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Causes of Insomnia
List of causes of Insomnia
Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Insomnia) that could possibly cause Insomnia includes:
- Common problems with the sleeping environment include:
- Sleeping area distractions
- Noise
- Extreme temperatures
- Poorly ventilated bedroom
- Stuffy bedroom
- Hot bedroom
- Cold bedroom
- Wrong mattress
- Too soft mattress
- Too hard mattress
- Some possible causes of infant or child sleep problems include:
- Hunger
- Colic
- Indigestion
- Dirty diaper
- Too hot
- Too cold
- Teething
- Earache
- Dental problem
- Worms
- Leg cramps
- Common causes of mild insomnia:
- Stress
- Anxiety (type of Neurosis)
- Normal aging
- Caffeine before bedtime
- Sugar snack before bedtime
- Environment change
- Sleep schedule problems
- Jet lag
- Shift work
- Excessive caffeine
- Excessive alcohol
- Excitement
- Anger
- Grief
- Mental stimulation before bedtime
- Daytime napping (see Drowsiness) - can cause or prolong the problem.
- Worrying about insomnia - exacerbates the situation.
- Disrupted sleep schedules
- Smoking - especially at bedtime
- Sex at bedtime - some people become stimulated after sex.
- Substance abuse
- Sleep disorders
- Sleep apnea
- Obstructive sleep apnea
- Narcolepsy
- Restless legs syndrome
- Primary insomnia
- Circadian rhythm sleep disorder
- Parasomnias
- Breathing-related sleep disorder
- Substance-induced sleep disorder
- Emotional or mental disorders possibly causing insomnia:
- Chronic stress
- Depression
- Clinical depression
- Certain psychiatric disorders
- Mania
- Anxiety disorders (type of Neurosis)
- Schizophrenia
- Other possible underlying problems for severe insomnia:
- Physical discomfort - any disease that causes any discomfort may interface with sleep:
- Chronic pain
- Arthritis
- Arthritis pain
- Ulcer pain
- Angina
- Duodenal ulcers
- Shortness of breath - when it occurs at night
- Heart failure
- Lung disorders
- Night urination - may cause insomnia due to the need to urinate:
- Enlarged bladder (see Bladder symptoms)
- Cystitis
- See also causes of night urination
- Certain medications
- Withdrawal of medications
- See also causes of symptom insomnia
- Panic attack
- Sleep Disorders, Extrinsic - insomnia
- Silo unloader syndrome - insomnia
- Rénon-Delille syndrome - insomnia
- Food Allergy - cabbage - disturbed sleep
- Discontinuation syndrome - insomnia
- Depressive disorders - difficulty sleeping
- Cushing's syndrome - sleep disturbances
- Crack withdrawal - sleep disturbance
- Cluster headache - insomnia
- Caffeine addiction - insomnia
- Alcoholism - difficulty sleeping
- Oxazepam
- Pregabalin
- Pickwickian syndrome
- Bupropion
- Withdrawal of sleeping pills
- Disturbing thoughts
- Pierre Robin's sequence - sleep disturbance
- West African Trypanosomiasis - insomnia at night
- Vicodin withdrawal - insomnia
- Sopite syndrome - sleep disturbances
- Pituitary tumors, adult - insomnia
- Opium addiction - insomnia
- Narcotic addiction - insomnia
- Mycosis fungoides - insomnia
- LSD addiction - sleep disturbance
- Inborn amino acid metabolism disorder - sleeping difficulty
- Food allergies - poor sleeping
- East African Trypanosomiasis - insomnia at night
- Congenital hepatic porphyria - sleep disturbance
- Chemical poisoning - Antimony - insomnia
- Anemia, Iron-Deficiency - sleeping difficulty
- Selegiline
- Acute intermittent porphyria - insomnia
- Modafinil
- Menstruation
- Prostatitis
- Substance Withdrawal Syndrome - sleep disturbance
- Sinusitis - disturbed sleep
- Rett's syndrome - sleep disturbances
- Middle ear infection - Sleeping difficulty
- Eczema - difficulty sleeping
- Codeine withdrawal - insomnia
- Buerger's disease - insomnia
- Anemia, Refractory, with Excess of Blasts - sleeping difficulty
- Allergic tension-fatigue syndrome - insomnia
- Alcohol Withdrawal - insomnia
- Fatal familial insomnia - Insomnia
- Lamotrigine
- Pramipexole
- Efavirenz
- Amphetamine intoxication
- Certain illicit drugs (see Drug abuse)
- Not enough exercise
- Postpartum depression (type of Depression)
- Cirrhosis of liver
- Dementia
- Tranquilizer withdrawal - sleep disturbance
