Insomnia Lying among tousled sheets, eluded by sleep with thoughts racing, many people wrestle with the nightly demon named insomnia.

Insomnia is defined as, the perception or complaint of inadequate or poor-quality sleep because of one or more of the following: difficulty falling asleep, waking up frequently during the night with difficulty returning to sleep, waking up too early in the morning, or unrefreshing sleep (Rajput 1431). Because the definition of “poor-quality sleep” is not the same for every person, it is not easy to determine the frequency and severity of it’s occurrence (Holbrook 216). To add to the complexity of this problem, there is not even one universal treatment that can be used effectively in all cases. Many effective treatments have been discovered, but there is no “cure-all.

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” The two most popularly used treatment methods are pharmocological treatment and behavioral-cognitive treatment .Each of these treatments has its pros and cons and is recommended for different types of patients. Although taking a pill every day would appear to be the simplest way of overcoming insomnia, it is, “at best a temporary solution,” and in recent years, use of drugs as a treatment has declined rapidly. Medical records show that the yearly number of prescriptions for sleeping pills peaked in 1972 and were cut in half by 1982. The reason for this decline is that a large amount of cases, insomnia has been proven to be a “symptom of an underlying . . .problem (Sweeney 231).

” Drugs can be a good solution for a short period of time, but their long term use is discouraged, because a tolerance can develop after four weeks of regular use (Espie (?) 115-116). There are three main types of drugs used for treatment–benzodiapine hypnotics, sedating antidepressants, and antihistamines. Benzodiapine hypnotics are the most prescribed drugs for treating insomnia. They are most useful when treating short term problems and have relatively few side effects when used correctly. They reduce the time for sleep onset and increase sleep efficiency. Long-term use can lead to physical and psychological dependence and abruptly discontinuing their use may cause symptoms of withdraw.(Zammit 132-135). Gradually tapering off the drug is recommended to prevent rebound insomnia.

The possible side-effects of benzodiapines include inducing anterograde amnesia, excitability, agression, and symptoms of depression. (Longo 2121). Benzodiapines can be especially harmful for the elderly.They can heighten the symptoms of demensia related disorders.

Pregnant women are also discouraged from taking benzodiapines because they are considered teratogens (substances that can reach a fetus and cause harm) (Myers 118). A secondary option to benzodiapines is sedating antidepressants. These drugs can “promote sleep onset and maintain sleep (Zammit 136),” but they have not been scientifically proven to treat insomnia. There is no risk of dependence on antidepressants but it is possible for them to become ineffective after a very short time.The third drug option is antihistamines, which besides helping with allergies, are said to decrease sleep onset and reduce time in REM sleep. Many antihistamines are available without a prescription. They are not recommended for treating insomnia because they are not sedatives and very few studies have been done to show their effectiveness.

There are also side effects such as dry mouth and urinary retention associated with antihistamines (Walbroehl 1911). In addition to drugs, there are other sleeping pills available. These natural remedies are not regulated by the FDA and it is difficult to accurately jusdge their effectiveness and safety.

One of these remedies, which has gained a lot of attention recently, is melatonin. This hormone, naturally secreted by the pineal gland, helps control the sleep-wake cycle. It is now sold as a dietery supplement which aids in sleep.

It is still in the process of being tested as an accepted treatment for insomnia. Many results of these tests are coming back favorably, but there are still many questions about it’s safety to be answered. (Cupp ?) An alternative to sleeping pills, cognitive-behavior therapy can sometimes be used effectively as a treatment.This therapy focuses on encouraging the patient to “eliminate behavior incompatible with sleep (Rajput 1431).” This treatment has many components, which include stimulus control, sleep restriction, relaxation techniques, and cognitive therapy (GN 103). According to , “all of these therapies are known to be effective in the treatment of insomnia.

(103). Unlike pahrmacotherapy, these techniques do not have side effects. They do however have drawbacks.Results from using behavioral therapy techniques may not be substantially noticed for four to six weeks, and in today’s “now” society it is difficult for many patients to stick with the program that their doctor suggests. People trying this treatment are encouraged to keep a sleep log in order to better monitor their progress. The first aspect of behavioral treatment is stimulus control. According to Macintosh (?): If a change in a particular stimulus is always followed by the probability, amplitude, latency, or rater of a particular response, we may say that this stimulus exercised some control over tat response. The term stimulus control has come to be used as the convenient shorthand expression for describing such an observed relationship between changes in external stimuli and changes in recorded behavior.

