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Insomnia: Causes, Factor affecting Insomnia

These experiences (or resulting sleep disturbance) cause clinically important ... The insomnia causes daytime fatigue or impairs daytime functioning.

Factor affecting Insomnia

• Eating Disorders
• Sleep Disorders
• Substance-Related Disorders
  • Alcohol Withdrawal
  • Caffeine Withdrawal
  • Nicotine Withdrawal

Eating disorder

Anorexia Nervosa

• The patient will not maintain a minimum body weight (for example, 85% of expected weight for height and age).
• Despite being underweight, the patient intensely fears becoming fat.
• Self-perception of the body is abnormal, shown by at least 1 of:
  • Unduly emphasizes weight or shape in self-evaluation
  • Denies seriousness of low weight
  • Has a distorted perception of own body shape or weight
•  Due to weight loss, a female patient has missed at least 3 consecutive periods (or periods occur only when she is given hormones).

Bulimia Nervosa

• The patient repeatedly eats in binges. In a binge episode the patient has both of:
  • Consumes much more food than most people would in similar circumstances and in a similar period of time
  • Feels that the eating is out of control
• The patient repeatedly controls weight gain by inappropriate means such as: fasting, self-induced vomiting, excessive exercise or abuse of laxatives, diuretics or other drugs.
• On average, both of the above behaviors (binge eating and inappropriate control) have occurred at least twice a week for at least 3 consecutive months.
• Weight and body shape unduly affect the patient's self-evaluation.
• These symptoms do not occur solely during episodes of Anorexia Nervosa.

Sleep Disorders

Primary Insomnia

• For at least a month the patient's main complaint has been trouble going to sleep, staying asleep or feeling unrested.
• The insomnia, or resulting daytime fatigue, causes clinically important distress or impairs work, social or personal functioning.
• It does not occur solely in the course of Breathing-Related or Circadian Rhythm Sleep Disorder, Narcolepsy or a parasomnia.
• It does not occur solely in the course of another mental disorder (such as a delirium, Generalized Anxiety Disorder, Major Depressive Disorder).
• These symptoms are not directly caused by a general medical condition or substance use, including medications and drugs of abuse.

Primary Hypersomnia

• For at least a month (or less, if it is recurrent) the patient's main complaint has been excessive sleepiness. This has been shown by either of: -Prolonged sleep -Sleeping during the day, almost daily
• This sleepiness causes clinically important distress or impairs work, social or personal functioning.
• Neither insomnia nor an inadequate amount of sleep explains it better.
• It doesn't occur solely during another sleep disorder (such as Breathing-Related or Circadian Rhythm Sleep Disorder, Narcolepsy or a parasomnia).
• Another mental disorder doesn't explain it better.
• These symptoms are not directly caused by a general medical condition or substance use, including medications and drugs of abuse.

Specify if Recurrent: For at least 2 years, periods of hypersomnia lasting 3 days or more have occurred several times a year.

Narcolepsy

• Each day for 3 months or more the patient has had irresistible attacks of refreshing sleep.
• The patient experiences either or both of:
  • Cataplexy (sudden, brief loss of muscle tone bilaterally, usually associated with intense emotion)
  • Intrusions of REM sleep into transitions between waking and sleeping, as shown by either of:
    •  Hypnagogic or hypnopompic hallucinations or
    •  Sleep paralysis at the beginning or end of sleep

These symptoms are not directly caused by a general medical condition or substance use, including medications and drugs of abuse.

Breathing-Related Sleep Disorder

• The patient experiences disruption of sleep that causes excessive insomnia or sleepiness.
• The clinician judges this disruption to be caused by a breathing problem related to sleep such as central or obstructive sleep apnea or central alveolar hypoventilation syndrome.
• Another mental disorder does not better explain this behavior.
• The symptoms are not directly caused by a general medical condition or substance use, including medications and drugs of abuse.

Nightmare Disorder

• The patient repeatedly awakens with detailed recall of long, frightening dreams. These usually occur in the second half of the sleep or nap period and concern threats to security, self-esteem or survival.
• The patient quickly becomes alert and oriented upon awakening.
• These experiences (or resulting sleep disturbance) cause clinically important distress or impair work, social or personal functioning.
• They don't occur solely during another mental disorder (such as Posttraumatic Stress Disorder or a delirium).

The symptoms are directly caused by a general medical condition or substance use, including medications and drugs of abuse.

Sleep Terror Disorder

• On numerous occasions, the patient awakens abruptly, usually during the first third of sleep and usually beginning with a scream of panic.
• During each episode the patient shows evidence of marked fear and autonomic arousal, such as rapid breathing, rapid heartbeat and sweating.
• During the episode, the patient responds poorly to the efforts of others to provide comfort.
• The patient cannot recall any dream in detail at the time and cannot recall the whole episode later.
• These symptoms cause clinically important distress or impair work, social or personal functioning.

These symptoms are not directly caused by a general medical condition or substance use, including medications and drugs of abuse.

Sleepwalking Disorder

• On numerous occasions, the patient arises and walks about, usually during the first third of sleep.
• During sleepwalking, the patient stares blankly, can be awakened only with difficulty and responds poorly to others' attempts at communication.
• Although there may be a brief period of confusion upon first awakening from the episode, within a few minutes the patient's behavior and mental activity are unimpaired.
• After the episode or the next morning, the patient has no memory for the episode.
• These symptoms cause clinically important distress or impair work, social or personal functioning.
• The symptoms are not directly caused by a general medical condition or substance use, including medications and drugs of abuse.

Sleep Disorder Due to a General Medical Condition

• The patient has a sleep problem serious enough to warrant clinical attention.
• History, physical exam or laboratory findings suggest a general medical condition that seems likely to have directly caused this problem.
• The sleep problem causes clinically important distress or impairs work, social or personal functioning.
• It isn't better explained by another mental disorder (such as Adjustment Disorder, with a serious medical condition as the stressor).
• The problem is not due to Narcolepsy or a Breathing-Related Sleep Disorder.

It doesn't occur solely during a delirium

Substance-Related Disorders

Alcohol Withdrawal

A patient who has been drinking heavily and for a long time suddenly stops or markedly reduces its intake.

Caffeine Intoxication

The patient has recently consumed caffeine (usually, more than 250 mg, or 2-3 cups of coffee).

Nicotine Withdrawal

The patient has used nicotine daily for several weeks or more and Within 24 hours of abruptly reducing nicotine intake.

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