insomnia

不眠症 　 　

WordNet

1. an inability to sleep; chronic sleeplessness
2. be able to accommodate for sleeping; "This tent sleeps six people"
3. be asleep (同)kip, slumber, log Z''s, catch some Z''s
4. a period of time spent sleeping; "he felt better after a little sleep"; "there wasnt time for a nap" (同)nap
5. a natural and periodic state of rest during which consciousness of the world is suspended; "he didnt get enough sleep last night"; "calm as a child in dreamless slumber" (同)slumber
6. a torpid state resembling deep sleep (同)sopor
7. experiencing or accompanied by sleeplessness; "insomniac old people"; "insomniac nights"; "lay sleepless all night"; "twenty watchful, weary, tedious nights"- Shakespeare (同)sleepless, watchful
8. someone who cannot sleep (同)sleepless person

PrepTutorEJDIC

1. 不眠[症]
2. 〈U〉『眠り』,『睡眠』[『状態』] / 〈C〉《a sleep》一眠り[の時間] / 〈U〉永眠,死 / 〈U〉(一時的な手足などの)無感覚,しびれ;冬眠(hibernation) / 〈U〉目やに / 『眠る』 / 『文眠なる』,(死んで)葬られている / 〈人〉‘を'泊める[設備がある] / 《a+形容詞+sleepを目的語にして》…‘を'眠る
3. 不眠症患者・不眠症の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/06/11 19:35:55」(JST)

wiki ja

[Wiki ja表示]

インソムニア(Insomnia)

• 不眠症
• インソムニア (鬼束ちひろのアルバム) - 鬼束ちひろが2001年に発表したCDアルバム。
• インソムニア (2002年の映画) - 2002年に公開されたアメリカ映画。
• インソムニア (ファッションブランド) - ファッションブランドのひとつ。
• インソムニア (YMOの曲) - 細野晴臣作の楽曲。
• Insomnia (the HIATUSの曲) - the HIATUSが2009年に発表したCDシングル。
• インソムニア (漫画) - 外薗昌也の漫画作品。

このページは曖昧さ回避のためのページです。一つの語句が複数の意味・職能を有する場合の水先案内のために、異なる用法を一覧にしてあります。お探しの用語に一番近い記事を選んで下さい。このページへリンクしているページを見つけたら、リンクを適切な項目に張り替えて下さい。

wiki en

[Wiki en表示]

This article is about the sleeping disorder. For other uses, see Insomnia (disambiguation).

Insomnia
Classification and external resources
Specialty	Sleep medicine
ICD-10	F51.0, G47.0
ICD-9-CM	307.42, 307.41, 327.0, 780.51, 780.52
DiseasesDB	26877
MedlinePlus	000805
eMedicine	med/2698
Patient UK	Insomnia
MeSH	D007319

Insomnia is a sleep disorder. People with insomnia have trouble sleeping: difficulty falling asleep, or staying asleep as long as desired. While the term is sometimes used to describe a disorder as diagnosed by polysomnographic or actigraphic evidence, this is often practically defined as a positive response to either of two questions: "do you experience difficulty sleeping?" or "do you have difficulty falling or staying asleep?"

Insomnia is most often thought of as both a medical sign and a symptom that can accompany several sleep, medical, and psychiatric disorders characterized by a long term difficulty falling asleep and/or staying asleep or sleep of poor quality. Insomnia is typically followed by functional impairment while awake. Insomnia can occur at any age, but it is particularly common in the elderly. Insomnia can be short term (up to three weeks) or long term (above 3–4 weeks); it can lead to memory problems, depression, irritability and an increased risk of heart disease and automobile related accidents.

Insomnia can be grouped into primary and secondary insomnia. Primary insomnia is a sleep disorder not due to a medical, psychiatric, or environmental cause. It is described as a complaint of prolonged sleep onset latency, disturbance of sleep maintenance, or the experience of non-refreshing sleep. Conditions that can result in insomnia include depression, pain, benign prostatic hypertrophy, obstructive sleep apnea, and restless leg syndrome, and substance misuse. A diagnosis will differentiate between primary insomnia, insomnia as secondary to another condition, and primary insomnia co-morbid with one or more conditions.

Cognitive behavioral therapy is useful in insomnia that is present for a long duration and is recommended as the initial treatment. Those who are having trouble sleeping may use sleeping pills, which may help, but also may lead to substance dependency or addiction, and long-term worsening of sleep, if used regularly for an extended period. Medications are not recommended for more than four or five weeks.

Classification

DSM-5 criteria

The DSM-5 criteria for insomnia include the following:

Predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms:

• Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention.)
• Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.)
• Early-morning awakening with inability to return to sleep.

In addition,

• The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
• The sleep difficulty occurs at least 3 nights per week.
• The sleep difficulty is present for at least 3 months.
• The sleep difficulty occurs despite adequate opportunity for sleep.
• The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia).
• The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).
• Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.

Types of insomnia

Insomnia can be classified as transient, acute, or chronic.

