CAN'T SLEEP? ISSUES OF BEING AN INSOMNIAC Edited by Saddichha Sahoo Can't Sleep? Issues of Being an Insomniac Edited by Saddichha Sahoo Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Ivona Lovric Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published March, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Can't Sleep? Issues of Being an Insomniac, Edited by Saddichha Sahoo p. cm. ISBN 978-953-51-0261-8 Contents Preface VII Part 1 Epidemiology and Risk Factors 1 Chapter 1 Epidemiology of Insomnia: Prevalence and Risk Factors 3 Claudia de Souza Lopes, Jaqueline Rodrigues Robaina and Lúcia Rotenberg Chapter 2 Drugs Inducing Insomnia as an Adverse Effect 23 Ntambwe Malangu Part 2 Clinical Issues, Diagnosis and Management 37 Chapter 3 Specific Quality of Life Measures for Sleep Disorders 39 Sermin Timur and Nevin Hotun Şahin Chapter 4 Fatigue 49 Per Hartvig Honoré Chapter 5 The Diagnosis and Treatment of Insomnia 65 Michał Skalski Part 3 Psychopharamcology of Insomnia 81 Chapter 6 Treatment of Insomnia with Comorbid Mental Illness 83 Tracy L. Skaer Chapter 7 Structural Relationship Study of Octanol-Water Partitioning Coefficients and Total Biodegradation of Barbiturate Medicines by Randić Descriptor 99 Avat (Arman) Taherpour, Zhiva Taherpour and Omid Taherpour Preface The word "insomnia" originates from the Latin "in" (no) and "somnus" (sleep). It is a disorder characterized by inability to fall asleep or a total lack of sleep. Being the first psychosomatic disorder to be described by Johann Heinroth in 1818, insomnia clinically presents as a subjective perception of dissatisfaction with the amount and/or quality of the sleep. The presenting complaints are often that of difficulties falling asleep in spite of being in bed, waking up several times during the night and having trouble going back to sleep, waking up too early in the morning or having an un- refreshing sleep. Various studies have noted insomnia to be quite a common condition with symptoms present in about 33-50% of the adult population. The prevalence, however, ranges from 10 to 15% among the general population, with higher rates seen among divorced, separated, or widowed people, older ages, female gender, White population, and in the presence of a co-morbid medical or psychiatric illness. About 30% of all adults complain of occasional insomnia and 10% of chronic insomnia, of whom 40% may have an underlying psychiatric illness. Despite these high prevalence rates, evidence suggests that insomnia is mostly under-recognized, under-diagnosed, and under- treated, with the condition continuing to remain persistent in most individuals over follow-up intervals of one to several years. Chronic insomnia represents a more complex condition than acute insomnia, which may be transient. Patients with chronic insomnia usually have accompanying daytime impairment of cognition, mood, or performance that impacts not only the patient and his family, but also affects friends, coworkers, and caretakers. Insomnia patients are more likely to visit hospitals and physicians, have increased absenteeism, make errors or have accidents at work, and have more fatal road accidents. There is also an increased risk for depression, anxiety, substance use, suicide, and possible immune dysfunction. It is imperative that clinicians remain alert to these possible individual and societal risks during the evaluation. This book deals with several issues that are pertinent to the clinician and researcher in insomnia practice. The first chapter deals with the current knowledge of the epidemiology and risk factors for developing insomnia. A review of medications that may also induce insomnia follows which details out the common mistakes that a VIII Preface clinician does while examining a patient with insomnia. Since insomnia is directly linked to issues such as productivity and quality of life, comprehensive reviews cover these subjects. The diagnosis and management of insomnia is detailed out next with a brief and lucid description of barbiturates which are often used in the treatment of insomnia. Dr. Saddichha Sahoo, DPM MD, Clinical Fellow, Dept of Psychiatry, University of British Columbia, Vancouver, BC, Canada . CAN'T SLEEP? ISSUES OF BEING AN INSOMNIAC Edited by Saddichha Sahoo Can't Sleep? Issues of Being an Insomniac Edited by Saddichha. to this period of life or to vasomotor symptoms (hot flashes and/or nocturia), besides chronic pain are some of the probable causes of Can't Sleep? Issues of Being an Insomniac 10 insomnia. entity in 30%–50% of patients (Coleman et al., 1982). Can't Sleep? Issues of Being an Insomniac 8 As with physical morbidity, the relationship between insomnia and mental disorders