RxMed: Illness Information

Valuable information for over 200 common illnesses

General Illness Information

Medical Term:

INSOMNIA

Common Name:

None Specified

Description:

Difficulty in falling asleep or maintaining sleep, intermittent wakefulness, early morning awakening or a combination of these. Insomnia can be transient or chronic.

Transient insomnia may be due to- a life crisis, bereavement, change in environment or concomitant illness.

Chronic insomnia may be due to--medical and psychiatric conditions or drug intake.

Affects an estimated 35% of the adult population and is one of the most frequent complaints in primary care practice.

Affects all age groups and affects males and females equally, but commonest in elderly

Causes:

Anxiety caused by stress.

Depression. This is usually characterized by early-morning wakefulness.

Over-activity of the thyroid gland.

Noisy environment (including a snoring partner).

Allergies and early-morning wheezing.

Heart or lung conditions that cause shortness of breath when lying down.

Painful disorders, such as fibromyositis or arthritis.

Urinary or gastrointestinal problems that require urination or bowel movement during the night.

Consumption of stimulants, such as coffee, tea or cola drinks.

Use of some medications, including amphetamines, cortisone drugs , decongestants, theophylline, phenytoin (Dilantin) and levodopa (Sinemet, Dopa.)

Erratic work hours, shift change.

New environment or location.

Lack of physical exercise.

Jet lag after travel.

Alcoholism.

Drug abuse, including overuse of sleep-inducing drugs.

Withdrawal from addictive substances.

Prevention:

Establish a lifestyle that fosters healthy sleep patterns (see General Measures).

Avoidance of all possible causes.

If unable to sleep, get up and carry out routine mundane chores (don't watch TV).

Signs & Symptoms

Restlessness when trying to fall asleep.

Brief sleep followed by wakefulness.

Normal sleep until very early in the morning (3 a.m. or 4 a.m.), then wakefulness (often with frightening thoughts).

Periods of sleeplessness, alternating with periods of excessive sleep or sleepiness at inconvenient times.

Tiredness

Anticipatory anxiety

Risk Factors

	Stress, obesity, smoking, excessive alcohol intake.
	Age over 50.

Diagnosis & Treatment

Diagnosis is generally made on history. Diagnosis can be confirmed by the use of polysomnography, particularly if sleep apnea is suspected. This is generally not necessary or practical.
General Measures:
	Seek ways to minimize stress. Learn and practice relaxation techniques.
	See your doctor to rule out physical causes.
	Don't use stimulants for several hours before bedtime. Avoid alcohol after 5 PM or within 6 hours of retiring because of secondary rebound stimulation
	Treat any underlying drug use or medical cause.
	Relax in a warm bath before bedtime.
	Don't turn your bedroom into an office or a den. Create a comfortable sleep environment.
	Turn off your mind. Focus on peaceful and relaxing thoughts. Play soft music or relaxation tapes
	Set a rigid sleep schedule.
	Use mechanical aids such as ear plugs, eye shades or electric blanket.
	Psychotherapy or counseling, if the cause is psychological.

Medications:
	Sleep-inducing drugs may be prescribed for a short time if temporary insomnia is interfering with your daily activities; if you have a medical disorder that regularly disturbs sleep ,you need to establish regular sleep patterns.
	Long-term use of sleep inducers may be counter-productive or addictive. Don't use sleeping pills given to you by friends, and don't take non-prescription sleeping pills.
	Analgesics as indicated for pain ( if pain is the cause of insomnia).
	Three classes of sleep inducers are:
	1. Benzodiazepines e.g. Flurazepam (Dalmane), Temazepam (Restoril), Triazolam (Halcion).
	2. Non benzodiazepine agents e.g. Zolpidem (Ambien), Zaleplon (Sonata)- a short-acting hypnotic and is the newest drug approved for treatment of insomnia.
	3.Tricyclic antidepressants- very helpful in insomnia due to depression. Preferred agent is amitriptyline (Elavil) because of its marked sedative effect. A typical starting dose is 50-100 mg at bedtime.
	ALTERNATIVE DRUGS:
	Diphenhydramine (Benadryl) has been used to induce sleep in the elderly, but it may also cause confusion and "hangover"
	Melatonin, a pineal hormone. Marketed as a dietary supplement. There is some evidence that controlled-release melatonin improves sleep quality in a selected elderly population. Not FDA approved. Appears useful for jet lag. Has mild hypnotic effect. No adverse effects have been reported, but controlled studies are lacking.
	Other dietary supplements used for insomnia are Kava kava , valerian , passion flower . Unlike sleeping pills these are not addictive. For more information click on Kava kava.

Activity:

Exercise regularly to create healthy fatigue, but not within 2 hours of going to bed.

Have sexual relations, if they are fulfilling and satisfying, before going to bed.

Diet:
	No special diet, but don't eat within 3 hours of bedtime if indigestion has previously disturbed your sleep. Drinking a glass of warm milk before bedtime helps some people.

Possible Complications :
	Transient insomnia becomes chronic.
	Increased daytime sleepiness that can affect all aspects of your life.

Prognosis

Most persons can establish good sleep patterns if the underlying cause of insomnia is treated or eliminated.

Other

'Nothing Specified'.