Insomnia Due To Mental Disorders
Most chronic psychiatric disorders are associated with sleep disturbances. Depression is most commonly associated with early morning awakenings and an inability to fall back asleep. Conversely, studies have also demonstrated that insomnia can lead to depression: insomnia of more than 1-year duration is associated with an increased risk of depression.
Schizophrenia and the manic phase of bipolar illness are frequently associated with sleep-onset insomnia. Anxiety disorders are associated with both sleep-onset and sleep-maintenance complaints.
To meet the formal definition of this form of insomnia, a mental disorder must be diagnosed according to the criteria of the Diagnostic and Statistical Manual, Fifth Edition . The insomnia must be temporally associated with the mental disorder however, in some cases, insomnia may appear a few days or weeks before the emergence of the underlying mental disorder.
The insomnia is more prominent than that typically associated with the mental disorders, as indicated by causing marked distress or constituting an independent focus of treatment. The sleep disturbance is not better explained by another sleep disorder, medical or neurologic disorder, medication use, or substance-abuse disorder.
Cut Back On Stimulants Such As Caffeine And Alcohol
Besides affecting your kidney condition, caffeine and alcohol can disrupt your sleep. Steering clear from stimulants, at least 8 hours before intended sleep time, can get you back to normal sleeping patterns. Consider minimizing caffeine intake and taking it before noon to reduce sleep interruption. Slow down on alcohol or try not to drink them before bedtime since it can disrupt your sleep.
Treatment Of Chronic Insomnia
A number of at-home and professional treatment options are available for chronic insomnia. Treatment will depend on the cause of your insomnia and may involve medication or therapy to address an underlying condition.
Along with treating any existing conditions, your doctor may recommend one or a combination of treatment options for chronic insomnia.
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Key Points About Insomnia
- Insomnia is a sleep disorder marked by problems falling asleep or staying asleep.
- Insomnia can be acutelasting for only one night or a few weeksor chronic, meaning it occurs at least three times per week for over three months.
- There are two categories of insomnia: primary insomnia and secondary insomnia.
- Primary insomnia refers to sleep problems that are not attributable to any other underlying physical or mental health condition.
- Secondary insomnia refers to sleep problems that are caused by some other condition, such as arthritis or depression, or by drugs such as prescription medication or alcohol.
- Set up an appointment with your doctor if you are suffering from chronic insomnia that interferes with your daily life.
There Are Many Possible Reasons Why You Can’t Sleep
Jason DelCollo, DO, board-certified in family medicine. He is associate faculty at Philadelphia College of Osteopathic Medicine as well as adjunct faculty with the Crozer Family Medicine Residency Program, and is an attending physician at Glen Mills Family Medicine in Glen Mills, Pennsylvania.
Insomnia is the most common sleep disorder and it may cause you to not get enough sleep or wake frequently during the night. If your difficulty sleeping persists and lasts for more than 3 months, it is called chronic insomnia.
What causes long-term insomnia? Can it manifest as the result of another sleep disorder or medical problem? These are common questions among people who have trouble sleeping and any number of potential causes may be affecting you.
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Can Melatonin Help Me Sleep
Your body produces a hormone called melatonin that promotes sleep. Some people take melatonin supplements as a sleep aid. But theres no proof that these supplements work. Because the U.S. Food and Drug Administration doesnt regulate supplements the same as medications, you should talk to your healthcare provider before taking one.
Early Morning Awakening Insomnia
Early morning awakening insomnia involves waking up well before a person wants or plans to in the morning. Some experts view this as a component of sleep maintenance while others consider it separately.
Inability to get their desired amount of sleep can impair a persons physical and mental function the next day.
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Advancing Research For Improved Health
In support of our mission, we are committed to advancing insomnia research in part through the following ways.
- Investigating the link between insomnia and heart disease. People who have insomnia have a higher risk of heart disease and high blood pressure. We support research to explore this link and develop comprehensive treatment plans for people who have insomnia and other serious health conditions. View Sleep Quality and Mechanisms of Cardiovascular Risk in Adults With Hypertension and Disentangling Subclinical Cardiovascular Risk Associated With Insomnia, Short Sleep Duration, and Their Combination for more information.
