sleep disorder

What is insomnia and how we can treat it without medication:
Humans typically have 4 to 6 cycles of Nonrapid eye movment (NREM) and rapid eye movment (REM) sleep each cycles lasting 70 to 120 minutes usually there is progression through four stages of NREM sleep which are befor first REM period.
The stages of NREM are:
Stage 1: transitional state which is the stage between wakefulness and sleep
Stage 2: 50% of sleep time is spent in these stage , sleep here is light sleep
Stage 3 & 4: deep sleep (delta sleep i.e., slow-wave sleep)
These stages categorized using sleep EEG
After the four stages then comes the REM period (rapid eye movment): these period neither light nor deep sleep it is chractrized by the body being more physiologically active than during other sleep stages while skeletal muscles are actively inhibted.the first REM period lasts 5-7 minutes, the sleep cycles repeats every 90-120 minutes, with each progressive REM period becoming longer and the time in deep sleep becoming shorter.
Insomnia :
defention of insomnia: in insomnia patients complain of difficulty falling asleep, difficulty maintaining a sleep (nocturnal awakening), not feelling rested in spite of a sufficient opportunity to sleep ( poor quality of sleep), or early morning awakening.
causes of insomnia:
Situational
Work or financial stress, major life events, interpersonal conflicts Jet lag or shift work.
Medical
Cardiovascular (angina, arrhythmias, heart failure), Respiratory (asthma, sleep apnea), Chronic pain, Endocrine disorders (diabetes, hyperthyroidism), GI (gastroesophageal reflux disease, ulcers), Neurologic (delirium, epilepsy, Parkinson’s disease), Pregnancy
Psychiatric
Mood disorders (depression, mania), Anxiety disorders (e.g., generalized anxiety disorder, obsessive-compulsive disorder), Substance abuse (alcohol or sedative-hypnotic withdrawal).
Pharmacologically induced
Anticonvulsants, Central adrenergic blockers, Diuretics, Selective serotonin reuptake inhibitors, Steroids, Stimulants



Clssification of insomnia:
a- Tranient
b- Short term
c- Long term
a- transient:
usually is situational, caused by environmental changes or life stresses, e.g. travelling, hospitalization, participation in an important or stressful event. Transient insomnia is self limiting and lassts for less than a week, if more sever stresses are present, it may progress to short term insomnia.
b- Short term:
In more sever life stresses (e.g. death or bereavement of loss a job).It lasts 1-3 weeks and if not managed properly, it may progress to chronic insomnia.
c-chronic insomnia (long term):
it lasts for more than 3 weeks often it is results of a medical problem, psycholoic dysfunction (e.g. depression) or substance abuse.
Nonpharmacological treatment of insomnia:
In many cases insomnia can be treated without sedative-hypnotics. Education about normal sleep and habits for good sleep hygiene are often sufficient interventions. Nonpharmacologic interventions for insomnia frequently consist of short-term cognitive behavioral therapies, most commonly stimulus control therapy, sleep restriction,
relaxation therapy, cognitive therapy, paradoxical intention, and education on good sleep hygiene (recommendation for insomnia below, part1 and part 2). In patients age 55 and older, a recent study indicates that cognitive behavioral therapy may be more effective than pharmacologic therapy at improving certain measures of insomnia.

Nonpharmacologic Recommendations for Insomnia
Parts 1:
Stimulus control procedures:
1- Establish regular time to wake up and to go to sleep ( including weekends).
2- Sleep only as much as necessary to feel rested.
3- Go to bed only when sleepy. Avoid long period of wakefulness in bed. Use the bed only for sleep or intimacy; do not read or watch television in bed.
4- Avoid trying to force sleep; if you do not fall asleep within 20-30 minutes, leave the bed and perform a relaxing activity(e.g. read, listen to music, or watch televsion) until drowsy. Repeat this as often as necessary.
5- Avoid daytime nap.
6- Schedule worry time during the day. Do not take your troubles to bed.
Part 2: Sleep hygiene recommendations:
1- Exercise routinely (3-4 times weekly), but not close to bedtime becuse this may cause arousal.
2- Create a comfortable sleep environment by avoiding temperature extremes, loud noises, and illuminated clocks in the bedroom.
3- Discontinue or reduce the use of alcohole, caffeine, and nicotine.
4- Avoid drinking larg quantities of liquids in the evening to prevent nighttime trips to the restroom.
5- Do something relaxing and enjoyable befor bedtime.