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| '''For patient information click [[Insomnia (patient information)|here]]''' | | '''For patient information click [[Insomnia (patient information)|here]]''' |
| | {{Insomnia}} |
| | {{CMG}}; {{AE}} {{Adnan Ezici}} , {{AF}} , {{KS}} , {{JC}} , {{NS}} |
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| {{Infobox_Disease | | | {{SK}} Insomnia disorder |
| Name = {{PAGENAME}} |
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| Image = |
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| Caption = |
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| DiseasesDB = 26877 |
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| ICD10 = {{ICD10|F|51|0|f|50}}, {{ICD10|G|47|0|g|40}} |
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| ICD9 = {{ICD9|307.42}}, {{ICD9|307.41}}, {{ICD9|780.51}}, {{ICD9|780.52}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = 000805 |
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| MeshID = D007319 |
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| }}
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| {{SI}}
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| {{CMG}}; {{AE}} {{KS}}
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| {{SK}} Insomnia disorder
| | ==[[Insomnia overview|Overview]]== |
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| ==Overview==
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| '''Insomnia''' is a [[sleep disorder]] characterized by an inability to [[sleep]] and/or inability to remain asleep for a reasonable period. Insomniacs typically complain of being unable to close their eyes or "rest their mind" for more than a few minutes at a time. Both organic and nonorganic insomnia constitute a [[sleep disorder]].<ref>http://www3.who.int/icd/currentversion/fr-icd.htm?gf50.htm+f510 </ref><ref>http://www3.who.int/icd/currentversion/fr-icd.htm?gg40.htm+g47 </ref>
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| ==Classification== | | ==[[Insomnia historical perspective|Historical Perspective]]== |
| ===Types of insomnia===
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| Three types of insomnia exist: transient, acute, and chronic
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| #'''Transient insomnia''' lasts from one night to a few weeks. Most people occasionally suffer from transient insomnia due to such causes as [[jet lag]] or short-term anxiety. If this form of insomnia continues to occur from time to time, the insomnia is classified as intermittent.
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| #'''[[Acute (medical)|Acute]] insomnia''' is the inability to consistently sleep well for a period of between three weeks to six months.
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| #'''[[chronic (medicine)|Chronic]] insomnia''' is regarded as the most serious; persists almost nightly for at least a month.
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| ===Patterns of Insomnia===
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| The pattern of insomnia often is related to the etiology.[http://www.emedicine.com/MED/topic609.htm]
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| # Initial insomnia - difficulty falling asleep at the beginning of the night, often associated with [[anxiety disorder]]s.
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| # Middle insomnia - waking during the middle of the night, difficulty maintaining sleep. Often associated with pain syndromes or medical illness.
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| # Terminal (or late) insomnia - early morning waking. Characteristic of [[Clinical depression]].
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| ==Causes== | | ==[[Insomnia pathophysiology|Pathophysiology]]== |
| Insomnia can be caused by:
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| * [[Psychoactive drug|Psychoactive drugs]] or [[Stimulant|stimulants]], including certain [[medication]], [[herbs]], [[Caffeine|caffeine]], [[Cocaine|cocaine]], [[Ephedrine|ephedrine]], [[Amphetamine|amphetamines]], [[Methylphenidate|methylphenidate]], [[MDMA]], [[Methamphetamine|methamphetamine]] and [[Modafinil|modafinil]]
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| * [[Hormone]] shifts such as those that preceed [[menstruation]] and those during [[menopause]]
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| * Psychological problems like [[fear]], [[stress (psychology)|stress]], [[anxiety]], emotional or mental tension, work problems, financial stress, unsatisfactory sex life
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| * [[Mental disorder|Mental Disorders]] such as [[Clinical depression|clinical depression]], [[bipolar disorder]], [[General anxiety disorder|general anxiety disorder]], [[Sleep disorder|sleep disorders]]
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| * [[Circadian rhythm sleep disorder|Disturbances of the circadian rhythm]] such as shift work and [[Jet lag|jet lag]]
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| * Certain [[Neurology|neurological disorders]], [[Brain|brain]] [[Lesion|lesions]], or a [[Medical history|history]] of [[Traumatic brain injury]]
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| * [[Disease|Medical conditions]] such as [[Hyperthyroidism]] and [[Wilson's Syndrome]]
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| *[[Drugs]]: [[Acamprosate calcium]], [[acetaminophen]], [[caspofungin acetate]], [[Leuprolide]], [[levofloxacin]], [[Oxandrolone]], [[Nandrolone]], [[Pirfenidone]], [[Rasagiline]], [[Secobarbital sodium]], [[Sulfasalazine]], [[Trifluoperazine]], [[Varenicline]].
