Insomnia

Insomnia
Insomnia is an experience of inadequate or poor quality sleep characterized by one or more of the following:
difficulty falling asleep
difficulty maintaining sleep
waking up too early in the morning
nonrefreshing sleep

Insomnia also involves daytime consequences such as:
tiredness
lack of energy
difficulty concentrating
irritability
As many as one-third of patients seen in the primary care setting may experience occasional difficulties in sleeping, and 10 percent of those may have chronic sleep problems.

About 30 to 40 percent of adults indicate some level of insomnia within any given year, and about 10 percent to 15 percent indicate that the insomnia is chronic and/or severe. The prevalence of insomnia increases with age and is more common in women.

Types of Insomnia
Acute Insomnia: Periods of sleep difficulty lasting between one night and a few weeks are referred to as acute insomnia. Acute insomnia is often caused by emotional or physical discomfort. Some common examples include significant life stress; acute illness; and environmental disturbances such as noise, light, and temperature. Sleeping at a time inconsistent with the daily biological rhythm, such as occurs with jet lag, also can cause acute insomnia.

Chronic insomnia refers to sleep difficulty at least three nights per week for one month or more. Chronic insomnia can be caused by many different factors acting singly or in combination, and often occurs in conjunction with other health problems. In other cases sleep disturbance is the major or sole complaint, and involves abnormal sleep-wake regulation or physiology during sleep.

Insomnia associated with psychiatric, medical and neurological disorders. Although psychiatric disorders are a common source of chronic insomnia, they account for less than 50 percent of cases. Mood and anxiety disorders are the most common psychiatric diagnoses associated with insomnia. Insomnia can also be associated with a wide variety of medical and neurological disorders. Factors that cause problems throughout the day such as pain, immobility, difficulty breathing, dementia, and hormonal changes associated with pregnancy, peri-menopause, and menopause can also cause insomnia. Many medical disorders worsen at night, either from sleep per se, circadian influence (e.g., asthma), or lying down (e.g. gastro-oesophageal reflux).

Insomnia associated with medication and substance use. A variety of prescription drugs, non-prescription drugs, and drugs of abuse can lead to increased wakefulness and poor-quality sleep. The likelihood of any given drug contributing to insomnia is unpredictable and may be related to dose, lipid solubility, individual genomic differences, and other factors. Some drugs commonly related to insomnia are stimulating antidepressants, steroids, decongestants, beta blockers, caffeine, alcohol, nicotine, and recreational drugs such as Ecstasy.

At the Sleep Medicine group of sleep centres we offer a specialised treatment service for patients who have insomina associated with substance abuse please contact us for further information.

Insomnia associated with specific sleep disorders. Insomnia can be associated with specific sleep disorders, including restless legs syndrome (RLS), periodic limb movement disorder (PLMD), sleep apnoea, and circadian rhythm sleep disorders.

Primary Insomnia: When other causes of insomnia are ruled out or treated, remaining difficulty with sleep may be classified as primary insomnia. Factors such as chronic stress, hyper-arousal, poor sleep hygiene, and behavioural conditioning may contribute to Primary Insomnia.