Insomnia

Introduction:

Background Info:
Insomnia as a definition, is a person's inability to fall asleep, or remain in the sleep state for as long as the subject desires, erratic sleep patterns are also a major characteristic of this particular disorder. The first mention of the term insomnia, was found in Henry Cockerham's third english language dictionary published circa. 1623. It reveals the origin of the word as a product of the latin "in" which means "not" and "somnus" which means sleep.
Although there is some disagreement on wether or not insomnia is a disorder unto itself, or simply an associated symptom of another mental or psychiatric disorder, it has generally been classified as a "Sleep Disorder", which basically states that it may be both independent as well as associated. A common occurrence with persons who suffer from insomnia is "Functional Impairment", which translates to a person's inability to perform simple functions during normal awake hours, due to the obvious lack of rest, as well as memory loss, due to the fact that short term memory is converted to long term memory during the sleep state.

Insomnia is classified into three types:
1- Transient Insomnia: onset to remission is usually within a period of less than one week. This type is usually an associated symptom of another disorder such as anxiety and/or depression.
2- Acute Insomnia: also known as short term insomnia, has pattern of occurrence of less than one month but more than two weeks. This type is indicative of inability to maintain sleep or initiating it despite the presence f adequate opportunities. It is more likely associated with short term stress than the other two types.
3- Chronic Insomnia: Occurs throughout a period longer than one month, and is usually a primary or independent disorder unto itself. Subjects who suffer from chronic insomnia, may be subject to extreme mental or psychiatric disorders such as schizophrenia, hallucination and severe muscular and functional impairment, due to fact that this type is chemically induced through the abnormal or impairment of the Cytokines (Regulatory proteins that act as signaling agents for normal physical activities) operational levels in the body.

Research Question:
1- Is Insomnia purely a mentally related occurrence, or physical as well?
2- Can Insomnia lead to greater mental disorders?
3- Is Insomnia a symptom of another disorder or a primary disorder itself?

This paper will aim to seek definitive answers to the aforementioned questions, through empirical qualitative data obtained in the form of interviews with subjects who have reported suffering from insomnia within the last five years. And through the analysis that will be provided, suggest certain treatment methods that may be effective for each different case.

Objectives:
The importance and relevance of Insomnia to human behavioral and mental processes cannot be overestimated. As we have seen from the background information provided, if Insomnia is not addressed and treated, especially in severe conditions, it can lead to dangerous and potentially life threatening mental disorders such as hallucinations or even schizophrenia, which in itself accounts for the most suicidal and murderous tendencies of any recorded disorder, seeing as the subject is not in control of his/her actions. Also, mental functionality is not the only consequence of Insomnia, physical functionality is also affected by lack of sleep. In simple terms "Insomnia decreases productivity". So how can a person be in paramount mental and physical status, if Insomnia is prevalent? The answer to this question will be revealed later on, after conduction of the interviews and composing an analysis of the observed data.

Previous Studies and Literature Review:

A Varied Nature of Insomnia By: Arthur. J Spielman & Paul Glovinsky:
This study focused on the very nature of Insomnia and wether it is in fact and independent or associated. Through a series of both individual and group diagnostic sessions with different subjects, this study had reached the following conclusions:
1- Insomnia is a not a disease, rather an associated complaint.
2- Personality plays an important part in a person's sleep pathology (e.g degree of neuroticism).
3- The degree of sleep deprivation depends on the severity of the primary disorder affecting the person.
4- Occurrences during the sleep state (e.g snoring, thrashing, etc) are an indicator of the severity of Insomnia.
5- Behavioral therapy plays a major role in the reduction of Insomnia severity

A Case Study In Insomnia, National Sleep Foundation:
This study focused on a 42 year old individual, namely a Mrs. A (for ambiguity purposes). Mrs. A had been suffering from excessive sleepiness for a period of 8 years. Though Physically she was completely healthy. A Single mother with three teenage boys, and owner and operator of her own business, she had stated that she was "Hanging on by her fingernails", having sacrificed her social life to entirely devote herself to her family and business. Through a series of psychiatric and physical examinations, and her subsequent treatment a year later, the researchers at the foundation were able to come to the following conclusions:
1- The Insomnia was mainly stress related, therefore an also an associated symptom.
2- Insomnia persisted even after alleviation of stressful situation.
3- Anti-Depressants taken during the stressful period, created dependency.
4- Decreasing work load, through hiring more employees helped reduce stress related Insomnia.
5- Alternative therapeutic methods (e.g meditation) helped alleviate Insomnia.