When applying this to insomnia, these are probably stimuli that are detrimental the ideal sleep environment. For a good sleeper, laying in bed is associated with falling asleep, but for an insomniac, the bed represents a place of frustration.(Espie 158). Stimulus control therapy aims to differentiate the habits that reinforce sleep from the habits that discourage sleep. According to Espie (?), there are six rules to follow. The first rule is that the insomniac should only lie down when they feel tired. This presents difficulty for some, because past failure to sleep has made them unsure of their ability to determine when they are tired.

They may need guidance to let them know which cues for sleep they should pay attention to.Rule number two is to only use the bed and bedroom for sleeping. Such normal bedroom habits such as reading, watching television, talking, eating, smoking and drinking should be discontinued, because they are cues for being awake. Rule number three is go to another room if you do not fall asleep quickly. Quickly is defined by about ten to twenty minutes of wakefulness. However, that does not mean that the patient should watch the clock for an exact period of time.

That can cause additional stress. It is recommended that the patient do something relaxing after getting out of bed. Rule number four is that rule three should be repeated. Early on in the treatment the insomniac should expect to get out of bed many times during the night. Persistence with this technique is the key.Step five suggests setting the alarm for the same time each morning.

The object of this is to set a biological sleep rhythm. The final rule, rule six, discourages the insomniac from taking naps. Afternoon and evening naps are especially discouraged since sleep onset times are related to how much time has passed since a person last slept. (Espie 158-166) Like stimulus control, sleep restriction therapy places limits on time spent in bed, but the idea behind it is different. Sleep restriction aims to make deeper sleep possible by diminishing the time spent lying in bed without sleeping.The first step is to keep a sleep log to track how many hours are spent trying to fall asleep and how many hours are spent actually sleeping per night. The next step is to calculate the average sleep time. Then it needs to be determined how much extra time is spent in bed while not sleeping.

After this is calculated, use this time to determine what time you should go to bed and what time you should get up in the morning. It is important that this schedule is strictly adhered to reset your biological clock. A very broad form of behavioral-treatment is relaxation techniques.

These techniques include progressive relaxation, autogenic training, and meditation.Progressive relaxation is a sequential tensing and relaxing of the main muscle groups (Espie 107). This causes a decrease in muscle activity, blood pressure, and heart rate. Another form of relaxation is autogegnic training, where the patient rehearses simple phrases referring to warmth or heaviness of the legs and arms. In this technique the person is instructing their body to respond as if they are in a low state of physiological arousal. (Espie 110).Insomnia in itself is a very frustration and complex condition, and sorting through the possible treatments can be an additional frustration.

Since there are so few specially trained sleep specialists, many doctors will go initially with drug treatments as an “easy way out,” but as I found out, the easy way is not necessarily the best way for every patient. Medicine Essays.


In this research paper I will attempt to familiarize you, the reader, on therole of sleep, health risks of sleeping disorder that is most common, Insomnia.I will give you some of the aspects which cause Insomnia and how it can betreated. We human beings spend one third of our lives in a mysterious,potentially dangerous and seemingly unproductive state of unconsciousness—andno one knows exactly why.

Scientists have attempted to study the effects ofsleep and its role on our existence but have yet to come up with an accuratereason why we need sleep. Yes, we do need sleep. All animals, be they mammal,amphibian, aquatic, etc., need some form of sleep in order to rejuvenate theirbody and/or mind.

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Without sleep our bodies tend to experience some type ofmental or physical malfunctions. Some of us human beings can even become downright incapable of proper social function. In other words, cranky frustratedemotional nutcases. So, sleep does play an important role in our dailyfunctions, and no matter what we must fit it into our lives/schedule. Edisonslight bulb can be considered one of the major technological “curses” of themodern age, says sleep researcher Harvey Moldofsky, chief psychiatrist atToronto Western Hospital. Edison believed that his light bulb would liberate usfrom the night and in the process transform our lives.

The fact that the lightbulb served as a reliable, controlled was to, banish the night, did not act asperhaps Edison hoped it would. Yet, it helped banish our need for sleep. Andwith this a change in our sleeping patterns. This is one of the ultimate causesof sleep problems. Insomnia is the perception or complaint of inadequate orpoor-quality sleep because of one or more of the following: difficulty sleeping,waking up too early, unrefreshing sleep, waking frequently through the night.When one has Insomnia it is difficult to initiate and/or maintain sleep.

