Sleep Disorders
General Facts about Insomnia
1 - the inability to get the amount of sleep needed to function efficiently during the day
2 - not a disease, but a symptom to be investigated
3 - may be associated with organic disease (ie. arthritis, heart disorder)
4 - may be a symptom of depression
5 - may be caused by a person’s lifestyle
6 - can be temporarily abolished by administration of a drug
7 - bad to take medication for relief without investigating the underlying cause
8 - associated with increased mortality, poor career performance, over-eating, & increased hospitalization
9 - up to 35% of Americans complain of difficulty sleeping
10 - up to 18% of Americans complain of serious sleep problems
11 - approximately 4% of Americans receive prescription to help them sleep
Transient Insomnia
1 - can be caused by stress, jet lag, or physical environment
2 - may last several days
3 - can generally be relieved by exercise, a hot bath, warm milk, daytime napping, changing bedroom environment
Short-Term Insomnia
1 - result of stress, illness, or bereavement
2 - may linger for up to three weeks
Long-Term Insomnia
1 - lasts for more than three weeks
2 - calls for an extensive diagnostic examination by a sleep disorder specialist
Insomnia Related to Another Mental Disorder
1 - more than 1/2 of insomnia cases are related to depression, anxiety, or psychological stress
2 - early morning wakefulness can be a sign of depression
3 - sudden, dramatic decrease in sleep may be a sign of mania or schizophrenia
4 - poor sleep may suggest obsessive-compulsive disorder
5 - panic episodes during sleep suggest panic disorder
6 - alcohol causes numerous awakenings during the night for long periods of time
Insomnia in Children
1 - usually from stress
2 - problem resides within the sleep-wake circuits of the brain stem or within neurochemical balances impinging on these circuits
3 - children with insomnia have often been poor sleepers since birth
4 - medication is not recommended for most children
Insomnia in the Elderly
1 - often the result of changes in the body’s "internal clock"
2 - the elderly often experience depression or anxiety disorders which can disturb sleeping patterns
3 - the elderly often suffer from Alzheimer’s disease which can affect sleeping
4 - the elderly are prone to become confused & restless at night in the dark
5 - the elderly are often more sensitive than others to medication due to a less functioning liver & a more sensitive nervous system
6 - medication tends to linger for a long time in the bodies of elderly patients
7 - careful assessment is necessary when prescribing sleeping pills for the elderly
Treatments
1 - Benzodiazepines
a. flurazepam (Dalmane)/long-lasting & may cause drowsiness
b. temazepam (Restoril)/intermediate acting agent
c. triazolam (Halcion)/short-acting with no sedation
d. affect memory (learning new information) when taken in large doses
e. should not be used on a long-term basis/decrease in efficacy over time
2 - tricyclic antidepressants
3 - talk therapy
4 - cognitive therapy &/or stress management
5 - relaxation therapies
a. abdominal breathing, progressive muscle relaxation, meditation, imaging, hypnosis
b. biofeedback, stimulus control, sleep curtailment, light therapy
c. exercise, hot bath, warm milk, daytime napping, changing bedroom environment
d. may be used in combination with medication
6 - sometimes several treatments are necessary