1. Transient insomnia lasts for less than a week. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe depression, or by stress. Its consequences – sleepiness and impaired psychomotor performance – are similar to those of sleep deprivation.
2. Acute insomnia is the inability to consistently sleep well for a period of less than a month. Insomnia is present when there is difficulty initiating or maintaining sleep or when the sleep that is obtained is non-refreshing or of poor quality. These problems occur despite adequate opportunity and circumstances for sleep and they must result in problems with daytime function. Acute insomnia is also known as short term insomnia or stress related insomnia.
3. Chronic insomnia lasts for longer than a month. It can be caused by another disorder, or it can be a primary disorder. People with high levels of stress hormones or shifts in the levels of cytokines are more likely than others to have chronic insomnia. Its effects can vary according to its causes. They might include muscular weariness, hallucinations, and/or mental fatigue. Chronic insomnia can cause double vision.

Patterns of insomnia

Symptoms of insomnia:

• difficulty falling asleep, including difficulty finding a comfortable sleeping position
• waking during the night and being unable to return to sleep
• feeling unrefreshed upon waking
• daytime sleepiness, irritability or anxiety

Sleep-onset insomnia is difficulty falling asleep at the beginning of the night, often a symptom of anxiety disorders. Delayed sleep phase disorder can be misdiagnosed as insomnia, as sleep onset is delayed to much later than normal while awakening spills over into daylight hours.

It is common for patients who have difficulty falling asleep to also have nocturnal awakenings with difficulty returning to sleep. Two thirds of these patients wake up in the middle of the night, with more than half having trouble falling back to sleep after a middle of the night awakening.

Early morning awakening is an awakening occurring earlier (more than 30 minutes) than desired with an inability to go back to sleep, and before total sleep time reaches 6.5 hours. Early morning awakening is often a characteristic of depression.

Poor sleep quality

Poor sleep quality can occur as a result of, for example, restless legs, sleep apnea or major depression. Poor sleep quality is caused by the individual not reaching stage 3 or delta sleep which has restorative properties.

Major depression leads to alterations in the function of the hypothalamic-pituitary-adrenal axis, causing excessive release of cortisol which can lead to poor sleep quality.

Nocturnal polyuria, excessive nighttime urination, can be very disturbing to sleep.

Subjective insomnia

Main article: Sleep state misperception

Some cases of insomnia are not really insomnia in the traditional sense. People experiencing sleep state misperception often sleep for normal durations, yet severely overestimate the time taken to fall asleep. They may believe they slept for only four hours while they, in fact, slept a full eight hours.

Causes

Potential complications of insomnia.

Symptoms of insomnia can be caused by or be associated with:

• Use of psychoactive drugs (such as stimulants), including certain medications, herbs, caffeine, nicotine, cocaine, amphetamines, methylphenidate, aripiprazole, MDMA, modafinil, or excessive alcohol intake.
• Use of or withdrawal from alcohol and other sedatives, such as anti-anxiety and sleep drugs like benzodiazepines.
• Use of or withdrawal from pain-relievers such as opioids.
• Previous thoracic surgery.
• Heart disease.
• Deviated nasal septum and nocturnal breathing disorders.
• Restless legs syndrome, which can cause sleep onset insomnia due to the discomforting sensations felt and the need to move the legs or other body parts to relieve these sensations.
• Periodic limb movement disorder (PLMD), which occurs during sleep and can cause arousals of which the sleeper is unaware.
• Pain, an injury or condition that causes pain can preclude an individual from finding a comfortable position in which to fall asleep, and can in addition cause awakening.
• Hormone shifts such as those that precede menstruation and those during menopause.
• Life events such as fear, stress, anxiety, emotional or mental tension, work problems, financial stress, birth of a child and bereavement.
• Gastrointestinal issues such as heartburn or constipation.
• Mental disorders such as bipolar disorder, clinical depression, generalized anxiety disorder, post traumatic stress disorder, schizophrenia, obsessive compulsive disorder, dementia, and ADHD
• Disturbances of the circadian rhythm, such as shift work and jet lag, can cause an inability to sleep at some times of the day and excessive sleepiness at other times of the day. Chronic circadian rhythm disorders are characterized by similar symptoms.
• Certain neurological disorders, brain lesions, or a history of traumatic brain injury.
• Medical conditions such as hyperthyroidism and rheumatoid arthritis.
• Abuse of over-the counter or prescription sleep aids (sedative or depressant drugs) can produce rebound insomnia.
• Poor sleep hygiene, e.g., noise or over-consumption of caffeine.
• A rare genetic condition can cause a prion-based, permanent and eventually fatal form of insomnia called fatal familial insomnia.
• Physical exercise. Exercise-induced insomnia is common in athletes in the form of prolonged sleep onset latency.

Sleep studies using polysomnography have suggested that people who have sleep disruption have elevated nighttime levels of circulating cortisol and adrenocorticotropic hormone They also have an elevated metabolic rate, which does not occur in people who do not have insomnia but whose sleep is intentionally disrupted during a sleep study. Studies of brain metabolism using positron emission tomography (PET) scans indicate that people with insomnia have higher metabolic rates by night and by day. The question remains whether these changes are the causes or consequences of long-term insomnia.

Substance-induced

Alcohol-induced

Main article: Alcohol use and sleep

Alcohol is often used as a form of self-treatment of insomnia to induce sleep. However, alcohol use to induce sleep can be a cause of insomnia. Long-term use of alcohol is associated with a decrease in NREM stage 3 and 4 sleep as well as suppression of REM sleep and REM sleep fragmentation. Frequent moving between sleep stages occurs, with awakenings due to headaches, the need to urinate, dehydration, and excessive sweating. Glutamine rebound also plays a role as when someone is drinking; alcohol inhibits glutamine, one of the body's natural stimulants. When the person stops drinking, the body tries to make up for lost time by producing more glutamine than it needs. The increase in glutamine levels stimulates the brain while the drinker is trying to sleep, keeping him/her from reaching the deepest levels of sleep. Stopping chronic alcohol use can also lead to severe insomnia with vivid dreams. During withdrawal REM sleep is typically exaggerated as part of a rebound effect.

