James as circadian rhythm disorders often lead to

James C. Esparza1/28/18B1Annotated notesInsomnia: Definition, Prevalence, Etiology, and Consequences -Defined by the presence of an individual’s report of difficulty with sleep-Presence of polysomnographic evidence of disturbed sleep-Presence of a long sleep latency, frequent nocturnal awakenings, or prolonged periods of wakefulness are taken as evidence-Diagnostic criteria: Difficulty falling asleepDespite adequate opportunity and circumstance to sleepDaytime impairment or distress Occurs at least 3 times per week for a month-A disorder caused by the result of some sort of pathological response-30% of a variety of adult samples drawn report one or more of the symptoms-NIH State-of-the-Science Conference stated that 10% prevalence of insomnia-Diagnostic and Statistical Manual of Mental Disorders estimates approx. 6%-Increased prevalence in women and older adults-Comorbid medical disorders, psychiatric disorders, and working nights or rotational shifts are significant risks for insomnia-Chronic illness are a significant risk-Variety of primary sleep disorders as well as circadian rhythm disorders often lead to insomnia-Younger individuals may have phase delay syndrome-Most common comorbidities associated are psychiatric disorders. Estimated 40% have a coexisting psychiatric condition. -Considered diagnostic symptom for depressive and anxiety disorders.-Insomniacs typically reported a decrease in the following: A. Physical functioningB. Role limitation- physical and emotional health problemsC. Bodily pain D. General health perceptionsE. Vitality (energy)F. Social functioningG. Mental health-Increase occurrence of accidents are 2.5 to 4.5 more likely to happen-Insomnia is more frequently associated with psychiatric disorders than any other medical illness-In most cases, insomnia precedes the psychiatric disorder-Quite possible both disorders would respond to the same therapeutic intervention (eg, corticotropin-releasing hormone antagonists)Behavioral Treatment of Insomnia: Treatment Outcome and the Relevance of Medical And Physical Morbidity-Patients who completed 4+ sessions of cognitive behavioral therapy for insomnia were on average, 33% improved-56% reduction in wake time after sleep onset-34% reduction in sleep latency-29% increase in total sleep time-13% decrease in number of awakenings per night-Patients were evaluated on three criteria: Primary insomnia to stable medical and/or psychiatric conditionsHypnotic medicationsInclination to attempt a behavioral treatment regimen-Patients were instructed to keep a sleep diary for 1-2 weeks-Sleep diaries allowed the clinician to evaluate sleep disturbance complaints, tailor sleep restriction therapy, and track treatment outcome-After reviewing the date with the doctor, patients underwent sleep restriction and stimulus control-Sleep hygiene was introduced after the 3rd session-28 out of 80 subjects met the minimum adequate trial and complete data-Common medical problems: Musculoskeletal disordersHeadachesGastrointestinal disorders-Common psychiatric disorders: mood and anxiety disorders-Patients on average fell asleep about 33 min. quicker, woke up about 1 fewer times, and obtained about 50 more min. of sleep