Insomnia

							Insomnia
             What is insomnia?
• Insomnia can include some or all of the following
  common symptoms:
• Lying awake for a long time at night before getting to
  sleep.
• Waking up several times in the middle of the night.
• Waking up early in the morning (and not being able to
  get back to sleep).
• Feeling tired and not refreshed by sleep.
• Inability to function properly during the day,
  especially having difficulty concentrating.
• Irritability due to lack of sleep.
            Physical insomnia
• Physical
• Insomnia can be caused by an underlying physical
  condition causing involuntary movement, pain or
  discomfort. Examples include:
• Restless leg syndrome,
• Coughing,
• Arthritis, headaches and back pain,
• Hot flushes (due to the menopause),
• Head injury,
• Gastrointestinal disorders, e.g. ulcers,
• Pruritus (excessive itching), and Parkinson's disease.
   If we need sleep….why cant
       some people sleep?
• The causes can be split into a number of
  categories:
• Physical
• Medical
• Psychological
• Pharmacological
• Physiological
• To name a few..
Primary and secondary symptoms.
•   Primary insomnia is characterised by symptoms of difficulty in falling
    asleep, waking several times during sleep, and fatigue.

•   These symptoms last for a month and has unknown cause.



This is how the professionals
distinguish between the types
of symptoms.




•   Secondary insomnia-there is a known underlying medical condition.
    Depression is major cause of secondary insomnia.
       Psychological & Psychiatric
                insomnia
• Loss or worry can make sleeping difficult, caused by events such
  as:
• Bereavement,
• Relationship problems,
• Exam stress,
• Work worries, and
• Anxieties about being unable to sleep.
•

• Psychiatric
• Underlying mental health problems can affect your sleeping
  patterns, such as:
• Depression,
• Dementia, or anxiety
         Physiological Insomnia
• Disruptions within the sleeping environment or to bedtime
  routines can cause insomnia. Factors include:
• noise,
• light,
• snoring,
• partner moving about,
• jet lag,
• activities before bedtime, like reading or exercise.
•

• If you are a night or shift worker, your job can disturb your
  ability to sleep properly as your natural body clock will be
  affected. This is because your body is designed to release awake
  chemicals when there is daylight and sleepy chemicals when it
  gets dark.
                  Pharmacological
•   Sleeping problems can result from the effects of medicines.

•   Withdrawal from certain medicines such as hypnotics (prescribed for
    short-term insomnia) may cause re-bound insomnia, which means if you
    stop taking them, the sleeping problems can come back.

•   Taking other medicines can produce side effects reduce the quality of
    sleep, for example:
•   alcohol,
•   antidepressants,
•   appetite suppressants,
•   decongestants,
•   thyroid hormones,
•   beta-blockers and
•   corticosteroids
    Other treatments/actions that
            can be taken..
•   Avoid caffeine, alcohol, or nicotine before bed.
•   Don't take daytime naps.
•   Eat at regular times each day (avoid large meals near bedtime).
•   Exercise early in the day.
•   Get out of bed if you are not asleep after 5 - 10 minutes and do
    something else (going to another room may help reduce your
    anxiety about falling asleep).
•   Go to bed at the same time every night.
•   Keep comfortable sleeping conditions.
•   Remove the anxiety that comes with trying to sleep by
    reassuring yourself that you will sleep or by distracting yourself.
•   Use the bed only for sleep and sex.
•   Practice evening relaxation routines such as muscle relaxation or
    meditation.
    What other conditions may effect
               insomnia?
• Sleep apnea is a common related condition and is defined
  by the sufferer not breathing/decreased breathing
  whilst asleep.
• There are two types of apnea:
• *Sleep apnea (most common)
• Common central sleep apnea (least common)

• *Although cases are usually diagnosed on the basis of a
  patients history there are several tests that can be
  carried out to formally diagnose the condition.
          Sleep Apnea cont..
• Apnea occurs when a person stops breathing
  for 10 seconds or more. So, if normal breath
  airflow is 70% to 100%, an apnea is if you stop
  breathing completely, or take less than 25%
  of a normal breath (for a period that lasts 10
  seconds or more). This definition includes
  complete stoppage of airflow.
         Sleep Apnea cont…
• Apneas are usually measured during sleep
  (preferably in all stages of sleep) over a two-
  hour period. An estimate of the severity of
  apnea is calculated by dividing the number of
  apneas by the number of hours of sleep, giving
  an apnea index (AI).

• The greater the AI, the more severe the
  apnea.
  What does apnea look like?
• An apnea event has 4 components.
• First, the airway collapses.
• Second, an effort is made to take a breath,
  but is unsuccessful.
• Third, the oxygen level in the blood drops.
• Finally, when the amount of oxygen reaching
  the brain decreases, the brain signals the
  body to wake up and take a breath. (This is
  what the bed partner hears as a silence
  followed by a gasp for air.)
         Huh??? Basically…..
• The muscles of breathing work to expand the
  chest and lower the diaphragm to draw in a breath
  of air.
• The negative pressure literally sucks air into the
  lungs.
• The nasal passages, palate, tongue, and pharyngeal
  tissues can all contribute to narrowing of the
  airway.
• If during an attempt to breathe, the airway
  collapses; the tissues of the airway are sucked
  together by the negative pressure.
• The harder the chest tries to pull air in, the
  greater the negative pressure, and the more the
  tissues of the airway are sealed together.
• Finally, when the oxygen in the blood stream
  decreases, the person wakes up or the level of
  sleep becomes more shallow.
   How common is obstructive sleep
              apnea?
• Obstructive sleep apnea (OSA) is estimated
  to affect about 4% of men and 2% of women.
• In one study of people over 18 years of age,
  obstructive sleep apnea was estimated to
  develop in 1.5 % of people per year over the 5
  year study.

• (It is probably more common than either of
  these numbers because the population is
  becoming more obese, and obesity worsens
  obstructive sleep apnea).
           Some more facts!
• Men are more likely to have obstructive sleep apnea
  than women before age 50.
• After age 50, the risk is the same in men and women.



• Among obese patients, 70% have obstructive sleep
  apnea. Obstructive sleep apnea worsens in severity
  and prevalence with increasing obesity.
• Among cardiac patients, 30-50% have obstructive
  sleep apnea, and among patients with strokes, 60%
  have obstructive sleep apnea.