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'''For patient information click [[Insomnia (patient information)|here]]'''
'''For patient information click [[Insomnia (patient information)|here]]'''
{{Insomnia}}
{{CMG}}; {{AE}} {{Adnan Ezici}} , {{AF}} , {{KS}} , {{JC}} , {{NS}}


{{Infobox_Disease |
{{SK}} Insomnia disorder
  Name          = {{PAGENAME}} |
  Image          = |
  Caption        = |
  DiseasesDB    = 26877 |
  ICD10          = {{ICD10|F|51|0|f|50}}, {{ICD10|G|47|0|g|40}} |
  ICD9          = {{ICD9|307.42}}, {{ICD9|307.41}}, {{ICD9|780.51}}, {{ICD9|780.52}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = 000805 |
  MeshID        = D007319 |
}}
{{SI}}
{{CMG}}; {{AE}} {{KS}},{{JC}}


{{SK}} Insomnia disorder
==[[Insomnia overview|Overview]]==


==Overview==
'''Insomnia''' is a [[sleep disorder]]  characterized by an inability to [[sleep]] and/or inability to remain asleep for a reasonable period. Insomniacs typically complain of being unable to close their eyes or "rest their mind" for more than a few minutes at a time. Both organic and nonorganic insomnia constitute a [[sleep disorder]].<ref>http://www3.who.int/icd/currentversion/fr-icd.htm?gf50.htm+f510 </ref><ref>http://www3.who.int/icd/currentversion/fr-icd.htm?gg40.htm+g47 </ref>


==Classification==
==[[Insomnia historical perspective|Historical Perspective]]==
===Types of insomnia===
Three types of insomnia exist: transient, acute, and chronic
#'''Transient insomnia''' lasts from one night to a few weeks. Most people occasionally suffer from transient insomnia due to such causes as [[jet lag]] or short-term anxiety. If this form of insomnia continues to occur from time to time, the insomnia is classified as intermittent.
#'''[[Acute (medical)|Acute]] insomnia''' is the inability to consistently sleep well for a period of between three weeks to six months.
#'''[[chronic (medicine)|Chronic]] insomnia''' is regarded as the most serious; persists almost nightly for at least a month.


===Patterns of Insomnia===
The pattern of insomnia often is related to the etiology.[http://www.emedicine.com/MED/topic609.htm]
# Initial insomnia - difficulty falling asleep at the beginning of the night, often associated with [[anxiety disorder]]s.
# Middle insomnia - waking during the middle of the night, difficulty maintaining sleep. Often associated with pain syndromes or medical illness.
# Terminal (or late) insomnia - early morning waking. Characteristic of [[Clinical depression]].


==Causes==
==[[Insomnia pathophysiology|Pathophysiology]]==
===Common Causes===
*[[Alcoholism]]
*[[Anxiety disorder]]
*[[Caffeine]]
*[[Depression]]
*[[Medication]]
*[[Sleep disorder]]
*[[Stress (medicine)|Stress]]


