People who have insomnia report that their sleep is inadequate or poor quality. It may be characterized by one or more of the following
Insomnia cannot be simply defined by the "facts" about sleep, such as how many hours someone sleeps or how long it takes to get to sleep. People have variable needs for and perceptions of their sleep. Consequences of insomnia can include excessive sleepiness, fatigue, irritability, and problems with tasks such as maintaining attention, organizing, and remembering.
About 30 to 40 percent of adults report insomnia in any given year. For 10 to 15 percent of these people, their insomnia is chronic and/or severe. Our ability to sleep decreases with age. Insomnia is more common in women, especially after menopause.
Insomnia may be transient (i.e., lasting from one night to several weeks), intermittent, (i.e., recurrent bouts of transient insomnia), or chronic, (i.e., occurring most nights and lasting a month or more). Transient insomnia is often triggered or perpetuated by stress or discomfort. Common disturbances include life crises, acute illness, a change in the sleep environment, uncomfortable temperature, and irregular sleep/wake schedule (e.g., shift work schedules, jet lag), and medications that impact sleep. Chronic insomnia may be due to ongoing factors, including those that cause transient insomnia, or mental or physical disorders. An irregular sleep-wake schedule can perpetuate poor sleep. Chronic sleep disturbance can reflect abnormal sleep-wake regulation or physiology during sleep. Excessive napping reduces the likelihood of sustained night sleep. Some sleep disorders, including restless legs syndrome (RLS), periodic limb movement disorder (PLMD), sleep apnea, and disturbances of circadian rhythms disrupt sleep.
Psychiatric problems frequently trigger chronic insomnia but account for less than half of cases. Depression, anxiety, and mood instability are often associated with insomnia. Medical and neurologic illnesses that disturb sleep include asthma, chronic lung disease, arthritis, heart failure, Parkinson's disease, and Alzheimer's disease. Sleep is disrupted by immobility, difficulty breathing, and pain. Hormonal changes that are associated with pregnancy, peri-menopause, and menopause disrupt sleep. Some medical problems are worse during sleep, either due to increased vulnerability because of underlying sleep physiology (e.g., asthma), and/or because they are worsened by recumbence (e.g., gastro-esophageal reflux).
When identifiable causes of insomnia are excluded or successfully treated, persisting insomnia may be classified as primary. Chronic stress, hyper-arousal, poor sleep habits, and negative conditioning may underlie primary insomnia.
Many over-the-counter prescriptions and drugs of abuse can worsen sleep quality. Individuals are variably susceptible to the effects of these agents. Activating antidepressants (e.g., buproprion), steroids, stimulant decongestants (e.g., pseudoephedrine), beta blockers (e.g., atenolol), caffeine, alcohol, nicotine, and recreational drugs degrade sleep.
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