Notes On a Case of Sleep Deprivation, British Sleep Society:
Focused on a 31 year old male subject, named Ken. Ken was an investment banker at a prestigious establishment in London. Financially well off, father of two children, and husband to a fitness entrepreneur, and a vegetarian. Although living a comfortable life, Ken suffered from irregular recurring Insomnia, specifically every two or three days. On the days of occurrence, he was continually described as crawling to work, taking hour long naps, missing meetings as well as struggling to accomplish simple tasks such as faxing. Through a series of physical examinations, his doctor reached the following conclusions:
1- Ken was hypoglycaemic.
2- He also suffered from decreased protein intake.
3- On the days Ken consumed protein for breakfast, Insomnia didn't follow.
4- Ken was in an early stage of sleep apnea development.

.Research Methodology:

This researcher will be using empirical evidence collected based on qualitative data obtained from a number of interviews conducted by the researcher himself, and assisted by sleep disorder specialist Dr. Siraj W and Pulmonary Specialist Prof. Brendan Frasier of RCSI (Royal College of Surgeons In Ireland), for the blood work analysis of each subject. Three subjects will be interviewed, with different backgrounds and no relation to one another.
Subject 1: Amy E, Age 55
Subject had been suffering from Bipolar disorder for nearly 25 years. The subject had been taking mood stabilizers and anti depressants such as Alprazolam, Serocsat, and Welbetrin. Occasionally suffering from bouts of hypomania and mental hyperactivity. Subject also displayed a rather irrational fear of death, motivated by his previous accidental overdose on his medication. This fear manifested itself in the form of his refusal to sleep in his bedroom, but rather the living room outside his daughter's bedroom. Subject also attempted to counteract the Insomnia using sleeping pills such as Temazepam, alas due to the chemical imbalance of bipolar patients, this did not alleviate the insomnia, rather worsened it to the point of hallucinations and another subsequent overdose. Subject was hospitalized and subjected to blood detoxification, and after a period of three months, resumed normal activity and slightly abnormal sleeping patterns, such as afternoon naps. (Diagnosis: Chronic Insomnia)
Subject 2: Cornelius M, Age 19
Subject was engaged to be married, and had been having a recurring dream of brutally murdering a close acquaintance, with no apparent reason or animosity toward him. In fact the relationship between the two was often admired for its strength. Subject suffered from the inability to maintain the sleep state for more than two hours a night, not being able to finish the dream, and would wake up in a cold sweat, screaming. Subject was performing poorly at school for a week, and displayed moderate functional impairment. When seeking the advice of psychiatrist, he was able to discover that the dream itself was a result of an unresolved issue regarding the unconscious fear that he would have to choose between his friends or his soon to be wife. The conflict turned out to be unfounded, as all that was ailing the subject turned out to be a fear of losing his friends to his marriage, and so reacted violently in the dream in order to avoid the conflict all together. As soon as the subject realized this, he fell asleep and did not wake for 17 hours. (Diagnosis: Transient Insomnia)
Subject 3: Nina I, age 35
Subject reported suffering from insomnia for a duration of 22 days. Subject had been an obese child, and was often abused. When subject turned 15, she started a healthy dietary regimen and exercise plan, and ended up losing 40% of total body weight, and was leading a healthy lifestyle for nearly 16 years. However, subject soon regained weight, and became obsessed with losing it again, thus began an extremely rigorous regimen once more. She developed an irrational and dangerous obsession with keeping weight off, and would often exercise three times a day, and eat almost nothing but dairy products. Through the course of the interview, I was able to pinpoint the exact cause of the Insomnia, "Prolonged Sleep Onset Latency", Taking a long period to transition from awake to sleep status, thus believing that she was not sleepy, and simply got back up. This was mainly due to the fact that the subject always exercised before bed. After nearly 5 months of dietary and behavioral therapy, subject reported to be in a normal healthy state, and the SOL was substantially reduced to normal levels. (Diagnosis: Acute Insomnia).

