Insomnia

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Insomnia , also known as lack of sleep , is a sleep disorder in which people have trouble sleeping. They may have trouble sleeping, or staying asleep for as long as they want. Insomnia is usually followed by daytime sleepiness, low energy, irritability, and depressed mood. This can lead to an increased risk of motor vehicle crashes, as well as problems of focus and learning. Insomnia can be short-term, lasting for several days or weeks, or longer term, lasting longer than a month.

Insomnia can occur independently or as a result of other problems. Conditions that can lead to insomnia include psychological stress, chronic pain, heart failure, hyperthyroidism, heartburn, restless leg syndrome, menopause, certain medications, and drugs such as caffeine, nicotine and alcohol. Other risk factors include night shift and sleep apnea. The diagnosis is based on sleeping habits and examinations to find the underlying cause. A sleep study can be done to look for an underlying sleep disorder. Screening can be done with two questions: "do you have trouble sleeping?" and "are you having trouble falling or staying asleep?"

Sleep hygiene and lifestyle changes are usually the first treatment for insomnia. Sleep hygiene includes consistent sleep time, sun exposure, quiet and dark spaces, and regular exercise. Cognitive behavioral therapy can be added to this. While sleeping pills can help, they are associated with injury, dementia, and addiction. These medications are not recommended for more than four or five weeks. The effectiveness and safety of alternative medicine is unclear.

Between 10% and 30% of adults experience insomnia at some point in time and up to half of people experience insomnia in a given year. About 6% of people experience insomnia that is not due to other problems and lasts for more than a month. People over the age of 65 are exposed more often than younger people. Women are more often affected than men. Description of insomnia occurs at least as far back as the ancient Greeks.

Video Insomnia

Signs and symptoms

Symptoms of insomnia:

• sleeping difficulties, including difficulty finding a comfortable sleeping position
• woke up at night and unable to go back to sleep
• feel unconscious after waking up
• daytime sleepiness, irritability or anxiety

Sleep-onset insomnia is difficulty falling asleep early in the night, often a symptom of anxiety disorder. The delayed phase delayed sleep can be misdiagnosed as insomnia, as sleep onset is delayed to slower than usual while generating spills during the day.

It is common for patients who have difficulty falling asleep and also awake at night with difficulty to go back to sleep. Two thirds of these patients wake up in the middle of the night, with more than half having trouble falling back to sleep after waking up at midnight.

The rise of the morning is an earlier resurgence (more than 30 minutes) than desired with the inability to go back to sleep, and before the total sleep time reaches 6.5 hours. Awakening in the morning is often a characteristic of depression.

Poor sleep quality

Poor sleep quality can occur as a result of, for example, restless legs, sleep apnea or major depression. Poor sleep quality is caused by individuals not reaching stage 3 or delta sleep that has restorative properties.

Severe depression causes a change in the function of the hypothalamus-pituitary-adrenal axis, causing an excessive release of cortisol which can lead to poor sleep quality.

Nocturnal polyuria, excessive nighttime urination, can be very disturbing to sleep.

Subjectivity

Some cases of insomnia are not really insomnia in the traditional sense, because people who experience a misperception of sleep status often sleep for a normal amount of time. The problem is that, despite sleeping for several hours every night and usually not experiencing significant daytime sleepiness or other symptoms of sleep loss, they do not feel like they have slept so much, if at all. Because their perception of their sleep is incomplete, they mistakenly believe that it takes them a long time to fall asleep, and they underestimate how long they stay asleep.

