Insomnia, chronic

Secondary symptoms Restlessness, anxiety, irritability, insomnia, chronic bleeding gums without pain, loss of teeth, spermatorrhea, turbid, scanty and dark urine, difficult and painful urination. 

HUMAN HEALTH RISKS Acute Risks (Fiberglass) cough sore throat asthma ear, eye and skin infections headaches nausea sinusitis insomnia Chronic Risks (Fiberglass) asthma chemical sensitivities respiratory disease Chronic Risks (Erionite) unscheduled DNA synthesis Chronic Risks (Glasswool) respiratory, lung cancer Chronic Risks (Rockwool and Slagwool) lung Cancer. 

Overall, caffeine, as consumed in foods, beverages, and over-the-counter drugs, does not seem to represent a threat to the health of most Americans. However, some sensitive individuals who consume large amounts may experience insomnia, chronic headaches, rapid heart beat, anxiety, and upset stomach. 

Chronic absorption of iodine causes iodism characterized by insomnia, inflammation of the eyes and nose, bronchitis, tremor, diarrhea, and weight... 

Severe withdrawal symptoms, including insomnia, irritability, agitation, withdrawal seizures, and delirium, have been described in both mice and humans chronically exposed to the anesthetics nitrous oxide, ether, and isoflurane (Arnold et al. 1993 Delteil et al. 1974 Deniker et al. 1972 Harper et al. 1980 Smith et al. 1979 Tobias 2000). These symptoms were controlled with the administration of y-aminobutyric acid (GABA)-ergic agents such as pentobarbital, midazolam, and diazepam (Arnold et al. 1993 Hughes et al. 1993). 

Hypoperfusion of skeletal muscles leads to fatigue, weakness, and exercise intolerance. Decreased perfusion of the central nervous system (CNS) is related to confusion, hallucinations, insomnia, and lethargy. Peripheral vasoconstriction due to SNS activity causes pallor, cool extremities, and cyanosis of the digits. Tachycardia is also common in these patients and may reflect increased SNS activity. Patients will often exhibit polyuria and nocturia. Polyuria is a result of increased release of natriuretic peptides caused by volume overload. Nocturia occurs due to increased renal perfusion as a consequence of reduced SNS renal vasoconstrictive effects at night. In chronic severe HF, unintentional weight loss can occur which leads to a syndrome of cardiac cachexia. This results from several factors, including loss of appetite, malabsorption due to gastrointestinal edema, elevated metabolic rate, and elevated levels of proinflammatory cytokines. 

Short-term use of corticosteroids is not associated with most of the adverse effects of chronic steroid use. The most common adverse effects encountered are gastrointestinal upset, insomnia, and mood swings.28... 

FDA for chronic use up to 6 months.33 Although not first line-agents for insomnia, sedating antihistamines are prescribed commonly, and the number of prescriptions has increased dramatically over the last 20 years.34 These and other therapies, detailed below, are used to treat insomnia. 

Eszopiclone (Lunesta ) 6 8 2-3 Oxidation Demethylation — Can be used up to 6 months for chronic insomnia... 

Krystal AD, Walsh JK, Laska E, et al. Sustained efficacy of eszopiclone over 6 months of nightly treatment Results of a randomized, double-blind, placebo-controlled study in adults with chronic insomnia. Sleep 2003 26 793-799. 

Long-term amphetamine abuse results in many damaging effects, not least of which is addiction. Chronic abusers exhibit symptoms that can include violent behavior, anxiety, confusion, and insomnia. They also can display a number of psychotic features, including paranoia, auditory hallucinations, mood disturbances, and delusions (for example, the sensation of insects creeping on the skin). The paranoia can result in homicidal as well as suicidal thoughts. 

Transient (two to three nights) and short-term (less than 3 weeks) insomnia is common and is usually related to a precipitating factor. Chronic insomnia (greater than 1 month) may be related to medical or psychiatric disorders or medication, or it may be psychophysiologic. 

Common causes of insomnia are shown in Table 72-2. In patients with chronic disturbances, a diagnostic evaluation includes physical and mental status examinations, routine laboratory tests, and medication and substance abuse histories. 

Chronic insomnia calls for careful assessment for a medical cause, non-pharmacologic treatment, and careful use of sedative-hypnotics (intermittently to prevent tolerance and dependence). 

Patients with short-term or chronic insomnia should be evaluated after 1 week of therapy to assess for drug effectiveness, adverse events, and compliance with nonpharmacologic recommendations. Patients should be instructed to maintain a sleep diary, including a daily recording of awakenings, medications taken, naps, and an index of sleep quality. 

Indeed, a pharmacological approach is the first line treatment in transient insomnia. Meanwhile, a behavioral or non-pharmacological approach is the recommended therapy for chronic insomnia, together with intermittent aid of pharmacological treatment [3]. 

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