Insomnia
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Amber Ehsan Faquih, MD[2] Kiran Singh, M.D. [3], Jyostna Chouturi, M.B.B.S [4]
Synonyms and keywords: Insomnia disorder
Overview
Historical Perspective
Pathophysiology
It is thought that insomnia is mediated by:
- Molecular Mechanism
- Hormones causing wakefulnessn: Catecholamine, Histamine, Orexin
- Hormones promoting sleep: Adenosine, serotonin, GABA, melatonin, Prostaglandin D2
- Hyperarousal model
- Cognitive
- Physiologic
- Cortical
- Genetic: ApoE4, PER3, 5HTTLPR, Single Nucleotide Polymorphism, CLOCK gene, HLA DQI*002
- Sleep switch Model (Orexin mediated)
- Sleep promoting areas:Ventrolateral Preoptic and Median preoptic Nucleus
- Wake promoting areas: Tuberomammillary nucleus, dorsal raphe, Locus coeruleus
- Cognitive and Behavioural Model
- Precipitating factors
- Predisposing factors
- Perpetuating factors
Classification
Insomnia has been classified by the International Classification of Sleep Disorders, 2nd Edition into 11 categories[1]:
- Psychophysiologic insomnia (primary insomnia)
- Adjustment insomnia (acute insomnia)
- Paradoxical insomnia
- Behavioral insomnia of childhood
- Primary sleep disorders causing insomnia
- Idiopathic insomnia
- Inadequate sleep hygiene
- Insomnia due to mental disorder
- Insomnia due to drug or substance abuse
- Insomnia due to a medical condition
- Insomnia not due to a substance or known physiologic condition, unspecified
Insomnia has also been classified by the International Classification of Sleep Disorder, 3rd Edition into[2]:
- Chronic Insomnia Disorder
- Short-term Insomnia Disorder
- Other Insomnia Disorder
Causes
Differentiating Insomnia from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | Other Diagnostic Studies
Treatment
Medical Therapy | Non-pharmacological therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
Management is guided by available clinical practice guidelines[3].
Case Studies
See also
References
- ↑ "Insomnia: Practice Essentials, Background, Anatomy".
- ↑ "Sleep Medicine: Insomnia and Sleep".
- ↑ Mysliwiec V, Martin JL, Ulmer CS, Chowdhuri S, Brock MS, Spevak C; et al. (2020). "The Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines". Ann Intern Med. doi:10.7326/M19-3575. PMID 32066145 Check
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