Insomnia and Its Causes

Insomnia is a symptom, not a stand-alone diagnosis or a disease. By definition, insomnia is† difficulty initiating or maintaining sleep, or both†or the perception of poor quality sleep. It is also a common sleep problem that can affect your quality of life. Poeple with insomnia have trouble falling asleep or staying asleep. They wake up during the night or wake up too early next morning. Insomnia may therefore be due to inadequate quality sleep. Insomnia is not defined by a specific number of hours of sleep that one gets, since individuals vary widely in their sleep needs and practices.Although most of us know what insomnia is and how we feel and perform after one or more sleepless nights, few seek medical advice. Many people remain unaware of the behavioral and medical options available to treat insomnia. Insomnia is generally classified based on the duration of the problem. These are the transcient, short-term and chronic insomnia. Insomnia affects all age groups. Among adults, insomnia affects women more often than men. The incidence tends to increase with age.It is typically more common in people in lower socioeconomic (income) groups, chronic alcoholics, and mental health patients. Stress most commonly triggers short-term or acute insomnia. If you do not address your insomnia, however, it may develop into chronic insomnia. Some surveys have shown that 30% to 35% of Americans reported difficulty falling asleep during the previous year and about 10% reported problems with long standing insomnia. There also seems to be an association between depression, anxiety and insomnia.Although the nature of this association is unknown, people with depression or anxiety were significantly more likely to develop insomnia. Insomnia may be caused by a host of different reasons. These causes may be divided into situational factors, medical or psychiatric conditions or primary sleep problems. Insomnia could also be classified by the duration of the symptoms into t ransient insomnia generally last less than seven days; short-term insomnia usually lasts for about one to three weeks, and chronic insomnia lasts for more than three weeks as mentioned earlier.The various causes of insomnia are elaborated in the paragraphs below. Many of the causes of the causes of transient and short-term insomnia are similar and they include: jet lag, changes in shift work, excessive or unpleasant noise, comfortable room temperature(too hot or too cold),stressful situations in life(exam preparation, loss of a loved one ,unemployment ,divorce ,or separation),presence of an acute medical or surgical illness or hospitalization and withdrawal from drug, alcohol, sedative, or stimulant medications.Also insomnia related to high altitude (mountains), uncontrolled physical Symptoms (pain, fever, breathing problems, nasal congestions, cough, diarrhea, etc. ) can also cause someone to have insomnia. Controlling these symptoms and their underlying causes may lead to resoluti on of insomnia. Furthermore, majority of the causes of chronic or long-term insomnia are usually linked to an underlying psychiatric or physiologic (medical) condition. Again, the most common psychological problems that may lead insomnia include:anxiety,depression,stress(mental,emotional,situational,etc. ,schizophrenia,and/or mania(bipolar disorder). Nevertheless, insomnia may be an indicator of depression. Many people will have insomnia during the acute phases of a mental illness. As mentioned earlier, depression and anxiety are strongly associated with insomnia. Out of all the other secondary medical and psychological causes of insomnia, anxiety and depression are the most common. Also, physiological causes span from circadian rhythm disorders (disturbances of the biological clock), sleep-wake imbalance, to a variety of medical conditions.The following are the most common medical conditions that trigger insomnia: chronic pain syndromes, chronic fatigue syndrome, congestive heart f ailure, night time angina(chest pain)from heart disease, acid reflux disease(GERD),Chronic Obstructive Pulmonary disease(COPD) and nocturnal asthma(asthma with night time breathing symptoms). Others include: obstructive sleep apnea, degenerated disease, such as Parkinson’s disease and Alzheimer’s disease(often insomnia is the deciding factor for nursing home placement. and brain tumors, strokes, or trauma to the brain. In addition to people with the above medical conditions, certain groups may be at higher risk for developing insomnia: travelers, shift workers with frequent changing of shifts, seniors, adolescents or young adult’s students, pregnant women, women in menopause, people who use abuse drugs and alcoholics. Another area worth mentioning is the medication related to insomnia. Certain medications have also been associated with insomnia.Among these are: certain over-the-counter cold and asthma preparations, the prescription varieties of these medications may also contain stimulants and thus produce similar effects on sleep, some medications used to treat high blood pressure have also been associated with poor sleep and some medications used to treat depression, anxiety and schizophrenia. Other causes of insomnia are common stimulants associated with poor sleep include caffeine and nicotine. You should consider not only restricting caffeine and nicotine use in the hours immediately before bedtime but limiting your total daily intake.Also, people often use alcohol to help induce sleep, as a nightcap. However, it is a poor choice. Alcohol is associated with sleep disruption and creates a sense of non-refreshed sleep in the morning. Lastly, a disruptive bed partner with loud snoring or periodic leg movements also may impair your ability to get a good night’s sleep. In spite of the above stated points doctors