Insomnia Disease

BASICS

DESCRIPTION

Difficulty in falling asleep or maintaining sleep, intermittent wakefulness, early morning awakening or a combination of these. Can be:

Transient - due to a life crisis, bereavement, change in environment or concomitant illness
Chronic - associated with medical and psychiatric conditions or drug intake
System(s) affected: Nervous
Genetics: N/A
Incidence/Prevalence in USA: Affects an estimated 35% of the adult population. One of the most frequent complaints in primary care practice.
Predominant age: Elderly
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Perceived reduction in sleeping time
Initial insomnia - difficulty initiating sleep at usual time
Middle insomnia - wakefulness during the usual sleep cycle, "tossing and turning"
Terminal insomnia - early awakening
Daytime sleepiness and napping
Tiredness
Anticipatory anxiety

CAUSES

Medical illnesses - arthritis, fibromyalgia, hyperthyroidism, gastroesophageal reflux disease, duodenal ulcer, Alzheimer's disease and other dementias, restless leg syndrome, sleep apnea, respiratory diseases, and all painful conditions (e.g., muscle cramps)
Psychiatric illnesses - mostly depression, classically associated with early morning awakening, but can also be manifested by initial or middle insomnia
Anxiety
Schizophrenia
Manic disorders
Drug induced insomnia - alcohol, caffeine, nicotine
Nonprescription drugs - diet aids, decongestants, cough preparations
Prescribed drugs - steroids, theophylline, phenytoin (Dilantin), levodopa (Sinemet, Dopar)
Obstructive sleep apnea
Jet lag (transient)
Heavy smoking

RISK FACTORS

Chronic illnesses
Age over 50
Multiple drug intake
Obesity

DIAGNOSIS

LABORATORY

N/A

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

N/A

SPECIAL TESTS

Diagnosis can be confirmed by the use of polysomnography, particularly if sleep apnea is suspected. This is generally not necessary or practical.

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Insomnia is a self-reported condition

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Transient insomnia
- Lasts less than three to four weeks
- Reassurance and supportive counseling are appropriate treatment modalities
Chronic insomnia
- Address the underlying cause: Pain, drugs, depression
- Avoid alcohol after 5 PM or within 6 hours of retiring because of secondary rebound stimulation
- Patient should be encouraged to avoid daytime napping and to develop bedtime rituals conducive to sleep
- A thorough review of the patient's habits, drug intake, diet, and exercise pattern may uncover correctable causes of insomnia
- Prescribe hypnotics only if the above strategies fail

SURGICAL MEASURES

N/A

ACTIVITY

No restriction
A daily exercise routine is helpful. Avoid exercise close to bedtime.

DIET

Avoid caffeine
Avoid heavy, late night snacks (sometimes a light snack before bedtime may help)
Avoid alcohol after 5 PM or within 6 hours of retiring, because of secondary rebound stimulation

PATIENT EDUCATION

Explain sleep patterns and sleep hygiene
Show limitations and noxious effects of drugs used for insomnia
Incorporation of appropriate dietary and exercise protocol

FOLLOW UP

PREVENTION/AVOIDANCE

Avoidance, when possible, of all possible causes

POSSIBLE COMPLICATIONS

Transient insomnia becomes chronic
Increased daytime sleepiness

EXPECTED COURSE AND PROGNOSIS

Should resolve with time. Treatment of underlying symptoms helpful.

MISCELLANEOUS

ASSOCIATED CONDITIONS

Obstructive sleep apnea
Drug or alcohol addiction and dependence

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric:

Exert caution when prescribing benzodiazepines or other sedative-hypnotics to the elderly
Educate older patients about age-related sleep changes

Others: N/A

PREGNANCY

Transient insomnia occurs due to discomfort in sleeping positions

OTHER NOTES

L-Tryptophan: formerly widely used - no longer available as a single ingredient

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.