===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |[[chronic stable angina|Angina]], [[buerger's disease]], [[congestive cardiac failure]], [[hypertension]], [[ischemic heart disease]], [[coronary heart disease|ischemic heart disease]], [[Nocturnal angina pectoris|nocturnal angina]], [[sleep apnea]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical/Poisoning'''
|bgcolor="Beige"|[[Acrodynia]], [[aldehyde dehydrogenase|Aldehyde syndrome]], [[antimony]], [[asbestosis]], [[benzoate ]], [[Cathinone|cathinone poisoning]], [[celery]], [[contact dermatitis|chemical-related eczema]], [[cumin]], [[erythrosine]], [[ethylbenzene]], [[gasoline]], [[Natural gasoline|gasoline]], [[contact dermatitis|irritant contact eczema]], [[lead]], [[mercury poisoning]], [[monocrotophos]], [[monosodium glutamate|Msg]], [[parsley]], [[Quinoline Yellow SS|quinoline yellow]], [[RDX|rdx]], silo unloader syndrome, [[sulfite]], [[sunset yellow]], [[tartrazine]], [[tetryl]], [[toluene]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| [[Dental caries|Dental problems]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"|[[contact dermatitis|Chemical-related eczema]], [[eczema]], [[Contact dermatitis|environmental allergen related eczema]], [[atopic dermatitis|erythrodermic eczema]],[[Contact dermatitis|chemical-related eczema]], [[dermatomyositis|eyelid eczema]],[[contact dermatitis|irritant contact eczema]], [[lyme disease]], [[Mycosis fungoides|mycosis fungoides,familial]], [[itch|pruritus]], [[systemic lupus erythematosus|sle related fibromyalgias]], [[eczema|stress-related eczema]], [[eczema|temperature-related eczema]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"|        [[4-Aminopyridine]],[[abecarnil]], [[alcohol withdrawal|alcohol withdrawal syndrome]], [[alemtuzumab]], [[amantadine]], [[Zolpidem|ambien withdrawal]], [[3,4-Diaminopyridine|amifampridine]],  [[aminophylline]], [[amobarbital sodium]], [[amoxicillin]], [[antidepressants]], [[armodafinil]], [[aspirin]], [[benzodiazepine withdrawal syndrome|ativan withdrawal]], [[benzphetamine]], [[beta blockers|beta antagonists]], [[bronchodilators]], [[bupropion]], [[Caffeine]], [[depressant|central nervous system depressants]], [[Stimulant|central nervous system stimulants]], [[Amphetamine|chronic amphetamine use]], [[clomifene]] , [[clonazepam]], [[clonidine]], [[cocaine withdrawal (patient information)|cocaine withdrawal]], [[cocaine withdrawal (patient information)|crack withdrawal]], [[dalfampridine]], [[dapsone]], [[Meperidine|demerol withdrawal]], [[desmopressin]], [[desmopressin]], [[Morphine Oral (patient information)|morphine withdrawal]], [[dextroamphetamine|dexamfetamine]], [[meperidine (patient information)|dexedrine withdrawal]], [[diazepam]], [[diflunisal]] ,  [[hydromorphone|dilaudid withdrawal]], [[dimebon]], [[Meperidine (patient information)|dxedrine withdrawal]], [[ecstasy withdrawal]], [[eculizumab]],[[efavirenz]], [[eribulin]], [[escitalopram]], [[felbamate]],[[fluvoxamine]],  [[flibanserin]], [[glucocorticoids]], [[levofloxacin]], [[morphine|hydrocodone withdrawal]], [[isoproterenol (aerosol)]], [[Mepenzolate|lacosamidemepenzolate]],  [[lamotrigine]], [[lisdexamfetamine]], [[lorazepam]], [[lysergic acid diethylamide]], [[melatonin]],[[mepenzolate|lacosamidemepenzolate]], [[meropenem]],  [[meropenem]], [[methcathinone]], [[methcathinone]], [[methylenedioxymethamphetamine]], [[methylphenidate]], [[middle ear infection]], [[milnacipran hydrochloride]], [[modafinil]], [[opioid withdrawal]],[[naltrexone]], [[oxazepam]], [[ofloxacin]], [[oxymetazoline]], [[oxycodone|oxycontin withdrawal]], [[peramivir]], [[oxycodone|percocet withdrawal]], [[pergolide]], [[paroxetine]],[[phentermine]], [[phentermine]],[[posaconazole]], [[pramipexole]], [[pregabalin]], [[propranolol]], [[pyrimethamine]], [[ramelteon]], [[methylphenidate|ritalin withdrawal]], [[rotigotine]], [[selegiline]], [[sesame]], [[sibutramine]], [[sulindac]], [[smoking|smoking especially at bedtime]], [[steroid withdrawal syndrome]], [[suvorexant]], [[tacrolimus]], [[tartrazine]], [[tasimelteon]], [[temazepam]], [[temozolomide]] , [[terbutaline]], [[tetryl]], [[thalidomide]], [[tolcapone]], [[toluene]], |[[topiramate]], ,[[ribavirin|tribavirin]], [[rifaximin]], [[romiplostim]],[[varenicline]], [[lortab|vicodin withdrawal]], [[vilazodone]], [[zolpidem|withdrawal of sleeping pills]], [[alprazolam|xanax withdrawal]], [[zonisamide]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"|[[sinusitis|Acute sinusitis]], [[otalgia|earache]], [[otitis media|middle ear infection]],
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"|[[Andropause]], [[Cushing's syndrome|cushing's diseases]], [[hyperthyroidism]], [[melatonin]], [[menopause]], [[menstruation]], [[Pituitary adenoma|pituitary tumors]], [[Effects of alcohol on the body|alcohol-induced pseudo-cushing syndrome]], [[Hypocalcemia|calcium deficiency]], [[Cushing's syndrome|cushing's diseases]], [[diabetes mellitus|diabetes]], [[graves disease]], [[hashimoto's thyroiditis|autoimmune thyroid diseases]], [[hyperthyroidism]], [[hypocalcemia|calcium deficiency]], [[melatonin]], [[menopause]], [[menstruation]], [[pineal teratoma]], [[pinealoma]], [[pituitary adenoma|pituitary tumors]], [[premenstrual dysphoric disorder|premenstrual dysphoric disorders]], [[premenstrual syndrome]], [[thyroid hormone resistance|resistance to thyroid stimulating hormone]],
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| [[sleep disorder|disrupted sleep schedules]], [[dyssomnia]], [[contact dermatitis|environmental allergen related eczema]], [[Acute mountain sickness|high altitude]],[[injury]],[[chronic stress]], [[sleep hygiene|inadequate sleep hygiene]], [[jet lag]], [[light]], [[noise]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Acute intermittent porphyria]], [[cirrhosis|cirrhosis of liver]], [[colic]],[[congenital hepatic porphyria]], [[Glucocorticoids]],[[Indigestion]],[[Inflammatory bowel disease]], [[congenital hepatic porphyria]], [[Helicobacter pylori infection|duodenal ulcers]], [[Food allergies]], [[gastroesophageal reflux disease]], [[visceroptosis|glenard syndrome]], [[wheat allergy|gluten allergy]], [[heartburn]], [[indigestion]], [[inflammatory bowel disease]], [[peptic ulcer|peptic ulcer disease]], [[esophagitis|reflux esophagitis]], [[food allergy|seafood allergy]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Acute intermittent porphyria]], [[congenital hepatic porphyria]],[[Down syndrome|Down's syndrome associated alzheimer's disease]], [[down syndrome|down's syndrome associated alzheimer's disease]], [[huntington's disease]], [[maple syrup urine disease|inborn amino acid metabolism disorder]], [[Neuralgia|Neuromuscular disorders including painful peripheral neuropathies]], [[autosomal dominant nocturnal frontal lobe epilepsy|nocturnal frontal lobe epilepsy type 1]], perry syndrome, phenol sulfotransferase deficiency, [[pick's disease]], [[Fatal familial insomnia|prion fatal familial insomnia]], [[variegate porphyria]], [[Wiskott-Aldrich syndrome|wiskott-aldrich syndrome]], x-linked angelman-like syndrome
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"|[[Aplastic anemia]], [[Iron deficiency anemia|iron-deficiency anemia]], [[Mycosis fungoides|mycosis fungoides,familial]], [[Wiskott-Aldrich syndrome|wiskott-aldrich syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| no underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"|[[Immunodeficiency|Acquired immunodeficiency syndromes]], [[ascariasis ]], [[Creutzfeldt-Jakob disease|creutzfeldt-jakob disease]], [[Helicobacter pylori infection|Duodenal ulcers]], [[african trypanosomiasis|east african trypanosomiasis]], [[Chronic fatigue syndrome (patient information)|Epstein barr virus related fibromyalgias]], [[Lyme disease]], [[peptic ulcer|peptic ulcer disease]], [[trigeminal neuralgia]], [[african trypanosomiasis|west african trypanosomiasis]], [[intestinal parasite|worms]], [[urinary tract infection]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"|[[Arthritis]],[[Restless legs syndrome]], [[fibromyalgia]], [[Chronic fatigue syndrome (patient information)|Epstein barr virus related fibromyalgias]],[[cramp|leg cramps]], [[tension myositis syndrome|tension myositis related fibromyalgias]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|[[altitude sickness|Acute mountain sickness]], [[chronic fatigue syndrome|allergic tension-fatigue syndrome]], [[alzheimer disease]], [[brain damage|brain injury]], [[brain tumor]], [[chronic pain]], [[sleep apnea|central sleep apnea]], [[stroke|cerebral hemispheric and brainstem strokes]], [[cluster headache]],[[concussion|brain concussion]], [[Creutzfeldt-Jakob disease|creutzfeldt-jakob disease]], [[diaphragmatic