- Shift work sleep disorder - insomnia
- Phenol sulfotransferase deficiency - insomnia
- OxyContin withdrawal - insomnia
- Opioid addiction - insomnia
- Olivopontocerebellar Atrophy - trouble sleeping
- Nocturnal asthma - disturbed sleep
- Combat stress reaction - insomnia
- Burnout syndrome - insomnia
- Ascariasis - disturbed sleep
- Clonidine
- Caffeine
- Lorazepam
- Sleep paralysis
- Nocturnal myoclonus
- Alcohol withdrawal syndrome
- Chronic amphetamine use (see Drug abuse)
- Disturbing feelings
- Huntington's disease
- Sleep Apnea Syndromes - insomnia
- Respiratory paralysis - insomnia
- Respiratory muscle paralysis - insomnia
- Prion diseases - insomnia
- Pinealoma - insomnia
- Mountain sickness - sleep disturbances
- Mild Traumatic Brain Injury - insomnia
- Insomnia - frequent night waking
- Glucose transport defect, blood-brain barrier - sleep disturbance
- Folic acid toxicity - insomnia
- Dyssomnia - difficulty staying asleep
- COPD - sleeplessness
- Cocaine addiction - insomnia
- Abuse dwarfism syndrome - insomnia
- Tribavirin
- Dexamfetamine
- Aminophylline
- Lysergic acid diethylamide
- Mood disorder
- Steroid withdrawal syndrome - insomnia
- Sleep Disorders, Intrinsic - insomnia
- Postconcussive syndrome - insomnia
- Opium withdrawal - insomnia
- Night eating syndrome - difficulty sleeping
- Menopause - insomnia
- Guarana overuse - insomnia
- Fibromyalgia - sleep disturbances
- Ecstasy abuse - insomnia
- Aplastic anemia - sleeping difficulty
- Ambien withdrawal - insomnia
- Bipolar affective disorder
- Alzheimer's Disease - sleeplessness
- Xanax withdrawal - sleep disturbance
- Whiplash - sleep disturbances
- Variegate porphyria - insomnia
- Resistance to thyroid stimulating hormone - insomnia
- Premenstrual syndrome - insomnia
- Periodic limb movements in sleep - trouble staying asleep
- Marie-Seé Syndrome - insomnia
- Insomnia with sleep apnea - insomnia
- Hydrocodone withdrawal - insomnia
- Herbal Agent overdose - Sabah vegetable - insomnia
- Glénard syndrome - insomnia
- Ginseng overuse - insomnia
- Ecstasy withdrawal - sleeplessness
- Chronic vitamin A toxicity - insomnia
- Autoimmune thyroid diseases - insomnia
- Ativan withdrawal - insomnia
- Anemia, Refractory, with Excess of Blasts, type 1 - sleeping difficulty
- Amphetamine abuse - chronic insomnia
- Methylenedioxymethamphetamine
- Amphetamine
- Heart disorder
- Pick's disease
- Vitamin B1 toxicity - insomnia
- Trigeminal neuralgia - difficulty sleeping
- Sedative dependence - Insomnia
- Percocet withdrawal - insomnia
- Opioid withdrawal - insomnia
- Mycosis fungoides, familial - insomnia
- Graves Disease - insomnia
- Dexedrine withdrawal - disturbed sleep
- Crack addiction - insomnia
- Cocaine abuse - insomnia
- Barbiturate abuse - insomnia
- Anemia, Refractory, with Excess of Blasts, type 2 - sleeping difficulty
- Andropause - sleep disturbance
- Pyrimethamine
- Diazepam
- Temazepam
- Creutzfeldt-Jakob disease - insomnia
- Heart congestion
- Wernicke-Korsakoff syndrome - insomnia
- Thyroid disorders - insomnia
- Ritalin withdrawal - insomnia
- Rape trauma syndrome - sleep disturbances
- Pyridoxine deficiency - insomnia
- Prescribed medication addiction - insomnia
- Pain killer addiction - insomnia
- Methamphetamine withdrawal - disturbed sleep
- Heroin dependence - insomnia
- Dilaudid withdrawal - insomnia
- Demerol withdrawal - insomnia
- Cocaine withdrawal - sleep disturbance
- Aldehyde syndrome - sleeplessness
- Acrodynia - insomnia
- Tolcapone
- Escitalopram
- Amantadine
- Kleine-Levin-Critchley syndrome
- Methcathinone
- Brain injury
- Renal failure
- Vitamin B12 Deficiency - disturbed sleep
- Thiamine deficiency - sleep disturbance
- Sleeping pill addiction - insomnia
- Premenstrual dysphoric disorder - insomnia
- Pineal Teratoma - insomnia
- Morphine withdrawal - insomnia
- Dysthymia - difficulty sleeping
- D'Acosta - insomnia
- Crystal meth addiction - insomnia
- Alcohol-induced pseudo-Cushing syndrome - insomnia
- Propranolol
- Pergolide
- Generalized anxiety disorder - trouble staying asleep
- Prostate disorders
- Overeating - eating too much before bedtime can cause insomnia.
