Diff: Insomnia
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'''Insomnia''' is a common sleep disorder characterized by difficulty falling asleep, staying asleep, or experiencing non-restorative sleep. It can have various causes, including stress, lifestyle factors, medical conditions, and psychiatric disorders. Insomnia can lead to daytime fatigue, impaired concentration, mood disturbances, and overall reduced quality of life. Management strategies may involve lifestyle modifications, cognitive-behavioural therapy, and, in some cases, medication. |
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==Overview== |
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Sleep Disturbance: |
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Difficulty Sleeping: Insomnia involves persistent difficulty in initiating or maintaining sleep. |
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Daytime Consequences: Individuals with insomnia often experience daytime impairment in various aspects of functioning. |
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Classification: |
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Acute Insomnia: Brief episodes often triggered by stress or life events. |
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Chronic Insomnia: Ongoing sleep difficulties lasting for at least three nights a week for three months or more. |
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Types of Insomnia: |
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Primary Insomnia: Not associated with other medical or psychiatric conditions. |
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Secondary Insomnia: Linked to underlying health issues, medications, or substances. |
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==Causes== |
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Lifestyle Factors: |
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Poor Sleep Hygiene: Irregular sleep schedules, excessive caffeine intake, and lack of a bedtime routine can contribute. |
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Shift Work: Irregular work hours may disrupt the natural sleep-wake cycle. |
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Psychological Factors: |
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Stress and Anxiety: Worries and stressors can interfere with the ability to relax and fall asleep. |
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Depression: Mood disorders can contribute to insomnia. |
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Medical Conditions: |
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Chronic Pain: Conditions causing pain, such as arthritis, can disrupt sleep. |
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Respiratory Disorders: Asthma or sleep apnoea may lead to sleep disturbances. |
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Medications and Substances: |
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Stimulants: Certain medications and substances, such as caffeine and nicotine, can interfere with sleep. |
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Antidepressants: Some medications may cause insomnia as a side effect. |
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==Symptoms== |
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Difficulty Initiating Sleep: |
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Taking Long to Fall Asleep: Individuals with insomnia may lie awake for an extended period before falling asleep. |
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Difficulty Maintaining Sleep: |
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Frequent Awakenings: Waking up multiple times during the night and struggling to go back to sleep. |
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Non-Restorative Sleep: |
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Feeling Unrefreshed: Despite spending adequate time in bed, individuals with insomnia may wake up feeling tired. |
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Daytime Consequences: |
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Daytime Fatigue: Insomnia can lead to excessive daytime sleepiness and fatigue. |
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Impaired Concentration: Difficulty focusing on tasks due to lack of sleep. |
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Mood Disturbances: Insomnia can contribute to irritability and mood swings. |
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==Diagnosis== |
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Sleep Diary: |
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Self-Reported Sleep Patterns: Keeping a sleep diary helps track sleep habits and patterns. |
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Polysomnography: |
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Sleep Study: In some cases, a sleep study may be conducted to monitor sleep patterns, brain activity, and other physiological parameters. |
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'''Insomnia''' is difficulty getting to sleep, staying asleep, waking too early, or sleeping in a way that does not feel refreshing. It becomes clinically important when it causes daytime problems such as tiredness, poor concentration, low mood, irritability or reduced ability to function. |
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Clinical Assessment: |
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Short periods of poor sleep are common during stress, illness, travel or life changes. Insomnia can also last for months or years, especially when worry about sleep becomes part of the pattern. |
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Medical and Psychiatric Evaluation: Identifying underlying conditions contributing to insomnia. |
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==Treatment== |
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Cognitive-Behavioural Therapy (CBT-I): |
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== Symptoms == |
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Symptoms include taking a long time to fall asleep, waking repeatedly during the night, waking early and being unable to return to sleep, feeling unrefreshed, daytime tiredness, poor concentration, irritability and reduced performance at work, study or daily tasks. |
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Behavioural Techniques: Addressing behaviours that contribute to insomnia. |
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People may also develop anxiety around bedtime, clock-watching and avoidance of sleep routines because they expect another bad night. |
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Cognitive Techniques: Addressing thoughts and attitudes that may interfere with sleep. |
