![]() It is helpful to determine the total sleep time (TST), wakefulness after sleep onset (WASO), sleep efficiency and circadian rhythm disturbances. ![]() Sleep diaries are another cost-effective way to evaluate the sleep-wake disturbances in the patients. Epworth Sleepiness Scale (total score 0–24 score>15 considered for severe daytime sleepiness) and Pittsburgh Sleep Quality Index (score > five is considered poor sleep score) are the two most widely used assessment tools in doctor’s office visits. Furthermore, questionnaires, sleep logs, and actigraphy can be helpful tools for the assessment of insomnia.Ī self-reported questionnaire can be helpful to evaluate the quality of sleep in chronic insomnia. Complete laboratory workup should be helpful to evaluate any underlying medical conditions contributing to insomnia. Clinicians should be able to recognize the sleep disturbances and rule out other sleep-related disorders like restless leg syndrome, sleep apnea, periodic limb movements, and nocturnal leg cramps that may be contributing to the sleep fragmentation. Insomnia can affect their school performance, daily activity of playing, inability to concentrate and behavior problems.Ī detailed sleep history is a key to the evaluation of insomnia. Children may have a dependency on certain stimulations (rocking, storytelling), objects (bottle feeding, favorite toy) or room setting (parents in the room) to fall asleep, and lack of these stimulations can create anxiety and fear in them and result in sleep disturbances. In children, insomnia can be reported as frequent nighttime awakening, resisting to go to bed and sleep independently. Insomnia can significantly impact the daytime functioning resulting in waking up tired in the morning, decreased workplace productivity, proneness to errors and accidents, inability to concentrate, frequent daytime naps and poor quality of life. The sleep disturbances in insomnia can manifest as difficulty in falling asleep (Sleep Onset Insomnia), maintaining the continuity of sleep (waking up in the middle of the night and difficulty in returning to sleep) or waking up too early in the morning well before the desired time, irrespective of the adequate circumstances to sleep every night (Early Morning Insomnia). 5 Other possible mechanisms noted in the literature are briefly illustrated in Figure 1. The orexin mediated increased neuronal firing in the wake-promoting areas (tuberomammillary nucleus, dorsal raphe and locus coeruleus) and inhibition of the sleep-promoting areas (ventrolateral preoptic nucleus and median preoptic nucleus) is one of the possible mechanisms contributing to insomnia (sleep switch model). The molecular factors responsible for the sleep-wake regulation include the wake-promoting chemicals like orexin, norepinephrine, and histamine, and sleep promoting chemicals like GABA (Gamma AminoButyric Acid), adenosine, melatonin, and prostaglandin D2. There is also a close association between insomnia and HLA-DQB1*0602. The genes associated with insomnia are Apolipoprotein (Apo) E4, PER3 (Period Circadian Regulator 3), Clock (Clock Circadian Regulator) and 5-HTTLPR(Serotonin Transporter Linked Polymorphic Region) genes. The genetic factors responsible for insomnia were identified from work on “insomnia-like Drosophila flies” (ins-l flies), which had traits similar to human insomnia. 4 Initially considered to be a symptom, insomnia is now defined as a disorder and classified separately in DSM-V (Diagnostic and Statistical Manual of Mental Disorders-5th edition) and ICSD-3 (International Classification of Sleep Disorders-3 rd edition). 3 There is also an increased risk of depression, anxiety, substance abuse, suicide, motor vehicle accidents and possible immune dysfunction with chronic insomnia. 2 Its prevalence ranges from 10 to 15% among the general population, with higher rates seen among females, divorced or separated individuals, those with loss of loved ones, and older people. 1 Studies have established insomnia to be a very common condition with symptoms present in about 33–50% of the adult population. The disorder is characterized by difficulty with sleep quality, initiating or maintaining sleep, along with substantial distress and impairments of daytime functioning. ![]() Insomnia is a public health concern and one of the most common complaints in medical practice.
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