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Disease: Insomnia Insomnia
Category: Psychiatric diseases
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Disease Definition:

One of the most common medical complaints is of one not being able to either fall asleep or stay asleep, and this condition is known as insomnia. One is often awaken feeling unrefreshed when suffering from insomnia, which takes a toll on one’s ability to function during the day. Insomnia can not only affect one’s energy level and mood, but also one’s health, quality of life and work performance as well.
How much sleep one needs differs from a person to the other. Most adults need seven to eight hours a night. More than one-third of adults have insomnia at some time, while 10 to 15% report long-term (chronic) insomnia.
One doesn’t have to endure sleepless nights because simple changes in one’s daily habits can resolve insomnia and restore one’s needed rest.

Work Group:

Prepared by: Scientific Section

Symptoms, Causes


The following are signs and symptoms of insomnia:



  • Awakening too early
  • Difficulty falling asleep at night
  • Daytime fatigue or sleepiness
  • Tension headaches
  • Gastrointestinal symptoms
  • Awakening during the night
  • Irritability, anxiety or depression
  • Increased errors or accidents.
  • Ongoing worries about sleep
  • Difficulty paying attention or concentrating on tasks
  • Not feeling well rested after a night’s sleep


In case insomnia makes it difficult for one to function throughout the day, a doctor could be consulted in order to determine what might be the reason behind the sleeping problem and how it can be treated. One might be referred to a sleep center for special testing in case there are doubts about having some other sleep disorder.


Insomnia is most frequently the outcome of another problem, like a medical condition that results in pain or use of substances that interfere with sleep. The following are common reasons of insomnia occurrence:
Stress: Concerns about work, health, school or family can keep one’s mind active at night, making it hard to sleep. Stressful life events, like divorce, job loss or death or illness of a loved one may contribute to insomnia.

Anxiety: Everyday anxieties as well as more-serious anxiety disorders may disrupt one’s sleep.

Depression: One may either sleep too much or have a difficult time trying to sleep when they’re depressed. This may be because of chemical imbalances in the brain or due to worries that are related to depression preventing one from relaxing enough to fall asleep. Insomnia is also usually associated with other mental health disorders.

Medications: Prescription drugs that can interfere with sleep include certain antidepressants, allergy medications, heart and blood pressure medications, corticosteroids and stimulants (such as Ritalin). Several over-the-counter (OTC) medications, such as certain pain medication combinations, weight-loss products, decongestants, contain caffeine and other stimulants. Antihistamines may at first make one groggy, but they can worsen urinary problems resulting in waking up more often during the night.

Caffeine: alcohol and nicotine. Tea, cola, coffee and other caffeine-containing drinks are well-known stimulants. Drinking coffee in the late afternoon can prevent one from drifting off to sleep at night. Nicotine in tobacco products is another stimulant that can result in insomnia. Alcohol is a sedative that may help one fall asleep, but it prevents deeper stages of sleep and usually results in awakening in the middle of the night.

Medical conditions: Insomnia may occur in the case of experiencing chronic pain, the urge to urinate frequently, or breathing difficulties. Conditions related to insomnia include congestive heart failure, lung disease, diabetes, arthritis, gastroesophageal reflux disease (GERD), stroke, Alzheimer’s disease, Parkinson disease, overactive thyroid and cancer. When one makes sure they are well treated from their medical conditions, it may help with resolving their insomnia. When experiencing arthritis, for instance taking a pain reliever preceding going to sleep may help sleeping better.

Change in the environment or work schedule: Travel or working a late or early shift can disrupt the body’s circadian rhythms, making it hard to sleep. One’s circadian rhythms act as internal clocks, guiding such things as one’s wake-sleep cycle, body temperature and metabolism.

Poor sleep habits: Habits that help promote good sleep are known as “sleep hygiene”. Poor sleep hygiene includes an irregular sleep schedule, stimulating activities before bed, an uncomfortable sleep environment and use of the bed for activities other than sleep or sex.

“Learned” insomnia: This may take place when one is excessively concerned about not being able to sleep well and try too hard to fall asleep. Most people suffering from this condition sleep better when they’re away from their habitual sleep environment or when they aren’t trying to sleep, for instance, when they’re reading or watching TV.

Eating too much late in the evening: It is ok to have a light snack before going to bed, but eating too much may result in them feeling physically uncomfortable while lying down, making it hard to go to sleep. Several people additionally go through heartburn, a backflow of acid and food from the stomach to the esophagus after eating. This uncomfortable feeling may prevent drifting off to sleep.
Insomnia and aging
Insomnia becomes more prevalent with age. Changes can take place as one grows older affecting their sleep. One may go through the following:

A change in sleep patterns: Sleep usually becomes less restful as one gets older. They spend more time in stages 1 and 2 of non-rapid eye movement (NREM) sleep and less time in stages 3 and 4. Stage 1 is transitional sleep, stage 2 is light sleep, and stage 3 is deep (delta) sleep, the most restful kind. One is additionally more likely to awaken because they’re sleeping more lightly. The internal clock of a person usually advances with age that is; one gets tired earlier in the evening and wake up earlier in the morning. But older people still need the same amount of sleep as younger people do.

