Although this statement does not have any scientific proof yet, it is possible, that every single person on the globe is affected by some form of insomnia. Not many of us are aware, that insomnia is a symptom, not a disease, and thus it is associated with a wide variety of medical, psychiatric, and sleep disorders. [Rowley, 2005].
Insomnia can be defined as abnormal wakefulness or inability to sleep [The Columbia Encyclopedia, 2004], and it may include problems like difficulty falling asleep, sleeping too lightly, being easily disrupted with multiple spontaneous awakenings, or awakening in the early morning with an inability to fall back asleep. Experts also state that there is one additional condition taken into account: to be considered a disorder, insomnia should be “accompanied by distress and impairment in daytime functioning” [Rowley, 2005].
In general practice, sleep disturbance is a common complaint that has numerous reports nation and worldwide. According to Janet Hopson, surveys conducted in the 1980s showed that a few adults in the United States reported some degree of insomnia at any given time. One-fifth of them believed their sleep problems were chronic [Hopson, 1986]. In a survey conducted in 1991, 30-35% of adult Americans reported difficulty sleeping in the past year and 10% said insomnia to be chronic, severe, or both [Rowley, 2005]. It is notable that, despite high levels of prevalence, only 5% of individuals with chronic insomnia visited their physicians specifically to discuss this problem, while just 26% considered it during a visit connected with another question. The situation seems to worsen in recent years: in 2001, approximately 38 percent of the same category of U.S. citizens claimed they were sleeping less than they were five years earlier. Statistics show Americans stay in bed per night on average for seven hours, and almost 60 percent report they have troubles with sleep at least a few nights every single week [Marano, 2003]. It is accepted that insomnia is a serious public health problem. According to the Annual Review of Psychology, in 2002, “the direct costs of assessing and treating insomnia were approximated as $14 billion in the United States” [Espie, 2002].
Types of Insomnia
There are three officially recognized categories of insomnia: acute, intermittent and chronic. Severe insomnia is brief but it, in fact, is the most common. Some crisis most often causes it, and the insomnia is over when the crisis ends. Intermittent insomnia implies that an individual sleeps well for weeks/months and then has troubles falling or staying asleep for days or weeks. Chronic insomnia is the most complicated and long-term form – it can last for years or even a lifetime. Scientists still argue what period to consider for either type of sleep impairment. Some believe that acute insomnia lasts no longer than four weeks (Rajput and Bromley, 1999). Others think that a period for this category should be much more substantial – up to six months [Rowley, 2005].
In most cases, transient, or intermittent type of insomnia can be relieved with appropriate attention to the cause of the problem. Chronic insomnia is much more complicated than acute transient insomnia, and it requires a more complicated approach identification and treatment.
Causes of sleep impairment
Experts have discovered numerous reasons that may lead to problems with sleep. The origins of insomnia can be psychological, medical, dietary, drug-related or even environmental. The most common cause of insomnia is mental such as depression, anxiety, worry, fear or an overactive mind. Medical causes of insomnia are physical pain and discomfort, chronic disease, or medical conditions (e.g., sleep apnea). Individuals that suffer the sleep apnea disorder stop breathing during sleep and wakes up abruptly numerous times a night. Excessive heat or cold, humidity, noise may all cause insomnia. Some medications may have a negative influence on the organism and lead to sleep shortage. Excessive food consumption late in the evening before bedtime may also cause insomnia.
The article of Vijay Rajput and Steven Bromley provides the following information. Acute (or transient insomnia) may be most often caused by stress (recent or recurring), change in sleeping environment, acute illness or injury, new medications, jet lag or shift change. Chronic insomnia that lasts longer has two forms: difficulty staying asleep and trouble falling asleep. Drug or alcohol use may cause the prior, psychiatric disorders (e.g., depression, anxiety), medical disorders and medicine, sleep-disordered breathing (e.g., sleep apnea), and much more. The latter has the following possible causes: poor sleep hygiene, conditioned insomnia (behavioral conditioning), restless legs syndrome, circadian rhythm disorder, advanced or delayed sleep-phase syndrome. The same article states that medical conditions that cause pain, such as arthritis, prostatic hyperplasia; and also menopause, heart failure, pulmonary or peptic ulcer disease, allergic rhinitis, seizure disorder – are all frequently associated with sleep impairment.
Conservative estimation of the percentage of chronic insomnia is from 9-12% in adulthood and up to 20% in later life [Espie, 2002]. It is also interesting that women suffer from insomnia symptoms twice more than men. The physiologic parameters of sleep typically change with age, and the elderly have insomnia patterns that are recognized as more complex and difficult to relieve. But, once established, sleep disorders may persist for many years.
Impact of insomnia on human lives
There is numerous ways sleep impairment may influence human beings. Insomnia may impair quality of life in many different ways. It usually causes daytime drowsiness, and therefore individuals may experience reduced memory, a diminished ability to concentrate, difficulty coping with minor irritations, and decreased the ability to enjoy family and social relationships. Poor sleepers also demonstrate poor productivity, higher rates of absenteeism and, no surprise, are found to have fewer promotions. The mortality rate appears to be higher in patients who sleep fewer than 5 hours each night [Rowley, 2005]. Individuals with insomnia are more than twice as likely to have a fatigue-related motor vehicle accident.
In different cases, there may be various causes of insomnia, sometimes there may even be more than one cause simultaneously, but these objectives may be difficult to identify and therefore eliminate. Ways of treating sleep impairment vary from drug therapy to behavioral intervention. The prior may be beneficial for short-term improvement, the latter – is more efficient and reliable in the long-term. Historically long-term sleep disorders were cured with psychotropic or sedative-hypnotic drugs. Most of them are reported to have adverse reactions. Most therapists consider the combination of behavioral intervention and pharmacologic agents to be the most effective way in comparison to the effects of either approach alone.
But still, the treatment indeed depends on the etiology of the problem. If pain syndromes cause insomnia, adequate pain control is used as a cure and a treatment to a sleep disorder. Psychiatric issues should be addressed directly and may be treated by appropriate medications, psychotherapy, etc. If the insomnia is related to medicine or drug abuse, the most useful therapy is the withdrawing of the offending medication or drugs.
Behavioral therapy is considered to be the most effective treatment for patients with primary insomnia caused by physiologic, emotional, or other related problems. Behavioral therapy includes relaxation therapies, stimulus control therapy and sleep-restriction therapy.
The sleep-related problems are not yet correctly studied and leave many questions to the future generations of psychologists. It is evident that the problem is global and has various causes but the same hazardous outcomes. If not treated adequately, insomnia may ruin not only the social aspects of human life but the life itself.
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