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Insomnia

Insomnia

Insomnia is a sleep disorder that presents as a persistent inability to fall asleep. It affects over 25 million Americans, yet it's causes are often unclear. As such, diagnosing and treating insomnia is a major psycological and pharmacological field of research.

 

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Julia Revzin

Julia Revzin

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Beginning in the 1970's, the conventional clinical wisdom with respect to insomnia was that it was a symptom not a disorder and that it would resolve either when the precipitating event passed or when a co-occurring medical and/or psychiatric disorder was resolved. This point of view has largely passed as clinicians and researchers in the field argued for the recognition of insomnia as a disorder (not a symptom), as insomnia was found to persist following treatment of the primary condition, as interventions for insomnia were developed, refined and found to be efficacious, as these efficacious treatments were found to improve self-reported health, mood, concentration/alertness, daytime functioning, and quality of life (77).

Article: Diagnosis, prevalence, pa...
Source: Indian Journal of Medical...
Julia Revzin

Julia Revzin

7 Knowledge Cards 

Insomnia, though very often comorbid with (attached to/related to) other disorders, such as depression, anxiety, and schizophrenia, can be a disease in and of itself. Sometimes, insomnia is genuinly just a sympton of an existing disease. But, in many cases, after the existing condition is treated, the insomnia remains, showing that in those cases, insomnia developped as a seperate condition.

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The same applies to other new generation antidepressants; certain ones are sedating (eg, mirtazapine) while others are alerting (eg, bupropion). Sedating versions may be effective even in nondepressed patients, and they are recommended for depression with sleep problems. The presence or degree of sedating or alerting effects from antidepressant drugs varies widely in individual expression...

Article: Insomnia: Therapeutic App...
Source: Southern Medical Journal

There are many medications that are used to treat insomnia. Medications for insomnia that you can buy without a prescription usually contain antihistamines. You should speak with your PA or doctor before using antihistamines for a sleep problem, especially if you are older than 65 years or if you take other medications...

Article: Q: What can I do about in...
Source: JAAPA-Journal of the Amer...

Behavioral and cognitive-based therapy, especially when combined in a cognitive-behavioral therapy package, have been shown in clinical trials to be as effective as prescription medication for the short-term treatment of insomnia and may have long-term benefits beyond the end of active treatment.

Only eight medications, all of which are benzodiazepine receptor agonists, have received FDA approval for insomnia, despite widespread off-label use of other preparations for this condition. Little research has been done on the impact of stopping medication and the subsequent reemergence of insomnia.

Article: Insomnia.(THE EFFECTIVE P...
Source: Internal Medicine News
Julia Revzin

Julia Revzin

7 Knowledge Cards 

Becuase insomnia is caused by so many different things, there are many different ways to treat insomnia. And becuase there are so many treatments, figuring out what works when is very difficult, since what works on one person might not work on another, and figuring out what sort of insomnia someone has is often complicated.

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There are several ways to treat insomnia without seeing a doctor, if the sleeplessness is not caused by illness or by a serious psychiatric problem. A person should avoid lying in bed fretting if he or she does not fall asleep, but rather get up and do something restful, such as reading a good but unexciting book until drowsiness occurs. Television may be too stimulating for this purpose and should be avoided.

Article: Insomnia. (Sleep Disorder...
Source: The Columbia Univ Coll. o...

A variety of behavioral and pharmacologic interventions are available for this condition, but there is a lack of randomized clinical trials that have evaluated these therapies to help guide clinical decision making. It is difficult to account for comorbid psychiatric conditions in conducting and analyzing treatment studies of insomnia.

Article: Insomnia.(THE EFFECTIVE P...
Source: Internal Medicine News

The effect of medications in altering sleep is all too often forgotten. Even the sleep medications themselves, while sometimes useful on a very short-term basis, lose their effectiveness after about 2 weeks. After that, many people who suspend taking such drugs ironically fall prey to drug withdrawal insomnia, which causes a feeling of agitation and, at times, frightening dreams...

Article: Insomnia. (Sleep Disorder...
Source: The Columbia Univ Coll. o...
Julia Revzin

Julia Revzin

7 Knowledge Cards 

Insomnia can be caused by a lot of different things. Stress, worry, existing psychological disorders, sleep medication itself, etc. So it can be difficult to pinpoint what exactly caused any given person's insomnia. And as a result, it can be difficult to treat insomnia if one doesn't know the underlying cause.

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Lack of sleep can be caused by physical or psychological problems. Any disease that causes pain or discomfort (e.g., asthma, palpitations, indigestion, or cancer) can make it difficult to fall asleep. Nutritional, hormonal, and neurological disorders may act directly on the brain to hamper sleep...

Article: Insomnia.(Sleep Disorders...
Source: The Columbia Univ Coll. o...

Idiopathic, which means primary, insomnia develops in childhood and persists throughout a person’s lifetime. Its true cause is a mystery, though people who exhibit this chronic sleeplessness often suffer from particular brain dysfunctions as well; dyslexia, for example. These disorders may share a root cause with idiopathic insomnia, but more studies will have to be commissioned before any theories may be formed...

Article: Insomnia
Source: The Gale Encyclopedia of ...

The diagnosis of insomnia depends on patient self-report, which has not been shown to be reliable by clinical research. Other unproven diagnostic techniques that have been used include sleep diaries and actigraphs (wrist devices that record movements associated with activity while asleep and awake).

Polysomnography is the most sensitive diagnostic tool, but it is expensive and requires cumbersome recording electrodes that themselves can alter sleep.

The prevalence of insomnia is not well understood. It is estimated that 30% of the population has sleep disturbance and 10% has daytime functional impairment...

Article: Insomnia.(THE EFFECTIVE P...
Source: Internal Medicine News

Temporary periods of sleep disruption are not harmful to a person's long-term well-being, but they can, under the wrong circumstances, evolve into a long-term problem. After several sleepless nights, an individual can become conditioned to regard bed as a place to toss and turn and fret, rather than sleep. This problem can be aggravated by attempts to solve it: taking daytime naps, using sleeping pills or alcohol, and getting to bed at irregular hours.

Article: Insomnia. (Sleep Disorder...
Source: The Columbia Univ Coll. o...
Julia Revzin

Julia Revzin

7 Knowledge Cards 

In other words, one all nighter isn't going to efect your health that much. Getting into a habit of all nighters, such that resuming a regular sleep schedule becomes impossible, can develop into full blown insomnia.

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Criteria for insomnia include:

* A complaint of difficulty initiating sleep, difficulty maintaining sleep or waking up too early, or sleep that is chronically nonrestorative or poor in quality.

* The sleep difficulty occurs despite adequate opportunity for sleep.

* At least one of the following forms of daytime impairment: impairment in attention, concentration, or memory; fatigue or malaise; mood disturbance or irritability; daytime sleepiness; reduction in motivation, energy, or initiative; proneness for errors and accidents at work or while driving; tension, headaches, or GI symptoms in response to sleep loss; and concerns or worries about sleep.

Article: Insomnia is not a diagnos...
Source: Internal Medicine News

Insomnia is the inability to obtain an adequate amount or quality of sleep. The difficulty can be in falling asleep, remaining asleep, or both. People with insomnia do not feel refreshed when they wake up...

Article: Insomnia
Source: The Gale Encyclopedia of ...
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