Topic Insomnia

Insomnia, or sleeplessness, is a sleep disorder in which there is an inability to fall

asleep or to stay asleep

Types of insomnia Insomnia can be classified as Transient Acute Chronic

• Transient insomnia Insomnia lasts for less than a week. It can

be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe depression, or by stress.

Acute insomnia Is the inability to consistently sleep well for a period

of less than a month. Acute insomnia is also known as short term insomnia or stress related insomnia. It present when there is difficulty initiating or maintaining sleep or when the sleep that is obtained is non-refreshing or of poor quality

Chronic insomnia lasts for longer than a month. It can be caused

by another disorder, or it can be a primary disorder. People with high levels of stress hormones or shifts in the levels of cytokines are more likely to have chronic insomnia. Its effects can vary according to its causes. They might include muscular fatigue, hallucinations, and/or mental fatigue. Chronic insomnia can cause double vision.

• Subjective insomnia/Paradoxical insomnia• Some cases of insomnia are not really

insomnia in the traditional sense. People experiencing sleep state misperception often sleep for normal durations, They may believe they slept for only four hours while they, in fact, slept a full eight hours.

Etiology• Stressful life situations (divorce or

separation, death of a loved one losing a job, preparing for an examination)

• Medications that can cause insomnia antidepressants, cold and flu medications that

contain alcohol, pain relievers that contain caffeine (Midol, Excedrin) diuretics, corticosteroids, thyroid hormone, high blood pressure medications.

• Sleep hygiene• Sleep hygiene can play an important role in insomnia. Poor

sleep hygiene includes physical factors such as:• using the bedroom for things other than sleeping,• eating or exercising prior to sleep,• going to bed hungry,• sleeping in a room with too much noise or lighting, or• doing work in bed.• Other causes of insomnia may be related to sleep disorders

including:• sleep walking , sleep apnea,resstless leg syndrom (creeping

sensations in the leg during sleep, relieved by leg movement),periodic limb movement disorder (involuntary repeated leg movement during sleep),

•Medical problems that can cause insomnia Asthma, allergies, Parkinson’s disease, hyperthyroidism, acid reflux, kidney disease, cancer, chronic pain.

Physiologic conditions can lead to insomnia such as: menopause, menstrual cycle, pregnancy.Psychological problems that can cause insomnia depression, anxiety, chronic stress, bipolar disorder, post-traumatic stress disorder. Psychophysiologic ("learned") insomnia - Many people go to bed worrying about insomnia because of previous episodes. This creates an anxiety about going to sleep, which usually leads to greater difficulty sleeping.

Clinical finding common symptoms include• daytime fatigue,• daytime sleepiness,• mood changes,• poor attention and concentration,• lack of energy,• anxiety,• poor social function,• headaches, • increased errors and mistakes.• Other according to diseases

Diadnosis• History• Medical (diseases & drugs) • Psychiatric patient history (stress & truamatic event)

• Sleep history focuses on (duration of sleep,time of sleep,

• time to fall sleep,• number and duration of awakenings,• time of final awakening in the morning, and• time and length of any daytime naps.

• General physical examination to assess for any abnormal findings (chronic diseases) is also important, including assessment of mental status and neurological function.

• Lab investigation (according to diseases, thyroid & blood test.

• Pt sleep pattern in sleep center

Treatments

• Behavioral techniques / non-medical treatments • Sleep as much as possible to feel rested, then get

out of bed (do not over-sleep).• Maintain a regular sleep schedule.• Do not force yourself to sleep.

• Do not drink alcohol prior to going to bed.• Do not smoke, especially in the evening.• Adjust the bedroom environment to induce sleep.• Do not go to bed hungry.• Resolve stress and anxiety before going to bed.• Exercise regularly, but not 4-5 hours prior to bed time.• Go to bed only when you feel ready to sleep.• Turn off the lights and all the noise in and around the

bedroom.• Get up at the same time every morning to avoid over-

sleeping.• If you do not fall asleep longer than 20 minutes after

going to bed, get up and try some relaxation techniques until you are ready to sleep again.

Medications Herbal• Hyponotic drugs Valariana , Lavender , Milk , Cinnamon , Honey , kaddu seed

, Opium , Almond , kahoo

Howalshafi kahoo seed + Almond seed (sheeri) + Opium seed Kaddu seed Equal wt. PowderHowalshafiMilk + Cinnamon + Honey at night 1 glass 1gm 2sHowalshafi Valariana powder 5g at night

• HowalshafiAlmond seed + Opium + Suji (grind) Paste in milk 10 no. 10g 10g Compound drug Rogen-e- khashkash Rogen-e- Kahoo Rogen-e- badam Majun nijah Barshasha Khamira gao zuba

Complications• Lower performance on the job or at school• Slowed reaction time while driving and higher risk of

accidents• Psychiatric problems, such as depression , Bipolar

disorder or an anxiety disorder• Overweight or obesity• Irritability• Increased risk and severity of long-term diseases or

conditions, such as high blood pressure, heart disease and diabetes

• Poor Immune System Function (Increased Risk for Chronic Diseases such as diabetes and cardiovascular diseases)