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[1]:
- 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(3P model): This model of insomnia helps to explain how acute insomnia becomes chronic and aids in assessing insomnia in individual patients
- Precipitating factors
- Predisposing factors
- Perpetuating factors
Classification
Insomnia has been classified by the International Classification of Sleep Disorders, 2nd Edition into 11 categories[2]:
- 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[3]:
- Chronic Insomnia Disorder
- Short-term Insomnia Disorder
- Other Insomnia Disorder
Causes
Symptoms may include waking up a night, waking up too early, difficulty falling asleep at night, daytime fatigue, impaired concentration and recall, irritability, Constant worries about sleep, Depression, anxiety and increased accidents or error prone.
Common causes include[4]:
- Excess consumption of caffeine, nicotine and alcohol
- Medication induced
- Prescription drugs
- Over the counter drugs
- Bad sleep habits: Using bed for work, eating or any other leisure, disrupted bedtime schedule, frequent naps, stimulating activities before bed, disturbed sleep environment.Use of electronic gadgets just before bed can also interfere with the sleep cycle.
- Eating too much before bedtime causing GI discomfort or heartburn while lying down.
- Jet lags, Constant change in shifts, working too late or an early shift can disrupt the body's circadian rhythm
- Trauma and Stressful life experiences
- Depression or Anxiety or PTSD
- Medical conditions like GERD, chronic pain, cancer, cardiac diseases, asthma, overactive thyroid, urinary complaints in elderly.
- Sleep-related disorders like Restless leg syndrome and sleep apnea
Differentiating Insomnia from other Diseases
Epidemiology and Demographics
Gender
Females have a higher prevalence of insomnia in adolescence and especially high during menopause.
Age
Higher prevalence of insomnia in the elderly population.
Socioeconomic status
More common in those with poor health, low socioeconomic status and quality of life.
Risk Factors
Common risk factors for insomnia include[5]:
- Gender(Female)
- Increasing age
- Depression
- Unemployed
- Widow/Divorced/Separated
- Lower educational qualification
- Economic inactivity
- Military Deployment
- Racial Discrimintion
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | Other Diagnostic Studies
DSM-5 diagnostic criteria for insomnia includes[6]:
- Symptoms occur ≥ 3 days/week for ≥ 3 months
- Symptoms cause functional impairment or distress
- Problems initiating or maintaining sleep, or awakening early in the morning and being unable to return to sleep
- Symptoms occur despite having enough time to sleep
- Symptoms are not caused by an underlying substance or medication use
- No underlying or coexisting psychiatric or medical disorder that explains symptoms
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[7].
Case Studies
See also
References
- ↑ "Sleep Medicine: Insomnia and Sleep - PubMed".
- ↑ "Insomnia: Practice Essentials, Background, Anatomy".
- ↑ "Sleep Medicine: Insomnia and Sleep".
- ↑ "Insomnia - Symptoms and causes - Mayo Clinic".
- ↑ "Insomnia Overview: Epidemiology, Pathophysiology, Diagnosis and Monitoring, and Nonpharmacologic Therapy | AJMC".
- ↑ "Evaluating DSM-5 Insomnia Disorder and the Treatment of Sleep Problems in a Psychiatric Population | Read by QxMD".
- ↑ 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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