Insomnia

BASICS

BASICS

BASICS

DESCRIPTION

DESCRIPTION

DESCRIPTION

Difficulty initiating or maintaining sleep or nonrestorative sleep despite adequate opportunity and circumstances for sleep, resulting in at least one of the following forms of daytime impairment:

  • Fatigue or malaise
  • Attention, concentration, or memory impairment
  • Social or vocational dysfunction or poor school performance
  • Mood disturbance or irritability
  • Daytime sleepiness
  • Motivation, energy, or initiative reduction
  • Proneness for errors or accidents at work or while driving
  • Tension, headaches, or GI symptoms in response to sleep loss
  • Concerns or worries about sleep

EPIDEMIOLOGY

EPIDEMIOLOGY

EPIDEMIOLOGY

  • Predominant age: increases with age
  • Predominant sex: female > male (5:1)

Prevalence

Prevalence

Prevalence

  • Most common sleep disorder
  • Insomnia (transient and chronic): 5–35% of the population; 10–15% associated with daytime impairment
  • Chronic insomnia: 10% middle-aged adults; 1/3 of people >65 years

ETIOLOGY AND PATHOPHYSIOLOGY

ETIOLOGY AND PATHOPHYSIOLOGY

ETIOLOGY AND PATHOPHYSIOLOGY

  • Transient/intermittent (<30 days) and short-term (<3 months)
    • Usually caused by an identifiable stressor
    • Stressor can be:
      • Physical (e.g., medical illness, high altitude)
      • Psychological (e.g., stress, excitement, bereavement)
      • Psychosocial (e.g., work deadlines, housing insecurity)
      • Interpersonal (e.g., arguments)
  • Usually resolves when stressor is removed
  • Chronic (>3 months)
    • Usually not due to one single cause
    • Possible contributing factors:
      • Medical (e.g., gastroesophageal reflux disease, sleep apnea, chronic pain, etc.)
      • Psychiatric (e.g., mood, anxiety, psychotic disorders)
      • Primary sleep disorder (e.g., idiopathic, psychophysiologic [heightened arousal and learned sleep-preventing associations], paradoxical [sleep state misperception])
      • Circadian rhythm disorder (e.g., irregular pattern, jet lag, delayed/advanced sleep phase, shift work)
      • Environmental (e.g., lights, noises, movements [partner/young children/pets])
      • Behavioral (e.g., poor sleep hygiene, adjustment sleep disorder)
      • Substance induced
      • Medications (e.g., antihypertensives, antidepressants, corticosteroids, levodopa-carbidopa, phenytoin, quinidine, theophylline, thyroid hormones)

Genetics

Genetics

Genetics

No known factors

RISK FACTORS

RISK FACTORS

RISK FACTORS

  • Age
  • Female gender
  • Medical comorbidities
  • Unemployment
  • Psychiatric illness
  • Impaired social relationships
  • Shift work
  • Separation from spouse or partner
  • Drug and substance abuse
  • Family or personal history of insomnia

GENERAL PREVENTION

GENERAL PREVENTION

GENERAL PREVENTION

  • Practice consistent sleep hygiene:
    • Fixed wake-up times and bedtimes regardless of amount of sleep obtained (weekdays and weekends)
    • Avoid naps; go to bed only when sleepy.
    • Sleep in a cool, dark, quiet environment.
    • No activities in bedroom associated with anything but sleep or sex
    • 30-minute wind-down time before sleep
    • If unable to sleep within 20 minutes, move to another environment and engage in quiet activity until sleepy.
  • Limit caffeine intake to mornings.
  • No alcohol after 4 pm
  • Fixed eating times
  • Avoid medications that interfere with sleep.
  • Regular moderate exercise

COMMONLY ASSOCIATED CONDITIONS

COMMONLY ASSOCIATED CONDITIONS

COMMONLY ASSOCIATED CONDITIONS

  • Psychiatric disorders
  • Painful musculoskeletal conditions
  • Obstructive sleep apnea
  • Restless leg syndrome
  • Drug or alcohol addiction/dependence

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