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| Insomnia also sometimes occurs for no apparent reason.<ref>http://www.paralumun.com/sleeplessness.htm</ref>
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| An overactive mind or physical pain may also be causes. Finding the underlying cause of insomnia is usually necessary to cure it. Insomnia can be common after the loss of a loved one, even months or a year after the death, if they are not grieving correctly (pretending they are over it when they are not).
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| === Acute === | | ==[[Insomnia classification|Classification]]== |
| * Environment changes
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| * Extremes of temperature
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| * Illness
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| * Injury
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| * Light
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| * Noise
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| * Poor bed
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| * Situational stress
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| === Chronic === | | ==[[Insomnia causes|Causes]]== |
| * [[Angina]]
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| * [[Anxiety]]
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| * [[Arthritis|Arthritis pain]]
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| * [[Asthma]]
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| * [[Benign prostatic hyperplasia]]
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| * [[Bipolar Disorder]]
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| * [[Caffeine]]
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| * [[Cancer]] pain
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| * [[Chronic Fatigue Syndrome]]
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| * [[Chronic Obstructive Pulmonary Disease]] (COPD)
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| * [[Chronic Renal Disease]]
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| * [[Headache|Cluster headaches]]
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| * [[Congestive Heart Failure]]
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| * [[Dementia]]
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| * [[Depression]]
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| * [[Diabetes Mellitus]]
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| * [[Drugs]]- [[Armodafinil]], [[Clomifene]], [[Diflunisal]], [[Eculizumab]], [[Efavirenz]], [[Fluvoxamine]], [[Levofloxacin]], [[Naltrexone]], [[Ofloxacin]], [[Oxymetazoline]], [[Paroxetine]], [[Phentermine]], [[Ribavirin]], [[Rifaximin]], [[Sulindac]], [[Tacrolimus]], [[Temozolomide]], [[Thalidomide]], [[Topiramate]], [[Varenicline]]
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| * [[Fibromyalgia]]
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| * [[Gastroesophageal Reflux Disease]] (GERD)
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| * [[Hyperthyroidism]]
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| * [[Inflammatory Bowel Disease]] (IBD)
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| * [[Mania]]
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| * [[Menopause]]
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| * Nocturnal [[panic disorder]]
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| * Other [[movement disorder]]s
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| * Pain
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| * [[Parkinson's Disease]]
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| * [[Peptic Ulcer Disease]]
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| * Poor sleep hygiene
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| * [[Posttraumatic Stress Disorder]]
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| * [[Pregnancy]]
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| * [[Pruritis]]
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| * [[Psychosis]]
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| * [[Reflux esophagitis]]
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| * [[Schizophrenia]]
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| * [[Seizures]]
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| * [[Sleep Apnea]]
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| * [[Uremia]]
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| * [[Urinary Tract Infection]] (UTI)
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| === Other === | | ==[[Insomnia differential diagnosis|Differentiating Insomnia from other Diseases]]== |
| * Circadian rhythm disorders
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| * Idiopathic insomnia
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| *Drugs
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| **[[Alemtuzumab]]
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| **[[Amoxicillin]]
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| **[[Amobarbital sodium]]
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| **[[Butorphanol]]
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| **[[Desmopressin]]
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| **[[Dapsone]]
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| **[[Lacosamide]]
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| **[[Milnacipran hydrochloride]]
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| **[[Vilazodone]]
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| **[[Meropenem]]
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| **[[Ramelteon]]
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| **[[Terbutaline]]
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| * [[Narcolepsy]]
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| * [[Obstructive sleep apnea]]
