Insomnia: Perbezaan antara semakan
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{{DiseaseDisorder infobox |
Name = Insomnia |
ICD10 = F51.0, G47.0 |
ICD9 = {{ICD9|307.42}}, {{ICD9|307.41}}, {{ICD9|780.51}}, {{ICD9|780.52}} |
}}
'''Insomnia''' dicirikan ketakupayaan bertidur dan/atau ketidakupayaan bertidur selama tempoh yang munasabah. Penghidap insomnia biasanya merungut kerana tidak berupaya menutup mata mereatau atau "merehatkan minda" buat melebihi beberapa minit setiap kali. Kedua-dua insomnia organik dan bukan organik merupakan [[gangguan tidur]]. <ref>http://www3.who.int/icd/currentversion/fr-icd.htm?gf50.htm+f510 </ref><ref>http://www3.who.int/icd/currentversion/fr-icd.htm?gg40.htm+g47 </ref> Insomnia biasanya diakibatkan oleh ketakutan, [[tekanan (psikologi)|tekanan]], [[kebimbangan]], [[ubat]], [[herba]], [[kafeina]], [[kemurungan]] atau kekadangnya tanpa sebarang sebab yang ketara. Minda yang terlalu aktif serta sakit fizikal juga boleh mengakibatkannya. Mencari sebab yang mengakibatkan insomnia biasanya diperlukan untuk merawatnya.
==Jenis==
[[Image:53-aspetti di vita quotidiana, insonnia, Taccuino Sanitatis,.jpg|thumb|250px|Insomnia, [[tacuinum sanitatis]] casanatensis (abad ke-14)]]
Three different types of insomnia exist: transient, acute, and chronic
#'''Transient Insomnia''' lasts from one night to a few weeks. Most people occasionally suffer from transient insomnia due to such causes as [[jet lag]] or short-term anxiety. If this form of insomnia continues to occur from time to time, the insomnia is classified as intermittent.
#'''Acute Insomnia''' is the inability to consistently sleep well for a period of between three weeks to six months.
#'''[[chronic (medicine)|Chronic]] Insomnia''' is regarded as the most serious; persists almost nightly for at least a month.
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==Common causes of insomnia==
Primary insomnia is sleeplessness that is not attributable to a medical or environmental cause. Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition, an example of which would be [[generalized anxiety disorder]].
Some of the most common causes of insomnia are:
*'''[[Circadian rhythm sleep disorders]]''' cause insomnia at some times of the day and excessive sleepiness at other times of the day. Common circadian rhythm sleep disorders include [[jet lag]] and [[delayed sleep phase syndrome]]. Jet lag is seen in people who travel through multiple time zones, as the time relative to the rising and falling of the sun no longer coincides with the body's internal concept of it. The insomnia experienced by shift workers is also a circadian rhythm sleep disorder.
*'''[[Clinophobia]]''' causes insomnia by preventing you from sleeping through anxiety and physical pain.(see article for more information)
*'''[[Parasomnia]]''' includes a number of disorders of arousal or disruptive sleep events including nightmares, sleepwalking, violent behavior while sleeping, and [[rapid eye movement behavior disorder|REM behavior disorder]], in which a person moves his/her physical body in response to events within his/her dreams. These conditions can often be treated successfully through medical intervention or through the use of a sleep specialist.
*'''[[Gastroesophageal Reflux Disease]]''' causes repeated awakenings during the night due to unpleasant sensations resulting from stomach acid flowing upward into the throat while asleep.
*'''[[Mania]] or [[Hypomania]]''' in bipolar disorder can cause difficulty falling asleep. A person going through a manic or hypomanic episode may feel a reduced need for sleep. Sleep deprivation can worsen a manic episode, or cause hypomania to develop into mania.
*'''[[Stimulant]]s''' like [[caffeine]], [[nicotine]], sugar, certain medicines, or other pills/drugs
*'''Lack of [[physical exercise|exercise]]''' - exercising four to five hours before bedtime can help you get to sleep easier. It has also been shown that people who are overweight or have high blood glucose levels have a harder time falling asleep
*'''[[Dehydration]]''' causes stimulants, hormones, and cellular waste to build up in the blood rather than being flushed out, causing irritation, aches, and headaches (and hyperactivity in the case of stimulants). Drinking a cup or two of water can cause sleepiness within an hour or two.
*'''[[Pain and nociception|Pain]]''' can produce insomnia and finding effective ways to treat pain can provide relief.