- Chronic fatigue syndrome
- Wiskott-Aldrich Syndrome - Sleeping difficulties
- Whiplash Injuries - sleeplessness
- Tranquilizer addiction - insomnia
- Sleep deprivation - poor sleep
- Problem Sleepiness - poor sleep
- Oxycontin addiction - sleep disturbance
- Diaphragmatic paralysis - insomnia
- Cathinone poisoning - insomnia
- Brain Concussion - insomnia
- Bipolar disorder - insomnia
- Benzodiazepine abuse - insomnia
- Asbestosis - sleep disturbances
- Obstructive sleep apnoea
- Melatonin
- Primary affective disorder
- Sibutramine
- Aspirin
- Ramelteon
- Amiodarone
- Lead
- Methylphenidate
- Clonazepam
- Sleep apnea syndrome
- Pregnancy - mild insomnia can occur during pregnancy (common in early pregnancy presumably related to hormonal changes).
- Medications
- Psychiatric illness
- Chronic diseases
- Extreme stress
- Restless leg syndrome
- It usually occur in people who are temporarily experiencing: stress, environmental noise, extreme temperatures, change in the surrounding environment, sleep/wake schedule problems such as those due to jet lag, or medication side effects
- It often results from a combination of factors, including underlying physical or mental disorders. One of the most common causes of chronic insomnia is depression
- Stressful event
- Environmental disturbances such as noise or extreme temperatures
- Disruption of normal sleep/wake cycle, from jet lag or caring for a newborn
- Side effects of certain medications like cough and cold medications
More causes: see full list of causes for Insomnia
Causes of Insomnia (Diseases Database):
The follow list shows some of the possible medical causes of Insomnia that are listed by the Diseases Database:
- Clonazepam
- Bipolar affective disorder
- Methcathinone
- Methylphenidate
- Efavirenz
- Lead
- Temazepam
- Amiodarone
- Bupropion
- Modafinil
- Sleep paralysis
- Lysergic acid diethylamide
- Acute intermittent porphyria
- Restless legs syndrome
- Aminophylline
- Narcolepsy
- Ramelteon
- Diazepam
- Aspirin
- Pickwickian syndrome
- Jet lag
- Lorazepam
- Pergolide
- Sibutramine
- Pramipexole
- Kleine-Levin-Critchley syndrome
- Dexamfetamine
- Propranolol
- Caffeine
- Primary affective disorder
- Primary insomnia
- Amphetamine
- Amantadine
- Tribavirin
- Escitalopram
- Pyrimethamine
- Pregabalin
- Melatonin
- Oxazepam
- Obstructive sleep apnoea
- Clonidine
- Lamotrigine
- Selegiline
- Tolcapone
- Methylenedioxymethamphetamine
- Fatal familial insomnia
Insomnia as a complication of other conditions:
Other conditions that might have Insomnia as a complication may, potentially, be an underlying cause of Insomnia. Our database lists the following as having Insomnia as a complication of that condition:
Insomnia as a symptom:
Conditions listing Insomnia as a symptom may also be potential underlying causes of Insomnia. Our database lists the following as having Insomnia as a symptom of that condition:
- Abuse dwarfism syndrome
- Acrodynia
- Acute intermittent porphyria
- Alcohol Withdrawal
- Alcohol-induced pseudo-Cushing syndrome
- Alcoholism
- Allergic tension-fatigue syndrome
- Ambien withdrawal
- Ativan withdrawal
- Autoimmune thyroid diseases
- Barbiturate abuse
- Benzodiazepine abuse
- Bipolar disorder
- Brain Concussion
- Buerger's disease
- Burnout syndrome
- Caffeine addiction
- Cathinone poisoning
- Chemical poisoning - Antimony
- Chemical poisoning - Ethylbenzene
