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Insomnia

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Sleep is vital for refreshing the brain and giving the body cells a rest. The imperativeness of sleep is most vividly described by the experiences of those individuals who suffer from sleep deprivation. Insomnia is the term used to refer to the lack of enough sleep while the conditions are favorable. Insomnia is also termed as sleeplessness and used to refer to a condition where the subject experiences difficulties staying asleep. It should be noted that this failure to sleep usually manifests with the inability of the person to undertake daily functions consummately. The person experiences difficulties in remaining active during the day. Insomnia is believed to arise from the hyper-arousal effect in some parts of the brain. This hypothesis has been supported by the evidence of elevated cortisol secretion, increased heart rate and accelerated metabolic rate. These activities play a synergic role in keeping the person awake, yet the cells get exhausted, causing the individual to become feeble. According to Perlis and Pigeon, insomnia falls under the category of DSV-IV-TR conditions and the symptoms of this condition are included in the criteria for determining psychiatric disorders (716). Medically, insomnia can be both a condition and a symptom. Ample conditions will manifest themselves with the lack of sleep or disturbed sleep patterns. Such conditions include psychiatric conditions and medical conditions. In severely ill patients, meditation, stress, depression and grief engulfs their thinking process, provoking worries that result in disturbed sleep patterns. As a condition, insomnia can manifest  along with another condition being present. In such cases, it becomes a condition that needs to be treated with optimal care like any other condition.

Classification of insomnia

Insomnia can be categorized into different classes depending on the criteria the evaluation is based on. The first category includes the criteria of cause. This leads to classifying insomnia into three categories, namely: primary, co-morbid and secondary. Primary insomnia is insomnia, which is not attributed to any medical, psychiatric or physical cause. The cause of this type of insomnia is believed to be solely psychological. Secondary insomnia results from existing medical, psychiatric, or environmental condition. This means that the cause of secondary insomnia is entirely associated with the existing disease or ailment. Co-morbid insomnia manifests when primary insomnia coexists with a medical and/or psychiatric condition. These conditions may not be claimed to cause insomnia directly, but they affect the treatment approach.

The second category is determined by the duration the condition has been affecting the patient. Under this category, three types of insomnia emerge, namely: acute insomnia, transient insomnia and chronic insomnia. Acute insomnia is short-term inability to sleep. The person may also complain of inadequate sleep patterns that result in exhaustion and feeling powerless during the time the patient is awake. Treatment for this type insomnia is more direct and highly effective if initiated in timely manner. However, ignoring or overlooking this condition may exacerbate it to a chronic condition. Chronic insomnia persists for over a month and its symptoms are much more vivid comparing to those of the acute type. The patient will present with dire impairment to perform chores during the daytime. Transient insomnia is described as being periodic with cycles lasting less than seven days. All the three types (acute, chronic and transient) can be either primary, secondary or co-morbid insomnias.

Patient with insomnia will present with a number of symptoms. According to Riemann and Ulrich, most of these symptoms are descriptive of inability to be active during the day, while at night they remain awake for long hours even when all the condition are favorable for sleeping. The psychomotor performance is severely impaired with signs of muscle fatigue, poor memory and mental functioning, hallucinations, and mood swings. The patient will complain of the tasks being complicated, when in fact the tasks are extremely easy.

Group of people at risk for insomnia

Insomnia is a condition that can affect all age groups, with no discrimination on race, sex or social status. However, the rates of presentation of this condition will vary from one demographic group to the other. Buysse (2008) noted that females are more prone to insomnia than men with a ration disparity of 1.4:1 respectively. The increased prevalence is associated with the emotional factor in females, which is undoubtedly higher than that of men. It is also noted that increased age raises the chances of getting insomnia. The rates of insomnia among old people are increased since they have a lot of responsibilities and things to reflect on, not to mention the aging brain cells. Moreover, those suffering from psychiatric and medical conditions are also ranked higher in the insomnia risk scale. Socioeconomic factors also play a critical role in determining the risk levels of getting insomnia. Those in the lower socioeconomic class are believed to be more prone to insomnia than those from the middle and the upper classes. This is attributed to financial instability, leading to stress. Other factors that subject the person to stress or depression will increase his/her chances of going insomniac. Byusse (2008) also argues that insomnia tend to recur in almost 50 percent of the cases progressing to chronic phase if measures are implemented late.