Benzodiazepine-induced

Like alcohol, benzodiazepines, such as alprazolam, clonazepam, lorazepam and diazepam, are commonly used to treat insomnia in the short-term (both prescribed and self-medicated), but worsen sleep in the long-term. While benzodiazepines can put people to sleep (i.e., inhibit NREM stage 1 and 2 sleep), while asleep, the drugs disrupt sleep architecture: decreasing sleep time, delaying time to REM sleep, and decreasing deep slow-wave sleep (the most restorative part of sleep for both energy and mood).

Opioid-induced

Opioid medications such as hydrocodone, oxycodone, and morphine are used for insomnia that is associated with pain due to their analgesic properties and hypnotic effects. Opioids can fragment sleep and decrease REM and stage 2 sleep. By producing analgesia and sedation, opioids may be appropriate in carefully selected patients with pain-associated insomnia. However, dependence on opioids can lead to long-term sleep disturbances.

Risk factors

Insomnia affects people of all age groups but people in the following groups have a higher chance of acquiring insomnia.

• Individuals older than 60
• History of mental health disorder including depression, etc.
• Emotional stress
• Working late night shifts
• Travelling through different time zones

Mechanism

Cortisol

Cortisol is typically thought of as the stress hormone in humans, but it is also the awakening hormone. Analyzing saliva samples taken in the morning has shown that patients with insomnia wake up with significantly lower cortisol levels when compared to a control group with regular sleeping patterns. Further studies have revealed that those with lower levels of cortisol upon awakening also have poorer memory consolidation in comparison to those with normal levels of cortisol. Studies support that larger amounts of cortisol released in the evening occurs in primary insomnia. In this case, drugs related to calming mood disorders or anxiety, such as antidepressants, would regulate the cortisol levels and help prevent insomnia.

Estrogen

Many postmenopausal women have reported changes in sleep patterns since entering menopause that reflect symptoms of insomnia. This could occur because of the lower levels of estrogen. Lower estrogen levels can cause hot flashes, change in stress reactions, or overall change in the sleep cycle, which all could contribute to insomnia. Estrogen treatment as well as estrogen-progesterone combination supplements as a hormone replacement therapy can help regulate menopausal women’s sleep cycle again.

Progesterone

Low levels of progesterone throughout the female menstruation cycle, but primarily near the end of the luteal phase, have also been known to correlate with insomnia as well as aggressive behavior, irritability, and depressed mood in women. Around 67% of women have problems with insomnia right before or during their menstrual cycle. Lower levels of progesterone can, like estrogen, correlate with insomnia in menopausal women.

A common misperception is that the amount of sleep required decreases as a person ages. The ability to sleep for long periods, rather than the need for sleep, appears to be lost as people get older. Some elderly insomniacs toss and turn in bed and occasionally fall off the bed at night, diminishing the amount of sleep they receive.

Diagnosis

In medicine, insomnia is widely measured using the Athens insomnia scale. It is measured using eight different parameters related to sleep, finally it is represented as an overall scale which assess an individual's sleep pattern.

A qualified sleep specialist should be consulted in the diagnosis of any sleep disorder so the appropriate measures can be taken. Past medical history and a physical examination need to be done to eliminate other conditions that could be the cause of the insomnia. After all other conditions are ruled out a comprehensive sleep history should be taken. The sleep history should include sleep habits, medications (prescription and non-prescription), alcohol consumption, nicotine and caffeine intake, co-morbid illnesses, and sleep environment. A sleep diary can be used to keep track of the individual's sleep patterns. The diary should include time to bed, total sleep time, time to sleep onset, number of awakenings, use of medications, time of awakening and subjective feelings in the morning. The sleep diary can be replaced or validated by the use of out-patient actigraphy for a week or more, using a non-invasive device that measures movement.

Workers who complain of insomnia should not routinely have polysomnography to screen for sleep disorders. This test may be indicated for patients with symptoms in addition to insomnia, including sleep apnea, obesity, a risky neck diameter, or risky fullness of the flesh in the oropharynx. Usually, the test is not needed to make a diagnosis, and insomnia especially for working people can often be treated by changing a job schedule to make time for sufficient sleep and by improving sleep hygiene.

Some patients may need to do a sleep study to determine if insomnia is present. The sleep study will involve the assessment tools of a polysomnogram and the multiple sleep latency test and will be conducted in a sleep center or a designated hotel. Specialists in sleep medicine are qualified to diagnose the many different sleep disorders. Patients with various disorders, including delayed sleep phase syndrome, are often mis-diagnosed with primary insomnia. When a person has trouble getting to sleep and awakening early, but has a normal sleep pattern once asleep, a delayed circadian rhythm is the likely cause.

In many cases, insomnia is co-morbid with another disease, side-effects from medications, or a psychological problem. Approximately half of all diagnosed insomnia is related to psychiatric disorders. In depression in many cases "insomnia should be regarded as a co-morbid condition, rather than as a secondary one;" insomnia typically predates psychiatric symptoms. "In fact, it is possible that insomnia represents a significant risk for the development of a subsequent psychiatric disorder." Insomnia occur in between 60% and 80% of people with depression. This may partly be due to treatment used for depression.

