NAME: Lovelane Bargayo

Insomnia is a sleep disorder that is characterized by difficulty falling and/or staying asleep. People
with insomnia have one or more of the following symptoms:

 Difficulty falling asleep

 Waking up often during the night and having trouble going back to sleep
 Waking up too early in the morning
 Feeling tired upon waking

Types of Insomnia
There are two types of insomnia: primary insomnia and secondary insomnia.

 Primary insomnia: Primary insomnia means that a person is having sleep problems that are
not directly associated with any other health condition or problem.
 Secondary insomnia: Secondary insomnia means that a person is having sleep problems
because of something else, such as a health condition
(like asthma, depression, arthritis, cancer, or heartburn); pain; medication they are taking; or a
substance they are using (like alcohol).

Acute vs. Chronic Insomnia

Insomnia also varies in how long it lasts and how often it occurs. It can be short-term (acute
insomnia) or can last a long time (chronic insomnia). It can also come and go, with periods of time
when a person has no sleep problems. Acute insomnia can last from one night to a few weeks.
Insomnia is called chronic when a person has insomnia at least three nights a week for a month or
longer.

Causes of Insomnia
Causes of acute insomnia can include:

 Significant life stress (job loss or change, death of a loved one, divorce, moving)
 Illness
 Emotional or physical discomfort
 Environmental factors like noise, light, or extreme temperatures (hot or cold) that
interfere with sleep
 Some medications (for example those used to treat colds, allergies, depression, high
blood pressure, and asthma) may interfere with sleep
 Interferences in normal sleep schedule (jet lag or switching from a day to night shift, for
example)

Causes of chronic insomnia include:

 Depression and/or anxiety

 Chronic stress
 Pain or discomfort at night

Prognosis

Up to 90% of Australians suffer from a sleep disorder, with 30% experiencing a severe sleeping
disorder. Insomnia is the most common sleep disorder. Approximately 5% of the population
experience chronic insomnia, with 25% of these cases being primary insomnia.

One third of adults experience some degree of insomnia in any given year, and 2–6% use
medications to aid sleep.
Insomnia is particularly common in individuals with disrupted circadian rhythms, such as shift
workersand individuals experiencing jet lag. Acute insomnia may also occur in individuals
experiencing traumasuch as the loss of a loved one. While insomnia following a tragedy often
NAME: Lovelane Bargayo

only occurs for the days or weeks following the event, if an individual does not receive
appropriate counselling and grief management, the insomnia can become chronic.

About 60% of adults sleep between 7 and 8 hours per night, with ~8% of individuals
sleeping for less than 5 hours per night. Individuals who sleep for less than 6 hours per
night have a shorter life expectancy than individuals who sleep 7–8 hours per night.
Cyclical insomnia may occur for a brief period, or may be an issue throughout the life of an
individual.
Transient insomnia usually lasts for less than 3 weeks. However, while insomnia following a
traumatic event often only occurs in the days or weeks following the event, it can become
chronic if an individual does not receive appropriate counselling and grief management.
Cognitive behavioural therapy and improved sleep hygiene are very effective as primary
interventions for alleviating insomnia. If these treatment options are not effective, then
pharmacological agents may be considered. In general, insomnia can be treated well in the
majority of people.

Symptoms of Insomnia
Symptoms of insomnia can include:
 Excessive daytime tiredness;
 Physical weariness;
 Fatigue;
 Muscle aches: These are common and are often more severe in the limbs. Muscle aches can
also precipitate neck and head aches. The aches are likely a result of the increased muscle
tension, since the muscles miss out on the normal inhibition of motor activity that occurs
during sleep;
 Increased risk of falls (particularly in the elderly);
 Hypertension (high blood pressure);
 Poor immune system function;
 Susceptibility to obesity;
 Increased risk of cardiovascular disease; and/or
 Increased risk of diabetes.

