Insomnia

Insomnia is a symptom, not a stand-alone diagnosis or a disease. By definition, insomnia is "difficulty initiating or maintaining sleep, or both" or the perception of poor quality sleep. Insomnia may therefore be due to inadequate quality or quantity of sleep. Insomnia is not defined by a specific number of hours of sleep that one gets, since individuals vary widely in their sleep needs and practices. Although most of us know what insomnia is and how we feel and perform after one or more sleepless nights, few seek medical advice. Many people remain unaware of the behavioral and medical options available to treat insomnia.

• symptoms lasting less than one week are classified as transient insomnia,
  
• symptoms between one to three weeks are classified as short-term insomnia, and
  
• those longer than three weeks are classified as chronic insomnia.

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:

• 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)

Uncontrolled physical symptoms (pain, fever, breathing problems, nasal congestion, cough, diarrhea, etc.) can also cause someone to have insomnia. Controlling these symptoms and their underlying causes may lead to resolution of insomnia.In addition to people with the above medical conditions, certain groups may be at higher risk for developing insomnia:

• Travellers
  
• Shift workers with frequent changing of shifts
• Adolescents or young adult students
  
• Pregnant women
  
• Women in menopause
  
• People who use abuse drugs
  
• Alcoholics

In general, transient insomnia resolves when the underlying trigger is removed or corrected. Most people seek medical attention when their insomnia becomes chronic. The main focus of treatment for insomnia should be directed towards finding the cause. Once a cause is identified, it is important to manage and control the underlying problem, as this alone may eliminate the insomnia all together. Treating the symptoms of insomnia without addressing the main cause is rarely successful. In the majority of cases, chronic insomnia can be cured if its medical or psychiatric causes are evaluated and treated properly. Generally, treatment of insomnia entails both non-pharmacologic (non-medical) and pharmacologic (medical) aspects. It is best to tailor treatment for individual patient based on the potential cause. Studies have shown that combining medical and non-medical treatments typically is more successful in treating insomnia than either one alone.