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

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).

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.

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.

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.

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.

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.

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.

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.

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.

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

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

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

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

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