Insomnia
Insomnia is the most common SD and may be particularlydisabling in the elderly. Individuals with insomnia have impaired next day functioning and increased risk of depression which significantly affects their quality of life.4 Short-term insomnia had been observed in 15–20% of the general population in developed countries, while chronic insomnia, which lasts over 1 month occurs in 9–15% of the population.1
Causes
Some of the common causes of insomnia include the following:
Psychological
- Psychological problems like fear, stress, emotional tension, work problems, unsatisfactory sexual life.
- Psychiatric problems such as clinical depression, anxiety and posttraumatic stress disorder.
- Psychoactive drugs or stimulants including caffeine, cocaine, ephedrine, amphetamines and methylphenidate.
Medical Conditions
Environmental
- Pregnancy
- Stressful or life-threatening events.
- Disturbances of the circadian rhythm— shift work and jet lag.
- Environmental noise or other disturbances—bed partner with loud snoring.
Symptoms
Symptoms may include difficulty in falling asleep, trouble in staying asleep, and not feeling restored by sleep. Most often daytime symptoms will bring people to seek medical attention. These daytime problems caused by insomnia include poor concentration, poor memory, irritability and impaired social interaction.
Treatment
The mainstay of treatment for insomnia is cognitive behavioral therapy (CBT) along with judicious use of hypnotic agents. Cognitive behavioral therapy shouldbe considered as first-line intervention for chronic insomnia.Recent study had shown that CBT had a long-term effect of improved sleep-related psychological activity and daytime functioning compared to other medications in chronic insomnia.2
Pharmacological treatments for insomnia involve judicious and intermittent usage of benzodiazepine or nonbenzodiazepine hypnotics. The most commonly used class of hypnotics is benzodiazepines such as temazepam, flurazepam, nitrazepam and midazolam. These medications can develop tolerance and dependence, especially after consistent usage over prolonged period.Nonbenzodiazepines cause both psychological and physical dependences, and the same memory and cognitive disturbances as benzodiazepines, in addition to morning sedation.
Other sedatives used in treatment of insomnia include antidepressants and antihistamines. Nevertheless, long-term use of sedative hypnoticsis contraindicated due to adverseeffects that can outweigh benefits, including habituation, dependency, andimpairment of daytime psychomotor and cognitive performance,daytime drowsiness and rebound insomnia.
General therapeutic recommendations for insomnia include the following:
- Practice relaxation techniques before sleep time.
- Avoid large meals, excessive fluid intake and strenuous exercise before bedtime.
- Avoid sleep-disturbing substances such as alcohol, nicotine and caffeine before bedtime.
- Avoid reading and watching television while on the bed.
- Establish a bedtime routine.
Written by: Healthplus24 team
Date: Jan28th,09
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