What is insomnia?

Insomnia Signs
Three types of insomnia are acute, transient, and chronic insomnia.

Insomnia is defined as repeated difficulty with sleep initiation, maintenance, consolidation, or quality that occurs despite adequate time and opportunity for sleep and results in some form of daytime impairment.

What are the three types of insomnia?

  • Acute insomnia
    • Lasts up to one month
    • Commonly referred to as adjustment insomnia 
    • Occurs due to acute situational stress such as a new job, deadline, or exams
    • It typically resolves when the stressor is no longer present or the individual adapts to the stressor.
  • Transient insomnia
    • Lasts for less than one week 
    • Caused by another disorder, changes in the sleep environment, stress, or depression
  • Chronic insomnia
    • Lasts more than one month
    • Insomnia is usually a transient or short-term condition. In some cases, insomnia can become chronic
    • Associated with chronic medical and psychiatric conditions 
    • Usually occurs in patients with an underlying risk of insomnia

What are the causes of insomnia?

  • Adjustment insomnia (acute insomnia)
    • can be environmental- or stress-related 
    • new environment and unfamiliarity
    • excessive noise or light
    • extremes of temperature
    • uncomfortable bed or mattress
    • new job or school
    • relocation to a new place
    • work deadlines or examinations
    • deaths of relatives or close friends
    • difficulties in a relationship
  • Psychophysiologic insomnia (primary insomnia)
    • begins due to a prolonged period of stress and bad sleep habits
  • Paradoxical insomnia (people who mistakenly perceive their sleep as wakefulness)
    • due to depression and other psychological conditions
  • Insomnia due to a medical condition
  • Insomnia due to mental disorders
  • Insomnia due to medication
  • Behavioral problems of childhood
  • Age — the satisfaction of sleep declines with age

What are the signs and symptoms of insomnia?

How is insomnia treated?

Cognitive-behavioral therapy
Multiple therapies can be combined with/without medication. These include:

  • Sleep hygiene education
  • Cognitive therapy
  • Relaxation therapy
  • Stimulus-control therapy
  • Sleep-restriction therapy

Sleep hygiene education
Addresses behaviors that are incompatible with sleep such as caffeine or alcohol use, environmental noise, inappropriate room temperature, and watching TV in bed.

Cognitive therapy and relaxation therapy

  • Correct inaccurate beliefs about sleep
  • Reduce fear and excessive worrying 
  • Relaxation therapy: The patient is advised to recognize and control tension through a series of exercises that consist of first tensing and then systematically relaxing each muscle group.
  • Guided imagery and meditation to focus on neutral or pleasant thoughts

Stimulus-control therapy
Works by associating the bed with sleepiness instead of arousal.  Rules for this therapy include:

  • Use the bed only for sleeping and sexual activity (no reading, TV, eating, or working in bed).
  • Go to bed only when sleepy.
  • If unable to fall asleep in 15-20 minutes, get out of bed to do something relaxing until sleepy; this can be repeated as often as needed.
  • Do not spend more time in bed than needed.
  • Establish a standard wake-up time.
  • Avoid daytime napping.

Sleep-restriction therapy

  • Sleep-restriction therapy is based on the fact that excessive time in bed can lead to insomnia. Limiting the time spent in bed leads to more efficient sleep.
  • Works by limiting time in bed to the patient’s estimated total sleep time (not less than five hours) and increasing it by 15-30 minutes for a given week period until the optimal sleep duration is achieved.

Medication to treat insomnia

Acupressure for insomnia

Devices

  • FDA-approved prescription devices can be used in patients with insomnia.

Diet, exercise, and lifestyle

  • Avoid caffeinated beverages in the late afternoon or evening.
  • Avoid alcohol in the evening.
  • Avoid large meals right before bedtime.
  • Exercising in the late afternoon or early evening (six hours before bedtime) can promote sleep. 

QUESTION

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Medically Reviewed on 6/17/2020
References
Reference: https://emedicine.medscape.com/article/1187829-overview
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