Insomnia

Insomnia: Cause, Effect, Diagnosis and Treatment
Ifeoluwa Temi-OgunyemiLee College
Introduction to Psychology 2301
Professor Dunn
Abstract
Insomnia is a type of sleep disorder that affects mental and physical state of individuals. Over one-third of Americans report difficulty sleeping. The problem associated with Insomnia if not addressed properly can be extremely grievous and cause the health of the patient to deteriorate. This paper focuses on the cause, effect and diagnosis of Insomnia. Insomnia is classified into 3 types based on how long it lasts or has been in effect. The inability to get a quality amount of sleep daily automatically affects a person’s productivity. Insomnia is most times a symptom of an illness which is why it is important to visit one’s doctor to know why. The cause which could be because of work schedule, lifestyle, medications. Proper diagnosis of this illness quickens the road to recovery for the person experiencing it.

Insomnia: Cause, Effect, Diagnosis and Treatment.

Insomnia is defined in the fifth edition of the Diagnostic and statistical manual of mental disorders (DSM-5) as difficulty getting to sleep, staying asleep or having non-restorative sleep despite having adequate opportunity for sleep, together with associated impairment of daytime functioning, with symptoms being present for at least 4 weeks. Insomnia is a common disorder that often leads to grievous health problems for the person experiencing it and could eventually lead to a long-term health issue if not properly diagnosed and treated in time. It is therefore paramount to examine what actually leads to inability of a person to sleep, a proper diagnosis of this illness will not only help the patient but also provide more information for research on this topic.

Sleep deprivation has been shown to be associated with increased heart rate and decreased heart rate variability (Palma et al, 2013). Insomnia is now recognized as a public health concern that affects the quality of life of millions of people around the world as it can lead to long-term physical and mental exhaustion with altered mood, concentration, and memory (Choueiry et al, 2018). Individuals with family histories of depression or anxiety and who manifest lifelong depression and anxiety beginning in childhood are at uniquely high risk for insomnia at midlife (Goldman et al, 2014).

The National Sleep Foundation suggests that most adults need 7–9 hours of sleep per night, although individual variations exist. Without this recommended hours of sleep, individuals tend to be less productive at work, other illnesses like anxiety, depression can set in and could lead to a much bigger problem, if not addressed, can lead to death. Insomnia, a comorbid condition, doesn’t always exist in isolation but rather present in an individual suffering from other medical conditions.

Classification of Insomnia
According to the DSM-5, Insomnia is classified as a sleep disorder. There are 3 types of Insomnia based on duration of the problem. It is classified as transient, acute, or chronic.

Transient insomnia lasts for less than a week. It can be caused by another disorder, by changes in the sleep environment, severe depression, or by stress. Its consequences; sleepiness and impaired psychomotor performance are similar to those of sleep deprivation.
Acute insomnia is the inability to consistently sleep well for a period of less than a month. Insomnia is present when there is difficulty initiating or maintaining sleep or when the sleep that is obtained is non-refreshing or of poor quality. These problems occur despite adequate opportunity and circumstances for sleep and they must result in problems with daytime function. Acute insomnia is also known as short term insomnia or stress related insomnia.
Chronic insomnia lasts for longer than a month. It can be caused by another disorder, or it can be a primary disorder. People with high levels of stress hormones or shifts in the levels of cytokines are more likely than others to have chronic insomnia. Its effects can vary according to its causes. They might include muscular weariness, hallucinations, and/or mental fatigue.
Causes of Insomnia
Insomnia may be associated with other conditions. It can be caused by physical factors as well as psychological factors. There is always an underlying medical condition that causes chronic insomnia, while transient insomnia may be due to a recent event or occurrence. Psychological issues: people with mood disorders, such as bipolar disorder or depression, as well as anxiety disorders or psychotic disorders are more likely to have insomnia.
Medical conditions: brain lesions and tumors, stroke, chronic pain, chronic fatigue syndrome, congestive heart failure, angina, acid-reflux disease (GERD), chronic obstructive pulmonary disease, asthma, sleep apnea, Parkinson’s and Alzheimer’s diseases, hyperthyroidism, arthritis, Nasal/sinus allergies, Gastrointestinal problems such as reflux.