Maps Insomnia

Cause

Symptoms of insomnia can be caused by or associated with:

• The use of psychoactive drugs (such as stimulants), including certain drugs, herbs, caffeine, nicotine, cocaine, amphetamines, methylphenidate, aripiprazole, MDMA, modafinil, or excessive alcohol intake.
• Use or withdrawal from alcohol and other sedatives, such as anti-anxiety and sleep medications such as benzodiazepines.
• Use or withdrawal from pain relievers such as opioids.
• Previous chest surgery.
• Heart disease.
• Nasal septal deviation and nocturnal breathing disorders.
• Restless leg syndrome, which can cause sleep-induced insomnia due to uncomfortable sensations and the need to move the feet or other body parts to eliminate this sensation.
• Periodic periodic movement of the limb (PLMD), which occurs during sleep and can cause unnoticed disturbance by the sleeper.
• Pain, injury or conditions that cause pain can prevent a person from finding a comfortable position to fall asleep, and otherwise can cause resurrection.
• Shifting hormones such as those that precede menstruation and during menopause.
• Life events such as fear, stress, anxiety, emotional or mental tension, work problems, financial stress, childbirth, and mourning.
• Gastrointestinal problems such as heartburn or constipation.
• Mental disorders such as bipolar disorder, clinical depression, general anxiety disorder, post-stress traumatic disorder, schizophrenia, obsessive compulsive disorder, dementia, and ADHD.
• Circadian rhythm disorders, such as shift and jet lag, can cause an inability to sleep at a certain time and excessive sleepiness at other times during the day. The disorder of chronic circadian rhythm is characterized by similar symptoms.
• Certain neurological disorders, brain lesions, or a history of traumatic brain injury.
• Medical conditions such as hyperthyroidism and rheumatoid arthritis.
• Abuse of over-the counter or prescription sleep aids (sedative or depressant) may produce rebound insomnia.
• Poor sleep hygiene, for example, excessive sound or caffeine consumption.
• Rare genetic conditions can lead to a permanent, ultimately fatal form of primary insomnia called fatal familial insomnia.
• Physical exercise. Insomnia induced by exercise is common in athletes in the form of extended sleep latency.

Sleep studies using polysomnography show that people who experience sleep disorders have increased levels of cortisol and adrenocorticotropic hormone at night. They also have a high metabolic rate, which does not occur in people who do not have insomnia but sleep deliberately disturbed during sleep studies. Brain metabolic studies using positron emission tomography (PET) scans showed that people with insomnia had higher metabolic rates during the night and day. The question remains whether this change is the cause or consequence of long-term insomnia.

Genetics

Heritability estimates that insomnia varies from 38% in males to 59% in females. A genome association study (GWAS) identified 3 genomic genes and 7 genes that affected the risk of insomnia, and showed that insomnia was highly polygenic. In particular, a strong positive relationship was observed for the MEIS1 gene in both men and women. This study shows that the genetic architecture of insomnia overlaps with psychiatric disorders and metabolic properties.

Substance-induced

Alcohol-induced

Alcohol is often used as a form of self-care insomnia to induce sleep. However, the use of alcohol to induce sleep can be the cause of insomnia. Long-term alcohol use was associated with decreased 3 and 4-stroke NREM sleep as well as REM sleep suppression and REM sleep fragmentation. Frequently moving between stages of sleep occurs, by awakening from headaches, need for urination, dehydration, and excessive sweating. Glutamine rebound also plays a role as when a person drinks; alcohol inhibits glutamine, one of the body's natural stimulants. When the person stops drinking, his body tries to replace the lost time by producing more glutamine than is needed. Increased levels of glutamine stimulate the brain when the drinker is trying to sleep, making it unable to reach the deepest level of sleep. Stopping chronic alcohol use can also cause severe insomnia with lively dreams. During withdrawal, REM sleep is usually exaggerated as part of the reflection effect.

Benzodiazepine-induced

Like alcohol, benzodiazepines, such as alprazolam, clonazepam, lorazepam, and diazepam, are commonly used to treat insomnia in the short term (both prescribed and self-medication), but worsen sleep in the long run. While benzodiazepines can make people fall asleep (ie, inhibit NREM stage 1 and 2 sleep), while asleep, medications interfere with sleep architecture: reduce sleep time, delay REM sleep time, and reduce deep slow wave sleep (most restore parts) sleeping for energy and mood).