A change in activity: One may be less physically or socially active. Activity helps promote a good night’s sleep. One may additionally be more likely to take a daily nap that can interfere with sleep at night as well.

A change in health: Sleep can be interfered by chronic pain of conditions like back problems, depression, arthritis, stress and anxiety. Older men usually develop noncancerous enlargement of the prostate gland (benign prostatic hyperplasia) that can result in the need to urinate oftener, interrupting sleep. Hot flashes in women related to menopause can be equally disruptive.
Other disorders that are related to sleep like restless legs syndrome and sleep apnea additionally become more common with age. Sleep apnea results in inability of breathing periodically during the night and then awakens. Restless legs syndrome results in unpleasant sensations in the legs and an almost irresistible desire to move them that may keep one from drifting off to sleep.

Increased use of medications: Older people use more prescription drugs than younger people do, which raises the chance of insomnia resulting from a medication.
Sleep problems may also be a concern for children and teenagers. Certain children and teenagers simply have trouble sleeping or resist a regular bedtime due to their more delayed internal clocks. They want to go to bed later and sleep later in the morning.
Almost everyone sometimes has sleepless night. But the risk of insomnia is greater when:

Being a woman: Women are twice as likely to go through insomnia. Hormonal shifts throughout the menstrual cycle and in menopause play a role. Several women report problems sleeping throughout perimenopause, the time leading up to menopause. Throughout menopause, hot flashes and night sweats usually disturb sleep. Lack of estrogen in postmenopausal women is considered to be leading to sleep difficulties.

Being over the age of 60: Insomnia increases with age due to changes in sleep patterns. According to certain estimates, insomnia affects almost 50% of all older people.

Experiencing mental health disorder: Early-morning awakening is a classic symptom of depression. Several disorders, such as anxiety, bipolar disorder, depression and post-traumatic stress disorder, disrupt sleep.

Being under a lot of stress: Stressful events can result in short term insomnia, and major or long-lasting stress as is the case with the death of a loved one or a divorce can contribute to chronic insomnia. Being poor or unemployed raises the risk as well.

Working night or changing shifts: Working at night or changing often shifts raises the risk of insomnia.

Traveling long distances: Jet lag from traveling across multiple time zones can result in insomnia.



Sleep is as much importance as a healthy diet and regular exercise does. Insomnia can affect a person both mentally and physically whatever is the reason for sleep loss. People suffering from insomnia report a lower quality of life compared with people who are sleeping well.
The following are the complications that may result from insomnia:


  • Psychiatric problems like depression or an anxiety disorder
  • High risk and severity of long-term diseases, like heart disease, diabetes and high blood pressure.
  • Obesity or overweight
  • Slowed reaction time while driving and greater risk of accidents
  • Lower performance on the job or at school.
  • Poor immune system function


Addressing any underlying reasons for insomnia occurrence or changing sleep habits can restore restful sleep for several people. Good sleep hygiene, simple steps like keeping the same bedtime and rising time, promotes sound sleep and daytime alertness. In case these measures fail to work, medications may be recommended to help with sleep and relaxation.

Behavior therapies
Behavioral treatments teach one new sleep behaviors and ways to make sleeping environment more conductive to sleep. Studies have shown behavior therapies are equally  or more effective than are sleep medications. Behavior therapies are in general recommended as the first line of treatment for people suffering from insomnia.
Behavior therapies include:

Education about good sleeping habits: Sleep hygiene teaches habits that promote good sleep.
Relaxation techniques. Biofeedback, breathing exercises and progressive muscle relaxation are ways to decrease anxiety at bedtime. These strategies help managing breathing, muscle tension, mood and heart rate.
Cognitive therapy: This involves replacing worries about not sleeping with positive thoughts. Cognitive therapy can be taught through one-on-one counseling or in group sessions.
‘Stimulus control’: That is, limiting the time one spends awake in bed and associating the bed and bedroom only with sleep and sex.
Sleep restriction: This treatment reduces the time one spend in bed, resulting in partial sleep deprivation that makes one more tired the next night. As soon as one’s sleep has improved, their time in bed will slowly be raised.
Light therapy: When one falls asleep too early and then awaken too early, they can use light to push back their internal clock. One goes outside for 30 minutes or obtains light via a medical-grade light box throughout times of the year when it’s light outside in the evenings.

One may be able to sleep with the help of some prescription sleeping pills as well, such as eszopiclone (Lunesta), Ramelteon (Rozerem), Zolpidem (Ambien) or Zaleplon (Sonata). These medications in rare cases may result in severe allergic reactions, unusual behaviors, and facial swelling like driving or preparing and eating food while asleep. Side effects of prescription sleeping medications are usually more pronounced in older people and may include impaired thinking, night wandering, balance problems, excessive drowsiness and agitation.
Although many newer medications are approved for indefinite use, it isn’t recommended in general to rely on prescription sleeping pills for more than a few weeks.
In case of experiencing depression additionally to insomnia, an antidepressant with a sedative effect may be prescribed like mirtazapine (Remeron), Doxepin (Sinequan, Adapin) or trazodone (Desyrel).
Over-the-counter sleep aids contain antihistamines that can induce drowsiness. But antihistamines may decrease the quality of one’s sleep, and they can result in side effects like dry mouth, blurred vision and daytime sleepiness.


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