Insomnia

Definition

Standard Treatment
Signs and Symptoms Alternative Treatment
Diagnosis Prevalence
Etiology References

By: Ryan Cowley, Martha Martinez, and Michelle Torres

Summer 2004

Definition: Insomnia

     Insomnia is defined as a neurological disorder characterized by the inability to sleep at times when sleep is expected to occur.  A person experiencing insomnia may have an inability to fall asleep, stay asleep, or both. 

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Signs and Symptoms: Insomnia

      Signs and symptoms of insomnia include inability to fall asleep, interrupted sleep, difficulty in falling back asleep once awake, early morning waking, restlessness, fatigue, sleepiness, reduction in quality of sleep, tiredness, "racing" mind, difficulty concentrating, irritability, aggression, and memory trouble.  Inadequate sleep can decrease the immune system's ability to fight infections.   It is also the most common cause of automobile accidents and can lead to occupational injuries.  

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Diagnosis: Insomnia

     Primary insomnia is diagnosed when there is no obvious signs and symptoms of a mental or physical problem that would precipitate the condition.  Secondary insomnia is diagnosed when the insomnia is directly related to anxiety, stress, pain, or the use of some pharmacological agent.  Insomnia can also be categorized into different subtypes.  It can be characterized as chronic, intermittent, and transient.  Insomnia is classified as chronic only when it occurs most nights for one month or more.  It is classified as transient when when it occurs from one single night to a few weeks at a time, and it is considered intermittent when it occurs infrequently.  In order to correctly diagnose insomnia it is important to have a detailed record of sleeping habits.  The patient's spouse or sleeping partner may also be questioned concerning the patient's sleeping patterns.  The physician may also send the patient to a sleep clinic for more accurate observation.  

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Etiology: Insomnia

     The exact cause of insomnia is difficult to determine.  Sometimes the cause is unknown, but for primary insomnia the most common causes are stress, anxiety, environmental noise, extreme temperatures, a change in environment, sleeping or waking schedules, jet lag, and as a side effect of some medicines.  Other causes of primary insomnia include caffeine use, alcohol use, substance abuse, excitement, nighttime shift work, anger, grief, worry, smoking, sleeping area distractions, and having the wrong mattress.  Secondary insomnia is most often chronic and is usually associated with some underlying physical or mental disorder.  Depression is the most common cause of secondary insomnia and is usually one of the first things that must be ruled out to make a diagnosis.  Other causes of secondary insomnia include bipolar disorder, night urination, chronic pain, duodenal ulcers, arthritis, heart failure, lung disorders, kidney disorders, asthma, clinical depression, mania, schizophrenia, and other sleep disorders like sleep apnea.  

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Standard Treatment: Insomnia

     A physician may prescribe a drug to treat insomnia on a short-term basis.  It is important that the physician advise the patient on all side-effects and risks of use.  The side effects of these drugs include overdose, habituation, tolerance, addiction, daytime drowsiness, lethargy, and amnesia.  The primary drug given would be a benzodiazepine.  The three drugs from this class most commonly used are triazolam, temazepam, and flurazepam.  There are many over-the-counter drugs that can be taken as well, but they are generally advised to be taken with caution.  The physician may suggest not going to bed until drowsy, doing something pleasurable during wakeful hours, and establishing a regular sleeping routine.  The patient can also avoid stimulating activities before bed such as caffeine consumption, drinking alcoholic beverages, and strenuous exercise.  Relaxation therapy may be helpful for some patients to stop the mind from "racing". This is done by having the patient image the brain as a muscle and attempt to stop the muscle from working.  The patient may be advised to avoid stress, worrying, and cold and noisy environments.  Exercising at a regular time every day, getting some natural light in the afternoon, having a small snack before bed, changing the mattress, establishing a bedtime routine, and using the bed only for sleeping may be helpful, as well.     

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Alternative Treatments: Insomnia

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Prevalence: Insomnia

  Insomnia effects approximately 32 million people in the U.S. today.  This is 1 in every 8 people or 11.76% of the entire U.S. population.  It can affect people of any age but is more common in older people.  It is also more common in women, people over 60, people with a history of depression, people that suffer from stress and anxiety, and people with certain medical problems.  It is estimated that the cost of sleep aids will rise from $2.5 million to $5 million dollars by 2010.  

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References:

     Contemporary Pediatrics, Feb. 2002 v.19  i.2 pg. 69(9). Insomnia: Herbal and dietary alternatives to counting sheep. Parents are turning to herbs and dietary supplements to treat problems their children have falling and staying asleep. Do these products work? Are they risky? by Paule Gardiner and Kathi J. Kemper

     Ancient Healing Secrets: Practical Cures That Work Today  by Dion Dincin Buchman Ph.D. Insomnia pg. 127(2).  

     Better Nutrition, March 1996 v. 58 n. 3 pg. 46(4).  Three top herbs that work so you can sleep by Steven Foster.

     Country Living, Sept. 1996 v.19 n. 9 pg. 46(3).  The Chinese medicine chest by Maggy Howe.

     Traditional Home Remedies: The Old Farmer's Home Library Almanac     pg. 108(2). Time tested methods for staying well the natural way by Martha White.  

     Herbally Yours by Penny C. Royal.  Health problems: Insomnia pg. 80.

     Taber's Cyclopedic Medical Dictionary edited by Clayton L. Thomas, M.D., Ph.D.  Sleep, disorders of: Insomnia pg. 1814(2).      

     USDA, NRCS. 2004. The PLANTS Database, Version 3.5 (http://plants.usda.gov). National Plant Data Center, Baton, Rouge, LA 70874-4490

     http://www.wrongdiagnosis.com

     http://www.medicinenet.com

     http://www.medlineplus.com

 

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Last updated 20 July 2004
For more information contact Dr. Mary O'Connell at moconnel@nmsu.edu

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