Somebelieve that Insomnia is not a disorder, it is a symptom that often indicatedother problems. Other diagnosis, hold that Insomnia is the most common of allsleep disorders and perhaps the most frequent health complaint after pain.Severe cases can disrupt social and occupational function and is associated withdepression, fatigue, and anxiety. There are different types of Insomnia whichaffect our sleep patterns in many different ways. Types of Insomnia are:? Sleep Onset Insomnia (delayed sleep Phase Syndrome): a disorder inwhich the major sleep episode is delayed in relation to the desires clock timewhich one wishes to be awakened. ? Idiopathic Insomnia: A life longinability to obtain adequate sleep that is due to an abnormality of theneurological control of the sleep-wake system. ? PsychophysiologicalInsomnia: A disorder or somatized tension (conversion of anxiety into physicalsymptoms) and learned sleep – preventing associated with results in a complaintof Insomnia and associated decreased functioning during wakefulness.

?Childhood Insomnia (limit-setting Sleep Disorder): Primarily a childhooddisorder that is characterized by the inadequate enforcement of bed times by acaretaker with resultant stalling or refusal to go to bed at the appropriatetime. ? Food Allergy Insomnia: A disorder of initiating and maintainingsleep due to an allergic response to food allergens. ? EnvironmentalInsomnia (Environmental Sleep disorder): A sleep disorder disturbance due to adisturbing environmental factor that causes a complaint of either Insomnia orexcessive sleepiness. ? Transient Insomnia (Adjustment Sleep Disorder):Represents sleep disturbance temporally related to acute stress, conflict orenvironmental change causing emotional agitation. ? Periodic Insomnia(Non 24-Hour Sleep-Wake Syndrome): Consists of a chronic steady patternconsisting of 1-2 hour daily delays in sleep onset and wake times in anindividual living in society.

? Altitude Insomnia: An acute Insomniausually accompanied by headaches, loss of appetite, and fatigue, that occursfollowing ascent to high altitudes. ? Hypnotic-Dependency Insomnia(Hypnotic Dependent Sleep Disorder): Characterized by Insomnia or excessivesleepiness that is associated with tolerance to or withdrawal from hypnoticmedications. ? Stimulant Dependent Sleep Disorder: Characterized by areduction of sleepiness or suppression of sleep by central stimulants andresultant alterations in wakefulness following drug abstinence. ? AlcoholDependent Insomnia (Alcohol Dependent Sleep Disorder): Characterized bythe sustained ingestion of sleep onset by the sustained ingestion of alcoholthat is used for its hypnotic effect. ? Toxins Induced SleepDisorders: Characterized by either Insomnia or excessive sleepiness produced bypoisoning with heavy metals or organic toxins. Transient and intermittentInsomnia generally occur in people who are temporarily experiencing eitherstress, environmental noise, extreme temperatures, change in ones environment,and sleep/wake schedule problems. Sleep is the way the body rests and allows themind to slow down and relax.

Sleep is a distinct state of mind and body in whichthe body is deeply at rest, the metabolism is lowered, and the mind becomesunconscious to the outside world. The sleeping mind does not become unconsciousentirely; instead, it shifts the direction of consciousness from a chair besideyour body to another chair inside your dream. Aristotle proposed that thepurpose of sleep was to help the body digest food although eating a big mealbefore getting into bed is one of the worst things you can do for your rest.Sleep is not a random phenomenon but a highly structured and well organizedactivity following a cycle pattern . Two types of sleep have been identifiedrapid eye movement (REM) and non rapid eye movement (NREM) sleep. The durationof NREM-REM cycles is approximately 90 minutes., but may vary between 70 and 120minutes NREM is subdivided into four stages from stage 1 a very light sleep, tostage 4, the deepest stage of sleep. NREM sleep is also called quiet”sleep, because most physiological functions are slowed down during this periodof slumber, NREM sleep has been described as an idling brain in a moveable body.

