Insomnia

Insomnia is a disorder of initiating and maintaining sleep. Patients may have either sleep-onset problems or wakenings from sleep or both of these.

Prevalence:

Persistent and severe sleep disturbance affects at least

• 1 in 10 adults &

• 1 in 5 older adults.

It is more common in women, in shift workers, and in patients with medical and psychiatric disorders.

Clinical Features:

Insomnia often remains unreported in the initial stages and presents only when a poor sleep pattern is well established. Alcohol & over-the-counter drugs has long been a first-line ‘self-help’ strategies. People seek medical help  when trapped in a vicious circle of anxiety and poor sleep, who report having ‘tried everything’.

Patients often report poor quality of sleep. Concerns are normally expressed about the daytime effects of poor sleep. These can be:

1. Cognitive effects: fatigue, sleepiness, inattention and some impairments in performance.

2. Emotional effects: irritability and anxiety.

Generally, the criteria for severe and chronic insomnia are a minimum duration of 6 months with problems presenting three or more nights per week. Mild and moderate insomnia may be diagnosed where problems are less intrusive.

Course and prognosis:

Untreated psychophysiological insomnia can last for decades, and may gradually worsen over time. Although certain insomnias tend to persist if untreated, prognosis with effective treatment can be very good.

Treatment:

Pharmacotherapy:

Benzodiazepines should be recommended mainly for short-term or occasional use. But  these are not the treatment of choice in chronic insomnia and are contraindicated in older adults and where insomnia may involve sleep-related breathing disorder because of their potentially depressant effects on respiration.

The pineal hormone melatonin has been the subject of highly publicized claims.
Several controlled studies support its sleep-promoting effects.

Exercise:

Athletic people sleep well. Exercise can have positive effects upon sleep quality, particularly if taken late afternoon or early evening and in otherwise relatively fit individuals. Morning exercise can also be an effective modality to encourage the same waking time and early morning light exposure; which help to reset sleep patterns on a daily basis.

Reference:

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