Insomnia is a disorder that is characterized by difficulty withsleep, which results in insufficient sleep (Ebben and Kapella 2014).The condition comprises of an inability to fall asleep, troubleremaining asleep, and repeatedly waking up at night (Ebben andKapella 2014). The disorder causes an individual to feel unrefreshedall through the day resulting in an inability to function competentlyin daytime tasks. While everyone is at risk of developing insomnia,specific groups of individuals have an increased risk. These arepeople with mood disorders like depression and anxiety, females, oldpeople and persons with persistent medical illnesses like asthma(Ebben and Kapella 2014). In addition, medication can also cause thedevelopment of insomnia. For example, “medications often taken bythose with lung problems, which include beta agonists, prednisone andtheophylline-containing medication” can cause the condition (Ebbenand Kapella 2014).
In some instances, insomnia begins as a sleep difficulty thatemerges due to events that happen in one’s life. Illustrationsinclude the death of a loved one, break-up from a relationship,stressing workplace or loss of employment (Ebben and Kapella 2014).However, it is possible for insomnia to continue even after anindividual has recovered from a saddening event. When people areunable to sleep, they unknowingly take measures that lead to moredifficulty with sleep. Such measures include consuming drinks thatcontain caffeine as a way of countering the fatigue associated withlack of ample sleep (Ebben and Kapella 2014). Caffeine acts as astimulant that might worsen the ability to sleep. Another measure isconsuming an alcoholic drink before sleeping. While it may beeffective, many people are likely to wake up once the alcohol wearsoff (Ebben and Kapella 2014).
Insomnia can be classified into different types, which are acute,chronic, comorbid, onset and maintenance insomnia (National SleepFoundation 2016). Acute insomnia occurs after a stressing lifeevent and resolves without the requirement of treatment. Chronicinsomnia is evident when an individual has a pattern of difficultywith sleep. The condition is termed chronic when a person is unableto sleep normally for three nights in one week, which persists formore than three months. Comorbid insomnia is linked to a differentcondition such as back pain that makes it difficult to fall asleep.Onset insomnia occurs when an individual is unable to fall asleep atthe onset of the night. Maintenance insomnia happens when people wakeup at night and are unable to fall asleep again.
Pathophysiology of Insomnia
The condition becomes apparent when an individual does not getenough sleep, in quality as well as quantity. Insomnia is perceivedas a hyper arousal disorder that is experienced all through the day(Levenson, Kay and Buysse 2015). The hyper arousal is displayed as aform of hypervigilance in the daytime and trouble instigating andretaining sleep at night. Advancements have been made over the yearsin comprehending the pathophysiology. However, none of the modelsidentified has been universally accepted. This is due to disorder’sheterogeneity, its enhanced comorbid and disparities in the levels ofanalysis for the models employed (Levenson, Kay and Buysse 2015).
The arousal is explained through cognitive as well as physiologicalmodels of the disorder. According to the cognitive model, anxiety andmeditation concerning life’s stresses causes a disruption on sleep,resulting in acute insomnia, specifically in triggering sleep orgoing back to sleep after waking up (Levenson, Kay and Buysse 2015).When a person experiences persistent difficulty in sleeping, anxietyand thoughts shifts from life stresses to worrying about theinability to sleep, as well as the daytime aftermaths of lack ofample sleep. Hence, the cognitive model explains that insomnia isassociated with a negative cognitive activity that is triggered by asleep-correlated threat.
The physiological model suggests that insomnia develops because ofneurophysiologic or physiologic aspects. The model has been assessedvia calculations of the entire body’s metabolic rate, functionalneuroimaging, differences in heart rate and through neuroendocrineassessments (Levenson, Kay and Buysse 2015). It is possible tocalculate the entire body’s metabolic rate through oxygenconsumption. Research depicts that individuals with insomnia depicteda higher level of metabolic activity, as compared to people withnormal sleep patterns (Levenson, Kay and Buysse 2015). In regard toheart rate, insomnia causes an enhanced heart rate and decreasedvariability at all sleeping stages. Additional evidence of hyperarousal as a major cause of insomnia arising from physiologic factorsis evident from research conducted on people with the disorder.Individuals who are unable to sleep have “increased bodytemperature, vasoconstrictions, body movements, and skin resistanceas compared with good sleepers” (Levenson, Kay and Buysse 2015).