REM sleep is called paradisiacal active, or fast sleep, characterized byelectroenchgalographic (EEG) activation, muscle tone , and the onset of (thename REM) rapid eye movements during this time. Vivid hallucinatory experiencesoccur during REM sleep. With the exception of periodic muscle twitches, the bodyis essentially paralyzed during REM, which has been described as a hyperactivebrain in a paralyzed body, Delta or slow wave sleep is predominant in the firstthird of the night , where as the proportion of REM sleep may come quicker thanusual, aid delta sleep may consequently be delayed and shortened. Patterns ofsleep generally look like this: light sleep deep sleep- REM sleep_ lightsleep- deep sleep rest and restoration. The first period of light sleeplasts about 45 minutes.

There are five distinct stages of sleep. Stage 1 and 2are the majority of the night. Stage 3 and 4 are deep sleeping or “deltasleep” and rest and restoration. Stage 5 is the dream-state, which generallyinvolves rapid eye movement or REM sleep.

Several developmental changes in sleeppatterns occur over the course of life span. Total sleep time is highest ininfancy and gradually declines, leveling off in young adulthood. There are manydifferent causes for insomnia that affect diverse groups of people in lots ofways. Causes for insomnia may range from the psychological to psyiological.Causes of chronic insomnia associated with psychological problems can be deeplyrooted in stress, anxiety and /or depression. Insomnia associated with medicalproblems can be caused by a variety of things including: anemia, asthma, kidneydysfunction, diabetes, HIV, and a variety of medication side effects. Insomniacan also be due to poor eating habits, caffeine, and lack of exercise. Snoring,not breathing, and Gasping for air are problems some people have when they areunable to sleep and breath at the same time which causes sleep apnea.

Legtwitches are a problem some experience when their body suddenly jerks and wakesthem as they are first falling asleep. Almost any sleeping pill, if takencontinuously, will cause insomnia. Sleep can be affected by ones individualdifferences, prior sleep history, circadian rhythms, drugs, life styles, andpsychopathology. Caffeine and nicotine are both central nervous systemstimulants, and as such are sleep-disrupting substances. Insomnia can also bedue to poor eating habits, caffeine, and lack of exercise.

Medications that areprescribed bed for sleep can disrupt or eliminate the sleep are: Doral, Halcion.Restoril , valium, and Xanax. Antihistamines can also cause sleep depravation.Vitamins and minerals such as B6, niacin amide, calcium, magnesium, orantioxidants. Life stress factors also cause significant variations in sleephabits from one individual to the next.

Work and leisure activities, the use ofalcohol and drugs, travel social and family obligations all affect the abilityto get a good nights sleep. Excessive daytime sleepiness and fatigue can be onecharacteristic of narcolepsy and hypersomnia . Insomnia can adversely affectboth physical and mental health. Some people suffering from Insomnia depend toomuch time in bed unsuccessfully trying to sleep.

Diagnosis Diagnosis is based ontwo symptoms: 1) the perceived difficulty of initiating and/or maintaining sleepor feeling unrested despite an adequate amount of sleep or 2) daytime tirednessor porsocialor work performance as a consequence of impaired sleep. Insomnia isnot defined by the number of hours of sleep a person gets or how long it takesto fall asleep. Identifying behaviors that may worsen Insomnia and stopping (orreducing) them. Normative developmental changes in sleep patterns are outlinedand distinguished from pathological sleeplessness. Sleep problems are also morecommon among the widowed, divorced and separated and among people with lowincomes and low socio-economic status. Certain individuals are more likely toexperience Insomnia are the elderly, females, and those persons with a historyof depression. Twenty-five percent of adults and fifty percent of seniorcitizens have insomnia problems.

Insomnia is also a problem that is prevalentamong people write HIV/ Aids. When loss of sleep impairs a persons ability tofunction properly during the day, it may indicate a potential problem. Insomniamay cause problems during the day, such as tiredness, a lack of energy,difficulty concentrating, and irritability. The main consequence of sleepdepravation in otherwise normal sleepers are sleepless, performance impairment,and mood alteration.

The severity of the effects of sleep depravation depend onthe effects sleep loss is partial, total, acute, or chronic. Insomniacs havemore difficulty coping with minor irritations and report less enjoyment offamily and relationships; they also feel less well physically. About one thirdof the adult population is affected by insomnia each year. Insomnia affects20-40% of all adults, mostly women and the elderly. According to the NationalSurvey of Psychotherapeutic Drug Use , about 35% of the adult populationisaffected by insomnia during the course of a year. The National Institute ofMental Health (NIMH) Epidomiologic Catchment Area study yielded a 10.2% of thepopulation on a chronic basis. Surveys indicate that one-third.

