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Insomnia

Insomnia is a condition where falling asleep or sleeping consistently is nearly impossible. Often difficult to find a cause as mental health, social, medical, and other factors may be involved. The quality of sleep is greatly affected and can be detrimental to physical and medical complications. Recently research has looked into the brain as a primary cause of changes to the sleep cycle.

The patient may be having some underlying sleep disorder such as anxiety-related sleep problems, bipolar, and/or restless leg syndrome.

More than 60% of Americans have insomnia in some form or at some time within the last year. The mortality rate increases dramatically with less than 4.5 hours of sleep for men and 3.5 hours for women.

Several Classifications:

1.)  Acute insomnia

–  The first weeks of persistent insomnia
–  May last for 3 to 6 weeks

2.)  Chronic insomnia

–  Can be caused by other disorders
–  Effects can vary widely
–  May last years at a time
–  Can experience a slowing down of visual movement, sleepiness, fatigue, hallucinations, and others

3.)  Transient insomnia

–  Can be caused by other disorders
–  Sleep is similar to sleep deprivation
–  May last from days to weeks

Types of Insomnia

1.)  Initial onset –  difficulty falling asleep

2.)  Middle-of-the-night –   After falling asleep, the individual awakes and has difficulty returning to sleep

3.)  Middle onset  –   wakes during middle of the night – often with pain disorders and mental illness

4.)  Terminal onset –   wakes rather early in the morning and unable to return to sleep – seen in Depression.

Causes

–  Stress
–  Anxiety
–  Sleeping pattern
–  Work timing – night shift
–  Jet lag
–  Excessive noise
–  Sleepwalking
–  Sleep disturbance
–  Nightmares
–  Medications
–  Stimulants
–  Methamphetamine
–  Hormone changes
–  Mental disorders
–  Traumatic brain injury
–  others

Treatment

–  Often insomnia is a symptom of another disease, condition, circumstance, or event and when that problem is treated then insomnia is resolved

Non Medication treatment

–  Limit caffeine, nicotine, and alcohol intake
–  Meditation
–  Sleep routine/pattern
–  Behavior changes
–  Sleep therapy
–  Relaxation therapy
–  others

Medications

Non-benzodiazepines

  –  Zolpidem  (Ambien)
  –  Zaleplon  (Sonata)
  –  Eszopiclone  (Lunesta)
  –  Zopiclone –  active form is eszopidlone

Benzodiazepines

  –  Midazolam  (Versed) –  occasionally used for insomnia, also used as a relaxant prior to surgery or dental procedure
  –  Temazepam (Restoril)
  –  Loprazolam  (Havlane)
  –  Nitrazepam
  –  Quazepam
  –  Flunitrazepam  (Rohypnol)  –  used only in severe cases
*** – This drug is also adversely used as the “date rape drug” or “roofie”

Antidepressants

  –  Amitriptyline  (Elavil)
  –  Doxepin 
  –  Trazadone
  –  Mirtazapine  (Remeron)

Melatonin and Melatonin Agonists

  –  Zopiclone  (Lunesta)
  –  Ramelteon  (Ramelteon)
  –  Tasimelteon

Antihistamines

  –  Benedryl  (diphenhydramine)