- Chemical poisoning - Gasoline
- Chemical poisoning - Jet Fuel-5
- Chemical poisoning - Manganese
- Chemical poisoning - Monocrotophos
- Chemical poisoning - RDX
- Chemical poisoning - Tetryl
- Chemical poisoning - Toluene
- Chronic depression
- Chronic vitamin A toxicity
- Circadian rhythm sleep disorder
- Cluster headache
- Cocaine abuse
- Cocaine addiction
- Codeine withdrawal
- Combat stress reaction
- Crack addiction
- Creutzfeldt-Jakob Disease
- Crystal meth addiction
- D'Acosta
- Demerol withdrawal
- Depression
- Diaphragmatic paralysis
- Dilaudid withdrawal
- Discontinuation syndrome
- Double Depression
- Dysomnia
- Ecstasy abuse
- Endogenous depression
- Fatal familial insomnia
- Folic acid toxicity
- Food Allergy - beef
- Food Allergy - buckwheat
- Food Allergy - chicken meat
- Food Allergy - duck meat
- Food Allergy - goose meat
- Food Allergy - lamb
- Food Allergy - meat
- Food Allergy - pork
- Food Allergy - red meat
- Ginseng overuse
- Glénard syndrome
- Graves Disease
- Guarana overuse
- Herbal Agent overdose - Sabah vegetable
- Heroin dependence
- Hydrocodone withdrawal
- Hyperthyroidism
- Insomnia with sleep apnea
- Jet lag
- Marie-Seé Syndrome
- Menopause
- Mild Traumatic Brain Injury
- Morphine withdrawal
- Mycosis fungoides
- Mycosis fungoides, familial
- Narcotic addiction
- Opioid addiction
- Opioid withdrawal
- Opium addiction
- Opium withdrawal
- Oxycontin addiction
- OxyContin withdrawal
- Pain killer addiction
- Percocet withdrawal
- Phenol sulfotransferase deficiency
- Pineal Teratoma
- Pinealoma
- Pituitary tumors, adult
- Postconcussive syndrome
- Premenstrual dysphoric disorder
- Premenstrual syndrome
- Prescribed medication addiction
- Primary insomnia
- Prion diseases
- Pyridoxine deficiency
- Resistance to thyroid stimulating hormone
- Respiratory muscle paralysis
- Respiratory paralysis
- Ritalin withdrawal
- Rénon-Delille syndrome
- Sedative dependence
- Shift work sleep disorder
- Silo unloader syndrome
- Sleep Apnea Syndromes
- Sleep disorders
- Sleep Disorders, Extrinsic
- Sleep Disorders, Intrinsic
- Sleeping pill addiction
- Steroid withdrawal syndrome
- Teeth grinding
- Thyroid disorders
- Tranquilizer addiction
- Variegate porphyria
- Vicodin withdrawal
- Vitamin B1 toxicity
- Wernicke-Korsakoff syndrome
Medications or substances causing Insomnia:
The following drugs, medications, substances or toxins are some of the possible
causes of Insomnia as a symptom.
This list is incomplete and various other drugs or substances
may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
- Various common substances can cause insomnia:
- Caffeine - especially before bedtime, but even in the afternoon for some people.
- Smoking - especially at bedtime
- Excessive alcohol
- Certain illicit drugs
- more drugs...»
See full list of 281 medications causing Insomnia
Drug interactions causing Insomnia:
When combined, certain drugs, medications, substances or toxins may react causing Insomnia as a symptom.
The list below is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.
- Cipro (Ciprofloxacin) and Aerolate interaction
- Cipro (Ciprofloxacin) and Bronkodyl interaction
- Cipro (Ciprofloxacin) and Elixophyllin interaction
- Cipro (Ciprofloxacin) and Slo-bid interaction
- Cipro (Ciprofloxacin) and Theobid interaction
- more interactions...»
See full list of 1667 drug interactions causing Insomnia
What triggers Insomnia?
