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Classification of insomnia A useful way of classifying insomnia in practice is to assess whether it is transient , acute or chronic .
Transient insomnia lasts for a few nights only and is typically caused by acutely stressful life events , changes in the sleep environment ( such as sleeping in a strange location or different bed ), by acute illness , grief and jet lag . Although transient insomnia typically lasts less than a week , the consequences are those of sleep deprivation .
Acute insomnia is the inability to consistently sleep well for a period of less than four weeks . Its causes are often the same as in transient insomnia , and it is also sometimes called short-term or stress-related insomnia .
Chronic insomnia lasts for longer than four weeks and is typically due to a variety of medical , behavioural and environmental conditions . People with high levels of stress are more likely than others to have chronic insomnia . Some health professionals also classify this further as primary – a diagnosis of exclusion where there is no identifiable cause and which accounts for up to 20 % of chronic insomnia – and secondary , which is associated with other conditions such as obstructive sleep apnoea , parasomnias and narcolepsy .
Some people may believe they suffer from insomnia , but have misperceptions about their sleeping state and in fact sleep for an appropriate amount of time and do not have daytime symptoms of sleep deprivation . They do not feel as if they have slept correctly and so they underestimate how long they remain asleep and also falsely believe they take an abnormally long time to fall asleep . Such people do not suffer from insomnia in the correct sense of the word .
Shift workers – especially if they cross time zones . People with chronic diseases such as diabetes , kidney disease , lung disease , Alzheimer ’ s or heart disease .
Those with a high intake of alcohol or recreational drug users . Smokers . People suffering from gastro-oesophageal reflux disease
( GORD ). People suffering from chronic pain . However , determination of a cause is not necessary for a diagnosis of insomnia to be made .
The Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition ( DSM-5 ) criterion for diagnosing insomnia is a predominant complaint of dissatisfaction with sleep quantity or quality , associated with one ( or more ) of the following symptoms : Difficulty getting to sleep . Difficulty maintaining sleep , characterised by frequent awakenings or problems returning to sleep after awakenings . Early-morning waking , with an inability to return to sleep once awake .
People with insomnia are often fatigued and anxious , and become more tense and worried as bedtime approaches . They are also at an increased risk of accidents and falls , and experience cognitive impairment such as reduced memory and concentration .
More than
50 %
of people in the UK suffered with insomnia during the first lockdown
Causes of insomnia There are multiple possible causes of insomnia , including the sleeping environment , medical comorbidities , medication use and substance misuse , and psychiatric causes . Examples of these include :
Medical comorbidities Movement disorders such as Parkinson ’ s , restless leg syndrome . Cardiorespiratory disorders such as congestive cardiac failure ( CCF ), angina , chronic obstructive pulmonary disease ( COPD ), asthma . Painful conditions such as arthritis . Gastrointestinal disease such as reflux , irritable bowel syndrome . Nocturia , caused by factors such as benign prostatic hypertrophy , diabetes and the use of diuretics . Dementia . Endocrine causes such as hyperthyroid sweats . Menopause-linked symptoms . Obstructive sleep apnoea .
Medication and substance misuse Alcohol ( this reduces time to sleep onset but disturbs sleep later ). Caffeine . Recreational drugs . Nicotine . Chronic use of hypnotics such as benzodiazepines . B-blockers and calcium-channel blockers . NSAIDs . Salbutamol , salmeterol and theophylline . Steroids .
Psychiatric causes Depression and bipolar disorder . Generalised anxiety disorder . Panic disorder . PTSD . Paranoia and schizophrenia .
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