insomniaInsomnia is a condition where sleep is at best difficult and more often than not nearly impossible.

Can be identified as either difficulty with attempting to fall asleep or in remaining asleep.

The quality of sleep is greatly affected.

More than 60% of Americans have insomnia in some form or at sometime within the last year.

Mortality rate increases dramatically with less then 4.5 hours of sleep for men and 3.5 hours for women.

Several different classifications of insomnia exist:

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, individual awakes and has a difficulty returning to sleep

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

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

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Causes

  • Stress
  • Anxiety
  • Sleeping pattern
  • Work timing – night shift
  • Jet lag
  • Excessive noise
  • Sleep walking
  • 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 than 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)
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