paralysis]], [[chronic fatigue syndrome (patient information)|epstein barr virus related fibromyalgias]], [[fatal familial insomnia]], [[De Vivo disease|glut-1 deficiency syndrome]], [[headache|headache syndromes]], [[huntington's disease]], [[maple syrup urine disease|inborn amino acid metabolism disorder]], [[circadian rhythm sleep disorder|irregular sleep-wake rhythm disorder]], [[jet lag]], [[concussion|mild traumatic brain injury]], [[movement disorders]], [[neuralgia|neuromuscular disorders including painful peripheral neuropathies]], [[autosomal dominant nocturnal frontal lobe epilepsy|nocturnal frontal lobe epilepsy type 1]],[[Blood-brain barrier|glucose transport defect]], [[nocturnal myoclonus]], [[olivopontocerebellar atrophy]], [[pain]], [[parkinson's disease]], [[perry syndrome]], [[pick's disease]],[[respiratory muscle paralysis]], [[obesity hypoventilation syndrome|pickwickian syndrome]], [[fatal familial insomnia|prion fatal familial insomnia]], [[restless legs syndrome|restless leg syndrome]],[[seizure|seizures]], [[gerstmann syndrome|right parietal lobe syndrome]], [[epilepsy classification|rolandic epilepsy]], [[sleep apnea]], [[sleep paralysis]], [[sopite syndrome]], [[traumatic brain injury|traumatic brain injury causing post-traumatic insomnia]], [[trigeminal neuralgia]], [[pain|ulcer pain]], [[wernicke-korsakoff syndrome]], [[x-linked angelman-like syndrome]],
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"|[[aldehyde dehydrogenase|aldehyde syndrome]], [[alzheimer disease]], [[amaranth]], [[anise|aniseed]], [[achiote|Annatto]], [[antioxidants]], [[capsicum|bell pepper]], [[butylated hydroxyanisole|bha]], [[butylated hydroxytoluene|bht]], [[hypocalcemia|calcium deficiency]], [[carrageenan|carageenan gum]], [[carmine]], [[chestnut]], [[cinnamon]], [[dementia]], [[fennel]], [[folic acid toxicity]], [[De Vivo disease|glut-1 deficiency syndrome]], [[guar gum]], [[acacia senegal|gum acacia]], [[hops]], [[iron deficiency anemia]], [[lecithin]], [[lentil]], [[lettuce]], [[milk]], [[monosodium glutamate|msg]], [[mussel]],[[niacin]], [[parkinson's disease]], [[phenol sulfotransferase deficiency]], [[pyridoxine deficiency]], [[quorn]], [[beriberi|thiamine deficiency]], [[thyme]], [[Vitamin B12 deficiency|vitamin B12 deficiency]], [[wernicke-korsakoff syndrome]], [[wheat]], [[xanthan gum]], [[zucchini]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"|[[Brain tumor]], [[cancer]], [[mycosis fungoides|mycosis fungoides, familial]], pineal teratoma, [[pinealoma]], [[pituitary adenoma|pituitary tumors]]
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| [[Acrodynia]], [[alcoholism]], [[amphetamine|amphetamine intoxication]], [[amphetamine|chronic amphetamine use]], [[Hypervitaminosis A|chronic vitamin a toxicity]], [[caffeine|excessive caffeine]], [[folic acid toxicity]], [[ginseng|ginseng overuse]], [[guarana|guarana overuse]], [[thiamine|vitamin b1 toxicity]], Marie-seé syndrome
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"|[[advanced sleep phase syndrome|Advanced sleep-wake phase disorder]], [[alzheimer disease]], [[amphetamine detailed information|amphetamine abuse]], [[amphetamine|chronic amphetamine use]], [[analgesic|pain killer addiction]], [[anger]], [[anxiety disorder]], [[anxiety disorder|fear of not sleeping]], [[barbiturate|barbiturate abuse]], [[benzodiazepine|benzodiazepine abuse]], [[bipolar disorder|bipolar affective disorder]], [[bipolar disorder|disturbing thoughts]], [[bruxism|teeth grinding]], [[burnout syndrome]], [[butorphanol]], [[chronic fatigue syndrome|allergic tension-fatigue syndrome]], [[chronic pain]], [[chronic stress]], [[circadian rhythm sleep disorder|irregular sleep-wake rhythm disorder]], [[cluster headache]], [[cocaine|cocaine abuse]], [[combat stress reaction]], [[crack cocaine|crack addiction]], [[Methamphetamine addiction|crystal meth addiction]], [[delayed sleep phase syndrome|delayed sleep-wake phase disorder]], [[dementia]], [[depression|primary affective disorder]], [[dyssomnia]], [[dysthymia|double depression]], [[effects of alcohol on the body|alcohol-induced pseudo-cushing syndrome]], [[excited state|exhilaration or excitement]], [[fatal familial insomnia|prion fatal familial insomnia]], [[generalized anxiety disorder]], [[grief]], [[heroin|heroin dependence]], [[hypervigilance|increased arousal]], [[illness]], [[jet lag]], [[lysergic acid diethylamide|lsd addiction]], [[lysergic acid diethylamide|lysergic acid diethylamide]], [[mania]], [[methylenedioxymethamphetamine detailed information|ecstasy abuse]], [[mood disorder]], [[narcolepsy]], [[narcolepsy|daytime napping]], [[narcotic|narcotic addiction]], [[night eating syndrome]],[[nightmare|nightmares]], [[nocturia]], [[nocturnal myoclonus]], [[opioid abuse and dependence|opioid addiction]], [[overeating]], [[oxycodone|oxycontin addiction]], [[panic disorder|nocturnal panic disorder]], [[parasomnia|parasomnias]], [[parkinson's disease]], [[pick's disease]], [[post traumatic stress disorder|post-traumatic stress]], [[postnatal depression|postpartum depression]], [[premenstrual dysphoric disorder|premenstrual dysphoric disorders]], [[primary insomnia]], [[psychiatric disorders]], [[psychogenic dwarfism|abuse dwarfism syndrome]], [[rape trauma syndrome|rape trauma syndromes]], [[rapid eye movement behavior disorder|rem-behavior disorder]], [[rett syndrome|rett's syndromes]], [[schizophrenia]], [[seasonal affective disorder|holiday depression]], [[sedative|sedative dependence]], [[sedative|sleeping pill addiction]], [[sedative|tranquilizer addiction]], [[sedative|tranquilizer withdrawal]], [[sedentary lifestyle|not enough exercise]], [[shift work sleep disorder|endogenous insomnia]], [[shift work]], [[sleep deprivation|chronic sleep restriction]], [[sleep disorder]], [[sleep disorder|situational/acute insomnia]], [[sleep hygiene|chronic insomnia disorder]], [[sleepwalking|somnambulism]], [[stress (medicine)|stress]], [[substance abuse]], [[tension myositis syndrome|tension myositis related fibromyalgias]], [[withdrawal|discontinuation syndrome]], [[perry syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"|[[altitude sickness|Acute mountain sickness]],[[Sleep apnea|breathing-related sleep disorder]], [[nocturnal asthma]],  diaphragmatic paralysis,
[[asbestosis]], [[asthma|bronchial asthma including nocturnal asthma]], [[chronic obstructive pulmonary disease]], [[dyspnea|shortness of breath]], [[nocturnal asthma]], [[obesity hypoventilation syndrome|pickwickian syndrome]], respiratory muscle paralysis, silo unloader syndrome, [[sleep and breathing|sleep-disordered breathing]], [[sleep apnea]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| [[hypocalcemia|Calcium deficiency]], [[chronic renal failure|chronic renal disease]], [[nephrology|kidney disease]], [[renal insufficiency|renal failure]], [[systemic lupus erythematosus|SLE related fibromyalgias]], [[chronic renal failure pathophysiology|uremia]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"|[[Hashimoto's thyroiditis|Autoimmune thyroid diseases]], [[Chronic fatigue syndrome (patient information)|Epstein barr virus related fibromyalgias]],[[Inflammatory bowel disease]], [[Asthma|Bronchial asthma including nocturnal asthma]], [[Sleep hygiene|chronic insomnia disorder]], [[Fibromyalgia|fibromyalgias]], [[buerger's disease]], [[chronic fatigue syndrome|allergic tension-fatigue syndrome]], [[contact dermatitis|environmental allergen related eczema]], [[dermatomyositis|eyelid eczema]], [[food allergy|seafood allergy]], [[graves disease]], [[hashimoto's thyroiditis|autoimmune thyroid diseases]], [[inflammatory bowel disease]], [[rheumatoid arthritis|rheumatoid arthritis related fibromyalgias]], [[systemic lupus erythematosus|SLE related fibromyalgias]], [[thyroid hormone resistance|resistance to thyroid stimulating hormone]], [[wheat allergy|gluten allergy]], [[Wiskott-Aldrich syndrome|wiskott-aldrich syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"|[[Brain concussion]], [[concussion|mild traumatic brain injury]], [[post-traumatic stress]], [[post-concussion syndrome|postconcussive syndrome]], [[traumatic brain injury|traumatic brain injury causing post-traumatic insomnia]], [[whiplash|whiplashs]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"|[[Benign prostatic hyperplasia|enlarged prostate]], [[Megacystis|Bladder distention]], [[Urinary retention|enlarged bladder]], [[Benign prostatic hyperplasia|Enlarged prostate]], [[chronic renal failure pathophysiology|uremia]], [[cystitis]] , [[prostatitis]], [[urinary tract infection]]
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Ageing]], [[Chronic pain]], [[Chronic stress]], [[dyssomnia]], [[hunger]], [[illness]], [[injury]], [[pregnancy]]
|-
|}