Knowledge of causation is not necessary for a diagnosis.

Prevention

Going to sleep and waking up at the same time every day can create a steady pattern which may help to prevent or treat insomnia. Avoidance of vigorous exercise and any caffeinated drinks a few hours before going to sleep is recommended, while exercise earlier in the day is beneficial. The bedroom should be cool and dark, and the bed should only be used for sleep and sex. These are some of the points included in what doctors call "sleep hygiene".

Treatment

It is important to identify or rule out medical and psychological causes before deciding on the treatment for insomnia. Cognitive behavioral therapy (CBT) has been found to be as effective as medications for the short-term treatment of chronic insomnia. The beneficial effects, in contrast to those produced by medications, may last well beyond the stopping of therapy. Medications have been used mainly to reduce symptoms in insomnia of short duration; their role in the management of chronic insomnia remains unclear. Several different types of medications are also effective for treating insomnia. However, many doctors do not recommend relying on prescription sleeping pills for long-term use. It is also important to identify and treat other medical conditions that may be contributing to insomnia, such as depression, breathing problems, and chronic pain.

Non-pharmacological

Non-pharmacological strategies have comparable efficacy to hypnotic medication for insomnia and they may have longer lasting effects. Hypnotic medication is only recommended for short-term use because dependence with rebound withdrawal effects upon discontinuation or tolerance can develop.

Non pharmacological strategies provide long lasting improvements to insomnia and are recommended as a first line and long term strategy of management. The strategies include attention to sleep hygiene, stimulus control, behavioral interventions, sleep-restriction therapy, paradoxical intention, patient education and relaxation therapy. Some examples are keeping a journal, restricting the time spent awake in bed, practicing relaxation techniques, and maintaining a regular sleep schedule and a wake-up time. Behavioral therapy can assist a patient in developing new sleep behaviors to improve sleep quality and consolidation. Behavioral therapy may include, learning healthy sleep habits to promote sleep relaxation, undergoing light therapy to help with worry-reduction strategies and regulating the circadian clock.

Music may improve insomnia in adults. EEG biofeedback has demonstrated effectiveness in the treatment of insomnia with improvements in duration as well as quality of sleep. Self-help therapy (defined as a psychological therapy that can be worked through on one's own) may improve sleep quality for adults with insomnia to a small or moderate degree.

Stimulus control therapy is a treatment for patients who have conditioned themselves to associate the bed, or sleep in general, with a negative response. As stimulus control therapy involves taking steps to control the sleep environment, it is sometimes referred interchangeably with the concept of sleep hygiene. Examples of such environmental modifications include using the bed for sleep or sex only, not for activities such as reading or watching television; waking up at the same time every morning, including on weekends; going to bed only when sleepy and when there is a high likelihood that sleep will occur; leaving the bed and beginning an activity in another location if sleep does not result in a reasonably brief period of time after getting into bed (commonly ~20 min); reducing the subjective effort and energy expended trying to fall asleep; avoiding exposure to bright light during nighttime hours, and eliminating daytime naps.

A component of stimulus control therapy is sleep restriction, a technique that aims to match the time spent in bed with actual time spent asleep. This technique involves maintaining a strict sleep-wake schedule, sleeping only at certain times of the day and for specific amounts of time to induce mild sleep deprivation. Complete treatment usually lasts up to 3 weeks and involves making oneself sleep for only a minimum amount of time that they are actually capable of on average, and then, if capable (i.e. when sleep efficiency improves), slowly increasing this amount (~15 min) by going to bed earlier as the body attempts to reset its internal sleep clock. Bright light therapy, which is often used to help early morning wakers reset their natural sleep cycle, can also be used with sleep restriction therapy to reinforce a new wake schedule. Although applying this technique with consistency is difficult, it can have a positive effect on insomnia in motivated patients.

Paradoxical intention is a cognitive reframing technique where the insomniac, instead of attempting to fall asleep at night, makes every effort to stay awake (i.e. essentially stops trying to fall asleep). One theory that may explain the effectiveness of this method is that by not voluntarily making oneself go to sleep, it relieves the performance anxiety that arises from the need or requirement to fall asleep, which is meant to be a passive act. This technique has been shown to reduce sleep effort and performance anxiety and also lower subjective assessment of sleep-onset latency and overestimation of the sleep deficit (a quality found in many insomniacs).

Sleep hygiene

Sleep hygiene is a common term for all of the behaviors which relate to the promotion of good sleep. These behaviors are used as the basis of sleep interventions and are the primary focus of sleep education programs. Behaviors include the use of caffeine, nicotine and alcohol consumption, maximizing the regularity and efficiency of sleep episodes, minimizing medication usage and daytime napping, the promotion of regular exercise, and the facilitation of a positive sleep environment. Exercise can be helpful when establishing a routine for sleep but should not be done close to the time that you are planning on going to sleep. The creation of a positive sleep environment may also be helpful in reducing the symptoms of insomnia. In order to create a positive sleep environment one should remove objects that can cause worry or distressful thoughts from view.

