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).
