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.” 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 . . .

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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 the
role 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 be
treated. We human beings spend one third of our lives in a mysterious,
potentially dangerous and seemingly unproductive state of unconsciousness—and
no one knows exactly why. Scientists have attempted to study the effects of
sleep and its role on our existence but have yet to come up with an accurate
reason 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 their
body and/or mind. Without sleep our bodies tend to experience some type of
mental or physical malfunctions. Some of us human beings can even become down
right incapable of proper social function. In other words, cranky frustrated
emotional nutcases. So, sleep does play an important role in our daily
functions, and no matter what we must fit it into our lives/schedule. Edisons
light bulb can be considered one of the major technological “curses” of the
modern age, says sleep researcher Harvey Moldofsky, chief psychiatrist at
Toronto Western Hospital. Edison believed that his light bulb would liberate us
from the night and in the process transform our lives. The fact that the light
bulb served as a reliable, controlled was to, banish the night, did not act as
perhaps Edison hoped it would. Yet, it helped banish our need for sleep. And
with this a change in our sleeping patterns. This is one of the ultimate causes
of sleep problems. Insomnia is the perception or complaint of inadequate or
poor-quality sleep because of one or more of the following: difficulty sleeping,
waking up too early, unrefreshing sleep, waking frequently through the night.

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When one has Insomnia it is difficult to initiate and/or maintain sleep. Some
believe that Insomnia is not a disorder, it is a symptom that often indicated
other problems. Other diagnosis, hold that Insomnia is the most common of all
sleep disorders and perhaps the most frequent health complaint after pain.

Severe cases can disrupt social and occupational function and is associated with
depression, fatigue, and anxiety. There are different types of Insomnia which
affect our sleep patterns in many different ways. Types of Insomnia are:
? Sleep Onset Insomnia (delayed sleep Phase Syndrome): a disorder in
which the major sleep episode is delayed in relation to the desires clock time
which one wishes to be awakened. ? Idiopathic Insomnia: A life long
inability to obtain adequate sleep that is due to an abnormality of the
neurological control of the sleep-wake system. ? Psychophysiological
Insomnia: A disorder or somatized tension (conversion of anxiety into physical
symptoms) and learned sleep – preventing associated with results in a complaint
of Insomnia and associated decreased functioning during wakefulness. ?
Childhood Insomnia (limit-setting Sleep Disorder): Primarily a childhood
disorder that is characterized by the inadequate enforcement of bed times by a
caretaker with resultant stalling or refusal to go to bed at the appropriate
time. ? Food Allergy Insomnia: A disorder of initiating and maintaining
sleep due to an allergic response to food allergens. ? Environmental
Insomnia (Environmental Sleep disorder): A sleep disorder disturbance due to a
disturbing environmental factor that causes a complaint of either Insomnia or
excessive sleepiness. ? Transient Insomnia (Adjustment Sleep Disorder):
Represents sleep disturbance temporally related to acute stress, conflict or
environmental change causing emotional agitation. ? Periodic Insomnia
(Non 24-Hour Sleep-Wake Syndrome): Consists of a chronic steady pattern
consisting of 1-2 hour daily delays in sleep onset and wake times in an
individual living in society. ? Altitude Insomnia: An acute Insomnia
usually accompanied by headaches, loss of appetite, and fatigue, that occurs
following ascent to high altitudes. ? Hypnotic-Dependency Insomnia
(Hypnotic Dependent Sleep Disorder): Characterized by Insomnia or excessive
sleepiness that is associated with tolerance to or withdrawal from hypnotic
medications. ? Stimulant Dependent Sleep Disorder: Characterized by a
reduction of sleepiness or suppression of sleep by central stimulants and
resultant alterations in wakefulness following drug abstinence. ? Alcohol
Dependent Insomnia (Alcohol Dependent Sleep Disorder): Characterized by
the sustained ingestion of sleep onset by the sustained ingestion of alcohol
that is used for its hypnotic effect. ? Toxins Induced Sleep
Disorders: Characterized by either Insomnia or excessive sleepiness produced by
poisoning with heavy metals or organic toxins. Transient and intermittent
Insomnia generally occur in people who are temporarily experiencing either
stress, environmental noise, extreme temperatures, change in ones environment,
and sleep/wake schedule problems. Sleep is the way the body rests and allows the
mind to slow down and relax. Sleep is a distinct state of mind and body in which
the body is deeply at rest, the metabolism is lowered, and the mind becomes
unconscious to the outside world. The sleeping mind does not become unconscious
entirely; instead, it shifts the direction of consciousness from a chair beside
your body to another chair inside your dream. Aristotle proposed that the
purpose of sleep was to help the body digest food although eating a big meal
before 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 organized
activity following a cycle pattern . Two types of sleep have been identified
rapid eye movement (REM) and non rapid eye movement (NREM) sleep. The duration
of NREM-REM cycles is approximately 90 minutes., but may vary between 70 and 120
minutes NREM is subdivided into four stages from stage 1 a very light sleep, to
stage 4, the deepest stage of sleep. NREM sleep is also called quiet”
sleep, because most physiological functions are slowed down during this period
of slumber, NREM sleep has been described as an idling brain in a moveable body
. REM sleep is called paradisiacal active, or fast sleep, characterized by
electroenchgalographic (EEG) activation, muscle tone , and the onset of (the
name REM) rapid eye movements during this time. Vivid hallucinatory experiences
occur during REM sleep. With the exception of periodic muscle twitches, the body
is essentially paralyzed during REM, which has been described as a hyperactive
brain in a paralyzed body, Delta or slow wave sleep is predominant in the first
third of the night , where as the proportion of REM sleep may come quicker than
usual, aid delta sleep may consequently be delayed and shortened. Patterns of
sleep generally look like this: light sleep deep sleep- REM sleep_ light
sleep- deep sleep rest and restoration. The first period of light sleep
lasts about 45 minutes. There are five distinct stages of sleep. Stage 1 and 2
are the majority of the night. Stage 3 and 4 are deep sleeping or “delta
sleep” and rest and restoration. Stage 5 is the dream-state, which generally
involves rapid eye movement or REM sleep. Several developmental changes in sleep
patterns occur over the course of life span. Total sleep time is highest in
infancy and gradually declines, leveling off in young adulthood. There are many
different causes for insomnia that affect diverse groups of people in lots of
ways. Causes for insomnia may range from the psychological to psyiological.