Opioid-induced

Opioid drugs such as hydrocodone, oxycodone, and morphine are used for insomnia associated with pain due to analgesic properties and hypnotic effects. Opioids can break down sleep and reduce REM and stage 2 sleep. By producing analgesia and sedation, opioids may be appropriate in carefully selected patients with pain-related insomnia. However, dependence on opioids can cause long-term sleep disorders.

Risk factors

Insomnia affects people of all age groups but people in the following group have a higher chance of getting insomnia.

• Individuals older than 60
• History of mental health disorders including depression, etc.
• Emotional stress
• Work late late at night
• Journey through different time zones

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Mechanism

Two main models exist for insomnia, (1) cognitive and (2) physiological mechanisms. The cognitive model suggests rumination and hyperarousal contribute to preventing a person from falling asleep and possibly causing an episode of insomnia.

The physiological model is based on three major findings in people with insomnia; first, elevated urinary cortisol and catecholamines have been found to show increased activity of the HPA axis and arousal; secondly increased utilization of global cerebral glucose while awake and NREM sleep in people with insomnia; and lastly increase full body metabolism and heart rate in those suffering from insomnia. All of these findings were taken together showing dysregulated stimulation systems, cognitive systems, and HPA axis all contribute to insomnia. However, it is unknown whether hyperarousal is the result of, or causes of insomnia. Changes in GABA inhibitory neurotransmitter levels have been found, but the results are inconsistent, and the implications of changing levels such as neurotransmitters everywhere are unknown. The study of whether insomnia is driven by circadian control over sleep or wake-dependent processes has shown inconsistent results, but some literature suggests circadian rhythm dysregulation based on core temperature. Increased beta activity and decreased delta wave activity have been observed in electroencephalograms; However, the implications are unknown.

About half of postmenopausal women experience sleep disturbances, and generally sleep disorders are about twice as common in women as compared to men; this seems partly due, but not completely, to changes in hormone levels, especially in and post-menopause.

Sex hormone changes in both men and women as they age may be part of the increased prevalence of sleep disturbance in the elderly.

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Diagnosis

In the world of medicine, insomnia is measured widely using the scale of insomnia Athena. It was measured using eight different sleep-related parameters, ultimately represented as an overall scale that assessed individual sleep patterns.

A qualified sleeping specialist should be consulted for the diagnosis of sleep disorder so that appropriate action can be taken. Past medical history and physical examination need to be done to eliminate other conditions that could be the cause of insomnia. After all other conditions are ruled out a comprehensive sleep history must be taken. Sleep history should include sleeping habits, medications (prescription and non-prescription), alcohol consumption, nicotine and caffeine intake, co-morbid diseases, and sleeping environments. Sleep diaries can be used to track individual sleep patterns. The diary should include bedtime, total sleep time, sleep time, waking amount, medication use, wake time, and subjective feelings in the morning. The sleep diary can be replaced or validated with the use of outpatient actigraphy for a week or more, using non-invasive devices that measure movement.

Workers who complain about insomnia should not routinely have polysomnography to screen for sleep disorders. This test may be indicated for patients with symptoms in addition to insomnia, including sleep apnea, obesity, thick neck diameter, or fullness of the meat in the oropharynx. Typically, these tests are not necessary to make a diagnosis, and insomnia especially for people who work can often be treated by changing work schedules to provide adequate sleeping time and by improving sleep hygiene.

Some patients may need to do overnight sleep studies to determine if insomnia is present. Such studies will typically involve assessment tools including polysomnograms and multiple sleep latency tests. Specialists in sleeping pills are eligible to diagnose internal disorders, according to ICSD, 81 major diagnostic categories of sleep disorders. Patients with multiple disorders, including delayed sleep phase disorders, are often misdiagnosed with primary insomnia; when a person has trouble sleeping and waking up at the desired time, but having a sleeping pattern is perfectly normal asleep, circadian rhythm disorder is a possible cause.