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== Causes == |
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Insomnia can be linked to stress, anxiety, depression, pain, breathing problems, restless legs, hot flushes, shift work, caring responsibilities, alcohol, caffeine, nicotine, some medicines and irregular sleep routines. |
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Sleep Hygiene: |
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The relationship can go both ways. Poor sleep can worsen mental and physical health, while mental and physical health problems can worsen sleep. |
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Establishing a Routine: Maintaining a consistent sleep schedule and bedtime routine. |
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== Assessment == |
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Assessment usually starts with the sleep pattern, duration of symptoms, daily impact, medicines, caffeine and alcohol use, mental health, pain, breathing symptoms and work pattern. A sleep diary can help show timing, naps, wake periods and triggers. |
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Optimizing Sleep Environment: Creating a comfortable and conducive sleep environment. |
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Sleep studies are not needed for most insomnia, but may be considered if sleep apnoea, periodic limb movement disorder or another sleep condition is suspected. |
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Medications: |
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== Self-Help and Sleep Routine == |
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Useful measures include keeping a regular wake time, winding down before bed, reducing caffeine later in the day, avoiding large meals or alcohol shortly before bed, keeping the bedroom quiet and comfortable, and using the bed mainly for sleep and sex. |
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Short-Term Use: In some cases, medications may be prescribed for short-term relief. |
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If someone cannot sleep and becomes anxious in bed, NHS inform advises getting up, going to another room, doing a quiet relaxing activity, and trying again after around 20 minutes or when sleepy. |
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Melatonin: A natural hormone that may be used to regulate sleep-wake cycles. |
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==Complications== |
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Impaired Functioning: |
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Daytime naps can make night sleep harder for some people. Exercise can help sleep, but vigorous exercise close to bedtime may be unhelpful. |
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Daytime Impairment: Reduced performance at work or in daily activities due to lack of sleep. |
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== Psychological Treatment == |
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Cognitive behavioural therapy for insomnia, often called CBT-I, is a structured treatment that targets habits and thoughts that keep insomnia going. It can include stimulus control, sleep scheduling, relaxation work and changing unhelpful beliefs about sleep. |
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Increased Accident Risk: Insomnia can contribute to accidents and injuries. |
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CBT-I is often preferred for persistent insomnia because it can have longer-lasting benefits than short-term sleeping tablets. |
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Mental Health Effects: |
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== Medication == |
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Medicines may sometimes be used for short-term relief or specific situations, but they can cause side effects and dependence, and some can make sleep problems worse if used poorly. Choice depends on age, other conditions, current medicines, pregnancy status, risk of falls, driving and the likely cause of insomnia. |
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Mood Disorders: Insomnia is associated with an increased risk of depression and anxiety disorders. |
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Melatonin or other medicines may be appropriate in selected cases, but persistent insomnia is usually better managed by addressing the sleep pattern and underlying causes. |
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Impact on Physical Health: |
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== When to Seek Help == |
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Someone should seek help if insomnia lasts for weeks, affects daily life, is linked to low mood or anxiety, follows a new medicine, happens with loud snoring or breathing pauses, or causes unsafe sleepiness while driving or working. |
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Cardiovascular Risk: Chronic insomnia may be linked to an increased risk of cardiovascular issues. |
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==Prevention== |
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Sleep Education: |
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== See Also == |
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* [[Sleep]] |
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* [[Mental_Health]] |
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* [[Anxiety]] |
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* [[Depression]] |
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Promoting Sleep Hygiene: Educating individuals on healthy sleep practices. |
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== References == |
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* [https://www.nhs.uk/every-mind-matters/mental-health-issues/sleep/ NHS Every Mind Matters: Sleep problems and insomnia] |
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* [https://www.nhsinform.scot/illnesses-and-conditions/mental-health/insomnia/ NHS inform: Insomnia] |
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* [https://royalpapworth.nhs.uk/download_file/6996/305 Royal Papworth Hospital NHS Foundation Trust: What to do when you cannot get to sleep] |
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* [https://cks.nice.org.uk/topics/insomnia/ NICE Clinical Knowledge Summary: Insomnia] |
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Stress Management: Techniques for managing stress and anxiety. |
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[[Category:Medicine]] |
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[[Category:Sleep]] |
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[[Category:Mental Health]] |