Insomnia is characterized by an inability to sleep and/or to remain asleep for a reasonable period. Insomniacs typically complain of being unable to close their eyes or "rest their mind" for more than a few minutes at a time. Both organic and nonorganic insomnia constitute a sleep disorder. It is often caused by fear, stress, anxiety, medications, herbs or caffeine. An overactive mind or physical pain may also be causes. Finding the underlying cause of insomnia is usually necessary to cure it.
Three different types of insomnia exist. Insomnia may be classified as transient, acute (short-term), and chronic. Insomnia lasting from one night to a few weeks is referred to as transient. This is generally the case for most people, as one often suffers from jet lag or short-term anxiety. If this form of insomnia continues to occur from time to time, the insomnia is classified to be intermittent. Acute insomnia is the inability to consistently sleep well for a period of three weeks to six months. However, after this time, the person does not experience insomniatic episodes. Insomnia is considered to be chronic, the most serious, if it persists almost nightly for at least a month, and sometimes longer.
A person can have primary or secondary insomnia. Primary insomnia is sleeplessness that is not attributable to a medical or environmental cause. Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition, an example of which would be generalized anxiety disorder.
Some of the most common causes of insomnia are:
Circadian rhythm sleep disorders cause insomnia at some times of the day and excessive sleepiness at other times of the day. Common circadian rhythm sleep disorders include jet lag and delayed sleep phase syndrome. Jet lag is seen in people who travel through multiple time zones, as the time relative to the rising and falling of the sun no longer coincides with the body's internal concept of it. The insomnia experienced by shift workers is also a circadian rhythm sleep disorder.
Parasomnia includes a number of disorders of arousal or disruptive sleep events including nightmares, sleepwalking, violent behavior while sleeping, and REM behavior disorder, in which a person moves his/her physical body in response to events within his/her dreams. These conditions can often be treated successfully through medical intervention or through the use of a sleep specialist.
Gastroesophageal Reflux Disease causes repeated awakenings during the night due to unpleasant sensations resulting from stomach acid flowing upward into the throat while asleep.
Mania or Hypomania in bipolar disorder can cause difficulty falling asleep. A person going through a manic or hypomanic episode may feel a reduced need for sleep. Sleep deprivation can worsen a manic episode, or cause hypomania to develop into mania.
Pain can produce insomnia and finding effective ways to treat pain can provide relief. A common misperception is that the amount of sleep one 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.
Insomnia is a common side-effect of some medications, and it can also be caused by stress, emotional upheaval, physical or mental illness, dietary allergy and poor sleep hygiene. Insomnia is a major symptom of mania in people with bipolar disorder, and it can also be a sign of hyper-thyroidism, depression, or other ailments with stimulating effects.
In addition, a rare genetic condition can cause a prion-based, permanent and eventually fatal form of insomnia called Fatal Familial Insomnia.
Treatment for insomnia
In many cases, insomnia is caused by another disease or psychological problem. In this case, medical or psychological help may be useful. All sedative drugs have the potential of causing psychological dependence where the individual can't psychologically accept that they can sleep without drugs. Certain classes of sedatives such as benzodiazepines and newer non-benzodiazepine drugs can also cause physical dependence which manifests in withdrawal symptoms if the drug is not carfully titrated down.
Many insomniacs rely on sleeping tablets and other sedatives to get rest. The most commonly used class of hypnotics prescribed for insomnia are the benzodiazepines. This includes drugs such as temazepam, diazepam, lorazepam, nitrazepam and midazolam. These medications can be addictive, especially after taking them over long periods of time.
Non-benzodiazepine prescription drugs, including Ambien and Lunesta, are quickly replacing benzodiazepines as a first-line treatment for insomnia. There are controversies over whether these non-benzodiazepine drugs are superior to benzodiazpines. These drugs appear to cause both psychological and physical dependence, and can also cause the same memory and cognitive disturbances as the benzodiazepines along with morning sedation.
The antihistamine diphenhydramine is widely used in nonprescription sleep aids, 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 antidepressants such as mirtazapine, trazodone and doxepin have a sedative effect, and are prescribed off label to treat insomnia. The major drawback of these drugs is that they have antihistaminergic, anticholinergic and antiadrenergic properties which can lead to many side effects.
Low doses of Atypical antipsychotics such as quetiapine(Seroquel) are also prescribed for their sedative effect but the danger of neurological and cognitive side effects make these drugs a poor choice to treat insomnia.
Some insomniacs use herbs such as valerian, chamomile, lavender, hops, and passion-flower. Valerian has undergone the most studies and appears to be modestly effective.
Alcohol may have sedative properties, but the REM suppressing effects of the drug prevent restful, quality sleep. Hangovers can also lead to morning grogginess.
Some traditional remedies for insomnia have included drinking warm milk before bedtime, taking a warm bath in the evening; 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, and making sure to get up early in the morning and to retire to bed at a reasonable hour. Pomegranates are also believed to be able to help insomniacs sleep.
Traditional Chinese medicine has included treatment for insomnia throughout its history. A typical approach may utilize acupuncture, dietary and lifestyle analysis, herbology and other techniques, with the goal of resolving the problem at a subtle level. Although these methods have not been scientifically proven, some insomniacs report that these remedies are sufficient to break the insomnia cycle without the need for sedatives and sleeping tablets. Warm milk contains high levels of tryptophan, a natural sedative. Using aromatherapy, including lavender oil and other relaxing essential oils, may also help induce a state of restfulness. Melatonin has proved effective for some insomniacs, mostly in regulating the sleep/waking cycle.
The more relaxed a person is, the greater the likelihood of getting a good night's sleep. Relaxation techniques such as meditation have been proven to help people sleep. Such techniques can lower stress levels from both the mind and body, which leads to a deeper, more restful sleep
And you are adivised to:
Avoid all stimulating substances/activities such as caffeine and exercise before bedtime.
Avoid distractions in the bedroom including excessive light and noise, television, alarm clocks, etc.
Avoid stressful thoughts and feelings before bedtime and while attempting to fall asleep.
Combat worries and preoccupations about the day ahead by tending to plans and schedules before bedtime.
Background noise, such as a fan or soft rhythmic music, can serve to ease some individuals into sleep.
You have to consult a clinical psychiatrist and find the underlying problem. Melatonin is not a good sleeping aid. Short acting benzodiazapines are recommended. Drugs like Alprazolam (Xanax), Lorazepam (Ativan, Temesta, Tavor) , Zolpidem (Ambien, Stilnox, Stilnoct, Hypnogen or Myslee) are effective drugs for insomnia. All these drugs have high abuse potential. Alprazolam and Lorazapam are very addictive.
Strictly follow the instructions of a good doctor.
2006-09-20 22:52:02
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answer #7
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answered by Ajeesh Kumar 4
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