In many cases, insomnia is co-morbid with other diseases, side effects from drugs, or psychological problems. About half of all diagnosed insomnia is associated with psychiatric disorders. In depression in many cases "insomnia should be considered a co-morbid condition, not as secondary;" insomnia usually precedes psychiatric symptoms. "In fact, it is possible that insomnia is a significant risk for the development of subsequent psychiatric disorders." Insomnia occurs between 60% and 80% of people with depression. This may be partly due to the treatment used for depression.

Determination of cause-effectiveness is not necessary for diagnosis.

DSM-5 Criterion

DSM-5 criteria for insomnia include the following:

The main complaint of dissatisfaction with the quantity or quality of sleep, associated with one (or more) of the following symptoms:

• Difficulty getting to sleep. (In children, this can manifest as difficulty getting started without nanny intervention.)
• Difficulty maintaining sleep, characterized by frequent waking or problems that fall back asleep after waking. (In children, this can manifest as difficulty getting back to sleep without caregiver intervention.)
• Awakening in the morning with the inability to go back to sleep.

In addition to,

• Sleep disturbances cause clinically significant disturbances or damage in the social, occupational, educational, academic, behavioral, or other important areas of functioning.
• Difficulty sleeping occurs at least 3 nights per week.
• Difficulty sleeping is present for at least 3 months.
• Difficulty sleeping occurs even though there are ample opportunities for sleep.
Insomnia is not described better and does not occur exclusively during other sleep-wake disorders (eg, narcolepsy, respiratory-related sleep disorders, sleep-wake disorder circadian rhythms, parasomnia).
• Insomnia is not caused by the physiological effects of a substance (eg drug abuse, drugs).
• Emerges mental disorders and medical conditions do not adequately explain the main complaints of insomnia.

Type

Insomnia can be classified as transient, acute, or chronic.

1. Temporary insomnia lasts less than a week. This can be caused by other disorders, by changes in the sleep environment, by bedtime, severe depression, or by stress. Consequences - drowsiness and psychomotor performance disorders - are similar to sleep deprivation.
2. Acute insomnia is the inability to sleep consistently for less than a month. Insomnia is present when there is difficulty starting or maintaining sleep or when sleep is not refreshing or poor quality. These problems occur despite the opportunities and circumstances that are sufficient to sleep and they must cause problems with daytime functions. Acute insomnia is also known as short-term insomnia or stress-related insomnia.
3. Chronic insomnia lasts more than a month. This can be caused by other disorders, or it could be a major annoyance. People with high levels of stress hormones or a shift in cytokine levels are more likely than others to experience chronic insomnia. The effect may vary according to the cause. They may include muscle fatigue, hallucinations, and/or mental fatigue. Chronic insomnia can cause double vision.

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Prevention

Sleeping and waking at the same time each day can create a stable pattern that can help prevent or treat insomnia. Avoiding strong exercise and caffeinated drinks a few hours before bed is recommended, while exercise in the morning is beneficial. The bedroom should be cool and dark, and the bed should only be used for sleeping and sex. These are some of the points included in what doctors call "sleep hygiene".

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Management

It is important to identify or rule out medical and psychological causes before deciding on treatment for insomnia. Cognitive behavioral therapy (CBT) has been found to be as effective as medication for short-term treatment of chronic insomnia. The beneficial effects, unlike those produced by drugs, can last long after the therapy is stopped. Drugs have been used primarily to reduce the symptoms of insomnia in short duration; their role in the management of chronic insomnia remains unclear. Several different types of drugs are also effective for treating insomnia. However, many doctors do not recommend relying on prescription sleeping pills for long-term use. It is also important to identify and treat other medical conditions that may contribute to insomnia, such as depression, respiratory problems, and chronic pain.

Non-remedies based on

Non-drug based strategies have properties that are comparable to hypnotic drugs for insomnia and they may have longer lasting effects. Hypnotic drugs are only recommended for short-term use because of dependence with the effects of withdrawal rebound after discontinuation or tolerance can develop.

