Insomnia

Definition
Insomnia can be a problem with falling asleep, staying asleep, waking early, or a combination of these. Insomnia affects all age groups, but is more common in the elderly.

Causes, incidence and risk factors
Insomnia is really a symptom, not a disease. It can be caused by physical, mental and environmental problems.
Risk increases with:

• Depression, anxiety, tension or stress
• Daytime napping
• Noise (including a snoring or restless partner)
• Allergies
• Heart or lung problems that cause shortness of breath while lying down
• Painful disorders such as arthritis
• Frequent need to urinate at night
• Night sweats or disorders that cause excessive itching
• Sexual problems
• Drinking too much caffeine
• Use of some drugs
• Odd work hours or work hours that fluctuate such as swing shifts
• Jet lag
• Lack of exercise
• Smoking, alcoholism or other drug abuse including over-use of sleep aid medications
• Withdrawal from addictive substances
• Sleep apnea

Symptoms

• Difficulty falling asleep
• A brief period of sleep followed by wakefulness
• Normal sleep until very early in the morning, then wakefulness (often with frightening thoughts)
• Daytime fatigue and tiredness
• Irritability and mood swings as a result of sleep deprivation

Tests
There are no specific tests for insomnia, but testing should be done to detect underlying causes such as thyroid disorder or sleep apnea.

Treatment
The underlying cause should be treated, but sleep-inducing medications can be used on a short-term basis (if not contraindicated) to allow a patient to get some sleep while the underlying problem is being treated.