Primary
Insomnia is only classified as a problem, if over a period of at least
one month, a person has difficulty falling asleep or maintaining their
sleep. To be diagnosed as primary insomnia, the sleep problem must cause
difficulty in the person's social, school, work, or other significant
area of life. Most often, people with insomnia complain of problems
in falling asleep, or they complain of fitful sleeping or frequent awakening.
Some report that the quality of their sleep is poor, that they are restless
during sleep. This condition may turn into an aggravating cycle in that
the more a person focuses on their sleep problems, they may be less
likely to get good quality sleep. Insomnia can also lead to difficulties
with a person’s concentration, energy level, or mood. The main characteristics
of primary insomnia are:
For at least a month the persons main complaint has been trouble going
to sleep, staying asleep or feeling unrested.
The insomnia, or resulting daytime fatigue, causes clinically important
distress or impairs work, social or personal functioning.
It does not occur solely in the course of Breathing-Related or
Circadian Rhythm Sleep Disorder, Narcolepsy
or a Parasomnia.
It does not occur solely in the course of another mental disorder (such
as a Delirium, Generalized
Anxiety Disorder, Major Depressive
Disorder).
These symptoms are not directly caused by a general medical condition
or substance use, including medications and drugs of abuse.
Associated Features:
Chronic. Illness
Depression
Anxiety
Stress,
High caffeine consumption
Abuse of alcohol
Heavy smoking
Unusual sleep patterns
Differential
Diagnosis:
Some disorders have similar or even the same symptoms. The clinician,
therefore, in his/her diagnostic attempt, has to differentiate against
the following disorders which need to be ruled out to establish a precise
diagnosis .Frequently, but not always, insomnia can be caused by:
Anxiety
Depression
Circadian Rhythm Sleep
Disorder
Cause:
Insomnia is difficulty
in initiating or maintaining sleep, and may be short-term or chronic.
Short-term insomnia is most often related to anxiety, for example anticipation
of a serious life change, and usually resolves when anxiety lessens.
Individuals with chronic insomnia most often report not being able to
fall asleep, although individuals may also complain of frequent night-time
awakening. Time of onset of primary insomnia is usually young adulthood
or middle age.
Treatment:
The treatment is
related to the cause, if it can be determined. If there is an obvious
physical or psychological cause, these are the main focus of treatment.
Control ones environmental and lifestyle is also beneficial, factors
such as too much light, noise, caffeine or other stimulants, or erratic
hours of wakefulness should be addressed as part of the persons overall
treatment plan.
Counseling and
Psychotherapy [ See
Therapy Section ]:
Behavioral strategies
that promote good sleep practices, such as establishing a regular sleep/wake
schedule, taking moderate exercise prior to retiring for the night,
avoidance of alcohol or stimulating substances, such as caffeine. The
establishment of a regular schedule of activities allows the individual
to prepare for sleep and may effectively manage the sleep problem.
Pharmacotherapy
[ See Psychopharmacology
Section ] :
Benzodiazepines
and the related compounds, zolpidem and zaleplon, are the safest and
most effective hypnotic agents. Ideally, medications are only a short-term
solution and other forms of treatment should be tried before resorting
to drugs .Barbiturates and related compounds should be used cautiously,
if at all, as they are more likely to be associated with addiction and
adverse effects without significantly increasing effectiveness.
Other medications that may be used for insomnia include sedating antidepressants
such as TCAs or trazodone, as well as antihistamines (eg, diphenhydramine).
