Insomnia

Insomnia, also known as sleeplessness, is characterised by difficulty falling or staying asleep. Common symptoms include daytime sleepiness, low energy, irritability, and a depressed mood. It may also result in an increased risk of accidents and problems with focus and learning.

Insomnia can be classified into different types based on the nature of the sleep disturbance: sleep onset insomnia, nocturnal awakenings, and early morning awakening. Poor sleep quality can result from conditions like restless legs syndrome, sleep apnoea, or major depression.

Causes

Insomnia can occur independently or as a result of other conditions. Common causes include psychological stress, chronic pain, heart failure, hyperthyroidism, heartburn, restless leg syndrome, menopause, certain medications, and substances like caffeine, nicotine, and alcohol. Other risk factors include working night shifts and sleep apnoea. Genetic factors also play a role, with heritability estimates ranging from 38% in males to 59% in females. Substance-induced insomnia can result from the use or withdrawal of alcohol, benzodiazepines, and opioids.

Diagnosis

Diagnosis is based on a comprehensive sleep history and examination to rule out underlying causes. Tools such as sleep diaries and outpatient actigraphy can help track sleep patterns. Polysomnography and multiple sleep latency tests may be used in some cases. The DSM-5 criteria for insomnia require that the sleep difficulty occurs at least three nights per week for at least three months and causes significant distress or impairment.

Treatment

Non-Medication Based

Non-medication strategies are often as effective as hypnotic medications and have longer-lasting effects. Cognitive behavioural therapy for insomnia (CBT-I) is the first-line treatment and includes sleep hygiene, stimulus control, sleep restriction, paradoxical intention, and relaxation techniques. Sleep hygiene recommendations involve creating a conducive sleep environment and maintaining regular sleep habits.

Medications

While medications are used primarily for short-term relief, they can have side effects and are not recommended for long-term use. Common medications include antihistamines, antidepressants, melatonin receptor agonists, benzodiazepines, Z-drugs, and orexin antagonists. Each class of medication has its own profile of benefits and risks. For example, benzodiazepines can lead to dependence and tolerance, while melatonin receptor agonists like ramelteon have fewer side effects.

Alternative Medicine

Herbal products like valerian, kava, chamomile, and lavender are used to treat insomnia but lack quality evidence for effectiveness and safety. Acupuncture and cannabis also have unclear efficacy.

Epidemiology

Insomnia affects 10% to 30% of adults at any given time, with up to half experiencing it in a given year. Around 6% suffer from chronic insomnia lasting more than a month. Older adults and women are more frequently affected. Insomnia is also more common among university students compared to the general population.

Society and Culture

The term "insomnia" is derived from Latin, meaning "without sleep." While there are anecdotal stories of individuals who never sleep, such as Thái Ngọc and Al Herpin, these cases are not generally supported by scientific evidence.

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Self-assessment MCQs (single best answer)

Which of the following is NOT a common symptom of insomnia?

Which condition is NOT typically associated with poor sleep quality that can lead to insomnia?

What is the first-line treatment for insomnia recommended in the article?

Which of the following medications is noted for having fewer side effects compared to others?

What percentage of adults suffer from insomnia at any given time?

Which factor is NOT a common cause of insomnia?

How long must sleep difficulty persist to meet DSM-5 criteria for insomnia?

Which of the following is a non-medication-based treatment for insomnia?

Which of the following is NOT a risk factor for insomnia?

Thái Ngọc and Al Herpin are noted for: