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Sunday, September 03, 2006

Insomnia - Yes, me have that now!


Before I go on babbling, yadey yadey yadey about this and that, I think it's time we go into detail about this, this... erm, what do they call it? Owh yes - sleeping difficulties/ disorder... hiks!

These detailed facts regarding Insomnia were taken (copy+edit+paste) from www.emedicinehealth.com. Please click on the weblink to proceed to that particular page for other health/ medical cases.

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Insomnia Overview

Most adults have experienced insomnia or sleeplessness at one time or another in their lives. An estimated 30-50% of the general population are affected by insomnia, and 10% have chronic insomnia.

Insomnia is a symptom, not a stand-alone diagnosis. By definition, insomnia is "difficulty initiating or maintaining sleep, or both." Although most of us know what insomnia is and how we feel and perform after one or more sleepless nights, few seek medical advice. Many people remain unaware of the behavioral and medical options available to treat insomnia.

Insomnia affects all age groups. Among older adults, insomnia affects women more often than men. The incidence increases with age.

Stress most commonly triggers short-term or acute insomnia. If you do not address your insomnia, however, it may develop into chronic insomnia.

Insomnia Causes

Insomnia may result from either psychological or physical causes.

    * The most common psychological problems include anxiety, stress, and depression. In fact, insomnia may be an indicator of depression. Many people will have insomnia during the acute phases of a mental illness.

    * Physiological causes span from circadian rhythm disorders, sleep-wake imbalance, to a variety of medical conditions. Following are the most common medical conditions that trigger insomnia:
          o Chronic pain syndromes
          o Congestive heart failure
          o Chronic obstructive pulmonary disease (COPD)
          o Degenerative diseases, such as Alzheimer disease
            
    * Certain groups are at higher risk for developing insomnia:
          o Travelers
          o Shift workers
          o Seniors
          o Adolescent or young adult students
          o People with chronic pain, cardiopulmonary disease
          o Pregnant women
          o Women in menopause
            
    * Certain medications have been associated with insomnia. Among them are certain over-the-counter cold and asthma preparations.
          o The prescription varieties of these medications may also contain stimulants and thus produce similar effects on sleep.
          o Medications for high blood pressure have also been associated with poor sleep.
            
    * Common stimulants associated with poor sleep include caffeine and nicotine. You should consider not only restricting caffeine use in the hours immediately before bedtime but also limiting your total daily intake.

    * People often use alcohol to help induce sleep, as a nightcap. However, it is a poor choice. Alcohol is associated with sleep disruption and creates a sense of nonrefreshed sleep in the morning.

    * A disruptive bed partner with loud snoring or periodic leg movements also may impair your ability to get a good night's sleep.

Insomnia Symptoms

Doctors associate a variety of signs and symptoms with insomnia. Often, the symptoms intertwine with those of other medical or mental conditions.

    * People with insomnia may complain of difficulty falling asleep. The problem may begin with stress. Then, as you begin to associate the bed with your inability to sleep, the problem may become chronic.

    * Depression and mental illnesses are often associated with insomnia.

    * Most often daytime symptoms will bring people to seek medical attention. Daytime problems caused by insomnia include the following:
          o Poor concentration and focus
          o Difficulty with memory
          o Impaired motor coordination
          o Irritability and impaired social interaction
          o Motor vehicle accidents because of fatigued, sleep-deprived drivers

    * People may worsen these daytime symptoms by their own attempts to treat the symptoms.
          o In 1995, a Gallup poll said 7.9% of respondents used alcohol to help them sleep. Alcohol and antihistamines may compound the problems with sleep deprivation.
          o Others have tried nonprescription sleep aids.

When to Seek Medical Care

When to call the doctor

    * Your insomnia needs a doctor's attention if it lasts longer than 4 weeks or interferes with your daytime activities and ability to function.

    * Insomnia may be a symptom of another medical or psychological problem, which you may need to address first or at the same time.

When to go to the hospital

    * Generally, you will not be hospitalized for insomnia. However, accidents may result from poor coordination and attention lapse seen with sleep deprivation.

    * Worsening pain or increased difficulty breathing at night also may indicate your need to seek emergency medical care.

Exams and Tests

Your doctor will begin an evaluation of insomnia with a good medical history.

    * The doctor will seek to identify any medical or psychological illness that may be contributing to your insomnia.

          o For example, you may be asked about chronic snoring and recent weight gain. This may direct an investigation into the possibility of obstructive sleep apnea. In such an instance, your doctor may request an overnight sleep test (polysomnogram). This test is not part of the routine initial workup for insomnia, however.
          o It is likely that you will be asked to complete a sleep log—a 2-week diary of your sleep-wake periods.
          o The diary will include your personal assessment of your alertness at various times of the day on 2 consecutive days within the 2-week period.
            