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| * [[Periodic limb movement disorder]]
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| * Prion fatal familial insomnia
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| * Psychophysiologic insomnia
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| * REM-behavior disorder
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| * [[Restless leg syndrome]] (RLS)
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| * Sleep state misperception
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| ==Differential Diagnosis== | | ==[[Insomnia epidemiology and demographics|Epidemiology and Demographics]]== |
| *Breathing-related sleep disorders
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| *Delayed sleep phase and shift work types of circadian rhythm sleep-wake disorder
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| *[[Narcolepsy]]
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| *Normal sleep variations
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| *Parasomnias
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| *[[Restless legs syndrome]]
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| *Situational/acute insomnia
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| *Substance/medication-induced [[sleep disorder]], insomnia type<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
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| ==Epidemiology and Demographics== | | ==[[Insomnia risk factors|Risk Factors]]== |
| ===Prevalence===
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| The prevalence of insomnia disorder is 10,000-20,000 per 100,000 (10%-20%) in the primary care setting.<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
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| According to the U.S. [[Department of Health and Human Services]] in year 2007, approximately 64 million Americans suffer from insomnia each year.<ref name="titleBrain Basics: Understanding Sleep: National Institute of Neurological Disorders and Stroke (NINDS)">{{cite web |url=http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm |title=Brain Basics: Understanding Sleep: National Institute of Neurological Disorders and Stroke (NINDS) |accessdate=2007-12-16 |format= |work=}}</ref> Insomnia tends to increase with age and affects about 40 percent of women and 30 percent of men.<ref name="titleInsomnia">{{cite web |url=http://www.womenshealth.gov/faq/insomnia.htm |title=Insomnia |accessdate=2007-12-16 |format= |work=}}</ref> The average American gets 7 hours of sleep, instead of the 8 to 10 hours recommended by doctors. Children however are recommended more than 8 hours.
| | ==[[Insomnia screening|Screening]]== |
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| ==Risk Factors== | | ==[[Insomnia natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| *Advancing age
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| *Anxiety or worry-prone personality
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| *Chronic daily stress
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| *Cognitive styles
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| *Familial disposition
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| *Fear of not sleeping
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| *Female gender
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| *High altitude
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| *Increased arousal
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| *Irregular sleep scheduling
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| :*Excessive caffeine use
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| :* Irregular sleep schedules
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| *Light
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| *Major life events (e.g., illness, separation)
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| *Noise
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| *Poor sleep habits
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| *Poor sleep hygiene practices
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| *Tendency to repress emotions
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| *Uncomfortably high or low temperature<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
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| ==Diagnosis== | | ==Diagnosis== |
| Patients with [[delayed sleep phase syndrome]] are often mis-diagnosed with insomnia. If the patient has trouble getting to sleep, but has normal sleep architecture once asleep, a [[circadian rhythm]] disorder is a more likely cause.
| | [[Insomnia diagnostic criteria|Diagnostic Study of Choice]] | [[Insomnia history and symptoms|History and Symptoms]] | [[Insomnia physical examination|Physical Examination]] | [[Insomnia laboratory findings|Laboratory Findings]] | [[Insomnia electrocardiogram|Electrocardiogram]] | [[Insomnia x ray|X-ray]] | [[Insomnia echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Insomnia CT scan|CT scan]] | [[Insomnia MRI|MRI]] | [[Insomnia other imaging findings|Other Imaging Findings]] | [[Insomnia other diagnostic studies|Other Diagnostic Studies]] |
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| ===Diagnostic Criteria===
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| ====DSM-V Diagnostic Criteria for Insomnia Disorder<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>====
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| {{cquote|
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| *A.A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms:
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| :*1.Difficulty initiating sleep.(In children, this may manifest as difficulty initiating sleep without caregiver intervention.)