associate a variety of signs and symptoms with insomnia. Often, the symptoms intertwine with those of other medical or men tal conditions.They are: some people with insomnia may complain of difficulty falling asleep or waking up frequently during the night. The problem may begin with stress. Then, as you begin to associate the bed with your inability to sleep, the problem may become chronic. Also most often daytime symptoms will bring people to seek medical attention. Daytime problems caused by insomnia include the following: poor concentration and focus, difficulty with memory, impaired motor coordination (being uncoordinated), irritability and impaired social interaction and motor vehicle accidents because of fatigued, sleep-deprived drivers.Other symptoms may include: having trouble falling asleep, waking up during the night and having trouble going back to sleep, waking up too early in the morning, feeling tired when they wake up(like didn’t get enough sleep) and feeling grouchy, sleep, or anxious and be unable to get things done during the daytime. People may worsen these daytime symptoms by their own attempts to treat the symptoms; alcohol and antihistamines may compound the problems with sleep deprivation. Others have also tried non prescription sleep aids.Many people with insomnia do not complain of daytime sleepiness, and in fact, they may have difficulty falling asleep during intentional daytime naps. In diagnosing insomnia, the health practitioner will begin an evaluation of insomnia with a complete medical history. As with most medical examinations; a complete medical history and physical examination are import aspects of assessment and treatment of insomnia. The health care practitioner will seek to identify any medical or psychological illness that may be contributing to the patient’s insomnia.A thorough medical history and examination including screening for psychiatric disorders and drug and alcohol use is paramount in evaluation of a patient with sleep problems. Physical examination may particularly focus on heart and lung examination, and measuremen t of size of the neck and visualizing oral and nasal air passages(to see whether sleep apnea needs to be assessed in more detail). Treatment for insomnia focuses on the reason why you don’t sleep well. In general, transient insomnia resolves when the underlying trigger is removed or corrected.Most people seek medical attention when their insomnia becomes chronic. The main focus of treatment for insomnia should be directed towards finding the cause. Once a cause is identified, it is important to manage and control the underlying problem, as this alone may eliminate the insomnia without addressing the main cause is rarely successful. If you have a medical problem, such as stress, treating that problem may help you sleep better. You may be able to sleep better by making some small changes.It may help to: go to bed at the same time each night, get up at the same time each day, avoid caffeine and alcohol for several hours before bedtime, get regular exercise (but make sure you fin ish the exercise at least 3 to 4 hours before you go to bed) and avoid daytime naps. Some people may need medicine for a while to help them fall asleep. Doctors often prescribe medicine for a short time if other treatment isn’t working. But medicine doesn’t work as well over time as lifestyle and behavior changes do. Sleep medicine can also become habit-forming.Medicine works best as a short-term treatment combined with lifestyle and behavior changes. Your doctor may also recommend counseling, which can help you learn new habits that may help you sleep better. Talk to your doctor about your sleep problems and any other health issues you may have. This is important, because lack of sleep can lead to depression, accidents, and problems at work, marital and social problems, drinking more alcohol than usual and poor health. Treatment may help you avoid these problems and feel better. Generally, treatment of insomnia entails both non-pharmacologic (non-medical) and pharmaco logic (medical) aspects.It is best to tailor treatment for individual patient based on the potential cause. Studies have shown that combining medical and non-medical treatments typically is more successful in treating insomnia than either one alone. In a nutshell, I would advise that if you have insomnia caused by jet lag, your symptoms will generally clear up within a few days. If you are depressed and have had insomnia for many months, it is unlikely that your symptoms will go away on their own. Your outcome will also depend on coexisting medical conditions, which may include congestive heart ailure, chronic obstructive pulmonary diseases (COPD), and chronic pain syndromes. Synonyms and keywords Sleeplessness, stress, anxiety, depression, sleepless, chronic insomnia, acute insomnia, mental illness, sleep habits, insomniac, insomnia, difficulty sleeping, sleep, disorders that disrupt sleep, difficulty falling asleep, primary insomnia, sleep test, obstructive sleep apnea, insomnia m edications, daytime sleepiness, melatonin, jet lag, shift change. Authors and Editors Author: Siamak T. Nabili(2010),MD,MPH Editor: Melissa Conrad Stoppler, MD Reference: eMedicine. Com. Insomnia. http://emedicine. edscape. com/article/1187829-overview Previous contributing authors and editors: Author: Mary E. Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Associate Professor, Department of Clinical Pediatrics, State University of New York at Stony Brook, et al. Other works consulted: * Littner M, et al. (2003). Practice parameters for using polysomnography to evaluate insomnia: An update. Sleep, 26(6):754-760. * Ropper AH, Samuels MA (2009). Sleep and its abnormalities. In Adams and Victor’s principles of Neurology, 9th ed. , pp. 374-396. New York: McGraw-Hill.