INSOMNIA

INSOMNIA

7-Nov-14

INSOMNIA

INTRODUCTION

Insomnia comes from the Latin words for “no sleep.”

Insomnia is a sleep disorder where the sufferer finds it

difficult to fall and/or stay asleep. People with insomnia

have one or more of the following symptoms:

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INTRODUCTION

Diffculty Falling a sleep.

Waking up often during the night and having trouble getting

back to sleep.

Waking up too early in the morning.

Feeling tired upon waking.

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Types of insomniaThere are two types of insomnia: primary insomnia and

secondary insomnia.

Primary insomnia: This is when the sufferer has sleep problems that are not directly associated with any other health condition or problem.

Secondary insomnia: This is when the sufferer has sleep problems because of something else, such as a health condition like asthma, depression, arthritis, cancer or heartburn; pain; medicine being taken; or a substance being used, like alcohol.

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Acute vs. chronic insomnia

Insomnia also varies in how long it lasts and how often it occurs. It can be short-term (acute insomnia) or it can last a long time(chronic insomnia).

It can also come and go, with periods of time when a person has no sleep problems. Acute insomnia can last from one night to a few weeks.

Insomnia is called “chronic” when a person has insomnia at least three nights a week for a month or longer.

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Pathophysiology of Insomnia

Current research suggests that insomnia is a disorder of “hyperarousal” that is present 24 hours each day.

The pathophysiology of insomnia is multifactorial and may be thought of in terms of dysregulation involving the following 3 components:

Neurophysiologic Hyperactivation of the sympathetic nervous system.

Neuroendocrine Dysregulation of hormones associated with arousal.

Cognitive/Behavioral responses directed toward sleep that perpetuate arousal.

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Schematic diagram of the 24-hour sleep-wake cycle

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Time Period of Sleep Hours

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Etiology

Symptom of numerous diverse etiologies

Usually due to more than one factor and each needs a

separate evaluation

In all cases, one should strive to find the cause as it will

dictate the proper treatment

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Factors Influencing Insomnia

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Epidemiology

Studies throughout the world show that it occurs everywhere.Depending on the area, study, etc., between 10-50% of the population are affected.Increases with age.Twice as common in females.Up to the age of 30, there is little difference between sexes.Beyond 30 years, it is more common in females.Beyond 70 years, females are affected twice as much as males.

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Symptoms of Insomnia

Symptoms of insomnia can include:

Sleepiness during the day.

General tiredness.

Irritability.

Problems with concentration or memory.

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Risk FactorsYou're older than age 60. Because of changes in sleep patterns and health, insomnia increases with age.

You're under a lot of stress. Stressful events can cause temporary insomnia.

Major or long-lasting stress, such as the death of a loved one or a divorce, can lead to chronic insomnia. Being poor or unemployed also increases the risk.

You work night or changing shifts. Working at night or frequently changing shifts increases your risk of insomnia.

You travel long distances. Jet lag from traveling across multiple time zones can cause insomnia.

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Clinical Treatments

Acute insomnia may not require treatment. Mild insomnia can often be prevented or cured by practising good sleep habits.

If insomnia makes it hard for you to function during the day because you are sleepy and tired, your doctor may prescribe sleeping pills for a limited time.

Rapid onset, short-acting medications can help you avoid side effects such as drowsiness the following day.

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Clinical Treatments

Cognitive Behavior Therapy (CBT)

Longest lasting improvements, assuming the precipitating

cause is dealt with

“counseling” or “talk through” therapy for thoughts and

attitudes that may be leading to the sleep disturbances

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Clinical Treatments

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Diagnosis

Do you wake up during the night and find that you cannot fall back asleep?

Do you lie in bed, tossing and turning for hours each night?

Do you dread going to bed because you feel like you never get a good night’s sleep?

Do you wake up feeling unrefreshed after sleeping?

Does the problem occur even though you have the opportunity and the time to get a good night’s sleep?

If you answered “yes” to any of the above questions, then you may have insomnia.

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Drugs in MarketBenzodiazepines

Lorazepam

Clonezepam

Temazepam

Flurazepam

Quazepam

Alprazolam

Triazolam

Estazolam

Non Benzodiazepines

Zolpidem

Zolpidem CR

Zeleplon

Eszopiclone

Both these classes act on the GABAA receptors (BzRA) in PCN

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Drugs in Market

AntidepressantsTrazadone

Mirtazapine

Doxepin

Amitryptyline

AntipsychoticsOlanzapine

Quitiepine

Melatonin Receptor AgonistsMelatonin

Ramelteon

MiscellaneousValerian

Diphenhydramine

Cyclobenzaprine

Hydroxyzine

Alcohol

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Non-benzodiazepines

Nonbenzodiazepine sedative-hypnotic drugs.

such as zolpidem, zaleplon, zopiclone, and eszopiclone, are a class hypnotic medications indicated for mild to moderate insomnia.

Their effectiveness at improving time to sleeping is slight.However, there are controversies over whether these non-benzodiazepine drugs are superior to benzodiazepines.

These drugs appear to cause both psychological dependence and physical dependence.

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Antidepressants

Some antidepressants such as amitriptyline, doxepin, mirtazapine, and trazodone can have a sedative effect, and are prescribed to treat insomnia.

Amitriptyline and doxepin both have antihistaminergic, anticholinergic, and antiadrenergic properties, which contribute to their side effect profile.

The use of antidepressants in the treatment of insomnia can lead to withdrawal effects; withdrawal may induce rebound insomnia.

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Conclusion

Insomnia is a complex symptom with many causes and

perpetuating influences.

It is nerve-racking for patients and physicians yet it is very

remediable, if properly diagnosed and treated.

It should be aggressively treated as emerging evidence is

that chronic insomnia can precipitate major depressive

disorder.

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References

Golub, R. M. (2012). "Insomnia". JAMA: the Journal of the American Medical Association 307 (24): 2653–2653. doi:10.1001/jama.2012.6219

Wilson, Jennifer F. (2008). "Insomnia". Annals of Internal Medicine 148: ITC1. doi:10.7326/0003-4819-148-1-200801010-01001

http://www.psychologytoday.com/blog/sleepless-in-america/200905/cognitive-behavioral-therapy-insomnia-part-1

Sleepio – Research, accessed April 2014

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Thank you

HAVE GOOD SLEEP

By Saishree(11H61R0069)

7-Nov-14