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| :*2.Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.):
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| :*3. Early-morning awakening with inability to return to sleep.
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| '''''AND'''''
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| *B.The sleep disturbance causes clinically significant distress or impairment in social, occupational,educational, academic, behavioral, or other important areas of functioning.
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| '''''AND'''''
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| *C.The sleep difficulty occurs at least 3 nights per week.
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| '''''AND'''''
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| *D.The sleep difficulty is present for at least 3 months.
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| '''''AND'''''
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| *E.The sleep difficulty occurs despite adequate opportunity for sleep.
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| '''''AND'''''
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| *F.The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., [[narcolepsy]], a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia).
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| '''''AND'''''
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| *G.The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).
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| '''''AND'''''
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| *H. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.
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| Specify if:
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| *With non-sleep disorder mental comorbidity, including substance use disorders
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| *With other medical comorbidity
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| *With other sleep disorder
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| Specify if:
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| *Episodic:Symptoms last at least 1 month but less than 3 months.
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| *Persistent: Symptoms last 3 months or longer.
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| *Recurrent: Two (or more) episodes within the space of 1 year.
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| <SMALL>''Note:Acute and short-term insomnia (i.e., symptoms lasting less than 3 months but otherwise meeting all criteria with regard to frequency, intensity, distress, and/or impairment)should be coded as an other specified insomnia disorder.''</SMALL>
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| }}
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| ===Insomnia versus poor sleep quality===
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| Poor sleep quality can occur as a result of sleep apnea or [[major depression]]. Poor sleep quality is caused by the individual not reaching stage 4 or delta sleep which has restorative properties. There are, however, people who are unable to achieve stage 4 sleep due to brain damage who still lead perfectly normal lives.
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| *'''[[Sleep apnea]]''' is a condition that occurs when a sleeping person's breathing is interrupted, thus interrupting the normal sleep cycle. With the obstructive form of the condition, some part of the sleeper's respiratory tract loses muscle tone and partially collapses. People with obstructive sleep apnea often do not remember awakening or having difficulty breathing, but they complain of excessive sleepiness during the day. Central sleep apnea interrupts the normal breathing stimulus of the [[central nervous system]], and the individual must actually wake up to resume breathing. This form of apnea is often related to a cerebral vascular condition, congestive heart failure, and premature aging.
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| Major depression leads to alterations in the function of the hypothalamus and pituitary causing excessive release of cortisol which can lead to poor sleep quality.
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| Nocturnal polyuria or excessive nighttime urination can be very disturbing to sleep.<ref>{{cite book | coauthors = Adler and Thorpy | title = Sleep issues in Parkinson’s disease | url = http://www.neurology.org/cgi/content/full/64/12_suppl_3/S12 | accessyear = 2007 | accessmonth = June | year = 2005 | publisher = Neurology | language = English | pages = 64; S12-20 }}</ref> Nocturnal polyuria can be nephrogenic (related to kidney disease) or it may be due to prostate enlargement or hormonal influences. Deficiencies in vasopressin, which is either caused by a pituitary problem or by insensitivity of the kidney to the effects of vasopressin, can lead to nocturnal polyuria. Excessive thirst or the use of diuretics can also cause these symptoms.
