The insomnia

By Dr. Stefano Casali

The term insomnia derives from the Latin insomnia and literally means lack of dreams. In common language it indicates an insufficient continuity of Sleep. In the definition of insomnia, therefore, the aspect of insufficient duration and continuity of Sleep, objectively controllable in the laboratory, must be associated with that of unsatisfactory quality of Sleep, linked to the subjective evaluation of each on the restful properties of one's Sleep.

Insomnia is not a disease, but is a symptom of various psychological or physical pathological conditions, or of altered situational or environmental equilibria (Sudhansu Chokroverty., 2000). It is frequently perceived by the patient as a primary disorder, due to its considerable existential impact and due to the difficulty in recognizing the true primary pathology that it underlies. The polysomnographic parameters show that in sleeplessness the time for falling asleep is generally increased regardless of age, while the number of awakenings does not seem to be particularly influenced by insomnia. This observation leads us to interpret the difficulty in starting Sleep as the primary disorder of insomnia since it is in the foreground both at the beginning of Sleep and during awakenings during the night (Bergonzi P. et Al., 1992; Ferri R., 1996). The total waking time of the insomniacs seems to be influenced by age, similar to that of the normals.

Insomnia finds its highest expression during the first hours of the night, regardless of age. In the insomniacs a general representation of the stages of the Sleep similar to that of the normal dormitories was observed, but a greater variability of the percentage of REM sleep from one night to another. The percentage of sleep spent in stage 4, ie the deepest and most restful stage of sleep, is reduced, which together with the decrease in REM sleep, determine an increase in the less deep stages of sleep, ie stage 1 and, even more so the stadium 2. It can therefore be concluded that in general chronic insomniacs have greater difficulty falling asleep, have more intra-sleep vigil and total vigil during the night, have a remarkable variability in the quality and efficiency of Sleep from one night to the other, they can have more awakenings and a less deep sleep (Ferri R, Alicata F., 1995; G. Coccagna., 2000). From the point of view of the objective measurement of the polygraphic parameters of Sleep it can therefore be concluded that in the general population there are those who sleep well and do not have problems with Sleep, the so-called "good dormitories", and those who sleep less well or frankly badly, the so-called "bad dorms", which have a Sleep with the characteristics referred to above, which are generally attributed to chronic insomniacs. The latter are mostly bad dorms. Chronic insomniacs are therefore not a homogeneous population as far as the objective parameters of Sleep are concerned and, if some of them actually sleep badly, others do not find objective explanations for their disturbance in the Sleep laboratory (G. Coccagna., 2000; Sudhansu Chokroverty., 2000). Alongside the heterogeneity of the conditions responsible for insomnia, there is a considerable polymorphism in the clinical expression of this disorder. Under certain conditions, insomnia in fact presents peculiar characteristics that differentiate it from insomnia that occurs in different conditions, even though there is often a brief overlap of its clinical aspects (Mancia M., 1996; C. Barbui., 1998) . We can divide insomnia into:

1. psychophysiological insomnia;
2. insomnia associated with psychiatric disorders;
3. insomnia associated with the use of drugs, drugs and alcohol;
4. insomnia associated with sleep-induced respiratory disorders;
5. insomnia associated with nocturnal myoclonus and restless leg syndrome;
6. insomnia associated with diseases, intoxications and unfavorable environmental conditions;
7. onset insomnia in childhood;
8. insomnia associated with unusual polysomnographic pictures;
9. pseudoinsomnia: short dormitories;
10. subjective insomnia without corresponding polysomnographic findings.

In many cases insomnia evolves in parallel with the condition that triggered it and can be transient, recurrent or long lasting (G. Coccagna., 2000). In many cases it appears as a chronic disorder without apparent connections with the conditions that led to its onset or even without it being possible to identify obvious causal elements. Once established, insomnia changes the patients' way of life and determines, both in them and in others, reactions that can contribute to the maintenance of the disorder. As with any chronic condition, even for insomnia it is therefore incorrect to take into consideration only the disease and attribute all the symptoms to the factors that triggered the year. When an insomnia becomes chronic, a complex interaction of factors that go beyond those originally responsible for the disorder is at stake (Lungaresi E., 2005; G. Coccagna., 2000; Sudhansu Chokroverty., 2000).

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