Secondary insomnia

It is indicated in treatment of transient, situational and chronic insomnia, insomnia secondary to psychiatric disorders. 

Primary insomnia, with underlying pathophysiology of sleep Insomnia secondary to a psychiatric disorder Insomnia secondary to a medication or drug of abuse... 

Insomnia secondary to a general medical condition, especially with pain- or sleep-disordered breathing Circadian rhythm disturbance Periodic limb movement disorder Restless legs syndrome... 

If the insomnia is precipitated or aggravated by another sleep disorder or mental disorder, or if it is due to the direct physiological effects of a substance of abuse or a general medical condition, then the other disorder is termed primary and the insomnia secondary [13, 14],... 

Sancho-Del-Val L, Barrio-Andres J, Herranz-Bachiller MT, Alcaide-Suarez N. Hepatotoxicity and insomnia secondary to ranolazine. Rev Esp Enferm Dig 2013 105(5) 304-5. 

Most common Gastrointestinal upset, anxiety, insomnia Less common Hyperglycemia, facial flushing,euphoria, perineal itching or burning (with dexamethasone, probably secondary to vehicle and rate of injection)... 

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. 

Monti, J. M. (2004). Primary and secondary insomnia prevalence, causes and current therapeutics. Cum Med. Chem. Central Nerv. Syst. Agents, 4, 119-37. 

HY-10275 (no structure reported), having such a dual mechanism, has been recently reported to meet the primary and secondary endpoints in the initial phase II trial at doses of 1 and 3 mg in adults with transient insomnia [93]. 

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. 

Although the MAOIs can have serious and potentially life-threatening adverse effects, it is the more common and less dramatic side effects that often lead to the discontinuation of MAOIs. These side effects include orthostatic hypotension, drowsiness, insomnia, edema, weight gain, sexual dysfunction, and precipitation of mania. Rare side effects include hepatitis and leukopenia. Parasthesias may develop secondary to a MAOI-induced pyridoxine deficiency, which responds to oral pyridoxine supplementation. Overall, phenelzine appears to be more sedating, whereas trancylpromine is more activating because of its stimulant-like properties. Meclobomide has more excitatory side effects, such as restlessness and insomnia. 

The major benefit of BZDs may be in diminishing some of the secondary symptoms of an acute exacerbation (e.g., insomnia, agitation, panic, and other general anxiety symptoms) that are not necessarily rapidly and specifically affected by lithium or antipsychotics. With this approach, exposure to antipsychotics may be precluded in some situations and kept to a minimum in others, thus avoiding the potential for more serious antipsychotic-induced adverse effects. Additionally, given the high comorbidity with alcohol abuse/dependence, concurrent withdrawal symptoms may also be managed with BZDs. 

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 ... 

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

Insomnia is a complaint, not a disease. The causes of insomnia are classified both in the DSM-IV for psychiatrists and in the International Classification of Sleep Disorders for sleep experts (Table 8—3). Insomnia can be a primary problem, or it can be secondary to medical or psychiatric disorders or to medications. Insomnia can also be due psychophysiological factors such as stress or to circadian rhythm distur-... 

When these issues are taken into consideration, there is still a high frequency of primary insomnia, as well as secondary insomnia the primary cause of which cannot be satisfactorily treated. Many patients also have both a psychiatric disorder and a primary insomnia. Still others have a psychiatric disorder requiring a sleep-disrupting antidepressant. Here we will discuss the use of sedative-hypnotics for these patients. 

The focus of this section will be the prevention of sleep loss through the use of sleep-promoting medications. Choice of sleep medications will not be considered, as others have thoroughly discussed this issue (6). Short-acting benzodiazepine receptor agonists are generally the type of medication recommended for the treatment of transient insomnia and chronic primary insomnia, and as adjunctive therapy for secondary chronic insomnias. 

The remainder of this chapter discusses the characteristics of primary insomnia (PI) and secondary insomnia (SI). Each of these two sections is structured to cover prevalence, causes, and diagnosis. 

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