    * The Epworth Sleepiness Scale is an example of a validated questionnaire that can be used to assess daytime sleepiness.

    * Actigraphy is another technique to assess sleep-wake patterns over time. Actigraphs are small, wrist-worn devices (about the size of a wristwatch) that measure movement. They contain a microprocessor and on-board memory and can provide objective data on daytime activity.

    * Because insomnia may be a symptom of depression, anxiety, or another mental health issue, a mental status examination, mental health history, and basic mental evaluations may be part of your initial assessment.

Insomnia Treatment


Self-Care at Home

You can do several things to prepare yourself for sleep.

    * Exercise regularly.
          o Aerobic exercise and general fitness are important to maintaining good health.
          o You should exercise in the early part of the day and avoid strenuous activity before bedtime.

    * Avoid large meals and excessive fluids before bedtime.

    * Control your environment.
          o Light, noise, and elevated room temperature can disrupt sleep. Shift workers and night workers especially must address these factors.
          o Your body's circadian rhythm (biological clock) is particularly sensitive to light. Parents who need to sleep during the day may have to make child care arrangements to allow them to sleep.

Medical Treatment

Insomnia is a symptom not a diagnosis. As such, your treatment will be personal and will be focused on your underlying condition. Your treatment may include one or more of the following therapies:
    * Improving sleep habits
    * Correcting sleep misconceptions
    * Controlling your sleep environment
    * Behavior management
    * Light therapy
    * Medications

Medications

    * Nonbenzodiazepine sedatives: These include eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien).
    * Melatonin: Melatonin is secreted by the pineal gland, a pea-sized structure at the center of your brain. At night, melatonin is produced to help your body regulate your sleep-wake cycles. The amount of melatonin produced by your body seems to decrease as you get older.
    * Ramelteon (Rozerem) is a prescription drug that stimulates melatonin receptors. Melatonin is a hormone produced by the pineal gland (located in the brain) during the dark hours of the day-night cycle (circadian rhythm). Melatonin levels in the body are low during daylight hours. The pineal gland responds to darkness by increasing melatonin levels in the body. This process is thought to be integral to maintaining circadian rhythm. Ramelteon promotes the onset of sleep and helps normalize circadian rhythm disorders. Ramelteon is approved by the Food and Drug Administration (FDA) for insomnia characterized by difficulty falling asleep.

Next Steps

Follow-up

Follow your doctor's recommendations for your medical and psychological conditions. You will be asked to give your doctor feedback after you have followed a treatment plan.

Often you will have more than 1 option and more than 1 medication available to help you. Do not lose hope if the first medication does not give you the results you want or if you experience side effects or concerns. Report back to your doctor for advice.

Prevention

The following are suggestions to help anticipate and modify situations likely to be associated with insomnia. They are not foolproof, nor will they safeguard you from the consequences of sleep deprivation once it has occurred.

    * Insomnia from jet lag
          o Behavioral and short-term drug therapy has been used.
          o If you can anticipate your trip, begin to shift your bedtime to coincide with the time schedule in your destination.
          o Short-acting tranquilizers (benzodiazepines) have been shown to be useful. Melatonin, a hormone secreted by the pineal gland that regulates our sleep-wake cycles, is currently being studied.

    * Insomnia from shift changes
          o Behavioral therapy has been useful in modifying the insomnia and symptoms of sleep deprivation in shift workers.
          o You should shift your schedules forward in a clockwise direction—from days to evening to night shift—and allow sufficient time to adapt (at least 1 week) between shift changes.
          o Bright light is a potent stimulus to circadian rhythm. Bright light is being examined as a rhythm synchronizer.
          o Shift workers should stress the importance of good sleep habits with regular bedtime and awakening.
                + Supplemental naps may be necessary to ensure work time alertness.
                + Discuss the use of naps with your doctor.
                + Some people promote using short-acting sedatives in the first few days following a shift change, but not everyone agrees.

    * Insomnia from acute stresses
          o Stress may be positive or negative, and concerns about sleep may vary. Many stressors will go away with support and reassurance.
          o Education about the importance of good sleep habits is also helpful.
          o Some people may need short-term medication treatment. Your doctor will often work toward the lowest effective dose with a short-acting sedative to achieve proper sleep.

    * General recommendations include the following:
          o Work to improve your sleep habits.
                + Learn to relax. Self-hypnosis, biofeedback, relaxation breathing are often helpful.
                + Control your environment. Avoid light, noise, and excessive temperatures. Use the bed only to sleep and avoid using it for reading and watching TV. Sexual activity is an exception.
                + Establish a bedtime routine. Fix wake time.
          o Avoid large meals, excessive fluid intake, and strenuous exercise before bedtime and reduce the use of stimulants including caffeine and nicotine.
          o If you do not fall asleep within 30 minutes, try a relaxing activity such as listening to soothing music or reading.
          o Limit naps to less than 15 minutes unless directed by your doctor.
                + It is generally preferable to avoid naps whenever possible to help consolidate your night's sleep.
                + There are certain sleep disorders, however, that will benefit from naps. Discuss this is with your doctor.

Outlook

Recovery from insomnia can vary.

    * If you have insomnia caused by jet lag, your symptoms will generally clear up within a few days.
    * If you are depressed and have had insomnia for many months, it is unlikely that your symptoms will go away on their own. You will need further evaluation and treatment.
    * Your outcome will also depend on coexisting medical conditions, which may include congestive heart failure, chronic obstructive pulmonary disease, and chronic pain syndromes.



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Kesimpulannye, yer - mek have been experiencing sleeping problems like, for nearly, dah nak masuk 2, eh, jap... last week, ok, last two weeks penyakit nih mula menular into my life. I know I'm so used to sleeping late and getting up early. But this is like, first² tu macam, cannot sleep but later² can la kan. Then lama ke lamaan kan, I noticed one time tu, sh*t! I didn't sleep for like, approx. 24 hours straight! Mind you waktu tu, kalau nak diikutkan, exactly like 26 hours. Dan dah nak masuk week ke 3 dah problem nih dok dalam body system hidup mek nih kan, mek dah ade beberapa record dah - personal records I mean. Hiks!
  • Kes paling ringan: Can't sleep for approx. 26 hours straight.
  • Kes paling hazab: Was it last week ke yang I didn't sleep for approx. 72 hours. Now that's like, what, 3 days straight!? Mau kezombian aku jadiknye!
And so in between tu pun, ade lah cases like 48 hours ke (like nih kes latest lah, since Jumaat noon me got up from bed, then sampai Sabtu noon dinch tidur, then sampailah kul 1am kot baru leh tidur bebetul... eh, that's not 48! That's only like 36 hours ++), and this 'insomnia' thingy worries me. Haiyoh! Never lah mek ever experience bebende camginik sampai jadik zombie bagai. The norms dulu² la zaman² back in KL was like, what, max of 24 hours straight dinch tidur, then terus flat. Or the other way round, tidur tak hengat² dunia sampai 18 hours tidur, kan Volks? Hahah - but that's not insomnia, kan? Hahaha.
 
I've consulted
couple of friends (one of them was an expert I guess in medical field) regarding this matter. It seems rather interesting to know the fact that my sleeping disorder i.e insomnia nih might be caused by...
  1. Stress (due to work and erm, work lor! *nampak sangat ado lagi sebab² stress tapi tetap nak cover dengan work, kan? Muahahah!)
  2. Anxiety (adakah regarding weight issue lagi?)
  3. OVERDOSAGE OF... (My extreme hard-core crash diet with 3 different diet pills!)
OK OK! I know. Yang kes 1 and 2 tu leh dimaafkan lagi. I know I'm over doing it with the diet pills! YES I realized that, THANK YOU! Tapi, aiyoh - if you ols tau what a friend of mine yang jadik Pharmacist kat Guardian tu cakap... mek jadik risau pulak if I stop taking these pills; takut by stop takin' 'em, my nafsu makan akan meluak² jadiknye, thus I'll eat and eat and eat like there's no tomorrow and in the end, die with a big smile on my double-chin face and also, die FAT! (mati la bukan Die Young, kan? hehehe)

Arghhhhhhhhhhhhhhh! Don't know lah! That's why I've decided nak hamek that 1 week break tu. Hurm, seems to me it's not working well lah, I mean the 1 week break tu. Tah lah, mek pon dah tatau nak buat cemana. I think I over did it with my diet nih. Terlalu, no, not determined. Kawan mek cakap, bukan dah tahap determined dah nih - nih dah OBSESSED! Obsessed is not the word I would use. I'd used, DESPERATELY OBSESSED to be thin thin and thin balik kot? Hurmmm... But I guess I'll get over it soon I guess (the pills and diet hard-core giler² nih), in due time. But, bila tatau!? And when I do get over the pills, I hope my insomnia problems pun will go away... shuhhh shuhhh! Let me get back my minimum 8 hours of sleep, please! Hiks!