The psychological symptoms of insomnia include:

 Loss of concentration;
 Deterioration of memory;
 Irritability and mood disturbances;
 Anxiety and depression;
 Loss of motivation;
 Fear regarding long-term effects of insomnia; and/or
 Over-thinking at bedtime: These thoughts often centre around a fear of not sleeping or
frustration and anxiety regarding the insomnia

Diagnosing Insomnia
If you think you have insomnia, talk to your health care provider. An evaluation may include
a physical exam, a medical history, and a sleep history. You may be asked to keep a sleep diary
for a week or two, keeping track of your sleep patterns and how you feel during the day.
Your health care provider may want to interview your bed partner about the quantity and quality
of your sleep. In some cases, you may be referred to a sleep center for special tests.
 NAME: Lovelane Bargayo

Medications

According to the American Association of Retired Persons (AARP), the following medications
can cause insomnia in some patients:

 Corticosteroids  ARBs (angiotensin II-receptor blockers)

 statins  cholinesterase inhibitors

 alpha blockers  second generation (non-sedating) H1

agonists
 beta blockers
 glucosamine/chondroitin
 SSRI antidepressants

 ACE inhibitors

Treatment of primary insomnia

For acute insomnia (less than 2 weeks), which often follows a life-changing event, such as the
death of a loved one, medication over a short period is the normal method of treatment.
Treatment options for chronic insomnia are divided into pharmacological and non-
pharmacological interventions.
Non-pharmacological interventions

Cognitive behavioural therapy

Cognitive behavioural therapy addresses an individual’s incorrect beliefs and attitudes towards
sleep (e.g. unrealistic expectations, misconceptions). Techniques include reattribution training
(e.g. goal setting and planning appropriate coping responses), decatastrophising, and attention
shifting.
Cognitive behavioural therapy and other behavioural therapies, including relaxation therapy and
sleep restriction, have been shown to produce reliable and long-lasting improvements in
individuals suffering with chronic insomnia.
Relaxation therapy

Relaxation therapy involves tensing and relaxing different muscle groups, meditation and
hypnosis.

Sleep restriction

Sleep restriction is an approach in which an individual spends less time in bed. The aim is that
the individual then associates time spent in bed with time spent sleeping. Bedtimes are then
NAME: Lovelane Bargayo

increased or decreased, depending on sleep quality and duration. This state of minimal sleep
deprivation can eventually lead to improved quality of sleep

Exercise

Moderate-intensity level exercise can be useful, but should not be undertaken just before
bedtime. Exercise has been shown in some studies to be as effective at improving sleep as
benzodiazepines.

Avoiding stimuli

Avoiding stimuli before bedtime can promote more efficient sleep and decrease the amount of
time taken to fall asleep. Stimuli to avoid at night include:

 Bright lights;
 Noise and temperature extremes;
 Large meals;
 Caffeine;
 Smoking; and
 Alcohol.
Restricting use of the bedroom

Restricting the use of the bedroom to sleep and intimacy, and leaving the bedroom if unable to
fall asleep within 20 minutes can, over time, help an individual to associate the bedroom with
sleeping, and increase sleep efficiency.

Nursing Interventions

 Check the patient’s sleep pattern and observe the physical circumstances (sleep apnea,
airway obstruction, pain/discomfort and urinary frequency) and/or psychological ones
(fear/ anxiety) that disrupt sleep.

 Show the patient how to control the sleep patterns

 .Control participation in activities that cause fatigue during waking hours to avoid
excessive fatigue.

 Adjust the environment (light, noise, temperature, mattress and bedding) to promote
sleep.
NAME: Lovelane Bargayo

 Encourage the patient to establish a routine when going to bed to ease the transition from
wakefulness to sleep.

 Help to eliminate stressful situations before going to bed.

 Help the patient to refuse food or drinks that interfere with sleep just before going bed.

 Help the patient to limit sleep during the day by providing an activity to promote
wakefulness, if appropriate.

 Show the patient how to perform autogenic muscle relaxation or another non-
pharmacologic sleep induction exercise.

 Group activities to minimise the number of awakenings. allow sleep cycles of at least 90
minutes. Adjust the medication programme to help the patient’s sleep/wake cycle.

 Explain those factors that contribute to disturbing the sleep pattern to the patient and
loved ones (physiological, psychological, lifestyle, frequent changes of shift, rapid time
zone changes, excessively long working hours and other environmental factors).

 Discuss techniques to promote sleep with the patient and family. Provide written
information, pamphlets etc, on sleep promotion techniques.