A common misperception is that the amount of sleep one requires decreases as he or she 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.<ref>http://www.aafp.org/afp/991001ap/1431.html</ref>
Insomnia is a common [[Adverse effect (medicine)|side-effect]] of some medications, and it can also be caused by [[stress (psychology)|stress]], emotional upheaval, physical or [[mental illness]], dietary allergy and poor [[sleep hygiene]]. Insomnia is a major symptom of mania in people with [[bipolar disorder]], and it can also be a sign of [[hyper-thyroidism]], [[Clinical depression|depression]], or other ailments with stimulating effects.
In addition, a rare genetic condition can cause a [[prion]]-based, permanent and eventually fatal form of insomnia called '''[[fatal familial insomnia]]'''.
==Insomnia versus poor sleep quality==
Poor sleep quality can occur as a result of sleep apnea or major depression. Poor sleep quality is caused by the individual not reaching stage 4 or delta sleep which has restorative properties. There are, however, people who are unable to achieve stage 4 sleep due to brain damage that still lead perfectly normal lives.
*'''[[Sleep apnea]]''' is a condition that occurs when a sleeping person's breathing is interrupted, thus interrupting the normal sleep cycle. With the obstructive form of the condition, some part of the sleeper's respiratory tract loses muscle tone and partially collapses. People with obstructive sleep apnea often do not remember any of this, but they complain of excessive sleepiness during the day. Central sleep apnea interrupts the normal breathing stimulus of the [[central nervous system]], and the individual must actually wake up to resume breathing. This form of apnea is often related to a cerebral vascular condition, congestive heart failure, and premature aging.
Major depression leads to alterations in the function of the hypothalamus and pituitary causing excessive release of cortisol which can lead to poor sleep quality.
Nocturnal polyuria or excessive nighttime urination can be very disturbing to sleep. Urination produces strong signals to the brain to wake up. Nocturnal polyuria can be nephrogenic (related to kidney disease) or it may be due to prostate enlargement or hormonal influences. Deficiencies in vasopressin, which is either caused by a pituitary problem or by insensitivity of the kidney to the effects of vasopressin, can lead to nocturnal polyuria. Excessive thirst or the use of diuretics can also cause these symptoms.
==Treatment for insomnia==
In many cases, insomnia is caused by another disease or psychological problem. In this case, medical or psychological help may be useful.
All sedative drugs have the potential of causing psychological dependence where the individual can't psychologically accept that they can sleep without drugs. Certain classes of sedatives such as benzodiazepines and newer non-benzodiazepine drugs can also cause physical dependence which manifests in withdrawal symptoms if the drug is not carefully titrated down.
Many insomniacs rely on [[sleeping tablet]]s and other [[sedative]]s to get rest. The most commonly used class of hypnotics prescribed for insomnia are the [[benzodiazepine]]s. This includes drugs such as [[temazepam]], [[diazepam]], [[lorazepam]], [[nitrazepam]] and [[midazolam]]. These medications can be addictive, especially after taking them over long periods of time.
Recent research has shown that [[Cognitive therapy|cognitive behavior therapy]] can be more effective than medication in controlling insomnia [http://archinte.ama-assn.org/cgi/content/abstract/164/17/1888]. In this therapy, patients are taught improved sleep habits and relieved of counter-productive assumptions about sleep.
Non-benzodiazepine prescription drugs, including [[Ambien]] and [[Lunesta]], have a cleaner side effect profile than the older benzodiazepines; however, there are controversies over whether these non-benzodiazepine drugs are superior to benzodiazpines. These drugs appear to cause both [[Addiction#Psychological addiction|psychological dependence]] and [[physical dependence]], and can also cause the same memory and cognitive disturbances as the benzodiazepines along with morning sedation.
[[Melatonin]] has proved effective for some insomniacs in regulating the sleep/waking cycle, but lacks definitive data regarding efficacy in the treatment of insomnia.
Melatonin agonists, including Ramelteon ([[Rozerem]]), seem to lack the potential for abuse and dependence. This class of drugs has a relatively mild side effect profile and lower likelihood of causing morning sedation.