Cognitive behavioral therapy

Main article: Cognitive behavioural therapy for insomnia

There is some evidence that cognitive behavioural therapy for insomnia is superior in the long-term to benzodiazepines and the nonbenzodiazepines in the treatment and management of insomnia. In this therapy, patients are taught improved sleep habits and relieved of counter-productive assumptions about sleep. Common misconceptions and expectations that can be modified include: (1) unrealistic sleep expectations (e.g., I need to have 8 hours of sleep each night), (2) misconceptions about insomnia causes (e.g., I have a chemical imbalance causing my insomnia), (3) amplifying the consequences of insomnia (e.g., I cannot do anything after a bad night's sleep), and (4) performance anxiety after trying for so long to have a good night's sleep by controlling the sleep process. Numerous studies have reported positive outcomes of combining cognitive behavioral therapy for insomnia treatment with treatments such as stimulus control and the relaxation therapies. Hypnotic medications are equally effective in the short-term treatment of insomnia but their effects wear off over time due to tolerance. The effects of CBT-I have sustained and lasting effects on treating insomnia long after therapy has been discontinued. The addition of hypnotic medications with CBT-I adds no benefit in insomnia. The long lasting benefits of a course of CBT-I shows superiority over pharmacological hypnotic drugs. Even in the short term when compared to short-term hypnotic medication such as zolpidem (Ambien), CBT-I still shows significant superiority. Thus CBT-I is recommended as a first line treatment for insomnia. Metacognition is also a recent trend in approach to behaviour therapy of insomnia.

Internet interventions

Despite the therapeutic effectiveness and proven success of CBT, treatment availability is significantly limited by a lack of trained clinicians, poor geographical distribution of knowledgeable professionals, and expense. One way to potentially overcome these barriers is to use the Internet to deliver treatment, making this effective intervention more accessible and less costly. The Internet has already become a critical source of health-care and medical information. Although the vast majority of health websites provide general information, there is growing research literature on the development and evaluation of Internet interventions.

These online programs are typically behaviorally-based treatments that have been operationalized and transformed for delivery via the Internet. They are usually highly structured; automated or human supported; based on effective face-to-face treatment; personalized to the user; interactive; enhanced by graphics, animations, audio, and possibly video; and tailored to provide follow-up and feedback.

There is good evidence for the use computer based CBT for insomnia.

Medications

Many people with insomnia use sleeping tablets and other sedatives. In some places medications are prescribed in over 95% of cases. The percentage of adults using a prescription sleep aid increases with age. During 2005–2010, about 4% of U.S. adults aged 20 and over reported that they took prescription sleep aids in the past 30 days. Rayes of use was lowest among the youngest age group (those aged 20–39) at about 2%, increased to 6% among those aged 50–59, and reached 7% among those aged 80 and over. More adult women (5.0%) reported using prescription sleep aids than adult men (3.1%). Non-Hispanic white adults reported higher use of sleep aids (4.7%) than non-Hispanic black (2.5%) and Mexican-American (2.0%) adults. No difference was shown between non-Hispanic black adults and Mexican-American adults in use of prescription sleep aids.

Antihistamines

As an alternative to taking prescription drugs, some evidence shows that an average person seeking short-term help may find relief by taking over-the-counter antihistamines such as diphenhydramine or doxylamine. Diphenhydramine and doxylamine are widely used in nonprescription sleep aids. They are the most effective over-the-counter sedatives currently available, at least in the United States, and are more sedating than some prescription hypnotics. Antihistamine effectiveness for sleep may decrease over time, and anticholinergic side-effects (such as dry mouth) may also be a drawback with these particular drugs. While addiction does not seem to be an issue with this class of drugs, they can induce dependence and rebound effects upon abrupt cessation of use.

Melatonin

The evidence for melatonin in treating insomnia is overall poor. There is low quality evidence that it may speed the onset of sleep by 6 minutes. Ramelteon, a melatonin receptor agonist, does not appear to speed the onset of sleep or the amount of sleep a person gets.

Most melatonin drugs have not been tested for longitudinal side effects. Prolonged-release melatonin may improves quality of sleep in older people with minimal side effects.

Studies have also shown that children who are on the Autism spectrum or have learning disabilities, Attention-Deficit Hyperactivity Disorder (ADHD) or related neurological diseases can benefit from the use of melatonin. This is because they often have trouble sleeping due to their disorders. For example, children with ADHD tend to have trouble falling asleep because of their hyperactivity and, as a result, tend to be tired during most of the day. Another cause of insomnia in children with ADHD is the use of stimulants used to treat their disorder. Children who have ADHD then, as well as the other disorders mentioned, may be given melatonin before bedtime in order to help them sleep.

Antidepressants

Because insomnia is a common symptom of depression, antidepressants are effective for treating sleep problems whether or not they are associated with depression. While all antidepressants help regulate sleep, some antidepressants such as amitriptyline, doxepin, mirtazapine, and trazodone can have an immediate sedative effect, and are prescribed to treat insomnia. Amitriptyline and doxepin both have antihistaminergic, anticholinergic, and antiadrenergic properties, which contribute to both their therapetuic effects and side effect profiles, while mirtazapine's side effects are primarily antihistaminergic, and trazodone's side-effects are primarily antiadrenergic. Mirtazapine is known to decrease sleep latency (i.e., the time it takes to fall asleep), promoting sleep efficiency and increasing the total amount of sleeping time in people with both depression and insomnia.