===Causes in Alphabetical Order===
==[[Insomnia classification|Classification]]==
{{columns-list|3|
*[[4-Aminopyridine]]
*[[Abecarnil]]
*[[Psychogenic dwarfism|Abuse dwarfism syndrome]]
*[[Immunodeficiency|Acquired immunodeficiency syndromes]]
*[[Acrodynia]]
*[[Acute intermittent porphyria]]
*[[Altitude sickness|Acute mountain sickness]]
*[[Pain|Acute pain]]
*[[Sinusitis|Acute sinusitis]]
*[[Advanced sleep phase syndrome|Advanced sleep-wake phase disorder]]
*[[Ageing]]
*[[Alcohol withdrawal|Alcohol withdrawal syndrome]]
*[[Effects of alcohol on the body|Alcohol-induced pseudo-cushing syndrome]]
*[[Alcoholism]]
*[[Aldehyde dehydrogenase|Aldehyde syndrome]]
*[[Alemtuzumab]]
*[[Chronic fatigue syndrome|Allergic tension-fatigue syndrome]]
*[[Alzheimer disease]]
*[[Amantadine]]
*[[Amaranth]]
*[[Zolpidem|Ambien withdrawal]]
*[[3,4-Diaminopyridine|Amifampridine]]
*[[Aminophylline]]
*[[Amobarbital sodium]]
*[[Amoxicillin]]
*[[Amphetamine detailed information|Amphetamine abuse]]
*[[Amphetamine|Amphetamine intoxication]]
*[[Andropause]]
*[[Anemia]]
*[[Anger]]
*[[Chronic stable angina|Angina]]
*[[Anise|Aniseed]]
*[[Achiote|Annatto]]
*[[Antidepressants]]
*[[Antimony]]
*[[Antioxidants]]
*[[Anxiety disorder]]
*[[Aplastic anemia]]
*[[Armodafinil]]
*[[Arthritis]]
*[[Asbestosis]]
*[[Ascariasis ]]
*[[Aspirin]]
*[[Asthma]]
*[[Benzodiazepine withdrawal syndrome|Ativan withdrawal]]
*[[Hashimoto's thyroiditis|Autoimmune thyroid diseases]]
*[[Barbiturate|Barbiturate abuse]]
*[[Capsicum|Bell pepper]]
*[[Benign prostatic hyperplasia]]
*[[Benzoate]]
*[[Benzodiazepine|Benzodiazepine abuse]]
*[[Benzphetamine]]
*[[Beta blockers|Beta antagonists]]
*[[butylated hydroxyanisole|BHA]]
*[[butylated hydroxytoluene|BHT]]
*[[Bipolar disorder|Bipolar affective disorder]]
*[[Megacystis|Bladder distention]]
*[[Concussion|Brain concussion]]
*[[Brain damage|Brain injury]]
*[[Brain tumor]]
*[[Sleep apnea|Breathing-related sleep disorder]]
*[[Asthma|Bronchial asthma including nocturnal asthma]]
*[[Bronchodilators]]
*[[Buerger's disease]]
*[[Bupropion]]
*[[Burnout syndrome]]
*[[Butorphanol]]
*[[Hypocalcemia|Calcium deficiency]]
*[[Cancer]]
*[[Carrageenan|Carageenan gum]]
*[[Carmine]]
*[[Cathinone|Cathinone poisoning]]
*[[Celery]]
*[[Depressant|Central nervous system depressants]]
*[[Stimulant|Central nervous system stimulants]]
*[[Sleep apnea|Central sleep apnea]]
*[[Stroke|Cerebral hemispheric and brainstem strokes]]
*[[Contact dermatitis|Chemical-related eczema]]
*[[Chestnut]]
*[[Congestive heart failure|CHF]]
*[[Amphetamine|Chronic amphetamine use]]
*[[Chronic fatigue syndrome]]
*[[Sleep hygiene|Chronic insomnia disorder]]
*[[Chronic obstructive pulmonary disease]]
*[[Chronic pain]]
*[[Chronic renal failure|Chronic renal disease]]
*[[sleep deprivation|Chronic sleep restriction]]
*[[Chronic stress]]
*[[Hypervitaminosis A|Chronic vitamin A toxicity]]
*[[Cinnamon]]
*[[Circadian rhythm sleep disorder]]
*[[Cirrhosis|Cirrhosis of liver]]
*[[Clomifene]]
*[[Clonazepam]]
*[[Clonidine]]
*[[Cluster headache]]
*[[Cocaine|Cocaine abuse]]
*[[Cocaine withdrawal (patient information)|Cocaine withdrawal]]
*[[Colic]]
*[[Combat stress reaction]]
*[[Congenital hepatic porphyria]]
*[[Congestive heart failure|Congestive cardiac failure]]
*[[Crack cocaine|Crack addiction]]
*[[Cocaine withdrawal (patient information)|Crack withdrawal]]
*[[Creutzfeldt-Jakob disease|Creutzfeldt-jakob disease]]
*[[Methamphetamine addiction|crystal meth addiction]]
*[[Cumin]]
*[[Cushing's syndrome|Cushing's diseases]]
*[[Cystitis]]
*[[Dalfampridine]]
*[[Dapsone]]
*[[Narcolepsy|Daytime napping]]
*[[Delayed sleep phase syndrome|Delayed sleep-wake phase disorder]]
*[[Dementia]]
*[[Meperidine|Demerol withdrawal]]
*[[Dental caries|Dental problem]]
*[[Depression]]
*[[Desmopressin]]
*[[Dextroamphetamine|Dexamfetamine]]
*[[Meperidine (patient information)|Dexedrine withdrawal]]
*[[Diabetes mellitus|Diabetes]]
*[[Diaphragmatic paralysis]]
*[[Diazepam]]
*[[Diflunisal]]
*[[Hydromorphone|Dilaudid withdrawal]]
*[[Dimebon]]
*[[Withdrawal|Discontinuation syndrome]]
*[[Sleep disorder|Disrupted sleep schedules]]
*[[Bipolar disorder|Disturbing thoughts]]
*[[Dysthymia|Double depression]]
*[[Down syndrome|Down's syndrome associated alzheimer's disease]]
*[[Helicobacter pylori infection|Duodenal ulcers]]
*[[Dyssomnia]]
*[[Otalgia|Earache]]
*[[African trypanosomiasis|East African trypanosomiasis]]
*[[Methylenedioxymethamphetamine detailed information|Ecstasy abuse]]
*[[Ecstasy withdrawal]]
*[[Eculizumab]]
*[[Eczema]]
*[[Efavirenz]]
*[[Shift work sleep disorder|Endogenous insomnia]]
*[[Urinary retention|Enlarged bladder]]
*[[Benign prostatic hyperplasia|Enlarged prostate]]
*[[Contact dermatitis|Environmental allergen related eczema]]
*[[Chronic fatigue syndrome (patient information)|Epstein barr virus related fibromyalgias]]
*[[Eribulin]]
*[[Atopic dermatitis|Erythrodermic eczema]]
*[[Erythrosine]]
*[[Escitalopram]]
*[[Ethylbenzene]]
*[[Caffeine|Excessive caffeine]]
*[[Exemestane]]
*[[Excited state|Exhilaration or excitement]]
*[[Dermatomyositis|Eyelid eczema]]
*[[Fatal familial insomnia]]
*[[Anxiety disorder|Fear of not sleeping]]
*[[Felbamate]]
*[[Fennel]]
*[[Fibromyalgia|fibromyalgias]]
*[[Flibanserin]]
*[[Fluvoxamine]]
*[[Folic acid toxicity]]
*[[Food allergies]]
*[[Natural gasoline|Gasoline]]
*[[Gastroesophageal reflux disease]]
*[[Generalized anxiety disorder]]
*[[Ginseng|Ginseng overuse]]
*[[Visceroptosis|Glenard syndrome]]
*[[Glucocorticoids]]
*[[Blood-brain barrier|Glucose transport defect, blood-brain barrier]]
*[[De Vivo disease|Glut-1 deficiency syndrome]]
*[[Wheat allergy|Gluten allergy]]
*[[Graves disease]]
*[[Grief]]
*[[Guar gum]]
*[[Guarana|Guarana overuse]]
*[[Acacia senegal|Gum acacia]]
*[[Tragacanth|Gum tragacanth]]
*[[Headache|Headache syndromes]]
*[[Congestive heart failure|Heart congestion]]
*[[Heartburn]]
*[[Heroin|Heroin dependence]]
*[[Seasonal affective disorder|Holiday depression]]
*[[Hops]]
*[[Hunger]]
*[[Huntington's disease]]
*[[Morphine|Hydrocodone withdrawal]]
*[[Hypertension]]
*[[Hyperthyroidism]]
*[[Illness]]
*[[Sleep hygiene|Inadequate sleep hygiene]]
*[[Maple syrup urine disease|Inborn amino acid metabolism disorder]]
*[[Hypervigilance|Increased arousal]]
*[[Indigestion]]
*[[Inflammatory bowel disease]]
*[[Injury]]
*[[Iron deficiency anemia]]
*[[Circadian rhythm sleep disorder|Irregular sleep-wake rhythm disorder]]
*[[Contact dermatitis|Irritant contact eczema]]
*[[Coronary heart disease|Ischemic heart disease]]
*[[Isoproterenol (aerosol)]]
*[[Jet lag]]
*[[Nephrology|Kidney disease]]
*[[Lacosamide]]
*[[Mepenzolate|Lacosamidemepenzolate]]
*[[Lamotrigine]]
*[[Lead]]
*[[Lecithin]]
*[[Cramp|Leg cramps]]
*[[Lentil]]
*[[Lettuce]]
*[[Levofloxacin]]
*[[Light]]
*[[Lisdexamfetamine]]
*[[Lorazepam]]
*[[Lysergic Acid Diethylamide|Lsd addiction]]
*[[Lyme disease]]
*[[Lysergic Acid Diethylamide|Lysergic acid diethylamide]]
*[[Mania]]
*[[Melatonin]]
*[[Menopause]]
*[[Menstruation]]
*[[Mepenzolate]]
*[[Mercury poisoning]]
*[[Meropenem]]
*[[Methcathinone]]
*[[Methylenedioxymethamphetamine]]
*[[Methylphenidate]]
*[[Otitis media|Middle ear infection]]
*[[Concussion|Mild traumatic brain injury]]
*[[Milk]]
*[[Milnacipran hydrochloride]]
*[[Modafinil]]
*[[Monocrotophos]]
*[[Mood disorder]]
*[[Morphine Oral (patient information)|Morphine withdrawal]]
*[[movement disorders]]
*[[Monosodium glutamate|Msg]]
*[[Mussel]]
*[[Mycosis fungoides|Mycosis fungoides, familial]]
*[[Naltrexone]]
*[[Narcolepsy]]
*[[Narcotic|Narcotic addiction]]
*[[Neuralgia|Neuromuscular disorders including painful peripheral neuropathies]]
*[[Niacin]]
*[[Night eating syndrome]]
*[[Nightmare|Nightmares]]
*[[Nocturia]]
*[[Nocturnal angina pectoris|Nocturnal angina]]
*[[Nocturnal asthma]]
*[[Autosomal dominant nocturnal frontal lobe epilepsy|Nocturnal frontal lobe epilepsy type 1]]
*[[Nocturnal myoclonus]]
*[[Panic disorder|Nocturnal panic disorder]]
*[[Noise]]
*[[Sedentary lifestyle|Not enough exercise]]
*[[Sleep apnea|Obstructive sleep apnea]]
*[[Ofloxacin]]
*[[Olivopontocerebellar atrophy]]
*[[Opioid abuse and dependence|Opioid addiction]]
*[[Opioid withdrawal]]
*[[Overeating]]
*[[Oxaprozin]]
*[[Oxazepam]]
*[[Oxycodone|Oxycontin addiction]]
*[[Oxycodone|Oxycontin withdrawal]]
*[[Oxymetazoline]]
*[[Pain]]
*[[Analgesic|Pain killer addiction]]
*[[Panic attack]]
*[[Parasomnia|Parasomnias]]
*[[Parkinson's disease]]
*[[Paroxetine]]
*[[Parsley]]
*[[Peptic ulcer|Peptic ulcer disease]]
*[[Peramivir]]
*[[Oxycodone|Percocet withdrawal]]
*[[Pergolide]]
*[[Nocturnal myoclonus|Periodic limb movements in sleep]]
*Perry syndrome
*Phenol sulfotransferase deficiency
*[[Phentermine]]
*[[Phentermine]]
*[[Pick's disease]]
*[[Obesity hypoventilation syndrome|Pickwickian syndrome]]
*[[Pierre Robin syndrome|Pierre robin's sequence]]
*[[Pineal teratoma]]
*[[Pinealoma]]
*[[Pituitary adenoma|Pituitary tumors]]
*[[Posaconazole]]
*[[Post traumatic stress disorder|Post-traumatic stress]]
*[[Post-concussion syndrome|Postconcussive syndrome]]
*[[Postnatal depression|Postpartum depression]]
*[[Pramipexole]]
*[[Pregabalin]]
*[[Pregnancy]]
*[[Premenstrual dysphoric disorder|Premenstrual dysphoric disorders]]
*[[Premenstrual syndrome]]
*[[Depression|Primary affective disorder]]
*[[Primary insomnia]]
*[[Fatal familial insomnia|Prion fatal familial insomnia]]
*[[Propranolol]]
*[[Prostatitis]]
*[[Itch|pruritus]]
*[[Psychiatric disorders]]
*[[Pyridoxine deficiency]]
*[[Pyrimethamine]]
*[[Quinoline Yellow SS|Quinoline yellow]]
*[[Quorn]]
*[[Ramelteon]]
*[[Rape trauma syndrome|Rape trauma syndromes]]
*[[RDX]]
*[[Esophagitis|Reflux esophagitis]]
*[[Rapid eye movement behavior disorder|Rem-behavior disorder]]
*[[Renal insufficiency|Renal failure]]
*[[Thyroid hormone resistance|Resistance to thyroid stimulating hormone]]
*[[Respiratory muscle paralysis]]
*[[Restless legs syndrome|Restless leg syndrome]]
*[[Rett syndrome|Rett's syndromes]]
*[[Rheumatoid arthritis|Rheumatoid arthritis related fibromyalgias]]
*[[Ribavirin]]
*[[Rifaximin]],
*[[Gerstmann syndrome|Right parietal lobe syndrome]]
*[[Methylphenidate|Ritalin withdrawal]]
*[[Epilepsy classification|Rolandic epilepsy]]
*[[Romiplostim]]
*[[Rotigotine]]
*[[Schizophrenia]]
*[[Food allergy|Seafood allergy]]
*[[Sedative|Sedative dependence]]
*[[Seizure|Seizures]]
*[[Selegiline]]
*[[Sesame]]
*[[Chronic pain|Severe chronic pain]]
*[[Shift work]]
*[[Dyspnea|Shortness of breath]]
*[[Sibutramine]]
*[[Silo unloader syndrome]]
*[[Sinusitis|Sinusitis]]
*[[Sleep disorder|Situational/acute insomnia]]
*[[Systemic lupus erythematosus|Sle related fibromyalgias]]
*[[Sleep apnea]]
*[[Sleep disorder]]
*[[Sleep paralysis]]
*[[Sleep and breathing|Sleep-disordered breathing]]
*[[Sedative|Sleeping pill addiction]]
*[[Smoking|Smoking especially at bedtime]]
*[[Sleepwalking|Somnambulism]]
*[[Sopite syndrome]]
*Steroid withdrawal syndrome
*[[Stress (medicine)|Stress]]
*[[Eczema|Stress-related eczema]]
*[[Substance abuse]]
*[[Sulfite]]
*[[Sulindac]]
*[[Sunset yellow]]
*[[Suvorexant]]
*[[Tacrolimus]]
*[[Tartrazine]]
*[[Tasimelteon]]
*[[Bruxism|Teeth grinding]]
*[[Temazepam]]
*[[Temozolomide]]
*[[Eczema|Temperature-related eczema]]
*[[Tension myositis syndrome|Tension myositis related fibromyalgias]]
*[[Terbutaline]]
*[[Tetryl]]
*[[Thalidomide]]
*[[Beriberi|Thiamine deficiency]]
*[[Thyme]]
*[[Tolcapone]]
*[[Toluene]]
*[[Topiramate]]
*[[Sedative|Tranquilizer addiction]]
*[[Sedative|Tranquilizer withdrawal]]
*[[Traumatic brain injury|Traumatic brain injury causing post-traumatic insomnia]]
*[[Ribavirin|Tribavirin]]
*[[Trigeminal neuralgia]]
*[[Pain|Ulcer pain]]
*[[Chronic renal failure pathophysiology|Uremia]]
*[[Urinary tract infection]]
*[[Varenicline]]
*[[Variegate porphyria]]
*[[Lortab|Vicodin withdrawal]]
*[[Vilazodone]]
*[[Thiamine|Vitamin B1 toxicity]]
*[[Vitamin B12 deficiency]]
*[[Wernicke-korsakoff syndrome]]
*[[African trypanosomiasis|West African trypanosomiasis]]
*[[Wheat]]
*[[Whiplash|Whiplashs]]
*[[Wiskott-Aldrich syndrome]]
*[[Zolpidem|Withdrawal of sleeping pills]]
*[[Intestinal parasite|Worms]]
*X-linked Angelman-like syndrome
*[[Alprazolam|Xanax withdrawal]]
*[[Xanthan gum]]
*[[Zonisamide]]
*[[Zucchini]]
}}