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| ==Treatment== | | ==Treatment== |
| In many cases, insomnia is caused by another disease or psychological problem. In this case, medical or psychological help may be useful.
| | [[Insomnia medical therapy|Medical Therapy]] | [[Insomnia non-pharmacological therapy|Non-pharmacological therapy]] | [[Insomnia surgery|Surgery]] | [[Insomnia primary prevention|Primary Prevention]] | [[Insomnia secondary prevention|Secondary Prevention]] | [[Insomnia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Insomnia future or investigational therapies|Future or Investigational Therapies]] |
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| ===Medications=== | | ==Case Studies== |
| Many insomniacs rely on [[sleeping tablet]]s and other [[sedative]]s to get rest. All sedative drugs have the potential of causing psychological dependence where the individual cannot psychologically accept that they can sleep without drugs. Certain classes of sedatives such as [[benzodiazepine]]s and newer [[nonbenzodiazepine]] drugs can also cause physical dependence which manifests in withdrawal symptoms if the drug is not carefully titrated down.
| | [[Insomnia case study one|Case #1]] |
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| In comparing the options, a [[systematic review]] found that [[benzodiazepine]]s and [[nonbenzodiazepine]]s have similar efficacy which was [[statistical_significance | insignificantly]] more than for [[antidepressant]]s.<ref name="pmid17619935">Buscemi N, Vandermeer B, Friesen C, Bialy L, Tubman M, Ospina M, Klassen TP, Witmans M. The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs. J Gen Intern Med. 2007 Sep;22(9):1335-50. Epub 2007 Jul 10. PMID 17619935</ref> Benzodiazepines had an [[statistical_significance | insignificant]] tendency for more [[adverse drug reaction]]s.<ref name="pmid17619935"/>
| | ==See also== |
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| ====Benzodiazepines====
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| {{main|Benzodiazepine}}
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| The most commonly used class of hypnotics prescribed for insomnia are the [[benzodiazepine]]s. [[Benzodiazepine]]s bind unselectively to the [[GABAA receptor|GABA<sub>A</sub> receptor]].<ref name="pmid17619935"/> This includes drugs such as [[temazepam]], [[diazepam]], [[lorazepam]], [[flurazepam]], [[nitrazepam]] and [[midazolam]]. These medications can be addictive, especially after taking them over long periods of time.
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| ====Non-benzodiazepines====
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| {{main|Nonbenzodiazepine}}
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| [[Nonbenzodiazepine]] prescription drugs, including the [[nonbenzodiazepine]]s [[zolpidem]](Stilnoct) and [[zopiclone]](Imovane), are more selective for the [[GABAA receptor|GABA<sub>A</sub> receptor]]<ref name="pmid17619935"/> and may have a cleaner side effect profile than the older benzodiazepines; however, there are controversies over whether these non-benzodiazepine drugs are superior to benzodiazepines. These drugs appear to cause both [[Addiction#Psychological addiction|psychological dependence]] and [[physical dependence]], and can also cause the same memory and cognitive disturbances as the benzodiazepines along with morning sedation.
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| ====Antidepressants====
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| {{main|Antidepressants}}
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| Some [[antidepressant]]s such as [[mirtazapine]], [[trazodone]] and [[doxepin]] have a sedative effect, and are prescribed [[off label]] to treat insomnia. The major drawback of these drugs is that they have [[antihistaminergic]], [[anticholinergic]] and [[antiadrenergic]] properties which can lead to many side effects. Some also alter sleep architecture.
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| ====Melatonin====
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| [[Melatonin]] has proved effective for some insomniacs in regulating the sleep/waking cycle, but lacks definitive data regarding efficacy in the treatment of insomnia. Melatonin agonists, including Ramelteon ([[Rozerem]]), seem to lack the potential for abuse and dependence. This class of drugs has a relatively mild side effect profile and lower likelihood of causing morning sedation.
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| ====Antihistamines====
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| The [[antihistamine]] [[diphenhydramine]] is widely used in nonprescription sleep aids, with a 50 mg recommended dose mandated by the FDA. In the United Kingdom, Australia, New Zealand, South Africa, and other countries, a 50 to 100 mg recommended dose is permitted. While it is available over the counter, the effectiveness of these agents may decrease over time and the incidence of next-day sedation is higher than for most of the newer prescription drugs. Dependence does not seem to be an issue with this class of drugs.
