Insomnia (cont.)
IN THIS ARTICLE
- Insomnia Overview
- Insomnia Causes
- Primary Sleep Disorders
- Insomnia Symptoms
- When to Seek Medical Care
- Exams and Tests
- Insomnia Treatment
- Non-medical treatment and behavioral therapy
- Medical Treatment
- Medications and Medical Therapy
- Next Steps
- Follow-up
- Prevention
- Outlook
- For More Information
- Web Links
- Synonyms and Keywords
- Authors and Editors
Insomnia Causes
Insomnia may be caused by a host of different reasons. These causes may be divided into situational factors, medical or psychiatric conditions, or primary sleep problems. Insomnia could also be classified by the duration of the symptoms into transient, short-term, or chronic. Transient insomnia generally last less than seven days; short-term insomnia usually lasts for about one to three weeks, and chronic insomnia lasts for more than three weeks.
Many of the causes of transient and short-term insomnia are similar and they include:
- Jet lag
- Changes in shift work
- Excessive or unpleasant noise
- Uncomfortable room temperature (too hot or too cold)
- Stressful situations in life (exam preparation,
loss of a loved one, unemployment, divorce, or separation)
- Presence of an acute medical or surgical illness or hospitalization
- Withdrawal from drug, alcohol, sedative, or stimulant medications
- Insomnia related to high altitude (mountains)
Chronic or long-term insomnia
The majority of causes of chronic or long-term insomnia are usually linked to an underlying psychiatric or physiologic (medical) condition.
Psychological related insomnia
The most common psychological problems that may lead to insomnia include:
- anxiety,
- stress,
- schizophrenia,
- mania (bipolar disorder), and
- depression.
In fact, insomnia may be an indicator of depression. Many people will have insomnia during the acute phases of a mental illness.
Physiological related insomnia
Physiological causes span from circadian rhythm disorders (disturbance of the biological clock), sleep-wake imbalance, to a variety of medical conditions. The following are the most common medical conditions that trigger insomnia:
- Chronic pain syndromes
- Chronic fatigue syndrome
- Congestive heart failure
- Night time angina (chest pain) from heart disease
- Acid reflux disease (GERD)
- Chronic obstructive pulmonary disease (COPD)
- Nocturnal asthma (asthma with night time breathing symptoms)
- Obstructive sleep apnea
- Degenerative diseases, such as
Parkinson's disease and Alzheimer's disease (Often insomnia is the deciding factor for nursing home placement.)
- Brain tumors, strokes, or trauma to the brain
High risk groups for insomnia
In addition to the above medical conditions, certain groups may be at higher risk for developing insomnia:
- travelers
- shift workers with frequent changing of shifts
- seniors
- adolescent or young adult students
- pregnant women, and
- menopausal women
Medication related insomnia
Certain medications have also been associated with insomnia. Among them are:
- Certain over-the-counter cold and asthma preparations.
- The prescription varieties of these medications may also contain stimulants and thus produce similar effects on sleep.
- Certain medications for high blood pressure have also been associated with poor sleep.
- Some medications used to treat depression, anxiety, and schizophrenia.
Other causes of insomnia
- Common stimulants associated with poor sleep include caffeine and nicotine. You should consider not only restricting caffeine and nicotine use in the hours immediately before bedtime but also limiting your total daily intake.
- People often use alcohol to help induce sleep, as a nightcap. However, it is a poor choice. Alcohol is associated with sleep disruption and creates a sense of nonrefreshed sleep in the morning.
- A disruptive bed partner with loud snoring or periodic leg movements also may impair your ability to get a good night's sleep.
Next: Primary Sleep Disorders »
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Cymbalta is approved for the treatment of depression.
Important Safety Information
Cymbalta® (duloxetine HCl) is approved for the treatment of depression and generalized anxiety disorder, and for the management of diabetic peripheral neuropathic pain and fibromyalgia.
What should I talk about with my healthcare provider?
Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, unusual changes in behavior, thoughts of suicide, anxiety, agitation, panic attacks, difficulty sleeping, irritability, hostility, aggressiveness, impulsivity, restlessness, or extreme hyperactivity. Call your healthcare provider right away if you have thoughts of suicide or if any of these symptoms are severe or occur suddenly. Be especially observant within the first few months of antidepressant treatment or whenever there is a change in dose.
You should also know that:
- ·Suicide is a known risk of depression and some other psychiatric disorders.
- ·Antidepressants may increase suicidal thoughts or behaviors in some children, adolescents, and young adults especially within the first few months of treatment or when changing the dose. No increased risk has been shown for adults over age 24, and risk decreased for those over age 65.
- ·All patients starting therapy should be monitored appropriately and observed closely for new or worsening depression symptoms, suicidal thoughts or behavior, or unusual changes in behavior.
- ·Cymbalta® is not approved for use in patients under age 18.
Who should NOT take Cymbalta?
You should not take Cymbalta if:
- ·You have recently taken a type of antidepressant called a monoamine oxidase inhibitor (MAOI)
- ·You have uncontrolled narrow-angle glaucoma (an eye disease)
- ·You are taking Mellaril® (thioridazine)
What other important information should I discuss with my healthcare provider?
Before starting Cymbalta, tell your healthcare provider:
- ·about all of your medical conditions, including kidney problems, glaucoma, or diabetes
- ·about your alcohol use
- ·if you are taking nonprescription or prescription medicines, including those for migraine, to address a possible life threatening condition
- ·if you are taking NSAID pain relievers, aspirin, or blood thinners. Use with Cymbalta may increase bleeding risk
- ·if you are pregnant, plan to become pregnant during therapy, or are breastfeeding an infant
While taking Cymbalta, tell your healthcare provider:
- ·if you have itching, right upper belly pain, dark urine, yellow skin/eyes, or unexplained flu-like symptoms, which may be signs of liver problems. Severe liver problems, sometimes fatal, have been reported
- ·if you have high fever, confusion, and stiff muscles to address a possible life-threatening condition
- ·before stopping Cymbalta or changing your dose
- ·if you experience dizziness or fainting upon standing, especially when first starting Cymbalta or when increasing the dose. Your healthcare provider may periodically check your blood pressure while you are taking Cymbalta
If you have any questions, talk to your healthcare provider before taking Cymbalta.
What are the possible side effects of Cymbalta?
The most common side effect of Cymbalta was nausea. For most people who had it, the nausea was mild to moderate. Other common side effects included dry mouth, sleepiness, constipation, decreased appetite, and, increased sweating. This is not a complete list of side effects.
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Insomnia »
Insomnia is defined as repeated difficulty with the initiation, duration, maintenance, or quality of sleep that occurs despite adequate time and opportunity for sleep that results in some form of daytime impairment.
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