Insomnia: Symptoms, Diagnosis and Treatment
Disabled World: Revised/Updated: 2017/06/26
Synopsis: Insomnia is a symptom of a sleep disorder characterized by persistent difficulty falling asleep or staying asleep.
Insomnia is a symptom of a sleeping disorder characterized by persistent difficulty falling asleep or staying asleep despite the opportunity. It is typically followed by functional impairment while awake.
Insomnia, or sleeplessness, is a sleep disorder in which there is an inability to fall asleep or to stay asleep as long as desired. Many adults experience insomnia at some point, but some people have long-term (chronic) insomnia. Insomnia may be the primary problem, or it may be secondary due to other causes, such as a disease or medication.
Insomniacs have been known to complain about being unable to close their eyes or "rest their mind" for more than a few minutes at a time. Both organic and non-organic insomnia constitute a sleep disorder.
Although there are several different degrees of insomnia, three types of insomnia have been clearly identified: transient, acute, and chronic.
- a) Transient insomnia lasts from days to weeks. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe depression, or by stress. Its consequences - sleepiness and impaired psychomotor performance - are similar to those of sleep deprivation.
- b) Acute insomnia is the inability to consistently sleep well for a period of between three weeks to six months.
- c) Chronic insomnia lasts for years at a time. It can be caused by another disorder, or it can be a primary disorder. Its effects can vary according to its causes. They might include sleepiness, muscular fatigue, hallucinations, and/or mental fatigue; but people with chronic insomnia often show increased alertness. Some people that live with this disorder see things as though they were happening in slow motion, whereas moving objects seem to blend together. Can cause double vision.
An over-active mind or physical pain may also be the causes.
Finding the underlying cause of insomnia is usually necessary to cure it. Insomnia can be common after the loss of a loved one, even years or decades after the death, if they have not gone through the grieving process. Overall, symptoms and the degree of their severity affect each individual differently depending on their mental health, physical condition, and attitude or personality.
A common misperception is that the amount of sleep a person requires decreases as he or she ages. The ability to sleep for long periods, rather than the need for sleep, appears to be lost as people get older. Some elderly insomniacs toss and turn in bed and occasionally fall off the bed at night, diminishing the amount of sleep they receive.
Specialists in sleep medicine are qualified to diagnose the many different sleep disorders.
Patients with various disorders including delayed sleep phase syndrome are often mis-diagnosed with insomnia. If a patient has trouble getting to sleep, but has normal sleep architecture once asleep, a circadian rhythm disorder is a likely cause.
In many cases, insomnia is caused by another disease, side effects from medications or a psychological problem. It is important to identify or rule out medical and psychological before deciding on the treatment for the insomnia.
Many insomniacs rely on sleeping tablets and other sedatives to get rest.
All sedative drugs have the potential of causing psychological dependence where the individual cannot psychologically accept that they can sleep without drugs.
The antihistamine Benadryl (diphenhydramine) is widely used in nonprescription sleep aids such as Tylenol PM, with a 50 mg recommended dose mandated by the FDA. In the United Kingdom, Australia, New Zealand, South Africa, and other countries, a 50 to 100 mg recommended dose is permitted.
Some insomniacs use herbs such as valerian, chamomile, lavender, hops, and passion-flower.
Valerian has undergone multiple studies and appears to be modestly effective.
Using aromatherapy, including jasmine oil, lavender oil, Mahabhringaraj and other relaxing essential oils, may also help induce a state of restfulness.
Many believe that listening to slow paced music will help insomniacs fall asleep.
Some traditional and anecdotal remedies for insomnia include:
- drinking warm milk before bedtime,
- taking a warm bath,
- exercising vigorously for half an hour in the afternoon,
- eating a large lunch and then having only a light evening meal at least three hours before bed,
- avoiding mentally stimulating activities in the evening hours,
- going to bed at a reasonable hour and getting up early,
- avoiding exposing the eyes to too much light, especially blue light, a few hours before bedtime.
There are two types of insomnia: primary insomnia and secondary insomnia.
Primary insomnia: Primary insomnia means that a person is having sleep problems that are not directly associated with any other health condition or problem.
Secondary insomnia: Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition (like asthma, depression, arthritis, cancer, or heartburn); pain; medication they are taking; or a substance they are using (like alcohol).
A complete diagnosis will differentiate between free-standing primary insomnia, insomnia as secondary to another condition, and primary insomnia co-morbid with one or more conditions.
- Insomnia is 40% more common in women than in men.
- A survey of 1.1 million residents in the United States found that those that reported sleeping about 7 hours per night had the lowest rates of mortality, whereas those that slept for fewer than 6 hours or more than 8 hours had higher mortality rates.
- Getting 8.5 or more hours of sleep per night increased the mortality rate by 15%.
- Severe insomnia, sleeping less than 3.5 hours in women and 4.5 hours in men, led to a 15% increase in mortality. (Most of the increase in mortality from severe insomnia was discounted after controlling for co-morbid disorders. After controlling for sleep duration and insomnia, use of sleeping pills was also found to be associated with an increased mortality rate)
- The lowest mortality was seen in individuals who slept between six and a half and seven and a half hours per night.
- Sleeping only 4.5 hours per night is associated with very little increase in mortality.
- Mild to moderate insomnia for most people is associated with increased longevity and severe insomnia is associated only with a very small effect on mortality.
- The National Sleep Foundation's 2002 Sleep in America poll showed that 58% of adults in the U.S. experienced symptoms of insomnia a few nights a week or more.
- Although insomnia was the most common sleep problem among about one half of older adults (48%), they were less likely to experience frequent symptoms of insomnia than their younger counterparts (45% vs. 62%), and their symptoms were more likely to be associated with medical conditions, according to the poll of adults between the ages of 55 and 84.
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