Stress: Concerns about work, school, health, finances or family can keep the mind active at night, making it difficult to sleep. Stressful life events or trauma such as the death or illness of a loved one, divorce, or a job loss also may lead to insomnia.
Travel or work schedule: the circadian rhythms act as an internal clock, guiding such things as sleep-wake cycle, metabolism and body temperature. Disrupting the patient’s body’s circadian rhythms can lead to insomnia. Causes include jet lag from traveling across multiple time zones, working a late or early shift, or frequently changing shifts.
Mental health disorders: anxiety disorders, such as post-traumatic stress disorder, may disrupt asleep. Awakening too early can be a sign of depression. Insomnia often occurs with other mental health disorders as well.
Medications: any prescription drugs can interfere with sleep, such as certain antidepressants and medications for asthma or blood pressure. Many over-the-counter medications such as some pain medications, allergy and cold medications, and weight-loss products contain caffeine and other stimulants that can disrupt sleep.
Sleep-related disorders: sleep apnea causes patient to stop breathing periodically throughout the night, interrupting his sleep. Restless legs syndrome causes unpleasant sensations in legs and an almost irresistible desire to move them, which may prevent the patient from falling asleep. Caffeine, nicotine and alcohol. Coffee, tea, cola and other caffeinated drinks are stimulants. Drinking them in the late afternoon or evening can keep from falling asleep at night. Nicotine in tobacco products is another stimulant that can interfere with sleep.

Effects of Insomnia
Sleep is a very crucial part of our daily lives, when we do not get enough sleep daily we tend to become moody, unsettled and sometimes behave irrationally. These behaviors in turn can hugely impact our work, family, relationships negatively. Whatever is reason for sleep loss, insomnia can affect both mentally and physically. People with insomnia report a lower quality of life compared with people who are sleeping well. Complications of insomnia may include: lower performance on the job or at school, slowed reaction time while driving and a higher risk of accidents, mental health disorders, such as depression, anxiety disorder or substance abuse and increased risk and severity of long-term diseases or conditions, such as high blood pressure and heart disease
Diagnosis of Insomnia
Doctors use many different tools to diagnose and measure insomnia symptoms, some of which involve asking the questions in the office, having fill out logs and questionnaires, performing certain blood tests, or doing an overnight sleep study. All these tests help the doctor understand the patient’s personal experience with insomnia and create the right treatment plan.
Sleep log: a sleep log is a simple diary that keeps track of details about sleep. In a sleep log, record details like bedtime, wake up time, how sleepy one feels at various times during the day, and more. A sleep log can also help the doctor figure out what might be causing insomnia.
Sleep inventory: a sleep inventory is an extensive questionnaire that gathers information about personal health, medical history, and sleep patterns.
Blood tests: doctor may perform certain blood tests to rule out medical conditions such as thyroid problems, which can disrupt sleep in some people.
Sleep study: doctor may suggest an overnight sleep study, or polysomnography, to gather information about the night time sleep. In this exam, one sleeps overnight in a lab set up with a comfortable bed. During the exam the patient will be connected to an EEG, which monitors the stages of sleep. A sleep study also measures things like oxygen levels, body movements, and heart and breathing patterns. A sleep study is a non-invasive test.

Treatments for Insomnia
Medical treatments: There are many different types of sleep aids for insomnia, including over-the-counter and prescription medications. Determining which medication may be right for you depends on your insomnia and many different health factors. Major classes of prescription insomnia medications include; benzodiazepine hypnotics, non-benzodiazepine hypnotics, and melatonin receptor agonists. Prescription sleeping pills can have side effects, such as causing daytime grogginess and increasing the risk of falling, or they can be habit-forming, so therefore, it is important to consult with one’s doctor on what’s best and possible side effects.

Non-Medical (Cognitive & Behavioral) treatments (CBT) : There are psychological and behavioral techniques that can be helpful for treating insomnia.  Some of these techniques can be self-taught, while for others it’s better to enlist the help of a therapist or sleep specialist.

Relaxation training, or progressive muscle relaxation, teaches the person to systematically tense and relax muscles in different areas of the body. This helps to calm the body and induce sleep. Other relaxation techniques that help many people sleep involve breathing exercises, mindfulness, meditation techniques, and guided imagery. Many people listen to audio recordings to guide them in learning these techniques. They can work to help you fall asleep and also return to sleep in the middle of the night.

Stimulus control helps to build an association between the bedroom and sleep by limiting the type of activities allowed in the bedroom. An example of stimulus control is going to bed only when you are sleepy and getting out of bed if you’ve been awake for 20 minutes or more. This helps to break an unhealthy association between the bedroom and wakefulness.
Cognitive behavioral therapy includes behavioral changes (such as keeping a regular bedtime and wake up time, getting out of bed after being awake for 20 minutes or so, and eliminating afternoon naps) but it adds a cognitive or “thinking” component. CBT works to challenge unhealthy beliefs and fears around sleep and teach rational, positive thinking. There is a good amount of research supporting the use of CBT for insomnia. For example, in one study, patients with insomnia attended one CBT session via the internet per week for 6 weeks. After the treatment, these people had improved sleep quality.

Conclusion
Sleep is a necessity in our everyday lives and getting the adequate amount of sleep daily will help improve our daily lives. It will enhance our productivity at work and home. The first step to overcoming this disorder is to know it’s a problem and needs immediate attention. Taking the necessary steps will also aid recovery in a timely manner.
References
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, Va: American Psychiatric Publishing, 2013.

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