- Preventing insomnia in teens. Insomnia in teens can cause long-term physical and mental health problems. We support research to discover new ways to prevent and treat insomnia in teens, including improving our understanding of why insomnia is more common in teen girls than in boys. View Sleep and Cardiovascular Health in Adolescence for more information.
- Understanding the risks of current insomnia treatments. Certain medicines used to treat insomnia can have serious side effects. We fund research to discover whether these medicines can cause heart disease, especially in older adults. We also support research to develop new medicines to treat insomnia with fewer side effects. View Discovering GIRK Channel Direct Activator as a Novel Chronic Insomnia Therapeutic and Prescription Hypnotics and the Risk of Cardiovascular Death for more information.
What Are The Treatments For Insomnia
Treatments include lifestyle changes, counseling, and medicines:
- Lifestyle changes, including good sleep habits, often help relieve acute insomnia. These changes might make it easier for you to fall asleep and stay asleep.
- A type of counseling called cognitive-behavioral therapy can help relieve the anxiety linked to chronic insomnia
- Several medicines also can help relieve your insomnia and allow you to re-establish a regular sleep schedule
If your insomnia is the symptom or side effect of another problem, it’s important to treat that problem .
NIH: National Heart, Lung, and Blood Institute
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Research For Your Health
The NHLBI is part of the U.S. Department of Health and Human Services National Institutes of Health the Nations biomedical research agency that makes important scientific discoveries to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders, including insomnia. Learn about current and future NHLBI efforts to improve health through research and scientific discovery.
Mechanisms Of Action Of Insomnia Medication
Benzodiazepines and benzodiazepine receptor agonists
Benzodiazepine receptor agonists work through GABAA receptors to promote sleep by inhibiting brainstem monoaminergic arousal pathways, through facilitation of VLPO inhibitory GABAergic projections to arousal centers such as the anterior hypothalamus TMN, the posterolateral hypothalamic hypocretin neurons, and the brainstem arousal regions.
The GABAA receptor consists of 5 protein subunits arranged in a ring around a central pore. Most GABAA receptors consist of 2 alpha subunits, 2 beta subunits, and 1 gamma subunit. Upon GABAA receptor activation, chloride ions flow into the cell, resulting in neuronal hyperpolarization.
BZRAs enhance the effect of GABA by lowering the concentration of GABA required to open the GABA channel. BZRAs bind to a modulatory site on the GABAA receptor that is distinct from the GABA binding site and change the receptor complex allosterically to increase the affinity of the receptor to GABA, thus producing a larger postsynaptic current prolonging inhibition. Although BZRAs do not directly open the chloride channel, they modulate the ability of GABA to do so, thus enhancing its inhibitory effect.
Synaptic GABAA receptors typically contain a subunit in combination with an 1, 2, and 3 subunit. Most GABAA receptors expressed in the CNS are 1 2 2, 2 3 2, 3 3 2, 5 3 2.
Melatonin and melatonin receptor agonists
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Keep Sleep In Perspective
People who suffer from insomnia are normally frustrated or annoyed by it. Paradoxically, this emotional state contributes to keeping them awake, starting a vicious cycle. It helps to stop expecting a set amount of sleep every night. Having less sleep than youd like doesnt cause any harm. Allow yourself to fall short of the ideal without getting anxious about it.