The antihistamine [[diphenhydramine]] is widely used in nonprescription sleep aids, with a 50 mg recommended dose mandated by the FDA. In the United Kingdom, Australia, New Zealand, South Africa, and other countries, a 50 to 100 mg recommended dose is permitted. While it is available over the counter, the effectiveness of these agents may decrease over time and the incidence of next-day sedation is higher than for most of the newer prescription drugs. Dependence does not seem to be an issue with this class of drugs.{{Fact|date=February 2007}}
Some [[antidepressants]] such as [[mirtazapine]], [[trazodone]] and [[doxepin]] have a sedative effect, and are prescribed [[off label]] to treat insomnia. The major drawback of these drugs is that they have [[antihistaminergic]], [[anticholinergic]] and [[antiadrenergic]] properties which can lead to many side effects. Some also alter sleep architecture.
Low doses of [[atypical antipsychotics]] such as [[quetiapine]] (Seroquel) are also prescribed for their sedative effect but the danger of neurological and cognitive side effects make these drugs a poor choice to treat insomnia.
Some insomniacs use [[herb]]s such as [[valerian plant|valerian]], [[chamomile]], [[lavender]], [[hops]], and [[passion-flower]]. Valerian has undergone the most studies{{Fact|date=February 2007}} and appears to be modestly effective{{Fact|date=February 2007}}.
[[Alcohol]] may have sedative properties, but the [[Rapid eye movement|REM sleep]] suppressing effects of the drug prevent restful, quality sleep. Middle-of-the-night awakenings due to [[polyuria]] or other effects from alcohol consumption are common, and hangovers can also lead to morning grogginess.
Some traditional remedies for insomnia have included drinking warm milk before bedtime, taking a warm bath in the evening; exercising vigorously for half an hour in the afternoon, eating a large lunch and then having only a light evening meal at least three hours before bed, avoiding mentally stimulating activities in the evening hours, and making sure to get up early in the morning and to retire to bed at a reasonable hour.
[[Pomegranates]] are also believed to help insomniacs sleep.
Warm milk contains high levels of [[tryptophan]], a natural sedative. Using [[aromatherapy]], including jasmine oil, [[lavender oil]], [[Mahabhringaraj]] and other relaxing [[essential oil]]s, may also help induce a state of restfulness.
*Adding [[honey]] to warm [[milk]] helps get the tryptophan in your system faster. Tryptophan absorption is normally inhibited or deterred by other amino acids but in the presence of sugar tryptophan is absorbed more quickly. {{Fact|date=February 2007}}
The more relaxed a person is, the greater the likelihood of getting a good night's sleep. Relaxation techniques such as meditation have been proven to help people sleep. Such techniques can lower stress levels from both the mind and body, which leads to a deeper, more restful sleep.{{Fact|date=February 2007}}
===Alternative approaches===
[[Traditional Chinese medicine]] has included treatment for insomnia throughout its history. A typical approach may utilize [[acupuncture]], dietary and lifestyle analysis, [[Herbalism|herbology]] and other techniques, with the goal of resolving the problem at a subtle level. Although these methods have not been scientifically proven, some insomniacs report that these remedies are sufficient to break the insomnia cycle without the need for sedatives and sleeping tablets{{Fact|date=February 2007}}.
In the Buddhist tradition, people suffering from insomnia or nightmares may be advised to meditate on "loving-kindness", or ''[[metta]]''. This practice of generating a feeling of love and goodwill is claimed to have a soothing and calming effect on the mind and body<ref>[http://www.pnas.org/cgi/content/full/101/46/16369 Lutz, A., Greischar, L.L., Rawlings, N.B., Ricard, M., and Davidson, R.(2004). Long-term meditators self-induce high-amplitude gamma synchrony during mental practice. Proc. Natl. Acad. Sci. USA 101,16369–16373.]</ref>. This is claimed to stem partly from the creation of relaxing positive thoughts and feelings, and partly from the pacification of negative ones. In the ''Mettā Sutta'', Siddhartha Gautama, the Buddha, tells the gathered monks that easeful sleep is one benefit of this form of meditation.
There are a number of alternative cures for this disorder that are currently marketed. Often, a combination of dietary and lifestyle changes is claimed to be the most helpful approach. However, it should be noted the reason they are considered "alternative" medical treatments is the lack of empirical evidence to back up such claims. There are always studies going on to either confirm or deny the effectiveness of such medicine, but in many cases even if no effect is shown to exist in a treatment, proponents will still believe in their effectiveness.