Agomelatine a novel melatonergic antidepressant with sleep-improving qualities that does not cause daytime drowsiness, is licensed for marketing in the European Union and TGA Australia. After trials in the United States its development for use there was discontinued in October 2011 by Novartis, who had bought the rights to market it there from the European pharmaceutical company Servier.

Benzodiazepines

Normison (temazepam) is a benzodiazepine commonly prescribed for insomnia and other sleep disorders.

The most commonly used class of hypnotics for insomnia are the benzodiazepines. Benzodiazepines are not significantly better for insomnia than antidepressants. Chronic users of hypnotic medications for insomnia do not have better sleep than chronic insomniacs not taking medications. In fact, chronic users of hypnotic medications have more regular nighttime awakenings than insomniacs not taking hypnotic medications. Many have concluded that these drugs cause an unjustifiable risk to the individual and to public health and lack evidence of long-term effectiveness. It is preferred that hypnotics be prescribed for only a few days at the lowest effective dose and avoided altogether wherever possible, especially in the elderly. Between 1993 and 2010, the prescribing of benzodiazepines to individuals with sleep disorders has decreased from 24% to 11% in the US, coinciding with the first release of nonbenzodiazepines.

The benzodiazepine and nonbenzodiazepine hypnotic medications also have a number of side-effects such as day time fatigue, motor vehicle crashes and other accidents, cognitive impairments and falls and fractures. Elderly people are more sensitive to these side-effects. Some benzodiazepines have demonstrated effectiveness in sleep maintenance in the short term but in the longer term benzodiazepines can lead to tolerance, physical dependence, benzodiazepine withdrawal syndrome upon discontinuation, and long-term worsening of sleep, especially after consistent usage over long periods of time. Benzodiazepines, while inducing unconsciousness, actually worsen sleep as—like alcohol—they promote light sleep while decreasing time spent in deep sleep. A further problem is, with regular use of short-acting sleep aids for insomnia, daytime rebound anxiety can emerge. Although there is little evidence for benefit of benzodiazepines in insomnia compared to other treatments and evidence of major harm, prescriptions have continued to increase. This is likely due to their addictive nature, both due to misuse and because—through their rapid action, tolerance and withdrawal—they can "trick" insomniacs into thinking they are helping with sleep. There is a general awareness that long-term use of benzodiazepines for insomnia in most people is inappropriate and that a gradual withdrawal is usually beneficial due to the adverse effects associated with the long-term use of benzodiazepines and is recommended whenever possible.

Benzodiazepines all bind unselectively to the GABA_A receptor. Some theorize that certain benzodiazepines (hypnotic benzodiazepines) have significantly higher activity at the α₁ subunit of the GABA_A receptor compared to other benzodiazepines (for example, triazolam and temazepam have significantly higher activity at the α₁ subunit compared to alprazolam and diazepam, making them superior sedative-hypnotics – alprazolam and diazepam in turn have higher activity at the α₂ subunit compared to triazolam and temazepam, making them superior anxiolytic agents). Modulation of the α₁ subunit is associated with sedation, motor-impairment, respiratory depression, amnesia, ataxia, and reinforcing behavior (drug-seeking behavior). Modulation of the α₂ subunit is associated with anxiolytic activity and disinhibition. For this reason, certain benzodiazepines may be better suited to treat insomnia than others.

Benzodiazepine-like medications

Drugs that may prove more effective and safer than benzodiazepines for insomnia is an area of active research. Nonbenzodiazepine sedative-hypnotic drugs, such as zolpidem (Ambien), zaleplon, zopiclone (Imovane), and eszopiclone (Lunesta), are a class hypnotic medications that are similar to benzodiazepines in their mechanism of action, and indicated for mild to moderate insomnia. Their effectiveness at improving time to sleeping is slight, and they have similar—though potentially less severe—side effect profiles compared to benzodiazepines.

Suvorexant is FDA approved for insomnia, characterized by difficulties with sleep onset and/or sleep maintenance.

Prescribing of nonbenzodiazepines has seen a general increase since their initial release on the US market in 1992, from 2.3% in 1993 among individuals with sleep disorders to 13.7% in 2010.

Antipsychotics

The use of antipsychotics for insomnia, while common, is not recommended as the evidence does not demonstrate a benefit and the risk of adverse effects is significant. Concerns regarding side effects is greater in the elderly.

Alternative medicine

Some insomniacs use herbs such as valerian, chamomile, lavender, cannabis, hops, Withania somnifera, and passion-flower. L-Arginine L-aspartate, S-adenosyl-L-homocysteine, and delta sleep-inducing peptide (DSIP) may also be helpful in alleviating insomnia. It is unclear if acupuncture is useful.

Epidemiology

Disability-adjusted life year for insomnia per 100,000 inhabitants in 2002.

  no data

  less than 25

  25–30.25

  30.25–36

  36–41.5

  41.5–47

  47–52.5

  52.5–58

  58–63.5

  63.5–69

  69–74.5

  74.5–80

  more than 80

A survey of 1.1 million residents in the United States found that those that reported sleeping about 7 hours per night had the lowest rates of mortality, whereas those that slept for fewer than 6 hours or more than 8 hours had higher mortality rates. Getting 8.5 or more hours of sleep per night increased the mortality rate by 15%. Severe insomnia – sleeping less than 3.5 hours in women and 4.5 hours in men – also led to a 15% increase in mortality. However, most of the increase in mortality from severe insomnia was discounted after controlling for co-morbid disorders. After controlling for sleep duration and insomnia, use of sleeping pills was also found to be associated with an increased mortality rate.