Non-drug based strategies provide long-term improvement for insomnia and are recommended as first-line and long-term management strategies. Strategies include attention to sleep hygiene, stimulus control, behavioral intervention, sleep restriction therapy, paradoxical intentions, patient education, and relaxation therapy. Some examples are keeping a journal, limiting time spent in bed, practicing relaxation techniques, and maintaining a regular sleep schedule and waking time. Behavior therapy can assist patients in developing new sleeping behaviors to improve sleep quality and consolidation. Behavioral therapy may include, studying healthy sleep habits to promote sleep relaxation, undergoing light therapy to help with anxiety reduction strategies and regulating circadian clocks.

Music can improve insomnia in adults. EEG biofeedback has shown effectiveness in the treatment of insomnia with increased duration as well as sleep quality. Self-help therapy (defined as self-administered psychological therapy) can improve sleep quality for adults with insomnia to small or moderate levels.

Therapeutic stimulus therapy is a treatment for patients who have conditioned themselves to associate a bed, or sleep in general, with a negative response. As stimulus control therapy involves taking steps to control the sleep environment, sometimes referred to alternately with the concept of sleep hygiene. Examples of such environmental modifications include using a bed for sleeping or sex only, not for activities such as reading or watching television; wake up at the same time every morning, including on weekends; sleep only when sleepy and when there is a high probability that sleep will occur; leave the bed and start activity in another location if sleep does not produce a short enough period of time after sleep (usually ~ 20 minutes); reducing the subjective effort and energy spent trying to fall asleep; avoiding exposure to bright light during curfew, and eliminating daytime naps.

The therapeutic component of stimulus control is sleep restriction, a technique that aims to match the time spent in bed with time spent sleeping. This technique involves maintaining a tight sleep-wake schedule, sleeping only at certain times of the day and for a certain amount of time to induce light sleep. Complete treatment usually lasts up to 3 weeks and involves making yourself sleep only with the minimum amount of time they can afford on average, and then, if able (ie when sleep efficiency improves), slowly increase this amount (~ 15 min) by go to bed early when the body tries to rearrange the internal sleep clock. Bright light therapy, often used to help morning sleepers regulate their natural sleep cycle, can also be used with sleep restriction therapy to reinforce a new wake-up schedule. Although applying this technique with difficult consistency, it can have a positive effect on insomnia in motivated patients.

The paradoxical intention is a cognitive reframing technique in which the insomniac, instead of trying to fall asleep at night, makes every effort to stay awake (ie stop trying to fall asleep). One theory that can explain the effectiveness of this method is that by not voluntarily making itself asleep, it reduces performance anxiety arising from the need or necessity to fall asleep, which is meant to be a passive action. This technique has been shown to reduce sleep performance and performance anxiety as well as a lower subjective assessment of sleep-onset and overestimation of sleep deficits (quality found in many insomniacs).

Sleep hygiene

Sleep hygiene is a generic term for all behaviors associated with good sleep promotion. This behavior is used as a basis for sleep intervention and is the main focus of the sleep education program. Behavior includes reducing caffeine, nicotine and alcohol consumption, maximizing the regularity and efficiency of sleeping episodes, minimizing drug use and daytime sleep, regular exercise promotion, and positive sleep environment facilitation. Exercise can be helpful when forming a routine for sleep but should not be done close to the time you plan to sleep. The creation of a positive sleep environment can also help reduce symptoms of insomnia. To create a positive sleep environment, one must remove objects that can cause worries or thoughts that deviate from view.

Cognitive behavioral therapy

There is some evidence that cognitive behavioral therapy (CBT) for insomnia excels in the long term for benzodiazepines and nonbenzodiazepines in the treatment and management of insomnia. In this therapy, patients are taught improved sleep habits and are released from counter-productive assumptions about sleep. Common misconceptions and expectations that can be modified include

1. unrealistic sleep expectations (eg, I should have 8 hours of sleep each night)
2. misconceptions about the cause of insomnia (eg, I have a chemical imbalance that causes my insomnia)
3. strengthen the consequences of insomnia (for example, I can not do anything after a bad night's sleep) and
4. performance anxiety after trying so long for a restful night's sleep by controlling the sleep process.

