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.