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| ====Atypical antipsychotics====
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| Low doses of certain [[atypical antipsychotics]] such as [[quetiapine]] (Seroquel) are also prescribed for their sedative effect but the danger of neurological and cognitive side effects make these drugs a poor choice to treat insomnia.
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| ===Other substances===
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| Some insomniacs use [[herb]]s such as [[valerian plant|valerian]], [[chamomile]], [[lavender]], [[hops]], and [[passion-flower]]. Valerian has undergone multiple studies and appears to be modestly effective.<ref name="pmid10761819">{{cite journal |author=Donath F, Quispe S, Diefenbach K, Maurer A, Fietze I, Roots I |title=Critical evaluation of the effect of valerian extract on sleep structure and sleep quality |journal=Pharmacopsychiatry |volume=33 |issue=2 |pages=47-53 |year=2000 |pmid=10761819 |doi=}}</ref><ref name="pmid16335333">{{cite journal |author=Morin CM, Koetter U, Bastien C, Ware JC, Wooten V |title=Valerian-hops combination and diphenhydramine for treating insomnia: a randomized placebo-controlled clinical trial |journal=Sleep |volume=28 |issue=11 |pages=1465-71 |year=2005 |pmid=16335333 |doi=}}</ref><ref name="pmid17561634">{{cite journal |author=Meolie AL, Rosen C, Kristo D, ''et al'' |title=Oral nonprescription treatment for insomnia: an evaluation of products with limited evidence |journal=Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine |volume=1 |issue=2 |pages=173-87 |year=2005 |pmid=17561634 |doi=}}</ref> [[Cannabis]] has also been suggested as a very effective treatment for insomnia. <ref>[http://www.cannabis.net/medical-marijuana/pot-docs.html http://www.cannabis.net/medical-marijuana/pot-docs.html ]</ref>
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| [[Alcohol]] may have sedative properties, but the [[Rapid eye movement sleep|REM sleep]] suppressing effects of the drug prevent restful, quality sleep. Middle-of-the-night awakenings due to [[polyuria]] or other effects from alcohol consumption are common, and hangovers can also lead to morning grogginess.
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| Insomnia may be a symptom of [[magnesium deficiency (medicine)|magnesium deficiency]], or lower [[magnesium]] levels. A healthy diet containing [[magnesium]], can help to improve sleep in individuals without an adequate intake of [[magnesium]].<ref name="pmid9703590">{{cite journal |author=Hornyak M, Voderholzer U, Hohagen F, Berger M, Riemann D |title=Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study |journal=Sleep |volume=21 |issue=5 |pages=501-5 |year=1998 |pmid=9703590 |doi=}}</ref>
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| Other reports cite the use of an elixir of cider vinegar and honey but the evidence for this is only anecdotal. <ref>{{cite web|url=http://www.cidervinegar.org/2007/06/cider-vinegar-rocks.html|title=Cider Vinegar and Insomnia}}</ref>
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| ===Non-medicinal, complimentary and alternative medicine===
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| Recent research has shown that [[Cognitive therapy|cognitive behavior therapy]] can be more effective than medication in controlling insomnia [http://archinte.ama-assn.org/cgi/content/abstract/164/17/1888]. In this therapy, patients are taught improved sleep habits and relieved of counter-productive assumptions about sleep.<ref>{{cite journal
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| | last = Jacobs, PhD
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| | first = Gregg
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| | authorlink = http://www.bidmc.harvard.edu/display.asp?leaf_id=3956
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| | coauthors = Edward F. Pace-Schott, MA; Robert Stickgold, PhD; Michael W. Otto, PhD
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| | title = Cognitive Behavior Therapy and Pharmacotherapy for Insomnia: A Randomized Controlled Trial and Direct Comparison
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| | journal = Archives of Internal Medicine
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| | volume = 164
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| | issue = 17
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| | pages = 1888-1896
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| |date=September 27, 2004
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| | url = http://archinte.ama-assn.org/cgi/content/abstract/164/17/1888}}</ref>
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| Some traditional remedies for insomnia have included drinking warm milk before bedtime, taking a warm bath in the evening; exercising vigorously for half an hour in the afternoon, eating a large lunch and then having only a light evening meal at least three hours before bed, avoiding mentally stimulating activities in the evening hours, and making sure to get up early in the morning and to retire to bed at a reasonable hour.
