian, chamomile, lavender, hops, and passion-flower. Valerian has undergone the most studies[citation needed] and appears to be modestly effective[citation needed].
Alcohol may have sedative properties, but the REM sleep suppressing effects of the drug prevent restful, quality sleep. Middle-of-the-night awakenings due to polyuria or other effects from alcohol consumption are common, and hangovers can also lead to morning grogginess.
Some traditional remedies for insomnia have included drinking warm milk before bedtime, taking a warm bath in the evening; exercising vigorously for half an hour in the afternoon, eating a large lunch and then having only a light evening meal at least three hours before bed, avoiding mentally stimulating activities in the evening hours, and making sure to get up early in the morning and to retire to bed at a reasonable hour.
Pomegranates are also believed to help insomniacs sleep.
Warm milk contains high levels of tryptophan, a natural sedative. Using aromatherapy, including jasmine oil, lavender oil, Mahabhringaraj and other relaxing essential oils, may also help induce a state of restfulness.
- Adding honey to warm milk helps get the tryptophan in your system faster. Tryptophan absorption is normally inhibited or deterred by other amino acids but in the presence of sugar tryptophan is absorbed more quickly.[citation needed]
Many believe that listening to slow paced music will help insomniacs fall asleep. This theory is currently being studied by professor Jedediah Fajman at the University of Illinois.
The more relaxed a person is, the greater the likelihood of getting a good night's sleep. Relaxation techniques such as meditation have been shown to help people sleep. Such techniques can lower stress levels from both the mind and body, which leads to a deeper, more restful sleep.[citation needed]
[edit] Alternative approaches
Traditional Chinese medicine has included treatment for insomnia throughout its history. A typical approach may utilize acupuncture, dietary and lifestyle analysis, herbology and other techniques, with the goal of resolving the problem at a subtle level. Although these methods have not been scientifically proven, some insomniacs report that these remedies are sufficient to break the insomnia cycle without the need for sedatives and sleeping tablets[citation needed].
In the Buddhist tradition, people suffering from insomnia or nightmares may be advised to meditate on "loving-kindness", or metta. This practice of generating a feeling of love and goodwill is claimed to have a soothing and calming effect on the mind and body[3]. This is claimed to stem partly from the creation of relaxing positive thoughts and feelings, and partly from the pacification of negative ones. In the Mettā Sutta, Siddhartha Gautama, the Buddha, tells the gathered monks that easeful sleep is one benefit of this form of meditation.
There are a number of alternative cures for this disorder that are currently marketed. Often, a combination of dietary and lifestyle changes is claimed to be the most helpful approach. However, it should be noted the reason they are considered "alternative" medical treatments is the lack of empirical evidence to back up such claims. There are always studies going on to either confirm or deny the effectiveness of such medicine, but in many cases even if no effect is shown to exist in a treatment, proponents will still believe in their effectiveness.
[edit] The Cure for Insomnia
The Cure for Insomnia (1987) is a movie, directed by John Henry Timmis IV, that was designed to cure insomnia. It runs for 87 hours and has no plot, instead it consists of artist L. D. Groban reading his lengthy poem "A Cure for Insomnia", spliced with clips of heavy metal and pornographic videos. This movie was first shown at The School of the Art Institute in Chicago, Illinois from January 31 to February 3, 1987. It's unknown whether it has been shown after that.
[edit] Statistics for insomnia
According to the U.S. Department of Health and Human Services, approximately 60 million Americans suffer from insomnia each year.[4] Insomnia tends to increase with age and affects about 40 percent of women and 30 percent of men [5]. The average American gets 7 hours of sleep, instead of the 8 to 10 hours recommended by doctors.
[edit] Insomnia in popular culture
[edit] Movies
- Insomnia Sucks (2007)
- Cashback (2006)
- The Machinist (2004)
- Lost In Translation (2003)
- Insomnia (2002)
- Fight Club (1999)
- Insomnia (1998)
- Insomnia (1997)
- Dream of an Insomniac (1996)
- Taxi Driver (1976)
[edit] Books
- Insomnia by Stephen King
- Fight Club by Chuck Palahniuk
- Johnny the Homicidal Maniac by Jhonen Vasquez
[edit] Songs
- Insomnia (Faithless song)
- Insomnia (Feeder song)
- Insomnia, a song by Megadeth
- Flowing, a song by 311
- Insomnia, a song by The Rentals
- Insomnia, a song by The Cruxshadows
[edit] See also
[edit] External links
- NHS Direct information on Insomnia
- NIH state of the science report on management of chronic insomnia in adults
- Insomnia from the NSF Sleeptionary
- Sleeplessness
- American Academy of Sleep Medicine
- Insomnia at FamilyDoctor.org
- Insomnia at University of Maryland Medical Center
- Vietnam Man goes 3 Decades Without Sleep - Unconfirmed (Probably bogus considering source)
- Insomnia Treatment Information
- Personal Accounts and Support
- Information on non-chemical treatment of insomnia by use of music compiled from user's brainwaves
- Insomnia and sleep disorder
[edit] References
[PhD, Gregg]; Edward F. Pace-Schott, MA; Robert Stickgold, PhD; Michael W. Otto, PhD (September 27, 2004). "Cognitive Behavior Therapy and Pharmacotherapy for Insomnia: A Randomized Controlled Trial and Direct Comparison". Archives of Internal Medicine 164 (17): 1888-1896.
- ^ http://www3.who.int/icd/currentversion/fr-icd.htm?gf50.htm+f510
- ^ http://www3.who.int/icd/currentversion/fr-icd.htm?gg40.htm+g47
- ^ Lutz, A., Greischar, L.L., Rawlings, N.B., Ricard, M., and Davidson, R.(2004). Long-term meditators self-induce high-amplitude gamma synchrony during mental practice. Proc. Natl. Acad. Sci. USA 101,16369–16373.
- ^ http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm
- ^ http://www.womenshealth.gov/faq/insomnia.htm