” About 15to18 percent suffer from percent suffer from intractable sleep difficulties thatare perceived to impediments to them life says Harvey Moldofsky , chiefpsychologist at Toronto Western Hospital. Acute sleep loss causes fatigue anddecreases motivation administrative. Total sleep loss for more than one nightleads to micro sleep episodes intruding into wakefulness, effecting attentionspan reduction, difficulty concentrating, and performance efficiency isimpaired. As sleep loss accumulates, daytime sleepless increases, and bothcognition and behavioral deficits are exalelated. Chronic insonmia may induceemotional distress and increase the use of psychotropic medications and the riskof substance abuse.

Sleep disturbances can affect a persons life, causingsignificant psychosocial, occupational and health reprocassions. Sleep durationis low lend to lavevity . Insomnacs are move likely (5% US. 2%) to report motorvehicle accidents in which fatigue was a factor. Individuals with sleepdisturbances are move likely to display concomitent pshchological distress thanthose without sleep complaints reported by insomniacs often have a psychosomaticconnotation: thsior headaches, gadro intestinal problems, no specific aches andpains, and allergies. There is a strong relationship between sleep and emotionaldisturbances. Insomnia causes psychological distress in some individuals, andthat in those already afflicted by emotional problems, chronically disturbedsleep may only potentiate these difficulties. Reports of fatigue, tiredness, ordrowsiness almost always accompany Insomnia complaints.

Sleepiness is almost adirect result of sleep depravation. And, chronic inability to sleep willultimately lead to Insomnia or some type of sleep disorder. Insomnia encompassesa wide variety of complaints typically reflecting unsatisfactory duration,efficiency, or quality of sleep. Technology Technology used to measure and aidin the diagnosis of sleep consist of the EEG, the electro-oculogram (EOG), andthe electromyogram (EMG). The EEG records brain wave activity from the centraland occipital areas. The EOG measures a difference of electrical potentialbetween the cornea and the retina; this difference is generated with each eyemovement. The EMG monitors muscle tone, and its main recording site is the chin.

Monitoring of oxygen saturation is used in the assessment diagnosis of sleepapnea. The electrocardiogram (EKG) documents arrhythmias accompanyingrespiratory disturbances. Accompanying respiratory disturbances. EMG monitoringof the anterior tibilias muscles is used for detection of periodic leg movementsduring sleep. Most adults need seven or eight hours of sleep a night, but someadults are ” short sleepers” and functions well and only there of fourhours. Being that the purpose of sleep could be to allow the body time to repairand rejurvenate- some find 4 to 6 hours as a sufficient amount at sleep. Sleepreduces fatigue and relieves stress and dreaming helps to clear the nervoussystems.

The amount of time needed for sleep is eshonaly usaible from person toperson. The clinical significanes of insomnia is detemined according to itssevenrity, frequency, duration, and daytime sequence. Treatment for dramicinsomia consists of: -There are many foods you may try to get est thatwould/will aid in putting you to sleep. Foods such as oats, sweet corn, rice,zawgen, tomatoes, bananas, and barely all are rich in malnutrion which helpsreduce sleep. -Lifestyle changes can also hepls you to sleep better. -Herbalremedies that as help induce sleep are Valerian roots, skull cap, passionflower, wood betony or California poppy. -Over the counter sleep medicines arenot usually recommended for the treatment of insomnia . Though using sleepingpills without supervision of a physican for long periods of time can treatchronic insomnia.

-Tayrs behavioral techniques to improve sleep, such asrehilbilation therpy, sleep restrictions therapy, and reconditioning may help.There are specific and effective technques through rehilbilation therapy thatcan reduces or eliminate anxiety and body tension. Insomnia can not be curedwithout treaty the underlying imbalance that causes it. The Association of SleepDisorders Caters was established in 1975; its purpose is to accidet clinics inthe United States and to promote professional education and the development ofstandards and guidelines for patient care. Most clinics are based in large urbanhospitals or university medical schools, usually in conjunction withsleep-research programs . Medical experts from widely diverse fields areinvolved in sleep clinics. Psychologists and psychiatrists, internist,psycologists and specialist in disorders of the heart, lungs, brain, respiratorysystem and central nervous system are involved can givers at sleep clinics.

Conclusion Insomnia can be treated if diagnosed properly and medication can begiven to aid in the elimination of the problem.


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