==Causes of Insomnia Based On Severity==
==[[Insomnia causes|Causes]]==
=== Acute ===
* Environment changes
* Extremes of temperature
* Illness
* Injury
* Light
* Noise
* Poor bed
* Situational stress


=== Chronic ===
==[[Insomnia differential diagnosis|Differentiating Insomnia from other Diseases]]==
* [[Angina]]
* [[Anxiety]]
* [[Arthritis|Arthritis pain]]
* [[Asthma]]
* [[Benign prostatic hyperplasia]]
* [[Bipolar Disorder]]
* [[Caffeine]]
* [[Cancer]] pain
* [[Chronic Fatigue Syndrome]]
* [[Chronic Obstructive Pulmonary Disease]] (COPD)
* [[Chronic Renal Disease]]
* [[Headache|Cluster headaches]]
* [[Congestive Heart Failure]]
* [[Dementia]]
* [[Depression]]
* [[Diabetes Mellitus]]
* [[Drugs]]
* [[Fibromyalgia]]
* [[Gastroesophageal Reflux Disease]] (GERD)
* [[Hyperthyroidism]]
* [[Inflammatory Bowel Disease]] (IBD)
* [[Mania]]
* [[Menopause]]
* Nocturnal [[panic disorder]]
* Other [[movement disorder]]s
* Pain
* [[Parkinson's Disease]]
* [[Peptic Ulcer Disease]]
* Poor sleep hygiene
* [[Posttraumatic Stress Disorder]]
* [[Pregnancy]]
* [[Pruritis]]
* [[Psychosis]]
* [[Reflux esophagitis]]
* [[Schizophrenia]]
* [[Seizures]]
* [[Sleep Apnea]]
* [[Uremia]]
* [[Urinary Tract Infection]] (UTI)