PS: In case some of you who are wonderin' what sort of pills I took, on top of my Herbalife+Diet+Skipping Meals routine tu, nah... nih dia! (Tapi mek tak bertanggungjawab nah kalau u ols lalui apa yang mek tgh lalui - PERIT wooiii!)
  • NH Detoxlim
Campur sekali dengan
  • Xenical
Campur pulak dengan
  • Pill apa tah yang sama level ngan Duromine yang telah dibeli dari Danok (Opppps!)
Mati la rojak pill katanya! Hahahahah! Owh and when I said CAMPUR SEKALI tu bukan lah telan pill tu tiga² sekali SERENTAK. Gila! Mek nak telan satu pill pun susah! (Nampak sangat susah makan ubat, kan!? HAHAH) Kirenye, lepas mek makan NH Detoxlim tu, lepas dah telan dengan air segelas, telan pulak the next pill... and then lepas tu baru telan the 3rd pill. Hehehehe. Tak kuruih jugak lepas nih, aku tatau lah! Bunuh diri terus! (By taking these 3 pills serentak nih pun, dah ala² persis mau bunuh diri la jugak, kan? Aiyoh - mek insaf! *Tapi tetaplah dok amek jugak kan? Insaf kehaponye, kan!? Hahahah!)

Tu la kawan mek yang specialist dalam bidang pill pill nih cakap... "KO GILA!? Makan 3 jenis diet pills at one go - mau body system kau tak menghoyan?! System kau dinch tau mana satu jenis pill it needs to work with! HAIYOH!!!!" Hehehe gila katanya kat mek!? Isk isk isk...

Owh well - lately nih since I can't sleep that much, I guess I know one thing's for sure nak dilakukan. Yes, berblogging and get busy again! Hiks! I know I'm supposed to be back online, berblogging with a new entry by esok, kan? Guess I can cut one day and buat that 'be back soon' tu today, kan? *Adoiii... sakit dada la pulak. Nih kes angin dah banyak masuk dalam badan mek kah since I've been skipping meals dah brapa hari direct dah nih? OPSS!!! Mati kah aku lepas nih kena sagat dengan si Volk!?!?! 5thE, HELP! Lariiiiiiiiiiiiii!

Berblogging pon dah start balik, and so will Bloggers Idol 2006 week 6 pun akan bermula kembali since tetiber jer BI2006 tu went through "1 Week Break" also katanya... what a coincidence, kan? Mek cuti berblogging, BI2006 pun cuti 1 week katanya... hehehehehe (mati la mek!)



JANGAN KETINGGALAN!!!
Kini Berlangsung!
BLOGGERS IDOL 2006





Posted at 1:13:13 pm by Nurlea Laurielle Lai Lee Abdullah

[Y]
September 3, 2006   07:54 PM PDT
 
HAIYOHHH!!..

DETOXSLIM
XENICAL
DUROMINE

Giler apa..Burberries keluar apa? tatau..sah2 ko diet ngan exercise bagai kan??..jgn bery2 keluar usus ko dah..*matila ganaz..

Udah2 ler tuh...
Nurlea Laurielle
September 3, 2006   09:21 PM PDT
 
Motif burberries kuar USUS!? hahahah over ley!!!
fiebie
September 4, 2006   12:19 AM PDT
 
do you realise it started when you start blogging??

emmm
5thE
September 4, 2006   03:14 AM PDT
 
hik... xenical bak mai.. :P


anyways gurl... u know ur limit.

MATILA NANTI KENE SOAL SELIDIK!
Nurlea Laurielle
September 4, 2006   03:41 AM PDT
 
fiebs: motif kau cakap mek ado insomnia bila mek started blogging? sebelum nih, mek dok berblogging, ado ke mek dinch tidurans sampai 72 hours straight semata2 berblogging? Mek blogger tak serik2 yes tapi tak der lahhh sampai tak tidur smapi 72 jam! hehehe
Nurlea Laurielle
September 4, 2006   03:43 AM PDT
 
5thE! NANTI SAPA NAK SOAL SELIDIK TU TATAU!? pemberi choker baru kat mek tu ke? OPPS!
kuchai
September 5, 2006   11:29 AM PDT
 
hallo...take it easy larling. take lots of fluids takut badan paneh kots. ooh ya not to forget the fruits & veges. work out also is a must takut the pluh tak kluaq membuak-buak lam badan. haiyooo gunung berapi apoo. take care!
Nurlea Laurielle
September 5, 2006   10:51 PM PDT
 
kuchai: u ols, mek dah tak laratttt bergelen2 ayaq mineral dan juice dok telan tang2 malam taw u ols... apatah lagik fruits. ponat dan kembung perut sundel! kekeke




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