Different up during the night and have difficulty

Different types of insomnia


There are multiple types of insomnia
that has been identified so far and they are as follows

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Acute insomnia


A brief episode of difficulty sleeping. Acute insomnia is usually caused
by a life event, such as a stressful change in a person’s job, receiving bad news,
or travel. Often acute insomnia resolves without any treatment.

Chronic insomnia


A long-term pattern of difficulty sleeping. Insomnia is usually
considered chronic if a person has trouble falling asleep or staying asleep at
least three nights per week for three months or longer. Some people with
chronic insomnia have a long-standing history of difficulty sleeping.

Comorbid insomnia


Insomnia that occurs with another condition. Psychiatric symptoms such
as anxiety and depression, are known to be associated with
changes in sleep. Certain medical conditions can either cause insomnia or make
a person uncomfortable at night (as in the case of arthritis or back pain,
which may make it hard to sleep.

Onset insomnia


Difficulty falling asleep at the beginning of the night.


Maintenance insomnia


 Inability to stay asleep.
People with maintenance insomnia wake up during the night and have difficulty
returning to sleep.


2.4 Causes of insomnia


  Psychiatric and medical
conditions, unhealthy sleep habits, specific substances, and/or certain
biological factors can cause insomnia. Your brain has a sleep cycle and a wake
cycle. When one is turned on the other is turned off, insomnia can be a problem
with either part of this cycle: too much wake drive or too little sleep drive. Recently,
researchers have begun to think about insomnia as a problem of your brain being
unable to stop being awake. Followings are the possible causes for insomnia.

Medical Causes of


There are many medical conditions (some mild and others more
serious) that can lead to insomnia. In some cases, a medical condition itself
causes insomnia, while in other cases, symptoms of the condition cause
discomfort that can make it difficult for a person to sleep.

Examples of medical conditions that can cause insomnia are:

problems such as reflux
problems such as hyperthyroidism
conditions such as Parkinson’s disease
Chronic pain
Low back pain

  Medications such as those
taken for the common cold and nasal allergies, high blood pressure, heart
disease, thyroid disease, birth control, asthma, and depression can also cause

   In addition, insomnia may
be a symptom of underlying sleep disorders. For example, restless legs
syndrome. A neurological condition in which a person has
an uncomfortable sensation of needing to move his or her legs can lead to
insomnia. Patients with restless legs syndrome typically experience worse
symptoms in the later part of the day, during periods of inactivity, and in the
transition from wake to sleep, which means that falling asleep and staying
asleep can be difficult. An estimated 10 percent of the population has restless
legs syndrome.

  Sleep apnea is another sleep disorder linked to insomnia. With sleep apnea, a
person’s airway becomes partially or completely obstructed during sleep,
leading to pauses in breathing and a drop in oxygen levels. This causes a
person to wake up briefly but repeatedly throughout the night. People with
sleep apnea sometimes report experiencing insomnia.

   If someone has trouble
sleeping on a regular basis, it’s a good idea to review your health and think
about whether any underlying medical issues or sleep disorders could be
contributing to your sleep problems. In some cases, there are simple steps that
can be taken to improve sleep (such as avoiding bright lighting while winding
down and trying to limit possible distractions, such as a TV, computer, or
pets). While in other cases, it’s important to talk to your doctor to figure
out a course of action. You should not simply accept poor sleep as a way of
life-talk to your doctor or a sleep specialist for help.

Insomnia &


Insomnia can be caused by psychiatric conditions such as depression. Psychological struggles can make it hard to sleep, insomnia
itself can bring on changes in mood, and shifts in hormones and physiology can
lead to both psychiatric issues and insomnia at the same time.

Sleep problems may represent a symptom of depression, and the risk
of severe insomnia is much higher in patients with major depressive disorders.
Studies show that insomnia can also trigger or worsen depression.

It’s important to know that symptoms of depression (such as low
energy, loss of interest or motivation, feelings of sadness or hopelessness)
and insomnia can be linked, and one can make the other worse. The good news is
that both are treatable regardless of which came first.