==Differential Diagnosis==
==[[Insomnia epidemiology and demographics|Epidemiology and Demographics]]==
*Breathing-related sleep disorders
*Delayed sleep phase and shift work types of circadian rhythm sleep-wake disorder
*[[Narcolepsy]]
*Normal sleep variations
*Parasomnias
*[[Restless legs syndrome]]
*Situational/acute insomnia
*Substance/medication-induced [[sleep disorder]], insomnia type<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>


==Epidemiology and Demographics==
==[[Insomnia risk factors|Risk Factors]]==
===Prevalence===
The prevalence of insomnia disorder is 10,000-20,000 per 100,000 (10%-20%) in the primary care setting.<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>


According to the U.S. [[Department of Health and Human Services]] in year 2007, approximately 64 million Americans suffer from insomnia each year.<ref name="titleBrain Basics: Understanding Sleep: National Institute of Neurological Disorders and Stroke (NINDS)">{{cite web |url=http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm |title=Brain Basics: Understanding Sleep: National Institute of Neurological Disorders and Stroke (NINDS) |accessdate=2007-12-16 |format= |work=}}</ref>  Insomnia tends to increase with age and affects about 40 percent of women and 30 percent of men.<ref name="titleInsomnia">{{cite web |url=http://www.womenshealth.gov/faq/insomnia.htm |title=Insomnia |accessdate=2007-12-16 |format= |work=}}</ref> The average American gets 7 hours of sleep, instead of the 8 to 10 hours recommended by doctors.  Children however are recommended more than 8 hours.
==[[Insomnia screening|Screening]]==


==Risk Factors==
==[[Insomnia natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
*Advancing age
*Anxiety or worry-prone personality
*Chronic daily stress
*Cognitive styles
*Familial disposition
*Fear of not sleeping
*Female gender
*High altitude
*Increased arousal
*Irregular sleep scheduling
:*Excessive caffeine use
:* Irregular sleep schedules
*Light
*Major life events (e.g., illness, separation)
*Noise
*Poor sleep habits
*Poor sleep hygiene practices
*Tendency to repress emotions
*Uncomfortably high or low temperature<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>


==Diagnosis==
==Diagnosis==
Patients with [[delayed sleep phase syndrome]] are  often mis-diagnosed with insomnia. If the patient has trouble getting to sleep, but has normal sleep architecture once asleep, a [[circadian rhythm]] disorder is a more likely cause.
[[Insomnia diagnostic criteria|Diagnostic Study of Choice]] | [[Insomnia history and symptoms|History and Symptoms]] | [[Insomnia physical examination|Physical Examination]] | [[Insomnia laboratory findings|Laboratory Findings]] | [[Insomnia electrocardiogram|Electrocardiogram]] | [[Insomnia x ray|X-ray]] | [[Insomnia echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Insomnia CT scan|CT scan]] | [[Insomnia  MRI|MRI]] | [[Insomnia other imaging findings|Other Imaging Findings]] | [[Insomnia other diagnostic studies|Other Diagnostic Studies]]
 
===Diagnostic Criteria===
 
====DSM-V Diagnostic Criteria for Insomnia Disorder<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>====
{{cquote|
 
*A.A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms:
:*1.Difficulty initiating sleep.(In children, this may manifest as difficulty initiating sleep without caregiver intervention.)
:*2.Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.):
:*3. Early-morning awakening with inability to return to sleep.
 
'''''AND'''''
 
*B.The sleep disturbance causes clinically significant distress or impairment in social, occupational,educational, academic, behavioral, or other important areas of functioning.
 
'''''AND'''''
 
*C.The sleep difficulty occurs at least 3 nights per week.
 
'''''AND'''''
 
*D.The sleep difficulty is present for at least 3 months.
 
'''''AND'''''
 
*E.The sleep difficulty occurs despite adequate opportunity for sleep.
 
'''''AND'''''
 
*F.The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., [[narcolepsy]], a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia).
 
'''''AND'''''
 
*G.The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).
 
'''''AND'''''
 
*H. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.
 
Specify if:
 
*With non-sleep disorder mental comorbidity, including substance use disorders
 
*With other medical comorbidity
 
*With other sleep disorder
 
Specify if:
 
*Episodic:Symptoms last at least 1 month but less than 3 months.
 
*Persistent: Symptoms last 3 months or longer.
 
*Recurrent: Two (or more) episodes within the space of 1 year.
 
