Insomnia

Insomnia is defined as difficulty initiating or maintaining sleep, or both, despite adequate opportunity and time to sleep, leading to impaired daytime functioning. Insomnia may be due to poor quality or quantity of sleep.

Insomnia affects people of all ages including children, although it is more common in adults and its frequency increases with age. In general, women are affected more frequently than men.

Classification of Insomnia based on the duration of symptoms & stress:

• 1) Insomnia lasting one week or less may be termed transient insomnia
• 2) Short-term insomnia lasts more than one week but resolves in less than three weeks
• 3) Long-term or chronic insomnia lasts more than three weeks
• 4) Short duration sleep may be normal in some individuals who may require less time for sleep without feeling daytime impairment, the central symptom in the definition of insomnia

In insomnia, adequate time and opportunity for sleep is available, whereas in sleep deprivation, lack of sleep is due to intentional evasion of sleep.

The symptoms of insomnia depend on the type of sleeping problem. Lack of sleep can affect mood and cause tiredness and fatigue during the day. Symptoms of insomnia include:

• 1) Lying awake for a long time at night before falling asleep
• 2) Waking up several times in the middle of the night
• 3) Waking up early in the morning and not being able to get back to sleep
• 4) Feeling tired and not refreshed by sleep
• 5) Not being able to function properly during the day and finding it difficult to concentrate
• 6) Being irritable

Sleep Apnea

Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. When breathing pauses or becomes shallow, often move out of deep sleep and into light sleep.

As a result, the quality of sleep is poor, which makes a person tired during the day. Sleep apnea is a leading cause of excessive daytime sleepiness.

Types of Sleep Apnea:

Obstructive sleep apnea is the most common type of sleep apnea. It occurs when the soft tissue in the back of your throat relaxes during sleep and blocks the airway, often causing you to snore loudly. Central sleep apnea is a much less common type of sleep apnea that involves the central nervous system, occurring when the brain fails to signal the muscles that control breathing. People with central sleep apnea seldom snore.

Complex sleep apnea is a combination of obstructive sleep apnea and central sleep apnea.

Major signs and symptoms of sleep apnea

• 1) Loud and chronic snoring
• 2) Choking, snorting, or gasping during sleep
• 3) Long pauses in breathing
• 4) Daytime sleepiness

Untreated Sleep Apnea can:

• 1) Increase the risk of high blood pressure, heart attack, stroke, obesity, and diabetes
• 2) Increase the risk of heart failure
• 3) Make arrhythmias or irregular heartbeats
• 4) Increase the chance of having work-related or driving accidents

Sleep apnea is a chronic condition that requires long-term management. Lifestyle changes, mouthpieces, surgery, and breathing devices can successfully treat sleep apnea in many people.

Snoring

Snoring is a sound produced by vibration of the soft tissues of the upper airway during sleep. It usually occurs during inhaling, but can also occur during exhaling. It is indicative of increased upper airway resistance. It can be a sign of obstructive sleep apnea (OSA), a sleep disorder characterized by obstructive apneas and hypopneas that occurs when upper airway resistance is sufficient to disrupt sleep.

Snoring can also be associated with conditions that narrow the upper airway, including obesity, nasal clogging, craniofacial abnormalities, hypothyroidism, acromegaly, and adenotonsillar hypertrophy. These conditions, in turn, may cause snoring without obstructive sleep apnea, or snoring that occurs as a symptom of OSA. It is important to recognize the clinical features of conditions associated with snoring so that objective testing can be performed and treatment initiated, if indicated.

Lifestyle changes, such as losing weight, avoiding alcohol close to bedtime or sleeping on your side, can help stop snoring. In addition, medical devices and surgery are available that may reduce disruptive snoring. However, these aren't suitable or necessary for everyone who snores.

Treating Insomnia

Generally, treatment of insomnia entails both non-pharmacologic (non-medical) and pharmacologic (medical) aspects. It is best to tailor treatment for individual person based on the potential cause. Studies have shown that combining medical and non-medical treatments typically is more successful in treating insomnia than either one alone.

Non-medical treatment and behavioral therapy include:

• 1) Sleep hygiene education
• 2) Cognitive therapy
• 3) Relaxation therapy
• 4) Stimulus-control therapy
• 5)Sleep-restriction therapy

Sedative-hypnotics are the most commonly prescribed drugs for insomnia. Though not usually curative, they can provide symptomatic relief when used alone or adjunctively.