Sleep And Chronic Pain And Fatigue Syndromes
Chronic pain and fatigue syndromes such as fibromyalgia and chronic fatigue syndrome are most commonly diagnosed among women between the ages of 50 and 70 years, and may be initiated by the sleep disturbances that affect these women. Pain can act as both a cause and consequence of sleep disturbances, and in the case of chronic pain and fatigue syndromes, both elements are present. Neuroimaging studies on fibromyalgia patients have revealed functional sleep disturbances including reduced short-wave sleep and abnormal -rhythms , which suggest frequent awakenings during non-REM sleep , as is regularly described among aging, menopausal women. Deprivation of stage 4 deep sleep is common with these findings and can exacerbate pain and impair pathways that function to inhibit pain. These pathways are already compromised in fibromyalgia patients, leading to abnormal pain sensitivity. Improving sleep has resulted in better pain management and less fatigue while impaired sleep in healthy individuals has created pain and fatigue. This not only illustrates the critical role of sleep in pain management and its importance in those with chronic pain and fatigue syndromes, but at least partially explains why aging women are among the highest population group at risk for fibromyalgia.
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When Insomnia Becomes Chronic
You may have trouble either falling asleep or staying asleep throughout the night. If this happens for three nights a week for at least three months, it is considered a case of chronic insomnia.
Sleep specialists divide chronic insomnia into two categories: primary and secondary.
Primary chronic insomnia is not due to other medical conditions, or to medications. Research on this type of insomnia is ongoing. Many scientists think it may be related to changes in levels of certain brain chemicals.
Secondary insomnia has its cause in other conditions. It could be a symptom of another medical condition, such as asthma, diabetes, depression or Parkinsons disease.
Secondary insomnia can also be a result of certain medications, such as antidepressants or chemotherapy drugs. Any medication that acts as a stimulant, including some laxatives and antihistamines, can cause sleeplessness.
Insomnia Can Endanger More Than Your Sleep
Almost everyone has trouble falling asleep or staying asleep, from time to time.
Medications we take, stress from the day and a racing mind that just wont shut down, pain, or irregular sleep habits can be the cause.
If you have trouble sleeping, just know that youre far from alone. According to researchers at the Perelman School of Medicine at the University of Pennsylvania, about 25 percent of Americans will experience acute insomnia each year, but about 75 percent of these people will recover without going on to develop chronic insomnia.
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Medications And Illicit Drugs
The side effects of a number of prescription medications can include a disruption in normal sleep patterns. However, one study found that these warnings likely do not apply to everyone taking a particular medication. Instead, it is a generalization that it may occur in some people who take it.
Disturbances in sleep have been found to be prevalent in people who use illicit drugs as well. Researchers also report that the length of drug use plays a significant role. It is not limited to illegal drugs like heroin and methamphetamine, either. Alcohol and cigarette smoking can also disturb a person’s sleep patterns.
Silvano 1983 Bologna Italy
In late 1983, Italian neurologist/sleep expert Dr. Ignazio Roiter received a patient at the University of Bologna hospital’s sleep institute. The man, known only as Silvano, decided in a rare moment of consciousness to be recorded for future studies and to donate his brain for research in hopes of finding a cure for future victims.
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Sleep Issues And Chronic Kidney Disease
Sleep disorders and poor quality of sleep are very common with people with CKD. Poor sleep is linked to sleepiness, impaired daytime functioning, fatigue, increased morbidity, and mortality. Factors such as metabolic changes, inflammation, CKD complications and symptoms, comorbid conditions, medications, and dialysis may interrupt sleep and lead to insomnia. The long-term effects of sleep deprivation and sleep disorders have been linked to various health issues such as hypertension, diabetes, obesity, depression, stroke, and heart attack. All these health conditions are linked to diminishing Glomerular Filtration Rate .
It has been suggested that sleep deprivation due to periodic limb movements during sleep may trigger a renin-angiotensin-aldosterone system hyperactivation or renin-angiotensin-system that lead to increased blood pressure. It can increase the risk of CKD progression as a result. In addition, high rates of insomnia and excessive daytime sleepiness may also contribute to the risk of cardiovascular disease.
Sleep-related problems are largely undertreated, even though they are very essential for patients with CKD. A study revealed that patients with various degrees of kidney failure had progressively worse sleep quality over a 3-year follow-up.
These sleep problems can be connected to underlying uremia, . Patients need to undergo clinical assessment, polysomnography, and other standardized assessments for diagnosis.