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| Using [[aromatherapy]], including jasmine oil, [[lavender oil]], [[Mahabhringaraj]] and other relaxing [[essential oil]]s, may also help induce a state of restfulness. [[Horlicks]] is marketed as a sleeping aid.
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| Many believe that listening to slow paced music will help insomniacs fall asleep. <ref name="pmid16269944">{{cite journal |author=Robinson SB, Weitzel T, Henderson L |title=The Sh-h-h-h Project: nonpharmacological interventions |journal=Holistic nursing practice |volume=19 |issue=6 |pages=263-6 |year=2005 |pmid=16269944 |doi=}}</ref>
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| The more relaxed a person is, the greater the likelihood of getting a good night's sleep. [[Relaxation techniques]] such as [[meditation]] have been shown to help people sleep. Such techniques can lower stress levels from both the mind and body, which leads to a deeper, more restful sleep.
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| [[Traditional Chinese medicine]] has included treatment for insomnia. A typical approach may utilize [[acupuncture]], dietary and lifestyle analysis, [[Herbalism|herbology]] and other techniques, with the goal of resolving the problem at a subtle level.
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| In the Buddhist tradition, people suffering from insomnia or nightmares may be advised to meditate on "loving-kindness", or ''[[metta]]''. This practice of generating a feeling of love and goodwill is claimed to have a soothing and calming effect on the mind and body<ref>{{cite journal |author=Lutz A, Greischar LL, Rawlings NB, Ricard M, Davidson RJ |title=Long-term meditators self-induce high-amplitude gamma synchrony during mental practice |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=101 |issue=46 |pages=16369-73 |year=2004 |pmid=15534199 |doi=10.1073/pnas.0407401101 |url=http://www.pnas.org/cgi/content/full/101/46/16369 }}</ref>. This is claimed to stem partly from the creation of relaxing positive thoughts and feelings, and partly from the pacification of negative ones. In the ''Mettā (Mettanisamsa) Sutta''<ref>http://www.accesstoinsight.org/tipitaka/an/an11/an11.016.than.html</ref>, Siddhartha Gautama, the Buddha, tells the gathered monks that easeful sleep is one benefit of this form of meditation.
| | *[[Chronic colestites|Chronic colestites/total insomnia]] |
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| ==See also==
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| *[[Chronic colestites]], also known as "total insomnia"
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| *[[Fatal familial insomnia]] | | *[[Fatal familial insomnia]] |
| *[[Sleep deprivation]] | | *[[Sleep deprivation]] |
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| {{Mental and behavioural disorders}} | | {{Mental and behavioural disorders}} |
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| [[Category:Sleep]] | | [[Category:Sleep]] |
| [[Category:Psychiatry]] | | [[Category:Psychiatry]] |
| [[Category:Overview complete]]
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| [[Category:Signs and symptoms]]
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| [[ar:أرق]]
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| [[cs:Insomnie]]
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| [[et:Insomnia]]
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| [[es:Insomnio]]
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| [[fr:Insomnie]]
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| [[ko:불면증]]
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| [[hr:Nesanica]]
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| [[he:נדודי שינה]]
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| [[nl:Slapeloosheid]]
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| [[ja:不眠症]]
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| [[pl:Bezsenność]]
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| [[pt:Insônia]]
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| [[ru:Бессонница]]
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| [[sr:Инсомнија]]
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| [[fi:Unettomuus]]
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| [[sv:Sömnlöshet]]
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| [[vi:Mất ngủ]]
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| [[tr:İnsomnia]]
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| [[uk:Безсоння]]
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| [[zh:失眠]]
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