Numerous studies have reported positive results combining cognitive behavioral therapy for the treatment of insomnia with treatments such as stimulus control and relaxation therapy. Hypnotic drugs are just as effective in the treatment of short-term insomnia, but the effect disappears over time because of tolerance. The effects of CBT-I have a lasting and lasting effect for treating insomnia shortly after treatment is stopped. The addition of hypnotic drugs with CBT-I adds no benefit in insomnia. The long-term benefits of the CBT-I program show advantages over pharmacological hypnotics. Even in the short term when compared to short-term hypnotic drugs such as zolpidem (Ambien), CBT-I still shows significant advantages. Thus CBT-I is recommended as first-line treatment for insomnia.

Metacognition is the latest trend in the behavioral therapy approach of insomnia.

Internet intervention

Although therapeutic effectiveness and success of CBT are proven, the availability of treatment is significantly limited by the lack of trained doctors, poor geographic distribution of knowledgeable professionals, and costs. One way to overcome these obstacles is to use the Internet to provide care, making effective interventions more accessible and less expensive. The Internet has become an important source of health care and medical information. Although most health websites provide general information, there is a growing research literature on the development and evaluation of Internet interventions.

These online programs are usually behavior-based care that has been operationalized and changed for delivery over the Internet. They are usually highly structured; automatic or human supported; based on effective face-to-face treatment; personalized for users; interactive; enhanced by graphics, animations, audio, and possibly videos; and adjusted to provide follow-up and feedback.

There is good evidence to use computer-based CBT for insomnia.

Drugs

Many people with insomnia use sleeping tablets and other sedatives. In some places drugs are prescribed in more than 95% of cases. They; However, it is a second line treatment.

The percentage of adults using prescription sleep aids increases with age. During 2005-2010, about 4% of US adults aged 20 and over reported having taken prescription sleeping devices in the last 30 days. The lowest usage rates among the youngest age group (those aged 20-39) were about 2%, increasing to 6% among those aged 50-59 years, and reaching 7% among those aged 80 and older. More adult women (5.0%) reported using prescription sleep aids than adult men (3.1%). Non-Hispanic white adults reported higher use of sleep aids (4.7%) than non-Hispanic adults (2.5%) and Mexican-Americans (2.0%). No differences were demonstrated between non-Hispanic blacks and Mexican-American adults in the use of prescription sleep aids.

Antihistamines

As an alternative to using prescription drugs, some evidence suggests that the average person looking for short-term relief may find relief by taking over-the-counter antihistamines such as diphenhydramine or doxylamine. Diphenhydramine and doxylamine are widely used in non-prescription sleeping aids. It is the most effective over-the-counter antidote currently available, at least in most of Europe, Canada, Australia and the United States, and is more sedative than some prescribed hypnotics. The effectiveness of antihistamines for sleep may decrease over time, and anticholinergic side effects (such as dry mouth) can also be a disadvantage with certain drugs. While addiction does not seem to be a problem with this class of drugs, they can cause dependence and rebound effects after the cessation of sudden use. However, people whose insomnia is caused by restless leg syndrome may have aggravated symptoms with antihistamines.

Melatonin

The evidence of melatonin in treating insomnia is generally poor. There is low quality evidence that can accelerate the onset of sleep for 6 minutes. Ramelteon, a melatonin receptor agonist, does not seem to accelerate sleep time or the amount of sleep a person has.

Most melatonin drugs have not been tested for longitudinal side effects. Melatonin is prolonged release can improve the quality of sleep in the elderly with minimal side effects.