The following conditions are listed as possible triggers for Insomnia:
- Common triggers for short-term or intermittent insomnia include:
- Stress
- Noise
- Extreme temperatures
- Environment change
- Sleep schedule problems
- Jet lag
- Certain medications
- Caffeine
- Anxiety (type of Neurosis)
- Excitement
- Common triggers for chronic insomnia
- Caffeine
- Alcohol
- Substance abuse
- Shift work
- Nighttime activity schedules
- Chronic stress
Medical news summaries relating to Insomnia:
The following medical news items are relevant to causes of Insomnia:
- 40 health professionals fail to diagnose brain tumor
- Children being prescribed sleeping pills
- Cough medicine to treat fibromyalgia
- Excess weight is linked to a myriad of diseases
- HRT not for prevention of menopause
- Less sleep with age not normal
- Medication error involving malaria medication results in over $202,000 being awarded
- Melatonin not helpful in most sleep disorders
- More women using natural hormones for menopause therapy
- New gain in Chronic Fatigue awareness
- Self diagnose depression
- More news »
Related information on causes of Insomnia:
As with all medical conditions, there may be many causal factors. Further relevant information on causes of Insomnia may be found in:
Causes of Insomnia: Online Medical Books
16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Insomnia.
Insomnia:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Unnecessary concern about deviation from “normal” sleeping patterns
-
Acute, transient insomnia (<4 weeks)
–Situational stress (most common)
–Acute illness or injury
–Medications or drugs (e.g., cocaine)
–Change in sleep environment or hours - Chronic insomnia (>4 weeks)
–Difficulty falling asleep: May be due to poor sleep hygiene, conditioned insomnia (initial acute insomnia progresses to chronic due to maladaptive distorted sleep cognitions), medications (e.g., sedatives, decongestants, oral contraceptive use, antidepressants, bronchodilators), drugs (including over-the-counter and herbal preparations, alcohol, nicotine, illicit drugs), and caffeine (e.g., coffee, soda, medications)
–Difficulty staying asleep: May be due to sleep apnea, medications and drugs (e.g., alcohol), depression, anxiety, dementia, psychosis, mania, post-traumatic stress disorder, and various medical conditions (e.g., COPD, asthma, CHF, angina, GERD, peptic ulcer disease, IBD, BPH, UTI, pregnancy, uremia, diabetes mellitus, hyperthyroidism, menopause, pain, pruritus, seizures)
-
RLS
–“Creepy-crawly” unpleasant sensations in the legs and/or feet
–Temporarily relieved by moving limbs
-
Periodic limb movement disorder
–Arms and/or legs jerk during sleep
–May be a primary disorder or secondary to uremia, neuropathy, or iron deficiency
–Often in the elderly
–Often occurs with restless legs syndrome
–Rare, mostly in elderly
–Thrashing or seemingly purposeful behaviors during sleep
Source: In a Page: Signs and Symptoms, 2004
Insomnia:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Alcohol withdrawal syndrome
Abrupt cessation of alcohol intake after long-term use causes insomnia that may persist for up to 2 years
Other early effects of this acute syndrome include excessive diaphoresis, tachycardia, hypertension, tremors, restlessness, irritability, a headache, nausea, flushing, and nightmares. Progression to delirium tremens produces confusion, disorientation, paranoia, delusions, hallucinations, and seizures.
Generalized anxiety disorder
Anxiety can cause chronic insomnia as well as symptoms of tension, such as fatigue and restlessness; signs of autonomic hyperactivity, such as diaphoresis, dyspepsia, and high resting pulse and respiratory rates; and signs of apprehension.
Mood (affective) disorders
Depression commonly causes chronic insomnia with difficulty falling asleep, waking and being unable to fall back to sleep, or waking early in the morning
Related findings include dysphoria (a primary symptom), decreased appetite with weight loss or increased appetite with weight gain, and psychomotor agitation or retardation. The patient experiences loss of interest in his usual activities, feelings of worthlessness and guilt, fatigue, difficulty concentrating, indecisiveness, and recurrent thoughts of death.
Manic episodes produce a decreased need for sleep with an elevated mood and irritability. Related findings include increased energy and activity, fast speech, speeding thoughts, inflated self-esteem, easy distractibility, and involvement in high-risk activities such as reckless driving.
Nocturnal myoclonus
With nocturnal myoclonus, a seizure disorder, involuntary and fleeting muscle jerks of the legs occur every 20 to 40 seconds, disturbing sleep.