<SMALL>''Note:Acute and short-term insomnia (i.e., symptoms lasting less than 3 months but otherwise meeting all criteria with regard to frequency, intensity, distress, and/or impairment)should be coded as an other specified insomnia disorder.''</SMALL>
}}
 
===Insomnia versus poor sleep quality===
Poor sleep quality can occur as a result of sleep apnea or [[major depression]].  Poor sleep quality is caused by the individual not reaching stage 4 or delta sleep which has restorative properties. There are, however, people who are unable to achieve stage 4 sleep due to brain damage who still lead perfectly normal lives.
 
*'''[[Sleep apnea]]''' is a condition that occurs when a sleeping person's breathing is interrupted, thus interrupting the normal sleep cycle.  With the obstructive form of the condition, some part of the sleeper's respiratory tract loses muscle tone and partially collapses.  People with obstructive sleep apnea often do not remember awakening or having difficulty breathing, but they complain of excessive sleepiness during the day.  Central sleep apnea interrupts the normal breathing stimulus of the [[central nervous system]], and the individual must actually wake up to resume breathing.  This form of apnea is often related to a cerebral vascular condition, congestive heart failure, and premature aging.
 
Major depression leads to alterations in the function of the hypothalamus and pituitary causing excessive release of cortisol which can lead to poor sleep quality. 
 
Nocturnal polyuria or excessive nighttime urination can be very disturbing to sleep.<ref>{{cite book | coauthors = Adler and Thorpy | title = Sleep issues in Parkinson’s disease | url = http://www.neurology.org/cgi/content/full/64/12_suppl_3/S12 | accessyear = 2007 | accessmonth = June | year = 2005 | publisher = Neurology | language = English | pages = 64; S12-20 }}</ref> Nocturnal polyuria can be nephrogenic (related to kidney disease) or it may be due to prostate enlargement or hormonal influences. Deficiencies in vasopressin, which is either caused by a pituitary problem or by insensitivity of the kidney to the effects of vasopressin, can lead to nocturnal polyuria. Excessive thirst or the use of diuretics can also cause these symptoms.


==Treatment==
==Treatment==
In many cases, insomnia is caused by another disease or psychological problem.  In this case, medical or psychological help may be useful.
[[Insomnia medical therapy|Medical Therapy]] | [[Insomnia non-pharmacological therapy|Non-pharmacological therapy]] | [[Insomnia surgery|Surgery]] | [[Insomnia primary prevention|Primary Prevention]] | [[Insomnia secondary prevention|Secondary Prevention]] | [[Insomnia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Insomnia future or investigational therapies|Future or Investigational Therapies]]


According to [[clinical practice guideline]]s by the [[American Academy of Sleep Medicine]], "Psychological and behavioral interventions are effective for adults of all ages, including older adults, and chronic hypnotic users... These treatments should be utilized as an initial intervention when appropriate and when conditions permit".<ref name="pmid18853708">{{cite journal| author=Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M| title=Clinical guideline for the evaluation and management of chronic insomnia in adults. | journal=J Clin Sleep Med | year= 2008 | volume= 4 | issue= 5 | pages= 487-504 | pmid=18853708 | doi= | pmc=PMC2576317 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18853708  }} </ref>
==Case Studies==
[[Insomnia case study one|Case #1]]


===Behavior Therapy===
==See also==
[[Clinical practice guideline]] by the [[American Academy of Sleep Medicine]] (AASM) noted about [[cognitive therapy|cognitive behavior therapy]] for insomnia:
* “Initial approaches to treatment should include at least one behavioral intervention such as stimulus control therapy or relaxation therapy, or the combination of cognitive therapy, stimulus control therapy, sleep restriction therapy with or without relaxation therapy—otherwise known as cognitive behavioral therapy for insomnia (CBT-I).”<ref name="pmid18853708">{{cite journal| author=Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M| title=Clinical guideline for the evaluation and management of chronic insomnia in adults. | journal=J Clin Sleep Med | year= 2008 | volume= 4 | issue= 5 | pages= 487-504 | pmid=18853708 | doi= | pmc=PMC2576317 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18853708  }} </ref>
 
[[Cognitive therapy|cognitive behavior therapy]] for insomnia has been studied in a [[meta-analysis]] of 20 [[randomized controlled trial]]s that compared a combination of two modalities of CBT-i versus various control therapies. Different modalities of CBT-i were defined as cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation techniques. The meta-analysis found:
* Sleep onset latency improved by 19 (95% [[Confidence interval|CI]], 142 to 25) minutes
* Wake after sleep onset was reduced by 26 (95% [[Confidence interval|CI]], 15 to 37) minutes
* Total sleep time increased by 8 (95% [[Confidence interval|CI]], 1 to 16) minutes
* Sleep efficiency percentage improved by 10% (95% [[Confidence interval|CI]], 8% to 12%)
 
 
Sleep restriction therapy for insomnia has been studied in a [[meta-analysis]] of 4 [[randomized controlled trial]]s that reported "Weighted effect sizes for self-reported sleep diary measures of sleep onset latency, wake time after sleep onset, and sleep efficiency were moderate-to-large after therapy. Total sleep time indicated a small improvement"; however, the authors add "variability in the sleep restriction therapy implementation methods precludes any strong conclusions regarding the true impact of therapy"<ref name="pmid24629826">{{cite journal| author=Miller CB, Espie CA, Epstein DR, Friedman L, Morin CM, Pigeon WR et al.| title=The evidence base of sleep restriction therapy for treating insomnia disorder. | journal=Sleep Med Rev | year= 2014 | volume= 18 | issue= 5 | pages= 415-24 | pmid=24629826 | doi=10.1016/j.smrv.2014.01.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24629826  }} </ref>.
 
====Implementing behavior therapy====
 
===Medications===
Many insomniacs rely on [[sleeping tablet]]s and other [[sedative]]s to get rest. All sedative drugs have the potential of causing psychological dependence where the individual cannot psychologically accept that they can sleep without drugs. Certain classes of sedatives such as [[benzodiazepine]]s and newer [[nonbenzodiazepine]] drugs can also cause physical dependence which manifests in withdrawal symptoms if the drug is not carefully titrated down.
 
In comparing the options, a [[systematic review]] found that [[benzodiazepine]]s and  [[nonbenzodiazepine]]s have similar efficacy which was [[statistical_significance | insignificantly]] more than for [[antidepressant]]s.<ref name="pmid17619935">Buscemi N, Vandermeer B, Friesen C, Bialy L, Tubman M, Ospina M, Klassen TP, Witmans M. The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs. J Gen Intern Med. 2007  Sep;22(9):1335-50. Epub 2007 Jul 10. PMID 17619935</ref>  Benzodiazepines had an [[statistical_significance | insignificant]] tendency for more [[adverse drug reaction]]s.<ref name="pmid17619935"/>
 
====Benzodiazepines====
{{main|Benzodiazepine}}
The most commonly used class of hypnotics prescribed for insomnia are the [[benzodiazepine]]s. [[Benzodiazepine]]s bind unselectively to the [[GABAA receptor|GABA<sub>A</sub> receptor]].<ref name="pmid17619935"/> This includes drugs such as [[temazepam]], [[diazepam]], [[lorazepam]], [[flurazepam]], [[nitrazepam]] and [[midazolam]].  These medications can be addictive, especially after taking them over long periods of time.
 
====Non-benzodiazepines====
{{main|Nonbenzodiazepine}}
[[Nonbenzodiazepine]] prescription drugs, including the [[nonbenzodiazepine]]s [[zolpidem]](Stilnoct) and [[zopiclone]](Imovane), are more selective for the [[GABAA receptor|GABA<sub>A</sub> receptor]]<ref name="pmid17619935"/> and may have a cleaner side effect profile than the older benzodiazepines; however, there are controversies over whether these non-benzodiazepine drugs are superior to benzodiazepines.  These drugs appear to cause both [[Addiction#Psychological addiction|psychological dependence]] and [[physical dependence]], and can also cause the same memory and cognitive disturbances as the benzodiazepines along with morning sedation.
 