Recent Research and Possible Treatment
The pharmacologic and cognitive behavioral approaches are used astreatment for insomnia.
Pharmacological Approaches – there are four approaches thatcomprise of medical treatment of the condition. First is theutilization of sedative hypnotics as well as receptor agonists(Perlis and Gehrman 2013). It is presumed that the receptor agonistshave a greater probability of success in treating insomnia. Thesecond pharmacological approach entails using melatonin agonists.Third is the use of doxepin in low doses. The compound is anantidepressant and is effective in treating insomnia because itprovides “good efficacy while providing a reduced risk for sideeffects and tolerance, especially in elderly patients (Perlis andGehrman 2013)”. The fourth approach, involves the use of variousantipsychotic as well as antidepressant drugs.
Cognitive Behavioral Approach – it is the main approach totreating insomnia and includes a“multicomponent behavioral therapy that usually comprises of threecore treatments: stimulus control, sleep restriction, and sleephygiene therapies” (Perlis and Gehrman 2013). Stimulus controlentails restricting the activities that happen in the bedroom priorto sleeping, controls the time individuals with insomnia spend whilenot sleeping, and encourage counter-conditioning, which is ensuringthat the sleeping environment is sleep friendly. Sleep restriction isa form of therapy where patients are required to reduce the timespent in bed awake. Sleep hygiene is a treatment approach wherebythe patient and clinician go through a number of instructions thatare aimed at enabling the person with insomnia develop propersleeping habits (Chuo, Chang and Chung 2015).
Recent research on insomnia demonstrates that while treatmentapproaches such as the cognitive behavioral approach has beeneffective it appears to solely concentrate on behaviors that areconcerned with sleep (Cunnington 2015). New studies demonstrate thatapproaches like mindfulness have an important function in treatinginsomnia. For instance, Cunnington (2015) conducted a study thatconcentrated solely on training individual on “mindfulness-basedmeditation”. The research concludes that patients felt much betterall through the day, which altered how they slept during the nightand their perception about sleeping. This study differs from thecognitive approach, which instead focuses on changing sleep. Hence,resulting in the conclusion that treatment is more effective when itinitially focuses on changing sleep perceptions as compared toaltering sleep itself.
Recent research has also focused on the use of advent imagingmethods to determine how different sections in the brain respondduring sleep in individuals with the disorder. These include scansthat assess brain activity like “default mode network, executivecontrol network and salience network” (Cunnington 2015). It isapparent that in individuals with the disorder, the default as wellas executive network fails to turn off when sleeping. Patientsdescribe feeling that involve being perceptive of their surrounding,having a wandering mind, and thinking while asleep. As such, newtreatments are focusing on interventions that could reduce brainactivity at night and ensure that people are able to fall asleepfirst without frequent awakenings.
In future, I believe that research should focus on how to stop thedevelopment of insomnia. While many people experience a level ofmanageable lack of sleep, for some individuals it becomes impossibleto deal with their sleep difficulty. Current research on the disorderhas only focused on how the later group of people can manage theirlack of sleep. It would be more effective to use approaches that stopthe advancement of insomnia in persons that already depict indicatorsof inability to sleep that could become chronic. For instance, whensomeone losses a loved one and reports inability to sleep, theclinician should predict that the disorder could escalate to chronicinsomnia. Hence, therapy is introduced immediately to deal with thestressor, which is loss of someone, and this in turn solves andavoids an escalating sleeping difficulty.
Chou T L, Chang LI, Chung MH. 2015.The mediating and moderating effects of sleep hygiene practice onanxiety and insomnia in hospital nurses. InternationalJournal of Nursing Practice, 21(S2):9-18.
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Ebben M, Kapella M. 2014. Insomnia. American Journal ofRespiratory and Critical Care Medicine 190: 9-10.
Levenson JC, Kay DB, Buysse DJ. 2015. The Pathophysiology ofinsomnia. Chest 147(4): 1179-1192.
National Sleep Foundation. 2016. What are different types ofinsomnia? Available from:https://sleepfoundation.org/insomnia/content/what-are-different-types-insomnia
Perlis ML, Gehrman P. 2013. Types of insomnia. University ofPennsylvania, Philadephia: Elzervier Inc.