46 INSOMNIA General Discussion Insomnia is a symptom complex consisting of inadequate or poor-quality sleep characterized by one or more of the following problems: difficulty falling asleep, difficulty staying asleep, waking up too early in the morning, and sleep that is not refreshing. Insomnia also involves daytime consequences such as lack of energy, fatigue, irritability, and difficulty concentrating. Acute insomnia represents periods of sleep difficulty lasting between 1 night and a few weeks. Chronic insomnia is sleep difficulty occurring at least 3 nights per week for 1 month or more. Insomnia is one of the most common concerns encountered in clinical practice though rates of insomnia vary considerably by study. Thirty to 40 percent of adults indicate some level of insomnia within any given year. Insomnia is more common in women and the elderly. Insomnia experienced by older adults is more common in those who have chronic disease and poor health, suggesting that insomnia is not necessarily a direct consequence of aging. Five major diagnostic categories have been established for chronic insomnia: medical, psychiatric, circadian, pharmacologic, and primary sleep disorder. Primary insomnia is sleeplessness that is not attributable to a medical, psychiatric, or environmental cause. Most cases of insomnia develop initially in response to a medical or psychosocial stressor. As sleeplessness persists, the patient may begin to associate the bed with wakefulness and heightened arousal rather than sleep, thus perpetuating the insomnia. In general, individuals with prolonged periods of wakefulness before, after, or during sleep are likely to have a behavioral, psychiatric, or circadian disorder. In contrast, patients whose symptoms are primarily frequent, brief nocturnal awakenings, sleep fragmentation, or nonrefreshing sleep are more likely to have a medical or primary sleep disorder. One model of insomnia conceptualizes predisposing, precipitating, and perpetuating factors. Predisposing factors are those which increase one’s vulnerability to insomnia and may include personality characteristics, lifestyle, and extreme circadian rhythm tendencies. A precipitant may be any major stressor such as situational crises and medical, psychiatric, and underlying sleep disorders. Perpetuating factors include maladaptive responses to the initial sleep difficulty such as daytime napping or the use of alcohol to help with sleep. Medications Associated with Insomnia Albuterol Beta blockers Dextroamphetamine Diuretics Methylphenidate Pemoline Phenylephrine Phenylpropanolamine Pseudoephedrine Quinidine Selective serotonin reuptake inhibitors Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS HYPOTHYROIDISM SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on INSOMNIA Full access? Get Clinical Tree
46 INSOMNIA General Discussion Insomnia is a symptom complex consisting of inadequate or poor-quality sleep characterized by one or more of the following problems: difficulty falling asleep, difficulty staying asleep, waking up too early in the morning, and sleep that is not refreshing. Insomnia also involves daytime consequences such as lack of energy, fatigue, irritability, and difficulty concentrating. Acute insomnia represents periods of sleep difficulty lasting between 1 night and a few weeks. Chronic insomnia is sleep difficulty occurring at least 3 nights per week for 1 month or more. Insomnia is one of the most common concerns encountered in clinical practice though rates of insomnia vary considerably by study. Thirty to 40 percent of adults indicate some level of insomnia within any given year. Insomnia is more common in women and the elderly. Insomnia experienced by older adults is more common in those who have chronic disease and poor health, suggesting that insomnia is not necessarily a direct consequence of aging. Five major diagnostic categories have been established for chronic insomnia: medical, psychiatric, circadian, pharmacologic, and primary sleep disorder. Primary insomnia is sleeplessness that is not attributable to a medical, psychiatric, or environmental cause. Most cases of insomnia develop initially in response to a medical or psychosocial stressor. As sleeplessness persists, the patient may begin to associate the bed with wakefulness and heightened arousal rather than sleep, thus perpetuating the insomnia. In general, individuals with prolonged periods of wakefulness before, after, or during sleep are likely to have a behavioral, psychiatric, or circadian disorder. In contrast, patients whose symptoms are primarily frequent, brief nocturnal awakenings, sleep fragmentation, or nonrefreshing sleep are more likely to have a medical or primary sleep disorder. One model of insomnia conceptualizes predisposing, precipitating, and perpetuating factors. Predisposing factors are those which increase one’s vulnerability to insomnia and may include personality characteristics, lifestyle, and extreme circadian rhythm tendencies. A precipitant may be any major stressor such as situational crises and medical, psychiatric, and underlying sleep disorders. Perpetuating factors include maladaptive responses to the initial sleep difficulty such as daytime napping or the use of alcohol to help with sleep. Medications Associated with Insomnia Albuterol Beta blockers Dextroamphetamine Diuretics Methylphenidate Pemoline Phenylephrine Phenylpropanolamine Pseudoephedrine Quinidine Selective serotonin reuptake inhibitors Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS HYPOTHYROIDISM SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on INSOMNIA Full access? Get Clinical Tree
