Chronic Insomnia: A Primer

In the Fall of 2010, I began to suffer chronic insomnia. I had earlier in life suffered severe sleep problems due to obstructive sleep apnea, which since 2003 I have treated with a Continous Postitive Airway Pressure (CPAP) machine, but this bout of chronic insomnia proved to be something new, and might I add, horrible. 

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 to have chronic insomnia. Its effects can vary according to its causes. They might include muscular fatigue, hallucinations, and/or mental fatigue. Some people that live with this disorder see things as if they are happening in slow motion, wherein moving objects seem to blend together.

Symptoms of insomnia can be caused by or can be co-morbid with:

Use of psychoactive drugs (such as stimulants), including certain medications, herbs, caffeine, nicotine, cocaine, amphetamines, methylphenidate, aripiprazole, MDMA, modafinil, or excessive alcohol intake.

Withdrawal from depressant drugs such as opioids and benzodiazepines.Use of fluoroquinolone antibiotic drugs,

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 that the sleeper is unaware of.

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.

Mental disorders such as bipolar disorder, clinical depression, generalized anxiety disorder, post traumatic stress disorder, schizophrenia, obsessive compulsive disorder, or dementia.

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

Parasomnias, which include such disruptive sleep events as nightmares, sleepwalking, night terrors, violent behavior while sleeping, and REM behavior disorder, in which the physical body moves in response to events within dreams

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, causing 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.

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.

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."

Knowledge of causation is not necessary for a diagnosis, but it might be nice to know.