Insomnia factors

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. 

O Insomnia is most frequently a symptom or manifestation of an underlying disorder (secondary insomnia) but may occur in the absence of contributing factors (primary insomnia). Early treatment of insomnia may prevent the development of psychopathologic complications. 

Disturbances of sleep are typical of mood disorders, and belong to the core symptoms of major depression. More than 90% of depressed patients complain of impaired sleep quality [60], Typically, patients suffer from difficulties in falling asleep, frequent nocturnal awakenings, and early morning awakening. Not only is insomnia a typical symptom of depression but, studies suggest, conversely, insomnia may be an independent risk factor for depression. In bipolar disorders sleep loss may also be a risk factor for the development of mania. Hypersomnia is less typical for depression [61] and, in contrast to insomnia, may be related to certain subtypes of depression, such as seasonal affective disorder (SAD). 

The occurrence of seizures with bupropion is dose related and may be increased by predisposing factors (e.g., history of head trauma or CNS tumor). At the ceiling dose (450 mg/day), the incidence of seizures is 0.4%. Other side effects include nausea, vomiting, tremor, insomnia, dry mouth, and skin reactions. It is contraindicated in patients with bulimia or anorexia nervosa. 

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. 

A variety of factors can trigger insomnia. Medications, medical illness, pain, stress, schedule changes, depression, anxiety, and nighttime breathing problems all can produce insomnia. When insomnia has no clear cause, that is, it is not secondary to another condition, it is termed primary insomnia. The diagnostic criteria for primary insomnia are shown in Table 9.1. 

Primary Insomnia. Primary insomnia is a sleep disturbance lasting at least a month with no clear cause. However, many well-recognized psychological and physical factors contribute to prolonging the insomnia. For this reason, some call this condition psychophysiological insomnia. 

Steroid psychosis Steroid psychosis is characterized by a delirious or toxic psychosis with clouded sensorium. Other symptoms may include euphoria, insomnia, mood swings, personality changes, and severe depression. The onset of symptoms usually occurs within 15 to 30 days. Predisposing factors include doses greater than prednisone 40 mg equivalent, female predominance, and, possibly, a family history of psychiatric illness. 

Male Insomnia, chills, decreased libido, hepatic dysfunction, nausea, diarrhea, prostatic hyperplasia (elderly), iron deficiency anemia, suppression of clotting factors... 

Assessing the effectiveness of a new drug candidate can be complex and often difficult. This is because some diseases or symptoms do not follow a predictable path. For example, acute conditions such as influenza or insomnia may resolve without intervention, while chronic conditions such as multiple sclerosis or arthritis follow a varying course of progression. Depending on age, treatment, and other risk factors, heart attacks and strokes may produce variable mortality rates. Additional difficulty is introduced by subjective evaluation, which can be influenced by the expectations of patients and physicians. Some of these issues can be addressed in controlled clinical trials. 

Secondary insomnia related to a known organic factor may occur in conjunction with a physical illness (but not the person s emotional reaction to the illness), psychoactive substance abuse, or certain medications. Secondary insomnia may also be related to another mental disorder. 

As with the insomnia disorders, hypersomnias may be categorized as primary, as secondary to another mental disorder (e.g., mood disorders, schizophrenia, somatoform disorder, borderline personality disorder), or as secondary to a known organic factor such as the following ... 

Abrupt alcohol withdrawal leads to a characteristic syndrome of motor agitation, anxiety, insomnia, and reduction of seizure threshold. The severity of the syndrome is usually proportionate to the degree and duration of alcohol abuse. However, this can be greatly modified by the use of other sedatives as well as by associated factors (eg, diabetes, injury). In its mildest form, the alcohol withdrawal syndrome of tremor, anxiety, and insomnia occurs 6-8 hours after alcohol consumption is stopped (Figure 23-2). These effects usually abate in 1-2 days. In some patients, more severe withdrawal reactions occur, with patients at risk of hallucinations or generalized seizures during the first 1-3 days of withdrawal. Alcohol withdrawal is one of the most common causes of seizures in adults. Several days later, individuals can develop the syndrome of delirium tremens, which is characterized by total disorientation, hallucinations, and marked abnormalities of vital signs. 

At certain times, patients may experience extreme stress, anxiety, insomnia, tiredness and exhaustion, and at these times the body becomes very sensitive because the balance of Yin and Yang, and the normal relationship between the internal organs, are disturbed. In treatment, it is important to take into account all the relevant factors, such as how the Qi and the blood tend to move, the sensitivity of the body and the mind, and the possible coexistence of heat and cold, as well as weakness and excess. Herbal formulas should be gentle and balanced, and their administration should be carefully considered, as any strong reaction to the treatment may cause more disturbance to the patient s condition. 

Zhi Gan Cao is sweet in nature and enters all 12 regular meridians however, it primarily enters the Spleen meridian. If it is used in a reasonably large dosage (i.e. above 9 g as a crude herb) it can sufficiently tonify and smooth the Qi. Unlike Ren Shen, it does not cause restlessness and insomnia, and is particularly useful in an acute or persistent condition of anxiety. This is because its sweet taste can reduce the tension from the conflict between the body s resistance and the pathogenic factors, slow down the pathological process, ease the tendons and muscles, and thus calm the mind in a stable, gentle and pleasant way. 

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