Insomnia

Introduction

Insomnia is the inability to obtain an adequate amount or quality of sleep. Insomnia, defined as a persistent difficulty falling or staying asleep that impairs daytime function, is the most common sleep complaint.
Transient insomnia can be described as lasting from one night to a few weeks and is usually caused by events that alter your normal sleep pattern, such as traveling.
Intermittent insomnia occurs off and on and can be attributed to a number of emotional and physical factors. Chronic insomnia occurs most nights and lasts a month or more.

Causes

Insomnia can be caused by:

• Stress-related factors – significant personal events, such as losing a job, marital problems, stress and worry.
• Psychiatric conditions, such as depression, anxiety and schizophrenia.
• A medical condition or its treatment, including sleep apnea .
• Periodic limb movement disorder, the recurring movements of the legs.
• Restless leg syndrome, an unpleasant tickling, burning, pricking or aching sensations in the muscles of the legs.
• Use of substances such as caffeine, alcohol, and nicotine
• Circadian Rhythm Sleep Disorder (Sleep-wake Disorder), which occurs when your internal clock gets out of sync with your sleep schedule.
• Biological factors. As you age, sleep becomes lighter and more fragmented.
  Environmental factors. Noise, light and stale air can cause insomnia.
• Psychiatric conditions such as mood or anxiety disorders

Treatment

Treatment without Medication

• Develop a regular sleeping schedule. Avoid daytime naps and stimulating activities just before bedtime.
• Avoid stimulating drugs, such as caffeine and nicotine, particularly before going to bed.
• Avoid beverages containing caffeine after 2 PM in the afternoon.
• Avoid alcohol- it is a leading cause of poor sleep.
• Mask background noise in the bedroom throughout the night.
• Try using a sleep mask and ear plugs at night.
• Avoid all daytime sleeping including naps or TV snoozing.

Treatment with Medication

• Alcohol. Commonly self-prescribed as a sleep aid, alcohol is of limited benefit. A very small amount of alcohol can be relaxing and produce sleepiness early in the evening, but tolerance and withdrawal occur very rapidly.
• Benadryl and similar Antihistamines are probably the most commonly used sleeping preparations apart from alcohol. They are not consistently effective. Residual difficulty with coordination and memory can persist into the daytime.
• Benzodiazepines. In prescription form these drugs are relatives of diazepam (Valium) marketed as sleeping aids. The three most common ones are trade-named Dalmane, Halcion, and Restoril.
• Barbiturates were formerly the standard sleeping pills, sold under such names as Seconal and Nembutal. Barbiturates can depress the functioning of all electrically active tissue, including heart muscle.
• Other drugs such as ethchlorvynol are likely to produce neurologic side effects when taken. Many physicians prescribe a new, short-acting drug called Zolpidem (Ambien). It is not a benzodiazepine and may produce fewer side effects.
  Additionally, there are some behavioral techniques such as relaxation therapy, sleep restriction, reconditioning and bright-light therapy.