The lowest mortality was seen in individuals who slept between six and a half and seven and a half hours per night. Even sleeping only 4.5 hours per night is associated with very little increase in mortality. Thus, mild to moderate insomnia for most people is associated with increased longevity and severe insomnia is associated only with a very small effect on mortality. It is unclear why sleeping longer than 7.5 hours is associated with excess mortality.

Insomnia is 40% more common in women than in men.

Prevalence

The National Sleep Foundation's 2002 Sleep in America poll showed that 58% of adults in the U.S. experienced symptoms of insomnia a few nights a week or more. Although insomnia was the most common sleep problem among about one half of older adults (48%), they were less likely to experience frequent symptoms of insomnia than their younger counterparts (45% vs. 62%), and their symptoms were more likely to be associated with medical conditions, according to the poll of adults between the ages of 55 and 84.

As explained by Thomas Roth, estimates of the prevalence of insomnia depend on the criteria used as well as the population studied. About 30% of adults report at least one of the symptoms of insomnia. When daytime impairment is added as a criterion, the prevalence is about 10%. Primary insomnia persisting for at least one month yields estimates of 6%.

Society

The topic of insomnia is discussed in many cultural contexts.

The word insomnia is from Latin: in + somnus "without sleep" and -ia as nominalizing suffix.

See also

• Al Herpin, American insomniac, known as the "Man Who Never Slept"
• Hypnophobia
• Thai Ngoc, Vietnamese insomniac, claimed to be awake for 41 years

References

Further reading

• Ellis, J. J., Hampson, S. E., & Cropley, M. M. (2002). Sleep hygiene or compensatory sleep practices: an examination of behaviours affecting sleep in older adults. Psychology, Health & Medicine, 7(2), 156-161. doi:10.1080/13548500120116094
• Passarella, S., & Duong, M. (2008). Diagnosis and treatment of insomnia. American Journal Of Health-System Pharmacy, 65(10), 927-934. doi:10.2146/ajhp060640
• Insomnia Charles M. Morin and Geneviève Belleville, Scholarpedia, 3(4):3314. doi:10.4249/scholarpedia.3314

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 不眠症の治療 treatment of insomnia
• 2. 不眠症の概要 overview of insomnia
• 3. 不眠症の臨床的特徴および診断 clinical features and diagnosis of insomnia
• 4. Cognitive and behavioral consequences of sleep disorders in children
• 5. 緩和ケアにおける不眠症の概要 overview of insomnia in palliative care

English Journal

• Understanding mental and physical fatigue complaints in those with depression and insomnia.

• Carney CE1, Moss TG, Lachowski AM, Atwood ME.
• Behavioral sleep medicine.Behav Sleep Med.2014 Jul 4;12(4):272-89. doi: 10.1080/15402002.2013.801345. Epub 2013 Oct 15.
• Fatigue is a concern for both people with insomnia and with depression, yet it remains poorly understood. Participants (N = 62) included those meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) criteria for insomnia and major depressive disorder (MDD). Multiple re
• PMID 24128300

• Heart rate and heart rate variability modification in chronic insomnia patients.

• Farina B1, Dittoni S, Colicchio S, Testani E, Losurdo A, Gnoni V, Di Blasi C, Brunetti R, Contardi A, Mazza S, Della Marca G.
• Behavioral sleep medicine.Behav Sleep Med.2014 Jul 4;12(4):290-306. doi: 10.1080/15402002.2013.801346. Epub 2013 Oct 15.
• Chronic insomnia is highly prevalent in the general population, provoking personal distress and increased risk for psychiatric and medical disorders. Autonomic hyper-arousal could be a pathogenic mechanism of chronic primary insomnia. The aim of this study was to investigate autonomic activity in pa
• PMID 24128278

• Metabolic consequences of sleep and circadian disorders.

• Depner CM1, Stothard ER, Wright KP Jr.
• Current diabetes reports.Curr Diab Rep.2014 Jul;14(7):507. doi: 10.1007/s11892-014-0507-z.
• Sleep and circadian rhythms modulate or control daily physiological patterns with importance for normal metabolic health. Sleep deficiencies associated with insufficient sleep schedules, insomnia with short-sleep duration, sleep apnea, narcolepsy, circadian misalignment, shift work, night eating syn
• PMID 24816752

Japanese Journal

• THE EFFECTS OF TRIAZOLAM AND RILMAZAFONE ON THE PHYSICAL AND COGNITIVE FUNCTIONS IN HEALTHY ELDERLY PERSONS

• Inomata Shoko,Ito Sachiko U,Wakasa Masahiko,Osawa Yukihiko,Shimizu Kazumi,Ito Wakako,Kanbayashi Takashi,Shimizu Tetsuo
• 秋田医学 38(2), 63-69, 2011-12
• … Furtherstudies using an interdisciplinary approach with different professionals such nurses, physicaltherapists, pharmacists and physicians are needed for evaluating the safety use of hypnotics in theelderly patients with insomnia. …
• NAID 110008752362

• 生活習慣と睡眠(シンポジウム:睡眠と健康,2010年,第51回日本心身医学会総会ならびに学術講演会(仙台))

• 菅 重博,武田 彰久,佐々木 圭吾,端詰 勝敬,坪井 康次
• 心身医学 51(9), 783-789, 2011-09-01
• 社会の近代化,多様化に伴い労働環境および生活習慣が大きく変化している.その変化は,睡眠障害の増加につながっているといわれている.実際に,1970年は7時間57分であった睡眠時間は2005年には7時間22分と約30分近く短くなっている.また,医療機関を受診する患者以外にも,一般健常者における睡眠障害の増加が注目され,一般労働者の20〜40%が不眠であるといわれ社会への影響も大きい.睡眠障害があると, …
• NAID 110008711378

Related Links

• Insomniaとは - goo Wikipedia (ウィキペディア)

Symptoms of insomnia can be caused by or be co-morbid with: Use of psychoactive drugs (such as stimulants), including certain medications, herbs, caffeine, nicotine, cocaine, amphetamines, methylphenidate, aripiprazole, MDMA, modafinil ...

