Doctor Maya Alishayeva MS, Dipl. AC., L.AC National Board Certified Acupuncturist
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Insomnia is most frequently defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, survey studies define insomnia simply as a positive response to either of two questions: "Do you experience difficulty sleeping?" or "Do you have difficulty falling or staying asleep?"
Thus, insomnia is most often thought of as both a sign and a symptom that can accompany several sleep, medical and psychiatric disorders, characterized by persistent difficulty falling asleep and/or staying asleep or sleep of poor quality. Insomnia is typically followed by functional impairment while awake. One definition of insomnia is "difficulties initiating and/or maintaining sleep, or nonrestorative sleep, associated with impairments of daytime functioning or marked distress for more than 1 month."
Insomnia can be grouped into primary and secondary, or comorbid, insomnia. Primary insomnia is a sleep disorder not attributable to a medical, psychiatric, or environmental cause. A diagnosis will usually differentiate among --
insomnia as secondary to another condition, primary insomnia co-morbid with one or more conditions, or free-standing primary insomnia.
Types of insomnia Insomnia can be classified as transient, acute, or chronic.
1.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. 2.Acute insomnia is the inability to consistently sleep well for a period of less than a month. 3.Chronic insomnia lasts for longer than a month. It can be caused by another disorder, or it can be a primary disorder. Its effects can vary according to its causes. They might include muscular fatigue, hallucinations, and/or mental fatigue; but people with chronic insomnia often show increased alertness.Some people that live with this disorder see things as if they are happening in slow motion, wherein moving objects seem to blend together. Can cause double vision.
Patterns of insomnia Sleep-onset insomnia is difficulty falling asleep at the beginning of the night, often a symptom of anxiety disorders or the delayed sleep phase disorder.
Nocturnal awakenings are characterized by difficulty returning to sleep after awakening in the middle of the night or waking too early in the morning: middle-of-the-night insomnia and terminal insomnia. The former may be a symptom of pain disorders or medical illness; the latter is often a characteristic of clinical depression.
Poor sleep quality can occur as a result of, for example, restless legs, sleep apnea or major depression. Poor sleep quality is caused by the individual not reaching stage 3 or delta sleep which has restorative properties. There are, however, people who are unable to achieve stage 3 sleep due to brain damage who lead perfectly normal lives.
Major depression leads to alterations in the function of the hypothalamic-pituitary-adrenal axis, causing excessive release of cortisol which can lead to poor sleep quality.
Nocturnal polyuria, excessive nighttime urination, can be very disturbing to sleep.
Sleep state misperception Some cases of insomnia are not really insomnia in the traditional sense. People experiencing sleep state misperception often sleep for normal durations, yet severely overestimate the time taken to fall asleep. They may believe they slept for only 4 hours while, paradoxically, sleeping a full 8 hours.
Causes and co-morbidities Symptoms of insomnia can be caused by or can be co-morbid with:
Use of psychoactive drugs or stimulants, including certain medications, herbs, caffeine, nicotine, cocaine, amphetamines, methylphenidate, MDMA and modafinil
Use of fluoroquinolone antibiotic drugs, see fluoroquinolone toxicity, associated with more severe and chronic types of insomnia
Restless Legs Syndrome, which can cause sleep onset insomnia due to the discomforting sensations felt and the need to move the legs or other body parts to relieve these sensations.
Periodic limb movement disorder (PLMD) which occurs during sleep and can cause arousals which the sleeper is unaware of. Pain
An injury or condition that causes pain can preclude an individual from finding a comfortable position in which to fall asleep, and can in addition cause awakening.
Hormone shifts such as those that precede menstruation and those during menopause
Life events such as fear, stress, anxiety, emotional or mental tension, work problems, financial stress, birth of a child and bereavement.
Mental disorders such as bipolar disorder, clinical depression, generalized anxiety disorder, post traumatic stress disorder, schizophrenia, or obsessive compulsive disorder.
Disturbances of the circadian rhythm, such as shift work and jet lag, can cause an inability to sleep at some times of the day and excessive sleepiness at other times of the day.
Chronic circadian rhythm disorders are characterized by similar symptoms.
Certain neurological disorders, brain lesions, or a history of traumatic brain injury
Medical conditions such as hyperthyroidism and rheumatoid arthritis
Abuse of over-the counter or prescription sleep aids can produce rebound insomnia
Poor sleep hygiene, e.g., noise
Parasomnias which include such disruptive sleep events as nightmares, sleepwalking, night terrors, violent behavior while sleeping, and REM behavior disorder, in which the physical body moves in response to events within dreams.
A rare genetic condition can cause a prion-based, permanent and eventually fatal form of insomnia called fatal familial insomnia.
Physical exercise. Exercise-induced insomnia is common in athletes, causing prolonged sleep onset latency.
Sleep studies using polysomnography have suggested that people who have sleep disruption have elevated nighttime levels of circulating cortisol and adrenocorticotropic hormone They also have an elevated metabolic rate, which does not occur in people who do not have insomnia but whose sleep is intentionally disrupted during a sleep study.
Studies of brain metabolism using positron emission tomography (PET) scans indicate that people with insomnia have higher metabolic rates by night and by day. The question remains whether these changes are the causes or consequences of long-term insomnia.
A common misperception is that the amount of sleep required decreases as a person ages. The ability to sleep for long periods, rather than the need for sleep, appears to be lost as people get older. Some elderly insomniacs toss and turn in bed and occasionally fall off the bed at night, diminishing the amount of sleep they receive
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