Causes of chronic insomnia associated with psychological problems can be deeply
rooted in stress, anxiety and /or depression. Insomnia associated with medical
problems can be caused by a variety of things including: anemia, asthma, kidney
dysfunction, diabetes, HIV, and a variety of medication side effects. Insomnia
can 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 are
unable to sleep and breath at the same time which causes sleep apnea. Leg
twitches are a problem some experience when their body suddenly jerks and wakes
them as they are first falling asleep. Almost any sleeping pill, if taken
continuously, will cause insomnia. Sleep can be affected by ones individual
differences, prior sleep history, circadian rhythms, drugs, life styles, and
psychopathology. Caffeine and nicotine are both central nervous system
stimulants, and as such are sleep-disrupting substances. Insomnia can also be
due to poor eating habits, caffeine, and lack of exercise. Medications that are
prescribed 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, or
antioxidants. Life stress factors also cause significant variations in sleep
habits from one individual to the next. Work and leisure activities, the use of
alcohol and drugs, travel social and family obligations all affect the ability
to get a good nights sleep. Excessive daytime sleepiness and fatigue can be one
characteristic of narcolepsy and hypersomnia . Insomnia can adversely affect
both physical and mental health. Some people suffering from Insomnia depend too
much time in bed unsuccessfully trying to sleep. Diagnosis Diagnosis is based on
two symptoms: 1) the perceived difficulty of initiating and/or maintaining sleep
or feeling unrested despite an adequate amount of sleep or 2) daytime tiredness
or porsocialor work performance as a consequence of impaired sleep. Insomnia is
not defined by the number of hours of sleep a person gets or how long it takes
to fall asleep. Identifying behaviors that may worsen Insomnia and stopping (or
reducing) them. Normative developmental changes in sleep patterns are outlined
and distinguished from pathological sleeplessness. Sleep problems are also more
common among the widowed, divorced and separated and among people with low
incomes and low socio-economic status. Certain individuals are more likely to
experience Insomnia are the elderly, females, and those persons with a history
of depression. Twenty-five percent of adults and fifty percent of senior
citizens have insomnia problems. Insomnia is also a problem that is prevalent
among people write HIV/ Aids. When loss of sleep impairs a persons ability to
function properly during the day, it may indicate a potential problem. Insomnia
may cause problems during the day, such as tiredness, a lack of energy,
difficulty concentrating, and irritability. The main consequence of sleep
depravation in otherwise normal sleepers are sleepless, performance impairment,
and mood alteration. The severity of the effects of sleep depravation depend on
the effects sleep loss is partial, total, acute, or chronic. Insomniacs have
more difficulty coping with minor irritations and report less enjoyment of
family and relationships; they also feel less well physically. About one third
of the adult population is affected by insomnia each year. Insomnia affects
20-40% of all adults, mostly women and the elderly. According to the National
Survey of Psychotherapeutic Drug Use , about 35% of the adult populationis
affected by insomnia during the course of a year. The National Institute of
Mental Health (NIMH) Epidomiologic Catchment Area study yielded a 10.2% of the
population on a chronic basis. Surveys indicate that one-third. ” About 15to
18 percent suffer from percent suffer from intractable sleep difficulties that
are perceived to impediments to them life says Harvey Moldofsky , chief
psychologist at Toronto Western Hospital. Acute sleep loss causes fatigue and
decreases motivation administrative. Total sleep loss for more than one night
leads to micro sleep episodes intruding into wakefulness, effecting attention
span reduction, difficulty concentrating, and performance efficiency is
impaired. As sleep loss accumulates, daytime sleepless increases, and both
cognition and behavioral deficits are exalelated. Chronic insonmia may induce
emotional distress and increase the use of psychotropic medications and the risk
of substance abuse. Sleep disturbances can affect a persons life, causing
significant psychosocial, occupational and health reprocassions. Sleep duration
is low lend to lavevity . Insomnacs are move likely (5% US. 2%) to report motor
vehicle accidents in which fatigue was a factor. Individuals with sleep
disturbances are move likely to display concomitent pshchological distress than
those without sleep complaints reported by insomniacs often have a psychosomatic
connotation: thsior headaches, gadro intestinal problems, no specific aches and
pains, and allergies. There is a strong relationship between sleep and emotional
disturbances. Insomnia causes psychological distress in some individuals, and
that in those already afflicted by emotional problems, chronically disturbed
sleep may only potentiate these difficulties. Reports of fatigue, tiredness, or
drowsiness almost always accompany Insomnia complaints. Sleepiness is almost a
direct result of sleep depravation. And, chronic inability to sleep will
ultimately lead to Insomnia or some type of sleep disorder. Insomnia encompasses
a wide variety of complaints typically reflecting unsatisfactory duration,
efficiency, or quality of sleep. Technology Technology used to measure and aid
in the diagnosis of sleep consist of the EEG, the electro-oculogram (EOG), and
the electromyogram (EMG). The EEG records brain wave activity from the central
and occipital areas. The EOG measures a difference of electrical potential
between the cornea and the retina; this difference is generated with each eye
movement. The EMG monitors muscle tone, and its main recording site is the chin.