Sleep apnea syndrome
Apneic periods begin with the onset of sleep, continue for 10 to 90 seconds, and end with a series of gasps and arousal
With central sleep apnea, respiratory movement ceases for the apneic period; with obstructive sleep apnea, upper airway obstruction blocks incoming air, although breathing movements continue. Some patients display both types of apnea. Repeated possibly hundreds of times during the night, this cycle alternates with bradycardia and tachycardia. Associated findings include a morning headache, daytime fatigue, hypertension, ankle edema, and personality changes, such as hostility, paranoia, and agitated depression.
Thyrotoxicosis
Difficulty falling asleep and then sleeping for only a brief period is one of the characteristic symptoms of thyrotoxicosis
Cardiopulmonary features include dyspnea, tachycardia, palpitations, and an atrial or a ventricular gallop. Other findings include weight loss despite increased appetite, diarrhea, tremors, nervousness, diaphoresis, hypersensitivity to heat, an enlarged thyroid, and exophthalmos.
Other causes
Drugs
Use of, abuse of, or withdrawal from sedatives or hypnotics may produce insomnia
CNS stimulants — including amphetamines, theophylline derivatives, pseudoephedrine, phenylpropanolamine, cocaine, and caffeinated beverages — may also produce insomnia.
Herb alert
Herbal remedies, such as ginseng and green tea, can also cause insomnia.
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Insomnia:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Alcohol withdrawal syndrome
Abrupt cessation of alcohol intake after long-term use causes insomnia that may persist for up to 2 years. Other early effects of this acute syndrome include excessive diaphoresis, tachycardia, hypertension, tremors, restlessness, irritability, headache, nausea, flushing, and nightmares. Progression to delirium tremens produces confusion, disorientation, paranoia, delusions, hallucinations, and seizures.
Generalized anxiety disorder
Anxiety can cause chronic insomnia as well as symptoms of tension, such as fatigue and restlessness; signs of autonomic hyperactivity, such as diaphoresis, dyspepsia, and high resting pulse and respiratory rates; and signs of apprehension.
Mood (affective) disorders
Depression commonly causes chronic insomnia with difficulty falling asleep, waking and being unable to fall back to sleep, or waking early in the morning. Related findings include dysphoria (a primary symptom), decreased appetite with weight loss or increased appetite with weight gain, and psychomotor agitation or retardation. The patient experiences loss of interest in his usual activities, feelings of worthlessness and guilt, fatigue, difficulty concentrating, indecisiveness, and recurrent thoughts of death.
Manic episodes produce a decreased need for sleep with an elevated mood and irritability. Related findings include increased energy and activity, fast speech, speeding thoughts, inflated self-esteem, easy distractibility, and involvement in high-risk activities such as reckless driving.
Nocturnal myoclonus
With this seizure disorder, involuntary and fleeting muscle jerks of the legs occur every 20 to 40 seconds, disturbing sleep.
Pain
Almost any condition that causes pain can cause insomnia. Related findings reflect the specific cause.
Pheochromocytoma
This rare disorder causes paroxysms of acute hypermetabolic activity, which can prevent or interrupt sleep. Its cardinal sign is severe hypertension, which may be sustained between attacks. Other effects include headache, palpitations, and anxiety.
Pruritus
Localized skin infections and systemic disorders, such as liver failure, can cause pruritus, resulting in insomnia.
Sleep apnea syndrome
Apneic periods begin with the onset of sleep, continue for 10 to 90 seconds, and end with a series of gasps and arousal. With central sleep apnea, respiratory movement ceases for the apneic period; with obstructive sleep apnea, upper airway obstruction blocks incoming air, although breathing movements continue. Some patients display both types of apnea. Repeated possibly hundreds of times during the night, this cycle alternates with bradycardia and tachycardia. Associated findings include morning headache, daytime fatigue, hypertension, ankle edema, and personality changes, such as hostility, paranoia, and agitated depression.
Thyrotoxicosis
Difficulty falling asleep and then sleeping for only a brief period is one of the characteristic symptoms of this disorder. Cardiopulmonary features include dyspnea, tachycardia, palpitations, and atrial or ventricular gallop. Other findings include weight loss despite increased appetite, diarrhea, tremors, nervousness, diaphoresis, hypersensitivity to heat, an enlarged thyroid, and exophthalmos.
Other causes
Drugs
Use of, abuse of, or withdrawal from sedatives or hypnotics may produce insomnia. CNS stimulants—including amphetamines, theophylline derivatives, pseudoephedrine, cocaine, and caffeinated beverages—may also produce insomnia.