• Amazon.co.jp： Insomnia: 音楽

「the HIATUS」が新作を緊急リリース決定!5月27日に発売された1stアルバム「Trash We’d Love」(FLCF-4281)で多くの音楽ファンに衝撃を与えた「the HIATUS」が新作をリリース。アルバムはオリコン初登場1位を獲得し、発売直後から行われた全国21 ...

• Insomnia - 辞書すべて - goo辞書

Insomniaの意味は？goo辞書は無料で使える日本最大級の辞書サービスです。国語辞典、英和辞典、和英辞典、類語辞典、中国語辞典、百科事典などを提供しています。 ... Insomnia このページは「インソムニア」へ転送します。 Insomnia

Related Pictures

---

★リンクテーブル★

国試過去問	「104F003」
リンク元	「不眠症」「sleep」「sleeplessness」「sleep loss」「sleep disruption」
拡張検索	「transient insomnia」「chronic insomnia」「rebound insomnia」「insomniac」「fatal familial insomnia」

「104F003」

　　[★]

• 一般用語と専門用語の組合せで誤っているのはどれか。

• a　backbone － spine
• b　belly － abdomen
• c　chickenpox － varicella
• d　forehead － cranium
• e　sleeplessness － insomnia

[正答]

D

※国試ナビ4※　［104F002］←［国試_104］→［104F004］

「不眠症」

　　[★]

英

insomnia

関

睡眠薬、睡眠、睡眠障害、熟眠障害。睡眠障害国際分類

概念

• 不眠症とは入眠困難と睡眠維持困難のいずれかを指す

分類

• 一過性不眠症
• 持続性不眠症

原因

• 精神生理的
• 薬物
• 呼吸障害

• 睡眠時無呼吸症候群
• 肺胞低換気

• 精神障害による不眠、神経症状、うつ病

• 覚醒、覚醒リズム障害

• ジェット・時差症候群
• 交替制勤務による不眠症
• ASPS(DSDP)
• non-24 SWRS

5つのP

• 1. 身体的　　　疼痛、発熱、かゆみ
• 2. 生理的　　　時差、交替制勤務
• 3. 生理的　　　ストレス、重大な人生の変化など
• 4. 精神医学的　うつ病、統合失調症、アルコール依存症」
• 5. 薬理学的　　カフェイン、ニコチン

KPS.822

	身体疾患による二次的な不眠	精神的・環境的な状態による二次的な不眠
入眠困難	疼痛 or 耐え難い状態 中枢神経障害 下記の状態に常にあること	不安 不安筋緊張 環境変化 概日リズム睡眠障害
睡眠維持困難	睡眠時無呼吸症候群 夜間ミオクローヌス、むずむず脚症候群 食事因子 挿管性事象(睡眠時随伴症) 物質の影響(アルコールなど) 物質離脱の影響(アルコールなど) 物質相互作用 内分泌疾患/代謝性疾患 感染、悪性腫瘍などの疾患 疼痛 or 耐え難い状態 脳幹・視床下部障害・疾患 加齢	うつ病、とくに原発性うつ病 環境変化 概日リズム睡眠障害 外傷後ストレス障害 統合失調症

「sleep」

　　[★]

• n.

• 睡眠、眠り、活動休止

• adj.
• vi.
• vi.

関

insomnia

PHP

• sleep ( $seconds )：seconds で与えられた秒数ぶんプログラムの実行を遅延させる。

　 　 　 　 　 　

「sleeplessness」

　　[★]

• 不眠

関

chronic insomnia、insomnia、insomniac、primary insomnia、rebound insomnia、sleep disorder、sleep disruption、sleep loss、transient insomnia

「sleep loss」

　　[★]

• 不眠

関

insomnia、insomniac、sleep disruption、sleeplessness

「sleep disruption」

　　[★]

• 不眠

関

insomnia、insomniac、sleep loss、sleeplessness

「transient insomnia」

　　[★]

一過性不眠症

関

chronic insomnia、insomnia、primary insomnia、rebound insomnia、sleep disorder、sleeplessness

「chronic insomnia」

　　[★]

慢性不眠症

関

insomnia、primary insomnia、rebound insomnia、sleep disorder、sleeplessness、transient insomnia

「rebound insomnia」

　　[★]

反跳性不眠

関

chronic insomnia、insomnia、primary insomnia、sleep disorder、sleeplessness、transient insomnia

「insomniac」

　　[★]

• 不眠の、不眠症の

関

insomnia、sleep disruption、sleep loss、sleeplessness

　 　 　

「fatal familial insomnia」

　　[★] 致死性家族性不眠症 FFI