Insominia : Causes, Diagnosis, Treatment

Classification of Insomnia

Insomnia is classified based on its duration into:

1. Transient, lasting no more than a few nights.
2. Short-term (from several days to weeks).
3. Chronic (lasting three weeks or more).

Insomnia is also categorized as physiological (situational) or persistent (having a constant nature). By origin, insomnia is divided into primary insomnia, which arises from personal or idiopathic (unexplained) causes, and secondary insomnia, which arises against the background or as a result of psychological, somatic, and other pathologies.

Based on the severity of clinical symptoms, insomnia can be:

• Mild (lightly expressed) – occasional episodes of sleep disturbance.
• Moderate – moderately expressed clinical manifestations.
• Severe – sleep disturbances occur every night and significantly impact daily life.

Symptoms of Insomnia

Clinical signs of insomnia, depending on the time of their manifestation, are divided into groups: presomnic, intrasomnic, and postsomnic disturbances. Disturbances before, after, and during sleep can occur separately or in combination. All three types of disturbances are observed in only 20% of middle-aged patients and 36% of elderly patients with insomnia.

Insomnia leads to a decrease in daytime activity, impairment of memory, and attention. In patients with mental disorders and somatic diseases, the course of the underlying disease worsens. Insomnia can cause delayed reaction times, which is particularly dangerous for drivers and workers operating industrial machinery.

Presomnic Disturbances

Patients complain of difficulties in falling asleep. Typically, the onset of sleep takes 3-10 minutes. However, individuals suffering from insomnia may spend 30 to 120 minutes or more trying to fall asleep.

The prolonged onset of sleep may result from insufficient fatigue at bedtime due to late waking or early bedtime; somatic pain reactions and itching; intake of drugs that stimulate the nervous system; anxiety and fear experienced during the day.

Once in bed, the desire to fall asleep instantly disappears, and heavy thoughts arise, accompanied by distressing memories. Some motor activity is observed: the person cannot find a comfortable position. Occasionally, inexplicable itching and unpleasant sensations on the skin occur. Sometimes, falling asleep happens so imperceptibly that the person perceives it as wakefulness.

Sleep onset problems can lead to the development of peculiar rituals before bed, which are not typical for healthy individuals. Fear of not falling asleep and bed avoidance may also develop.

Intrasomnic Disturbances

The patient complains of a lack of deep sleep, where even minimal stimuli cause awakening followed by prolonged difficulty falling back asleep. The slightest noise, light, and other external factors are perceived particularly acutely.

The cause of spontaneous awakenings can be terrifying dreams and nightmares, the sensation of a full bladder (repeated urges to urinate), obstructive sleep apnea, and increased heart rate. A healthy individual, not suffering from insomnia, may also experience awakenings; however, their awakening threshold is noticeably higher, subsequent sleep onset is not problematic, and sleep quality is not affected.

Increased motor activity, manifested by restless legs syndrome, is also considered an intrasomnic disturbance, where the person makes jerking movements with their legs during sleep. The cause of sleep apnea syndrome, often observed in insomnia, is the activation of voluntary mechanisms regulating breathing. It occurs most frequently in cases of obesity and is accompanied by snoring.