Herb Alert
Herbal remedies, such as ginseng and green tea, can also cause insomnia.Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Visual Disturbance:
Differential Overview
(Field Guide to Bedside Diagnosis)
Acute Loss/Scotoma
❑ Ophthalmic migraine
❑ Amaurosis fugax
❑ Retinal detachment
❑ Acute angle closure glaucoma
❑ Optic neuritis
❑ Papilledema
❑ Retinal artery occlusion
❑ Giant cell arteritis
❑ Trauma
❑ Toxic
❑ Occipital stroke
❑ Ischemic optic neuropathy
❑ Retinal hemorrhage
❑ Vitreous hemorrhage
❑ Central retinal vein occlusion
Gradual Loss
❑ Refractive error
❑ Intraocular hypertension
❑ Cataract
❑ Diabetic retinopathy
❑ Macular degeneration
❑ Cytomegalovirus retinitis
❑ Drugs
❑ Keratoconjunctivitis sicca
❑ Optic nerve compression
❑ Pituitary adenoma
❑ Choroidal melanoma
❑ Retinitis pigmentosa
Source: Field Guide to Bedside Diagnosis, 2007
Sleep Disorders:
Differential Overview
(Field Guide to Bedside Diagnosis)
Insomnia
❑ Stress
❑ Drugs
❑ Medical disorders
❑ Phase shift
❑ Sleep apnea
❑ Conditioned insomnia
❑ Depression
❑ Restless leg syndrome
❑ Nocturnal myoclonus
❑ Nightmares
Hypersomnia
❑ Drugs
❑ Medical disorders
❑ Adolescence
❑ Narcolepsy
Source: Field Guide to Bedside Diagnosis, 2007
Insomnia:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Alcohol withdrawal syndrome
Abrupt cessation of alcohol intake after long-term use causes insomnia that may persist for up to 2 years. Other early effects of this acute syndrome include excessive diaphoresis, tachycardia, hypertension, tremors, restlessness, irritability, headache, nausea, flushing, and nightmares. Progression to delirium tremens produces confusion, disorientation, paranoia, delusions, hallucinations, and seizures.
Depression
Depression commonly causes chronic insomnia with difficulty falling asleep, waking and being unable to fall back to sleep, or waking early in the morning. Related findings include dysphoria (a primary symptom), decreased appetite with weight loss or increased appetite with weight gain, and psychomotor agitation or retardation. The patient experiences loss of interest in his usual activities, feelings of worthlessness and guilt, fatigue, difficulty concentrating, indecisiveness, and recurrent thoughts of death.
Generalized anxiety disorder
Anxiety can cause chronic insomnia as well as symptoms of tension, such as fatigue and restlessness; signs of autonomic hyperactivity, such as diaphoresis, dyspepsia, and high resting pulse and respiratory rates; and signs of apprehension.
Nocturnal myoclonus
With nocturnal myoclonus, a seizure disorder, involuntary and fleeting muscle jerks of the legs occur every 20 to 40 seconds, disturbing sleep. The patient typically reports poor sleep and daytime somnolescence.
Pain
Almost any condition that causes pain can also cause insomnia. Related findings reflect the specific cause. Behavioral responses that may accompany pain include altered body position, moaning, grimacing, withdrawal, crying, restlessness, muscle twitching, and immobility. With mild or moderate pain the patient may have pallor, elevated blood pressure, dilated pupils, skeletal muscle tension, dyspnea, tachycardia, and diaphoresis. Severe, deep pain may produce pallor, decreased blood pressure, bradycardia, nausea and vomiting, weakness, dizziness, and loss of consciousness.
Pruritus
Localized skin infections and systemic disorders, such as liver failure, can cause pruritus, resulting in insomnia. The patient may report scratching as a way to relieve the itching.
Sleep apnea syndrome
Apneic periods begin with the onset of sleep, continue for 10 to 90 seconds, and end with a series of gasps and arousal. With central sleep apnea, respiratory movement ceases for the apneic period; with obstructive sleep apnea, upper airway obstruction blocks incoming air, although breathing movements continue. Repeated possibly hundreds of times during the night, this cycle alternates with bradycardia and tachycardia. Associated findings include morning headache, daytime fatigue, hypertension, ankle edema, and personality changes, such as hostility, paranoia, and agitated depression.
