M05.08.07 Insomnia

Insomnia is a common sleep disorder characterized by difficulty initiating and maintaining sleep (DIMS). It can significantly impact a person’s overall health, leading to daytime dysfunction. Insomnia is typically categorized into two main types: primary and secondary.

Types of Insomnia

1. Primary Insomnia
   • Insomnia is not directly related to any other health condition or problem.
   • It is typically caused by prolonged periods of stress or significant life changes.
2. Secondary Insomnia (Most Common)
   • This form of insomnia occurs due to underlying conditions such as:
     • Medical issues: Chronic pain, asthma, or gastrointestinal issues.
     • Psychiatric problems: Depression, anxiety, or bipolar disorder.
     • Medications: Certain medications like Corticosteroid, antidepressants, and blood pressure medications may cause insomnia.

Symptoms of Insomnia

Common symptoms associated with insomnia include:

• Daytime sleepiness
• General fatigue and tiredness
• Irritability and mood disturbances
• Difficulty concentrating
• Memory problems

Treatment Options for Insomnia

1. Sleep Hygiene

• We are developing healthy sleep habits such as regular bedtimes, creating a comfortable sleep environment, and avoiding stimulants like caffeine.

2. Behavioral Therapy

• Stimulus Control Therapy: This involves associating the bed with sleep and establishing consistent sleep routines.
• Cognitive Behavioral Therapy for Insomnia (CBT-I): A structured program that helps identify and replace thoughts and behaviors that cause or worsen sleep problems.

3. Pharmacotherapy

• Sedative-hypnotics:
  • Zaleplon, Zolpidem, Eszopiclone: These medications help individuals fall and stay asleep by working on sleep receptors in the brain.
• Ramelteon: A melatonin receptor agonist that helps regulate the sleep-wake cycle and has a lower incidence of dependence compared to other sleep medications.

Treatment Summary Table

Points to Remember

• Secondary insomnia is the most common type and is often linked to other medical or psychological conditions.
• Cognitive-behavioral therapy (CBT) is considered highly effective for long-term treatment of insomnia.
• Medications like Zaleplon, Zolpidem, and Eszopiclone are effective but may lead to dependence.
• Ramelteon is a safer alternative due to its low risk of dependence.

Bibliography Reference Links

1. National Institute of Health – Insomnia
2. American Academy of Sleep Medicine
3. Cleveland Clinic – Insomnia Overview