The Diagnosis And Classification Of Insomnia Disorder
To identify insomnia disorder, the Chinese version of Pittsburgh Sleep Quality Index and DSM-IV criteria for insomnia disorder were used. Chinese version of PSQI has been shown to have good validity in community sample with insomnia disorder . This approach has been adapted to predict the survival of older adults with DSM-IV insomnia disorder in another study . The Pittsburgh Sleep Quality Index is composed of two clusters of questions. The first cluster assesses nighttime symptoms and the second cluster assesses sleep quality and daytime dysfunction.
Cluster 1: Nighttime symptoms
Difficultly falling asleep: defined as unable to fall asleep after resting in bed for more than 30 min, or
Difficultly maintaining asleep: defined as waking up more than three times during nighttime sleep, or early morning awakening: waking up 2 h earlier than usual.
Any symptoms should occur at least three times per week to qualify for Cluster 1.
Cluster 2: Sleep quality and/or daytime dysfunction
Subjectively poor sleep quality or
People who suffered a moderate or greater degree of daytime dysfunction in emotion, working efficacy, and daily living .
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Melatonin And The Circadian Process
The suprachiasmatic nucleus is entrained to the external environment by the cycle of light and darkness. The retinal ganglion cells transmit light signals via the retinohypothalamic tract to stimulate the SCN. A multisynaptic pathway from the SCN projects to the pineal gland, which produces melatonin.
Melatonin synthesis is inhibited by light and stimulated by darkness. The nocturnal rise in melatonin begins between 8 and 10 pm and peaks between 2 and 4 am, then declines gradually over the morning. Melatonin acts via 2 specific melatonin receptors: MT1 attenuates the alerting signal, and MT2 phase shifts the SCN clock. The novel sleep-promoting drug ramelteon acts specifically at the MT1 and MT2 receptors to promote sleep but is structurally unrelated to melatonin. It has a relatively a short half- life
Aging And Cognitive Function
As it is mentioned, dementia is a common disease among the elderly but just preclinical impairments may be expected decades before certain diagnosis and cognitive decline may not be seen until discussed mechanisms including the accumulation of amyloid and NFT, inflammatory processes, BBB disruption, loss of synapses, and neuron loss have reached a certain threshold .
Therefore, based on the related mechanisms that can lead insomnia to the development of AD, and with attention to the high prevalence of insomnia and sleep disorders among the elderly age group, it can be assumed that insomnia has possible effects on AD pathogenesis and cognitive deficit in older adults with Alzheimers disease risk.
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How To Get Your Best Nights Sleep
If you are one of those people who experiences periodic bouts of insomnia that resolve themselves, there are some simple things you can do to improve your sleep experience.
- Keep a regular bedtime and waking time. I have found that, even if it means an hour or so less sleep, I feel more alert during the morning hours if I go to bed around 10 and set my clock for 6 a.m. You will need to find the times that work best for you, based on your days schedule and physical preference. But once you find it, stick to it!
- Keep those devices out of the bedroom! Watching a movie before bed may seem like a good idea, but the blue light from your TV or computer screen is actually affecting your brain waves and disrupting a peaceful nights sleep.
Here are some more things you can do to help your body maintain its circadian rhythm and get a solid night of sleep. Studies have linked a disrupted circadian rhythm to cancer, so its more than exhaustion youre preventing here!
Egyptian Man 2011 Netherlands
In 2011, the first reported case in the Netherlands was of a 57-year-old man of Egyptian descent. The man came in with symptoms of double vision and progressive memory loss, and his family also noted he had recently become disoriented, paranoid, and confused. While he tended to fall asleep during random daily activities, he experienced vivid dreams and random muscular jerks during normal slow-wave sleep. After four months of these symptoms, he began to have convulsions in his hands, trunk, and lower limbs while awake. The person died at age 58, seven months after the onset of symptoms. An autopsy revealed mild atrophy of the frontal cortex and moderate atrophy of the thalamus. The latter is one of the most common signs of FFI.
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