Types of Insomnia, Causes , Symptoms, Diagnosis, Treatment

Having trouble falling or staying asleep is known as insomnia. This could indicate that you aren't sleeping properly, getting enough sleep, or are having difficulties falling or staying asleep. Insomnia is only a minor inconvenience for some people. Others may find insomnia to be quite disruptive. Just as many different factors can contribute to sleeplessness.

There are several reasons why your body needs to sleep (and science is only just beginning to comprehend these reasons). Experts are aware that not getting enough sleep can result in sleep deprivation, which is typically unpleasant (at the very least) and prevents you from performing at your best.

Abnormalities associated with Insomnia are:

• Initial Insomnia- Sleep initiation is difficult. It takes time to fall asleep.
• Middle Insomnia – There is difficulty in maintaining sleep. The person wakes up many times in between.
• Late Insomnia- When the person wakes up early morning (at least two hours before the usual wake-up time). Early morning awakening is one of the characteristics of depression.

Types Of Insomnia

Acute and chronic insomnia are the two basic kinds of the condition. 

Acute insomnia is the term used to describe sleep problems that last a few days or weeks, but no more than three months. A life stressor or external cause, such as a divorce, a loved one's death, or a serious disease, can frequently be linked to short-term insomnia. 

Chronic insomnia is the result of acute insomnia that lasts for more than several months. Chronic insomnia occurs when a person has trouble falling or staying asleep, as well as associated daytime symptoms including drowsiness and focus problems, at least three days a week for more than three months. 10% to 15% of adults are thought to suffer from persistent insomnia.

Causes Of  Insomnia

Although experts are uncertain of the exact cause of insomnia, they do know that a variety of factors may be involved. Some of these elements might be contributing elements or they might be causes. To fully comprehend how and why insomnia occurs, more research is required.

The following are just a few of the variables that could cause or contribute:

• Genetics and Family History-  Sleep disorders like insomnia appear to run in families.
• Brain Activity Modifications- People who experience insomnia may have more active brains or different brain chemistry, both of which impair their ability to fall asleep.
• Medical Conditions-  Your physical well-being can impact how well you sleep. This covers both transient ailments like minor injuries or infections as well as chronic disorders like acid reflux or Parkinson's disease.
• Conditions that impact your circadian rhythm, or the body's internal clock that regulates sleep and wakefulness, are additional considerations.
• Life Circumstances- Although stressful or challenging life situations frequently make insomnia worse, they don't always cause it.
• Alterations in life like Jet lag, sleeping in a strange environment, or getting used to a new work schedule (especially shift work) are all examples of brief or transitory changes that frequently affect people. Sleep can also be impacted by long-term changes, such as relocating.
• Your Schedule and Routines- Insomnia may be exacerbated by your sleep hygiene practices that include whether or not you take a nap when you go to sleep.

Symptoms Of Insomnia

Symptoms of insomnia can include:

• Having trouble falling asleep at night
• Waking up in the middle of the night
• Getting up too early
• After a night of sleep, you don't feel rested
• Fatigue or drowsiness during the day
• Irritability, despair, or anxiety
• Lack of concentration
• Increased mistakes or mishaps
• Ongoing concerns regarding sleeping

Diagnosis Of Insomnia

The diagnosis of insomnia and the investigation of its root cause may involve:

• Physical Examination. If the cause of your insomnia is unknown, your doctor may conduct a physical examination to check for any indications of underlying health issues that could be connected to your sleeplessness. On occasion, a blood test might be performed to look for thyroid issues or other disorders that could be related to a poor night's sleep.
• Review of Sleeping Patterns. Your doctor may ask you questions about your sleep habits and have you fill out a questionnaire to assess your level of daytime sleepiness and your pattern of sleep-wake time. Keeping a sleep diary for a few weeks can also be required of you.
• A Sleep Study. You might need to stay the night at a sleep facility if the cause of your insomnia is unclear or if you exhibit symptoms of another sleep condition, such as sleep apnea or restless legs syndrome. Numerous bodily functions, such as respiration, heartbeat, eye movements, and body movements, are tested in order to track and record them while you're sleeping.

Treatment Of Insomnia

Insomnia can be treated with the help of the following methods:

• Pharmacotherapy- Drugs such as Benzodiazepines, Zolpidem, and Zaleplon are helpful. Other sedative drugs may also be used.
• Psychotherapy
  • Cognitive Behaviour Therapy (CBT) – Cognitive therapies are used to overcome misperceptions and disruptive thoughts about sleep.
  • Certain behavior techniques such as universal sleep hygiene are used to improve sleep.
• Universal Sleep Hygiene – Certain modifiable environmental and lifestyle components are focussed on to improve. The dos and don’ts of Universal Sleep Hygiene are as follows: 
  • Do’s 
    • Maintain fixed sleeping and waking time. 
    • If the person feels hungry at night, eat a light snack before sleep.
    • A regular exercise schedule should be maintained.
    • Unwind everything one hour before sleep.
    • Keep the room cool, dark, and quiet.
  • Don’ts 
    • Taking naps.
    • Eating a heavy meal before sleeping.
    • Exercise before sleep.
    • See the time when unable to sleep.
    • Use alcohol and smoke cigarettes.
    • Reading, eating, watching TV, and talking on the phone in bed.

Some Disorders Associated with Insomnia

1. Restless Leg Syndrome (Ekbom Syndrome) 

There is an irresistible urge to move the legs when the person is at rest or while trying to fall asleep. There is an uncomfortable sensation in the legs such as insect crawling which gets relieved by moving or walking around. It can cause difficulty in sleep initiation as the patient keeps on moving the legs. It can lead to secondary insomnia. Uremia, Neuropathies, and Iron and Folic acid deficiencies can cause secondary RLS. Ferritin levels should be checked in all the patients of RLS. 

Treatment includes three Dopamine agonists that have been approved by the FDA for RLS treatment.

• Pramipexole
• Ropinirole
• Rotigotine

2. Periodic Limb Movement Disorder (PLMD)

There is a sudden contraction of a group of muscles usually the leg while sleeping. These are primarily seen in NREM. They can lead to brief arousals from sleep and cause insomnia. A person may not be aware of these contractions because they may occur in sleep but the partners sleeping next to the person may frequently get disturbed. It can occur in association with folic deficiencies, renal disease, and anemia.

Treatment includes Benzodiazepines may be used which are sufficient for the treatment of PLMD.

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