Studies have also shown that children who are on the autism spectrum or have learning disabilities, Attention-Deficit Hyperactivity Disorder (ADHD) or neurologically related disease may benefit from the use of melatonin. This is because they often have trouble sleeping because of their disturbance. For example, children with ADHD tend to have trouble sleeping because of their hyperactivity and, consequently, tend to be tired for most of the day. Another cause of insomnia in children with ADHD is the use of stimulants used to treat their disorders. Children suffering from ADHD at the time, as well as other disorders mentioned, may be given melatonin before bed to help them sleep.

Antidepressants

Because insomnia is a common symptom of depression, antidepressants are effective for treating sleep problems whether they are associated with depression or not. While all antidepressants help regulate sleep, some antidepressants such as amitriptyline, doxepin, mirtazapine, and trazodone can have an immediate sedative effect, and are prescribed to treat insomnia. Amitriptyline and doxepine have antihistaminergic, anticholinergic, and antiadrenergic properties, which contribute both to the therapeutic effect and its side effects, while the side effects of mirtazapine are primarily antihistaminergic, and the trazodone side effects are particularly antiadrenergic. Mirtazapine is known to reduce sleep latency (ie, the time it takes to fall asleep), promote sleep efficiency and increase the total amount of sleep time in people with depression and insomnia.

Agomelatine, a melatonergic antidepressant with sleep-enhancing qualities that do not cause daytime sleepiness, is licensed for marketing in the EU and TGA Australia. After trials in the United States, its development for use was halted in October 2011 by Novartis, who had bought the right to market it there from the European pharmaceutical company, Servier.

Benzodiazepines

The most common class of hypnotics used for insomnia is benzodiazepines. Benzodiazepines are not significantly better for insomnia than antidepressants. Chronic users of hypnotic drugs for insomnia do not have better sleep than people with chronic insomnia who are not taking the drug. In fact, chronic users of hypnotic medicines have more nightly awake regularly than insomniacs who do not take hypnotic drugs. Many have concluded that these drugs cause unfair risks to individuals and public health and lack evidence of long-term effectiveness. It is preferred that hypnotics are prescribed for only a few days at the lowest effective dose and are avoided altogether if possible, especially in the elderly. Between 1993 and 2010, the prescription of benzodiazepines for individuals with sleep disorders has declined from 24% to 11% in the US, coinciding with the first release of nonbenzodiazepines.

Benzodiazepine and nonbenzodiazepine hypnotic drugs also have a number of side effects such as daytime fatigue, motor vehicle accidents and other accidents, cognitive impairment, and fall and fractures. Older people are more sensitive to these side effects. Some benzodiazepines have shown effectiveness in sleep maintenance in the short term but in the long term benzodiazepines may cause tolerance, physical dependence, benzodiazepine withdrawal syndrome after discontinuation, and long-term worsening of sleep, especially after consistent use over long periods of time. Benzodiazepines, while inducing unconsciousness, actually worsen sleep as - like alcohol - they promote light sleep while reducing time spent in deep sleep. The next problem is, with the regular use of short-sleeping aids for insomnia, anxiety of daytime rebounds can appear. Although there is little evidence for the benefits of benzodiazepines in insomnia compared with other treatments and evidence of major hazards, the prescription continues to increase. This may be due to their addictive nature, both due to abuse and because - through their quick action, tolerance and withdrawal - they can "trick" insomnia sufferers into thinking they are helping to sleep. There is a general awareness that the long-term use of benzodiazepines for insomnia in most people is imprecise and that gradual withdrawal is usually beneficial due to adverse effects associated with long-term use of benzodiazepines and is recommended whenever possible.

Benzodiazepines all bind selectively to a GABA recipe _A . Some theorize that certain benzodiazepines (hypnotic benzodiazepines) have significantly higher activity in subunit ₁ GABA receptors _A than with other benzodiazepines (eg, triazolam and temazepam have significant activity higher in the subunit ₁ compared with alprazolam and diazepam, making it the superior hypnotics - alprazolam and diazepam, in turn, have higher activity in the subunit ₂ than for triazolam and temazepam, making them an anxiolytic superior agent). Subunit modulation? ₁ is associated with sedation, motor damage, respiratory depression, amnesia, ataxia, and strengthening behavior (drug seeking behavior). Subunit modulation? ₂ is associated with anxiolytic activity and disinhibition. For this reason, certain benzodiazepines may be better suited for treating insomnia than others.