Thyrotoxicosis
Difficulty falling asleep and then sleeping for only a brief period is one of the characteristic symptoms of thyrotoxicosis. Cardiopulmonary features include dyspnea, tachycardia, palpitations, and atrial or ventricular gallop. Other findings include weight loss despite increased appetite, diarrhea, tremors, nervousness, diaphoresis, hypersensitivity to heat, an enlarged thyroid, and exophthalmos.
Other causes
Drugs
Use of, abuse of, or withdrawal from sedatives or hypnotics may produce insomnia. CNS stimulants—including amphetamines, theophylline derivatives, pseudoephedrine, phenylpropanolamine, cocaine, and caffeinated beverages—may also produce insomnia.
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Vision Disturbances:
Principal Causes of Vision Disturbances
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Oculardisorders
- Congenitalanomalies
- Globe
- Lens
- Cornea
- Iris
- Vitreous
- Refractive errors
- Myopia
- Hyperopia
- Astigmatism
- Anisometropia
- Strabismus
- Amblyopia
- Trauma
- Infection
- Cataracts
- Glaucoma
- Uveitis
- Anterior uveitis
- Posterior uveitis
- Retinal disorders
- Retinopathyof prematurity
- Retinitis pigmentosa and other retinaldystrophies
- Retinal detachment
- Albinism
- Neoplasm
- Metabolic disorders
- Congenitalanomalies
- Neurologic disorders
- Lesionsof optic nerve or chiasm
- Optic nerve aplasia
- Optic nerve hypoplasia
- Optic atrophy
- Optic neuritis
- Lesions of optic pathways
- Lesions of visual cortex
- Lesionsof optic nerve or chiasm
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Insomnia:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Alcohol withdrawal syndrome.Abrupt cessation of alcohol intake after long-term use causes insomnia that may persist for up to 2 years. Other early effects of this acute syndrome include excessive diaphoresis, tachycardia, hypertension, tremors, restlessness, irritability, a headache, nausea, flushing, and nightmares. Progression to delirium tremens produces confusion, disorientation, paranoia, delusions, hallucinations, and seizures.
Generalized anxiety disorder.Anxiety can cause chronic insomnia as well as symptoms of tension, such as fatigue and restlessness; signs of autonomic hyperactivity, such as diaphoresis, dyspepsia, and high resting pulse and respiratory rates; and signs of apprehension.
Mood (affective) disorders.Depression commonly causes chronic insomnia with difficulty falling asleep, waking and being unable to fall back to sleep, or waking early in the morning. Related findings include dysphoria (a primary symptom), decreased appetite with weight loss or increased appetite with weight gain, and psychomotor agitation or retardation. The patient experiences loss of interest in his usual activities, feelings of worthlessness and guilt, fatigue, difficulty concentrating, indecisiveness, and recurrent thoughts of death.
Manic episodes produce a decreased need for sleep with an elevated mood and irritability. Related findings include increased energy and activity, fast speech, speeding thoughts, inflated self-esteem, easy distractibility, and involvement in high-risk activities such as reckless driving.
Nocturnal myoclonus (also known asperiodic limb movement disorder). With nocturnal myoclonus, a seizure disorder, involuntary and fleeting muscle jerks of the legs occur every 20 to 40 seconds, disturbing sleep.
Restless leg syndrome.With restless leg syndrome, uncomfortable sensations in the legs cause uncontrollable urges to move the limbs. Although movement brings relief, sleep is usually disrupted, causing insomnia, which may be severe.
Sleep apnea syndrome.With sleep apnea syndrome, apneic periods begin with the onset of sleep, continue for 10 to 90 seconds, and end with a series of gasps and arousal. With central sleep apnea, respiratory movement ceases for the apneic period; with obstructive sleep apnea, upper airway obstruction blocks incoming air, although breathing movements continue. Some patients display both types of apnea. Repeated possibly hundreds of times during the night, this cycle alternates with bradycardia and tachycardia. Associated findings include a morning headache, daytime fatigue, hypertension, ankle edema, and personality changes, such as hostility, paranoia, and agitated depression.
Other causes
Drugs.Use of, abuse of, or withdrawal from sedatives or hypnotics may produce insomnia. CNS stimulants—including amphetamines, theophylline derivatives, pseudoephedrine, cocaine, and caffeinated beverages—may also produce insomnia.
Source: Nursing: Interpreting Signs and Symptoms, 2007
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