Insomnia can manifest itself in different ways. Some can not sleep because of the persistent thoughts, constant pain or a cup of coffee at night, while others wake up middle of the night (eg, crowded bladder), and then the long roll in bed. For patients with depression insomnia means waking at five o'clock in the morning, with a sense of horror and desperate longing. From the point of view the physiological significance of sleep insomnia - it is insufficient sleep, which is not achieved full recovery. This handicapped son is familiar to all who received treatment in hospital - the constant noise, circulation, and the inclusion of off the light, procedures, pain and fear hinder sleep and how to get enough sleep. A common cause of insomnia - chronic pain.
In the United States suffer from insomnia nearly 80 million adults. Approximately 30% of it is constant or frequent. Particularly true for elderly insomnia and people suffering from mental disorders. It occurs in 50% of patients with schizophrenia and 75% of patients with affective disorders. It is important to stress that these figures indicate only the prevalence of insomnia, but not about its etiology or curability.
Diagnosis.
Accurate diagnosis is extremely important. Thus, in some patients with daytime sleepiness, irritability and depression can emerge fibromialgiya, obstructive or central apnea during sleep, troubled legs syndrome, night miokloniya. In such cases, of course, it is necessary to treat the basic disease (for example, breathing with continuous positive pressure in obstructive sleep apnea, depression, with antidepressants), and hypnotics can bring only harm. Sleep disturbance may be due to reaction of loss, separation syndrome change time zones or work at night. Important conditioned reflex factors. Some, for example, can only sleep at home, while others - the opposite. In the latter case is often that bedroom home on the mechanism of conditional reflexes associated with unpleasant events - quarrels, unwanted intimate proximity, feelings of guilt or fear. Often, insomnia can be due to improper or busy lifestyle or stress. In short, the causes of insomnia are many and all of them are here to consider the impossible.
Careful history taking sometimes allows to open such causes situational insomnia, which does not know himself sick. Sometimes it helps a patient to change something in their lives, and sleep established. Often enough to say that it is possible without compromising the health of not sleep a few nights: it is better to read the book, listen to quiet music, watch a movie on TV than writhe fruitless thoughts that «it is necessary to sleep». The patient calms down, and if he does not sleep during the day, soon accumulated fatigue and restores a normal night sleep. Sometimes the simplest tips are useful for preparing for the night (see Table. 21.1). In most cases, temporary insomnia somnografiya is not required.

About 15% suffering from insomnia are using sleeping pills - or at the doctor's prescriptions, or as self-treatment. These funds are for many the first time are really quite effective, but data to recommend their use of long, short. In some (but not all) studies show that in a few weeks or months of regular admission to the sleeping-pills it develops more or less pronounced tolerance. The sudden cancellation of - intentional or accidental (as, for example, hospitalized patients, not reported on the use of sleeping-pills) can lead to a resumption of insomnia or withdrawal symptoms if the patient has the money in the long or high doses. Such cases - are not uncommon. Approximately 30% of cases as the sleeping pills are alcohol.
Most belonged to the sleeping-pills OTC medicines. Most often they contain difengidramin or other H1-blockers. These funds are sedation and drowsiness, sometimes enough to sleep. However, their effect is often subjective and indirect and not due to a direct effect on the structure of sleep. Controlled trials confirming the effectiveness of H1-blockers, long enough. Most of these funds have long-lasting, and many complain of drowsiness, headaches, retardation in the morning. Perhaps enhancement of motor activity while asleep, M-holinoblokiruyuschie effects (dry mouth, delayed urine or difficulty urinating), confusion. Despite this, patients take OTC funds more carefully than a doctor. Usually within a few days or weeks sedative effect of H1-blockers waning.
2. Until recently, difficulty falling asleep when applied tryptophan. He also released without a prescription. Convincing data on efficacy and safety of this means yet, but apparently he has a weak hypnotic effect without significant side effects. Nevertheless, his medications are removed from production, as called eosinophilia-mialgii syndrome (a syndrome similar to systemic scleroderma, first described in 1989 and is observed only in patients who took medications tryptophan a Japanese firm - perhaps because of the lack of it cleaning). People's sleeping pills - a drink for a night of warm milk and cookies - probably based on facilitating the absorption of tryptophan in the presence of carbohydrates (either due to increased secretion of cholecystokinin). Some argue that the hypnotic effect may also have turkey and bananas - products with high content of tryptophan.
3. Alcohol - this is probably the most widely used sleeping pills. However, few realize that by accelerating onset of sleep, alcohol is its fragmentation (shortening the cycles of sleep, lack of deep sleep). As a result, a person wakes up periodically, and sleep becomes less complete. Some alcohol after taking the first fall asleep fast, but after a few hours awake and already can not sleep at all.