Insomnia sleep disorders Insomnia causes symptoms diagnosis with Insomnia treatment

  • The subjective experience of insufficient sleep or of sleep that is not refreshing
  • Insomnia is defined as a persistent AND difficulty initiating  to maintaining sleep.


  • Insomnia can be a primary ;, however  insomnia is more commonly a secondary symptom to underlying the environmental, medical, some time psychiatric disorders.
  • Insomnia is defined as a persistent AND difficulty initiating  to maintaining sleep.

Altitude insomnia —

  • A form of altitude sickness in which insomnia results from inadequate supply of oxygen.
  • It occurs commonly in High altitude places like mountaineers and to a lesser extent in aviators.
  • It is often accompanied by appetite disturbances, headaches,fatigue,  and shortness of breath.

Fatal familial insomnia —


  • An inherited, rapidly progressive prion disease of middle or later life.
  • Signs and symptoms include intractable insomnia, endocrine disturbances,autonomic dysfunction,  myoclonus, dysarthria, coma, and death.
  • There is no specific therapy

Pathophysiology – Etiology

  • Depression, anxiety, and trauma can initiate insomnia, and over the years a continue cycle of poor sleep can continue even after the initiation point is treated or removed .
  • Insomnia is caused by internal disorders of the sleep wake cycle and external factors affecting the quality of the timing of sleep.
  • Poor sleep hygiene, a disruptive sleep environment, alcohol- dependence, and chronic use of hypnotics can also cause insomnia
  • Finally many medical and psychiatric disorders can cause or be associated with insomnia.
  • Circadian rhythm disturbances (misalignment of sleep patterns with local time. can present with the primary symptom of insomnia.
2– Epidemiology
  • Insomnia is more prevalent in women and increases in prevalence with increasing age .
  • As many of the general adult population report symptoms of insomnia, and only between 9and 21 report insomnia with serious daytime consequences

Evaluation Insomnia sleep disorders

  • A good history of patient should focus on determining the cause and duration of insomnia. Precipitating events such as emotional shock, illness, stress, and prescription or
  • other drug use should be asked with the patient and to his or her partner.
  • Sleep patterns A thorough discussion of the patients sleep style and the sleep patterns of other members of their house should include the timing and the content of evening meals  bedroom environment  work schedules and sleep schedules including daytime napping
  • Review of systems The review of systems should pay special attention to common medical and psychological problems that are associated with insomnia.

Medications can cause insomnia. Physical examination is important —


  • In primary insomnia, the physical examination is likely to be normal.
  • The physical examination should focus on associated medical conditions associated with insomnia.


  • Laboratory and diagnostic testing is very useful in the diagnosis of primary insomnia.
  • Asking the patient to keep a 7 to 14 day sleep diary may help in determining extrinsic factors causing insomnia  Polysomnography can assist in the diagnosis of some sleep disorders, including sleep apnea, restless leg syndrome and periodic limb movement disorder.


  • Fatal familial insomnia is a rare prion disease that tends to run in families. In general, insomnia is not assumed to be genetically inherited

Diagnosis Differential diagnosis

  • The differential diagnosis of insomnia includes primary sleep disorders as well as medical, psychiatric, and environmental disturbances.

Clinical manifestations


  • Insomnia can cause significant functional impairment, difficulty in work or school, and marital or relationship problems.
  • Chronic sleep loss from untreated insomnia can cause fatigue-related accidents at work or while driving, job loss, decreased productivity, major depression, and suicidal
  • Individuals with insomnia may present with generalized fatigue and daytime sleepiness, and a careful history can help elucidate possible found out problems of insomnia.


Treatment Of INSOMNIA —


  • Biofeedback, sleep restriction, cognitive behavioral therapy,avoidance of depressants, or stimulants  and treatments for underlying conditions often effectively improve sleep duration and quality.
  • Benzodiazepines and other sedative/hypnotic drugs can also be used, although there may cause complications of dependency,  addiction, tolerance,or rebound sleep disturbances when the drugs are withdrawn.


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