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diseaseconditions.peperonity.net

◆ INSOMNIA

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=>GENERAL INFO:
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Insomnia means getting insufficient sleep which can be in the form of difficulty in falling asleep or difficulty in maintaing sleep. Insomnia is just a symptom, like fever, and is not a disease by itself. Diseases that can disturb sleep, like pain or anxiety usually cause insomnia.

Everyone goes through occasional phases of insomnia which resolves once the causative factor has been dealt with. Problems arise if insomnia continues to persist which can have deleterious effects on one's health. Inadequate sleep can cause daytime sleepiness, which can affect one's productivity at work and may also increase the chances of motor vehicle accidents due to fatigue and impaired concentration


=>INCIDENCE:
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Insomnia is as common a symptom, just as lack of appetite. Although about 30% of adults have symptoms of insomnia, it is seldom reported, and hence is an under- treated disorder. This could be due to the fact that sleep, like other basic needs, is taken for granted and therefore due importance is not given to it. This information is surprising because adequate sleep is very essential for an individual to function well. Less than 10% of adults are likely to suffer from chronic insomnia, of which women and elderly are likely to be more susceptible.


=>CAUSES:
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When insomnia occurs as an inborn condition it is termed "PRIMARY INSOMNIA", an example of which is fatal familial insomnia. This is a progressive disorder that begins with a difficulty in initiating sleep and leads to sleep deprivation within a few days time. The onset of this rare familial disease is between the ages of 30 and 60 and the patient progresses to death within 7 to 37 months of its onset.

Insomnia is usually caused by other diseases or conditions and is known as "SECONDARY INSOMNIA". Some of these diseases or conditions are:

(A). Those that produce pain or discomfort or breathing difficulties like asthma or arthritis

(B). Psychiatric disorders usually have an underlying element of insomnia. The severity of insomnia has a close relationship with the clinical course of psychiatric disorders. Depression, anxiety disorders, schizophrenia, personality disorders and somatoform disorders can affect sleep.

(C). Medications that affect the sleep-wake cycle by interfering with nocturnal sleep are beta-adrenergic blockers, thyroid preparations, corticosteroids, monoamine oxidase inhibitors, methyldopa, phenytoin and some chemotherapeutic agents.

(D). Abuse of substances like alcohol and nicotine can disrupt the normal sleep architecture.


=>OTHERS TYPES:
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Insomnia may be due to other sleep disorders, some of which are described below:

1). PSYCHOPHYSIOLOGICAL INSOMNIA:

This is a condition in which the person has difficulty falling asleep in his bed or using his bedroom. This insomnia is induced by a stressful situation, which can progress to a chronic entity.

2). SLEEP STATE MISPRECEPTION:

Here the person complains of insomnia in spite of having a good night's sleep. Patients with sleep state misperception can sleep entirely normally at night, but wake up feeling as if they have not slept well.

3). INADEQUATE HYGIENE:

This is a life style disorder that affects sleep. Here the person does not allocate adequate time for sleep. This could be the heavy price we pay for technical advances.

4). RESTLESS LEGS SYNDROME:

A disorder marked by disagreeable leg sensations just before sleep onset that causes an irresistible urge to move the legs.

5). OBSTRUCTIVE SLEEP APNEA:

A sleep disorder that is associated with repeated episodes of upper airway obstruction during sleep, resulting in snoring and frequent arousals from sleep.

6). CIRCARDIAN RHYTHM DISORDER:

In this disorder there is a mismatch between the timing of sleep and the underlying physiological tendency to sleep, like for e.g., Jet lag.


=>SYMPTOMS:
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THE AFFECTED PERSON HAS FOLLOWING SYMPTOMS:

-> Difficulty falling asleep,

-> Awakening during sleep and having trouble going back to sleep.

-> Awakening too early in the morning.

-> Feeling unrefreshed upon awakening.

-> Daytime irritability,

-> Drowsiness,

-> Anxiety, and/or nonproductivity at work.

Chronic sleep deprivation results in memory and concentration problems. There may be excessive daytime sleepiness and fatigue, which in turn may lead to occupational stress and marital disharmony.


BASED ON THE DURATION OF SYMPTOMS,
INSOMNIA IS CLASSIFIED AS:


(A). TRANSIENT INSOMNIA:

When symptoms last for less than two weeks it is transient insomnia.

(B). INTERMITTENT INSOMNIA:

Insomnia is intermittent when repetitive episodes of transient insomnia occur.

(C). CHRONIC INSOMNIA:

When symptoms last for at least a month, it is known as chronic insomnia.


=>DIAGNOSIS:
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HISTORY:

A careful history will usually help diagnose insomnia. Maintaining a sleep diary for two weeks will provide additional information. Here a record is made of when the person goes to sleep and when he wakes up, along with how long he is awake during the night. The sleep diary will help the doctor understand the patient's sleeping pattern.

EPWORTH SLEEPINESS SCALE:

It is a questionnaire filled out by the patient, estimating the likelihood of falling asleep in different situations. This permits a standardized subjective assessment of daytime sleepiness, which is an indicator of insomnia.

POLYSOMNOGRAM:

It is an over night sleep study, which can be undertaken to rule out other sleep disorders.



=>TREATMENT:
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Prior to initiating any therapy for insomnia, the patient needs to be educated about sleep hygiene
measures Therapy for insomnia is ideally aimed at the underlying cause. This is usually carried out with hypnotics and behavioral therapy. Melatonin, a hormone, is also employed in the treatment of certain insomnias. Once the cause has been identified and dealt with the person may have his sleep restored.

(A): HYPNOTICS:

These are sedatives that are given to induce sleep. The ideal dose is the lowest dose that adequately induces and maintains sleep. To prevent rebound insomnia, longer acting hypnotics are used. These medications should be used with caution in patients with suspected sleep apnea syndrome, hepatic, renal or pulmonary disease, pregnant women and also in individuals with excessive alcohol consumption.

Adverse effects of hypnotics occur more commonly in patients above 55 years of age in whom there can be increased daytime sleepiness and cognitive impairment.

(B): BEHAVIORAL THERAPY:

The basis of behavioral therapy is to help overcome phobias related to sleep, and to achieve ideal sleeping habits. Based on the type of insomnia and the associated history the appropriate therapy is chosen. The techniques employed are:

(C): RELAXATION THERAPY:

It effectively reduces mental or muscular tension in a person who has difficulty in initiating and maintaining sleep. Relaxation techniques like meditation help to relax the mind, and physical exercises help to relax the muscles.


(D): SLEEP RESTRICTION THERAPY:

This therapy imposes strict limits on the time of getting into bed and arising from the bed. This helps the person to tune his internal clock so that he can easily fall asleep and maintain good sleep.

(E): STIMULUS CONTROL THERAPY:

It is based upon the fact that the time spent in bed worrying about sleep is counterproductive to initiating sleep. The patient is advised to go to bed only when sleepy, and to associate bed with falling asleep quickly.


=>DRUGS:
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COMMONLY USE HYPNOTICS ARE:

-> Benzodiazepines.
( Furazepam/ Triazolam.)


->. Imidazopyridine medication
(Zolpidem,)


-> Cyclopyrrolone medication .
(Zopiclone)

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-[NOTE]-

PLEASE DO ASK YOUR DOCTOR OR CONSULTANT BEFORE USING THESE MEDICATIONS



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