Insomnia &


Most adults have had some trouble sleeping because they feel
worried or nervous, but for some it’s a pattern that interferes with sleep on a
regular basis. Anxiety symptoms that can lead to insomnia include:

caught up in thoughts about past events
worrying about future events
overwhelmed by responsibilities
A general
feeling of being revved up or over stimulated

It is not hard to see why these symptoms of general anxiety can
make it difficult to sleep. Anxiety may be associated with onset insomnia
(trouble falling asleep), or maintenance insomnia (waking up during the night
and not being able to return to sleep). In either case, the quiet and
inactivity of night often brings on stressful thoughts or even fears that keep
a person awake.

When this happens for many nights (or many months), the victims
might start to feel anxiousness, dread, or panic at just the prospect of not
sleeping. This is how anxiety and insomnia can feed each other and become a
cycle that should be interrupted through treatment. There are cognitive and mind-body techniques that help people with anxiety settle into sleep, and overall healthy sleep practices that can improve sleep for many people with anxiety and

2.5 Consequences of Insomnia


to its chronicity, insomnia is linked with substantial impairments in an
individual’s quality of life. In several studies, insomniacs reported decreased
quality of life on virtually all dimensions of the 36-item Short Form Health
Survey of the Medical Outcomes Study (SF-36), which assesses 8 domains: (1)
physical functioning; (2) role limitation due to physical health problems (role
physical); (3) bodily pain; (4) general health perceptions; (5) vitality; (6)
social functioning; (7) role limitations due to emotional health problems (role
emotional); and (8) mental health. (McHorney, Ware, & Raczek 1993; Ware, Lu, & Sherbourne 1994).


Balter, Uhlenhuth, (1992)
found that research has shown that among
the daytime consequences of insomnia, the increased occurrence of accidents
poses the greatest health risk. Insomniacs are 2.5 to 4.5 times more likely
than controls to have an accident. Kuppermann et al. (1995) found that individuals reporting a current sleep problem
were more likely than good sleepers to have decreased job performance and to
have been absent from work in the last month due to health problems.


Benca (2001)
identified that population–and clinic-based
studies have demonstrated a high rate of psychiatric comorbidities in patients
with chronic insomnia. In fact, insomnia is more frequently associated with
psychiatric disorders than any other medical illness. Additionally, depression
and anxiety are the most common comorbid psychiatric disorders in insomniacs.
It has traditionally been assumed that insomnia is secondary to the psychiatric
disorder; however, given the chronicity of insomnia, it is possible that in
some, if not most, cases the insomnia precedes the psychiatric disorder. In
fact, it is possible that insomnia represents a significant risk for the
development of a subsequent psychiatric disorder (Ohayon & Roth, 2003)


2.6 Current medications for Insomnia and their pros and cons





Cognitive and behavioral

a) Cognitive behavioral therapy
for insomnia (CBT-I)
A talking therapy specially designed for people with

Doesn’t involve with
pharmaceutical drugs so that the risk of side effects is eliminated.
Simple techniques, such as
relaxation training to improve sleep

Several weeks of treatments are required
Availability is fairly limited
Recommended only for those who are having sleep issues for
less than 3 weeks

Pharmaceutical Medications

b) OTC sleeping tablets
Over the counter sleeping tablets which are available at

Available without prescription
May be useful if used very occasionally

Not recommended as a long term solution
Effectiveness is limited
Underlying cause is not tackled but only masked the
Side effects such as drowsiness can be occurred and
continued to the following day

c) Benzodiazepines

A short-term based treatment for insomnia
Symptoms of severe or persistent
of insomnia can be eased

Not recommended as a long term solution
Can become less effective overtime
Can lead to dependency
Wide range of side effects such as drowsiness, difficulty
concentrating and feeling emotionally numb

d) Z- drugs

A short-term based treatment
Helpful for time-limited problems (i.e. sudden shocks or

Clumsiness, drowsiness that continues to the following
day, confusion in the night and diarrhoea can occur
Can lead to dependency and increased risk of falls in the

e) Melatonin (Circadin)

Effective for elderly people
Can be used for up to 13 weeks at
a time

Available only on prescription
Only licensed for those who are
more than 55 years old
Side effects such as headaches,
cold like symptoms, back and joint pain can occur