Analysis:

From the data provided, I can conclude that wether Insomnia in itself can be considered a primary disorder or a secondary disorder, or even an associated symptom, is entirely subjective. And depends largely on the reason behind it. However, we can assume that insomnia is dependent on a large number of diverse factors, unique to the context in which it is found, be it stress, chemical imbalance, severity of the case, and even an individual's personality plays a prominent role, if a person is overly neurotic and of a type A personality such as the third case.
It is up the specialist to decide and use proper diagnostic methodologies in order to detect the reason behind the prevalence of the disorder, and suggest the proper method of treatment.
Insomnia is almost always Co-morbid ( exists at the same time as another more serious disorder), specifically psychiatric disorders, in which case they are more severe, as in the first case. And precautions must be taken, in order to ensure that the selected method of treatment, does not clash with the primary disorder's treatment.
This researcher has concluded that the use of pharmacological aids such as sleeping pills and sedatives, although effective at first, may prove to be problematic, and even create substance dependency, and further cause chemical imbalance, that would prevent the body from functioning normally. Therapeutic sessions, have also proved to be helpful in understanding Insomnia, as they may reach the root of the some of the issues causing it in the first place, especially in issues regarding latency and repression. People who are more at risk of developing Insomnia include but are not limited to, individuals with mental disorders, adults over 50, overly cautious individuals, workaholics, and people with abnormal or fluctuating dietary regimens. As well as people who suffer from certain physical ailments such as sleep apnea, restless leg syndrome, epilepsy among others.
The absence of treatment for prolonged Insomnia may prove dangerous, sleep is vital process, and plays an important role in an individuals ability to control his/her actions, thus, sleep deprivation, if not treated, can lead to severe consequences, be they psychiatric, hallucinations, absent mindedness, impaired motor functionality, or physical, such as excessive daytime sleepiness, or in worst cases, comas (if a person goes without sleep for a period of 23 days).

Suggestions:

As seen in the analysis, the method of treatment must be chosen respective of the context in which the disorder is found. Treatments are classified into three categories:
1- Non-Pharmacological: methods such as Cognitive Behavioral Therapy (Altering the subject's perceptions and expectations of sleep through the reduction of negative responses among other methods), prevention scheduling (Scheduled sleeping patterns), and online interventions, stimulus control (Controlling factors or stimuli that might interfere with the sleep state such as, alarms), Improved sleep hygiene (Less noise, less caffeine intake), and sleep restriction during awake hours, as well as some forms of meditation.
2- Pharmacological or Medicinal: This researcher only recommends this method In sever cases of Insomnia, especially if diagnosed by a specialist, certain powerful sleeping aids or pills may be prescribed, such as Temazepam, Temesta, Ambien and Rozerem. Some might even be prescribed anti anxiety medication, if the cause is anxiety, such as Alprazolam and/or Valium. Over the counter medications can also be used, since they contain low levels of sedatives, such as anti histamines (Allergy medications) such as Zyrtec or Benadryl.
3- Alternative Medicine: Although considered to be effective in a moderate way, certain cultures hold true that nature provides a cure for all ailments, through the use of certain herbs such as passion flower, opioids, chamomile and in some countries the legal and medicinally approved use of cannabis.

Sot to conclude, we have seen that Insomnia however present, does indeed pose a threat to person's physical and mental wellbeing, and left unchecked can lead to much worse and more severe symptoms. The alteration and/or interference with one of the human being's basic need, naturally will have negative repercussions. Companies and organizations, should definitely address the issue of Insomnia on a regular basis, as it does directly affect productivity and efficiently. It should take to provide the proper services and treatment, should the problem ever arise in one or more of its employees. After all, if we cannot help our own with one of the most basic needs of human life, how can we expect better from them, and consequently, ourselves.

I hope this simple paper has provided at least some insight into the subject, and hopefully will contribute to the overall understanding of the issue, and consequently provide the necessary steps that myst be taken to prevent or treat it.