====Antidepressants====
{{main|Antidepressants}}
Some [[antidepressant]]s such as [[mirtazapine]], [[trazodone]] and [[doxepin]] have a sedative effect, and are prescribed [[off label]] to treat insomnia.  The major drawback of these drugs is that they have [[antihistaminergic]], [[anticholinergic]] and [[antiadrenergic]] properties which can lead to many side effects. Some also alter sleep architecture.
 
====Melatonin====
[[Melatonin]] has proved effective for some insomniacs in regulating the sleep/waking cycle, but lacks definitive data regarding efficacy in the treatment of insomnia. Melatonin agonists, including Ramelteon ([[Rozerem]]), seem to lack the potential for abuse and dependence. This class of drugs has a relatively mild side effect profile and lower likelihood of causing morning sedation.
 
====Antihistamines====
The [[antihistamine]] [[diphenhydramine]] is widely used in nonprescription sleep aids, with a 50 mg recommended dose mandated by the FDA. In the United Kingdom, Australia, New Zealand, South Africa, and other countries, a 50 to 100 mg recommended dose is permitted. While it is available over the counter, the effectiveness of these agents may decrease over time and the incidence of next-day sedation is higher than for most of the newer prescription drugs. Dependence does not seem to be an issue with this class of drugs.
 
====Atypical antipsychotics====
Low doses of certain [[atypical antipsychotics]] such as [[quetiapine]] (Seroquel) are also prescribed for their sedative effect but the danger of neurological and cognitive side effects make these drugs a poor choice to treat insomnia.
 
===Herbal medicines===
Some insomniacs use [[herb]]s such as [[valerian plant|valerian]], [[chamomile]], [[lavender]], [[hops]], and [[passion-flower]].  Valerian has undergone multiple studies and appears to be modestly effective.<ref name="pmid10761819">{{cite journal |author=Donath F, Quispe S, Diefenbach K, Maurer A, Fietze I, Roots I |title=Critical evaluation of the effect of valerian extract on sleep structure and sleep quality |journal=Pharmacopsychiatry |volume=33 |issue=2 |pages=47-53 |year=2000 |pmid=10761819 |doi=}}</ref><ref name="pmid16335333">{{cite journal |author=Morin CM, Koetter U, Bastien C, Ware JC, Wooten V |title=Valerian-hops combination and diphenhydramine for treating insomnia: a randomized placebo-controlled clinical trial |journal=Sleep |volume=28 |issue=11 |pages=1465-71 |year=2005 |pmid=16335333 |doi=}}</ref><ref name="pmid17561634">{{cite journal |author=Meolie AL, Rosen C, Kristo D, ''et al'' |title=Oral nonprescription treatment for insomnia: an evaluation of products with limited evidence |journal=Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine |volume=1 |issue=2 |pages=173-87 |year=2005 |pmid=17561634 |doi=}}</ref>
 
===Other substances===
[[Cannabis]] has also been suggested as a very effective treatment for insomnia. <ref>[http://www.cannabis.net/medical-marijuana/pot-docs.html http://www.cannabis.net/medical-marijuana/pot-docs.html ]</ref>
 
[[Alcohol]] may have sedative properties, but the [[Rapid eye movement sleep|REM sleep]] suppressing effects of the drug prevent restful, quality sleep. Middle-of-the-night awakenings due to [[polyuria]] or other effects from alcohol consumption are common, and hangovers can also lead to morning grogginess.
 
Insomnia may be a symptom of [[magnesium deficiency (medicine)|magnesium deficiency]], or lower [[magnesium]] levels.  A healthy diet containing [[magnesium]], can help to improve sleep in individuals without an adequate intake of [[magnesium]].<ref name="pmid9703590">{{cite journal |author=Hornyak M, Voderholzer U, Hohagen F, Berger M, Riemann D |title=Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study |journal=Sleep |volume=21 |issue=5 |pages=501-5 |year=1998 |pmid=9703590 |doi=}}</ref>
 
Other reports cite the use of an elixir of cider vinegar and honey but the evidence for this is only anecdotal. <ref>{{cite web|url=http://www.cidervinegar.org/2007/06/cider-vinegar-rocks.html|title=Cider Vinegar and Insomnia}}</ref>
 
===Complimentary and alternative therapies===
Some traditional remedies for insomnia have included drinking warm milk before bedtime, taking a warm bath in the evening; exercising vigorously for half an hour in the afternoon, eating a large lunch and then having only a light evening meal at least three hours before bed, avoiding mentally stimulating activities in the evening hours, and making sure to get up early in the morning and to retire to bed at a reasonable hour.
 
Many believe that listening to slow paced music will help insomniacs fall asleep. <ref name="pmid16269944">{{cite journal |author=Robinson SB, Weitzel T, Henderson L |title=The Sh-h-h-h Project: nonpharmacological interventions |journal=Holistic nursing practice |volume=19 |issue=6 |pages=263-6 |year=2005 |pmid=16269944 |doi=}}</ref>
 
The more relaxed a person is, the greater the likelihood of getting a good night's sleep. [[Relaxation techniques]] such as [[meditation]] have been shown to help people sleep. Such techniques can lower stress levels from both the mind and body, which leads to a deeper, more restful sleep.
 
[[Traditional Chinese medicine]] has included treatment for insomnia. A typical approach may utilize [[acupuncture]], dietary and lifestyle analysis, [[Herbalism|herbology]] and other techniques, with the goal of resolving the problem at a subtle level.
 
In the Buddhist tradition, people suffering from insomnia or nightmares may be advised to meditate on "loving-kindness", or ''[[metta]]''. This practice of generating a feeling of love and goodwill is claimed to have a soothing and calming effect on the mind and body<ref>{{cite journal |author=Lutz A, Greischar LL, Rawlings NB, Ricard M, Davidson RJ |title=Long-term meditators self-induce high-amplitude gamma synchrony during mental practice |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=101 |issue=46 |pages=16369-73 |year=2004 |pmid=15534199 |doi=10.1073/pnas.0407401101 |url=http://www.pnas.org/cgi/content/full/101/46/16369 }}</ref>. This is claimed to stem partly from the creation of relaxing positive thoughts and feelings, and partly from the pacification of negative ones. In the ''Mettā (Mettanisamsa) Sutta''<ref>http://www.accesstoinsight.org/tipitaka/an/an11/an11.016.than.html</ref>, Siddhartha Gautama, the Buddha, tells the gathered monks that easeful sleep is one benefit of this form of meditation.


Using [[aromatherapy]], including jasmine oil, [[lavender oil]], [[Mahabhringaraj]] and other relaxing [[essential oil]]s, may also help induce a state of restfulness. [[Horlicks]] is marketed as a sleeping aid.
*[[Chronic colestites|Chronic colestites/total insomnia]]


==See also==
*[[Chronic colestites]], also known as "total insomnia"
*[[Fatal familial insomnia]]
*[[Fatal familial insomnia]]
*[[Sleep deprivation]]
*[[Sleep deprivation]]
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[[Category:Sleep]]
[[Category:Sleep]]
[[Category:Psychiatry]]
[[Category:Psychiatry]]
[[Category:Overview complete]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[es:Insomnio]]
[[fr:Insomnie]]
[[ja:不眠症]]
[[pl:Bezsenność]]
[[pt:Insônia]]
[[ru:Бессонница]]
[[vi:Mất ngủ]]
[[tr:İnsomnia]]
[[zh:失眠]]
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