Monitoring of oxygen saturation is used in the assessment diagnosis of sleep
apnea. The electrocardiogram (EKG) documents arrhythmias accompanying
respiratory disturbances. Accompanying respiratory disturbances. EMG monitoring
of the anterior tibilias muscles is used for detection of periodic leg movements
during sleep. Most adults need seven or eight hours of sleep a night, but some
adults are ” short sleepers” and functions well and only there of four
hours. Being that the purpose of sleep could be to allow the body time to repair
and rejurvenate- some find 4 to 6 hours as a sufficient amount at sleep. Sleep
reduces fatigue and relieves stress and dreaming helps to clear the nervous
systems. The amount of time needed for sleep is eshonaly usaible from person to
person. The clinical significanes of insomnia is detemined according to its
sevenrity, frequency, duration, and daytime sequence. Treatment for dramic
insomia consists of: -There are many foods you may try to get est that
would/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 helps
reduce sleep. -Lifestyle changes can also hepls you to sleep better. -Herbal
remedies that as help induce sleep are Valerian roots, skull cap, passion
flower, wood betony or California poppy. -Over the counter sleep medicines are
not usually recommended for the treatment of insomnia . Though using sleeping
pills without supervision of a physican for long periods of time can treat
chronic insomnia. -Tayrs behavioral techniques to improve sleep, such as
rehilbilation therpy, sleep restrictions therapy, and reconditioning may help.

There are specific and effective technques through rehilbilation therapy that
can reduces or eliminate anxiety and body tension. Insomnia can not be cured
without treaty the underlying imbalance that causes it. The Association of Sleep
Disorders Caters was established in 1975; its purpose is to accidet clinics in
the United States and to promote professional education and the development of
standards and guidelines for patient care. Most clinics are based in large urban
hospitals or university medical schools, usually in conjunction with
sleep-research programs . Medical experts from widely diverse fields are
involved in sleep clinics. Psychologists and psychiatrists, internist,
psycologists and specialist in disorders of the heart, lungs, brain, respiratory
system and central nervous system are involved can givers at sleep clinics.

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


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