====The Cure for Insomnia====
[[The Cure for Insomnia|The Cure for Insomnia (1987)]] is a movie, directed by [[John Henry Timmis IV]], that was designed to cure insomnia. It runs for 87 hours and has no plot, instead it consists of artist [[L. D. Groban]] reading his lengthy poem "A Cure for Insomnia", spliced with clips of [[heavy metal music|heavy metal]] and [[pornography|pornographic]] videos. This movie was first shown at [[The School of the Art Institute]] in [[Chicago]], Illinois from [[January 31]] to [[February 3]], [[1987]]. It's unknown whether it has been shown after that.
==Statistics for insomnia==
According to the U.S. [[Department of Health and Human Services]], approximately 60 million Americans suffer from insomnia each year.<ref>http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm</ref> Insomnia tends to increase with age and affects about 40 percent of women and 30 percent of men <ref>http://www.womenshealth.gov/faq/insomnia.htm</ref>. The average American gets 7 hours of sleep, instead of the 8 to 10 hours recommended by doctors.
==Insomnia in popular culture==
===Movies===
*[[Cashback (film)]] ([[2006]])
*[[The Machinist]] ([[2004]])
*[[Lost in Translation (film)|Lost In Translation]] ([[2003]])
*[[Insomnia (2002 film)|Insomnia]] ([[2002]])
*[[Fight Club (film)|Fight Club]] ([[1999]])
*[http://www.imdb.com/title/tt0219831/ Insomnia (1998)]
*[[Insomnia (1997 film)|Insomnia]] ([[1997]])
*[[Dream of an Insomniac]] ([[1996]])
*[[Taxi Driver]] ([[1976]])
===Books===
* [[Insomnia (novel)|Insomnia]] by [[Stephen King]]
* [[Fight Club]] by [[Chuck Palahniuk]]
* [[Johnny the Homicidal Maniac]] by [[Jhonen Vasquez]]
===Songs===
* [[Insomnia_%28Faithless_song%29|Insomnia (Faithless song)]]
* [[Insomnia_%28Feeder_song%29|Insomnia (Feeder song)]]
* Insomnia, a song by [[Megadeth]]
* Flowing, a song by 311
--->
==Lihat juga==
*[[Aktigrafi]]
*[[Insomnia keluarga yang teruk]]
*[[Kehilangan tidur]]
==Rujukan==
{{cite journal
| last = Jacobs, PhD
| first = Gregg
| authorlink = http://www.bidmc.harvard.edu/display.asp?leaf_id=3956
| coauthors = Edward F. Pace-Schott, MA; Robert Stickgold, PhD; Michael W. Otto, PhD
| title = Cognitive Behavior Therapy and Pharmacotherapy for Insomnia: A Randomized Controlled Trial and Direct Comparison
| journal = Archives of Internal Medicine
| volume = 164
| issue = 17
| pages = 1888-1896
| date = September 27, 2004
| url = http://archinte.ama-assn.org/cgi/content/abstract/164/17/1888}}
<references />
== Pautan luar ==
* http://www.geocities.com/alam_penyakit/MasalahInsomnia.htm
*[http://www.nhsdirect.nhs.uk/articles/article.aspx?articleID=216 NHS Direct information on Insomnia]
*[http://consensus.nih.gov/2005/2005InsomniaSOS026html.htm NIH state of the science report on management of chronic insomnia in adults]
*[http://www.sleepfoundation.org/sleeptionary/index.php?id=19 Insomnia from the NSF Sleeptionary]
*[http://www.paralumun.com/sleeplessness.htm Sleeplessness]
*[http://www.aasmnet.org American Academy of Sleep Medicine]
*[http://www.insomnia.org.il/pages/about.php?lang=EN The Israeli Center for Insomnia Information ] mainly in Hebrew
*[http://familydoctor.org/110.xml Insomnia] at FamilyDoctor.org
*[http://www.umm.edu/altmed/ConsConditions/Insomniacc.html Insomnia at University of Maryland Medical Center]
*[http://www.weirdasianews.com/2007/01/11/vietnam-man-goes-3-decades-without-sleep Vietnam Man goes 3 Decades Without Sleep] - Unconfirmed
* [http://health.ivillage.com/quicklinks_sleepdisorders/0,,b6fj76m5,00.html Insomnia Treatment Information]
* [http://www.experienceproject.com/group_profile.php?g=41 Personal Accounts and Support]
*[http://www.brainmusicdc.com Information on non-chemical treatment of insomnia by use of music compiled from user's brainwaves]
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