Other sedatives

Drugs that prove to be more effective and safer than benzodiazepines for insomnia are active research areas. Nonbenzodiazepine sedative-hypnotic drugs, such as zolpidem, zaleplon, zopiclone, and eszopiclone, are a class of hypnotic drugs similar to benzodiazepines in their mechanism of action, and are indicated for mild to moderate insomnia. Their effectiveness in increasing the time to sleep a little, and they have similar side effects - although potentially less severe than benzodiazepines.

Suvorexant is FDA-approved for insomnia, characterized by difficulties with sleep onset and/or sleep maintenance. Nonbenzodiazepine prescribing has seen a general increase since their initial release in the US market in 1992, from 2.3% in 1993 among individuals with sleep disorders up to 13.7% in 2010.

Barbiturates, while once used, are no longer recommended for insomnia because of the risk of addiction and affect the other side.

Antipsychotics

The use of antipsychotics for insomnia, while common, is not recommended because evidence does not show benefit and the risk of side effects is significant. Concerns about side effects are greater in the elderly.

Alternative medicine

Some insomniacs use herbs such as valerian, chamomile, lavender, cannabis, hops, Withania somnifera , and passion flower. L -Arginine L -re create, S -adenosyl- L -homocysteine, and delta peptides that induce sleep (DSIP) can also help in reducing insomnia. It is unclear whether acupuncture is useful.

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Prognosis

A survey of 1.1 million people in the United States found that those who reported sleeping about 7 hours per night had the lowest mortality rate, while those who slept less than 6 hours or more than 8 hours had a higher mortality rate. Sleeping 8.5 hours or more per night was associated with a 15% higher mortality rate. Severe insomnia - sleep less than 3.5 hours in women and 4.5 hours in men - is associated with a 15% mortality increase.

With this technique, it is difficult to distinguish the lack of sleep caused by disorders that are also the cause of premature death, compared to the disorders that cause sleep deprivation, and lack of sleep leading to premature death. Much of the increased mortality due to severe insomnia is discounted after controlling co-morbid disorders. After controlling the duration of sleep and insomnia, the use of sleeping pills was also found to be associated with increased mortality.

The lowest deaths were seen in individuals who slept between six and a half and seven and a half hours per night. Even sleeping only 4.5 hours per night was associated with a slight increase in mortality. Thus, mild to moderate insomnia for most people is associated with increased longevity and severe insomnia is associated only with a very small effect on death. It is not clear why sleep longer than 7.5 hours is associated with excessive mortality.

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Epidemiology

Between 10% and 30% of adults experience insomnia at some point in time and up to half of people experience insomnia in a given year. About 6% of people experience insomnia that is not due to other problems and lasts for more than a month. People over the age of 65 are exposed more often than younger people. Women are more often affected than men. Insomnia is 40% more common in women than in men.

There is a higher rate of insomnia reported among students compared to the general population.

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Society and culture

Insomnia topics are discussed in many cultural contexts.

Insomnia comes from Latin: in somnus "without sleep" and -ia as nominising suffix.

The popular press has published stories about people who should never sleep, such as Paul Kern and Al Herpin; However, these stories are not accurate.

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References

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External links

• Ellis, J. J.; Hampson, S. E.; Cropley, M. M. (2002). "Sleep hygiene or sleep compensation practices: behavioral checks that affect sleep in older adults". Psychology, Health & amp; Drugs . 7 (2): 156-161. doi: 10.1080/13548500120116094.
• Passarella, S.; Duong, M.-T. (2008). "Diagnosis and treatment of insomnia". American Journal of Health-System Pharmacy . 65 (10): 927-934. doi: 10.2146/ajhp060640.

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