Causes of insomnia

Causes of insomnia can be classified into medical or drug-related, substance abuse related, pathological, psychological and socioeconomic factors. Medication is believed to cause insomniac side effects. Drugs labeled as psychoactive and stimulants have proved to cause sleeplessness. Taking these drugs for a long time will culminate in exacerbated sleeplessness in either acute or chronic phase. T the same time, insomnia can present as a withdrawal symptom in patients who have been taking opioid analgesics and benzodiazepines. In addition, toxicity of some drugs such as fluoroquinolones is associated with increased risk of developing chronic insomnia.

Substance abuse also causes insomnia. Substances with high concentration of caffeine, such as strong coffee, have been used as a means of overcoming sleep. Other substances include cocaine and its products, heroin, excessive drinking, khat and bhang. The active chemicals in these products excite the brain cells elevating the cortisol secretion and metabolic rate, thus keeping the person awake. Excessive usage of these products will exacerbate the condition to levels of chronic phase leading to psychotic disorders. This result is inevitably achieved when the threshold level for brain cells activity is stretched over the limit due to increased metabolic rate.

Psychological causes of insomnia are mostly stress and depression, though other psychological conditions can also lead to insomnia. Stress and depression are believed to interfere with hormonal concentration in the brain, depriving the individual of the ability to go to sleep, or experiencing disturbed sleep patterns. This hypothesis is supported by the evidence gathered from individuals who are faced with depressing or stressful situations in their lives. Such situations may include losing a relative or a close friend, financial instability, challenging tasks, or even imagining fearful scenarios. Other cases include a history of nightmares that psychologically prevents the person from sleeping.

Pathological causes include factors associated with conditions or diseases affecting the patient. Due to conditions, a patient may experience unrelenting pain, which interferes with the ability to sleep. Other conditions that will directly lead to insomnia include cardiac arrhythmias, brain injuries and hyperthyroidism. All these factors can interplay to cause insomnia directly or indirectly.

Treatment of insomnia

Insomnia can be treated by non-pharmacological means or by using pharmacological agents. A caution is to be taken before treatment in order to ensure that the patient is not suffering from any medical or psychological conditions. It is also vital to determine the cause of insomnia so that a precise approach can be adopted in the treatment process. Glovinsky and Spielman argue that it is advisable to initiate the treatment by implementing non-pharmacological aids first before going for pharmacological approaches. Cognitive behavioral therapy was certified in 2005 by National Institute of Health and its effectiveness is rated at the same level as that of medication.

Non pharmacological treatment

These approaches of treatment are preferable due to the fact that it does not result in tolerance or withdrawal repercussions associated with medication therapy. In addition, these approaches have long-term effects, as opposed to medical approaches. Morin points out that these therapies include behavioral and psychological measures that aim at emphasizing the need for sleep, improving the psychological regulation of sleep, increasing regular sleep hours, emphasizing the usage of bed, and creating the feeling of bed as a stimulus to sleep (726). Once these objectives are achieved, the patient progressively attains the normal sleeping hours. The imperativeness of sleep is emphasized to ensure that the patient understands the need to actively participate in the therapy. Glovinsky argues that the patient is also advised to avoid going to bed when not sleepy and using the bed for sleeping purposes only, but not studying, playng gams or watching movies (2006). The patient is introduced with a sleep schedule, which should be observed at all times, increasing the number of sleeping hours. These treatment methods include stimulus control therapy, sleep restriction therapy, paradoxical intention therapy and cognitive behavioral therapy.

Pharmacological therapy

A number of pharmacological agents can be prescribed to patients suffering from insomnia to help with the sleeping problems. These agents cause sedation by interfering with the hormonal balance and the brain cell activity. The main drawback of using these drugs is the toxicity and tolerance issues. Some patients will develop a level of dependence on the drugs, which means that they will not be able to sleep unless they are sedated. The dosage may also be increased gradually to attain the effect. In the end, the patient’s condition may even exacerbate to a chronic phase of insomnia. The drugs that have been qualified to treat insomnia include those in the class of benzodiazepines receptor agonist, melatonin receptor agonist and non-barbiturates drugs. Combining pharmacological and non-pharmacological approaches reduces demerits of drugs and ensures profound results. 

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