Insomnia
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Basics
Description
- Difficulty initiating or maintaining sleep or nonrestorative sleep despite adequate opportunity and circumstances for sleep
- Causes at least one of the following forms of daytime impairment related to nighttime sleep difficulty:
- 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
- Predominant age: increases with age
- Predominant sex: female > male (5:1)
Prevalence
- 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
- Transient/intermittent (<30 days)
- Stress/excitement/bereavement
- Shift work
- Medical illness
- High altitude
- Chronic (>30 days)
- Medical: gastroesophageal reflux disease, sleep apnea, chronic pain, congestive heart failure, Alzheimer disease, Parkinson disease, chronic fatigue syndrome, irritable bowel syndrome
- Psychiatric: mood, anxiety, psychotic disorders
- Primary sleep disorder: idiopathic, psychophysiologic (heightened arousal and learned sleep-preventing associations), paradoxical (sleep state misperception)
- Circadian rhythm disorder: irregular pattern, jet lag, delayed/advanced sleep phase, shift work
- Environmental: light (liquid crystal display [LCD] clocks), noise (snoring, household, traffic), movements (partner/young children/pets)
- Behavioral: poor sleep hygiene, adjustment sleep disorder
- Substance induced
- Medications: antihypertensives, antidepressants, corticosteroids, levodopa-carbidopa, phenytoin, quinidine, theophylline, thyroid hormones
Pediatric Considerations
Transient insomnia occurs secondary to change of sleep position, nocturia, gastritis, back pain, and anxiety.
Risk Factors
- Age
- Female gender
- Medical comorbidities
- Unemployment
- Psychiatric illness
- Impaired social relationships
- Lower socioeconomic status
- Shift work
- Separation from spouse or partner
- Drug and substance abuse
General Prevention
- Practice consistent sleep hygiene:
- Fixed wake-up times and bedtimes regardless of amount of sleep obtained (weekdays and weekends)
- Go to bed only when sleepy.
- Avoid naps.
- Sleep in a cool, dark, quiet environment.
- No activities or stimuli 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
- Psychiatric disorders
- Painful musculoskeletal conditions
- Obstructive sleep apnea
- Restless leg syndrome
- Drug or alcohol addiction/dependence
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Basics
Description
- Difficulty initiating or maintaining sleep or nonrestorative sleep despite adequate opportunity and circumstances for sleep
- Causes at least one of the following forms of daytime impairment related to nighttime sleep difficulty:
- 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
- Predominant age: increases with age
- Predominant sex: female > male (5:1)
Prevalence
- 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
- Transient/intermittent (<30 days)
- Stress/excitement/bereavement
- Shift work
- Medical illness
- High altitude
- Chronic (>30 days)
- Medical: gastroesophageal reflux disease, sleep apnea, chronic pain, congestive heart failure, Alzheimer disease, Parkinson disease, chronic fatigue syndrome, irritable bowel syndrome
- Psychiatric: mood, anxiety, psychotic disorders
- Primary sleep disorder: idiopathic, psychophysiologic (heightened arousal and learned sleep-preventing associations), paradoxical (sleep state misperception)
- Circadian rhythm disorder: irregular pattern, jet lag, delayed/advanced sleep phase, shift work
- Environmental: light (liquid crystal display [LCD] clocks), noise (snoring, household, traffic), movements (partner/young children/pets)
- Behavioral: poor sleep hygiene, adjustment sleep disorder
- Substance induced
- Medications: antihypertensives, antidepressants, corticosteroids, levodopa-carbidopa, phenytoin, quinidine, theophylline, thyroid hormones
Pediatric Considerations
Transient insomnia occurs secondary to change of sleep position, nocturia, gastritis, back pain, and anxiety.
Risk Factors
- Age
- Female gender
- Medical comorbidities
- Unemployment
- Psychiatric illness
- Impaired social relationships
- Lower socioeconomic status
- Shift work
- Separation from spouse or partner
- Drug and substance abuse
General Prevention
- Practice consistent sleep hygiene:
- Fixed wake-up times and bedtimes regardless of amount of sleep obtained (weekdays and weekends)
- Go to bed only when sleepy.
- Avoid naps.
- Sleep in a cool, dark, quiet environment.
- No activities or stimuli 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
- Psychiatric disorders
- Painful musculoskeletal conditions
- Obstructive sleep apnea
- Restless leg syndrome
- Drug or alcohol addiction/dependence
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