Insomnia

1. What causes Insomnia?
   
   Insomnia refers to difficulty falling or staying asleep, or a perception of unrefreshing sleep.
   
   Common Causes:
   • Depression
   • Excessive caffeine consumption
   • Irregular sleep habits
   Patients with persistent insomnia should be evaluated by a physician to rule out underlying depression, which often presents with early morning waking. Patients who are unable to sleep without sleeping pills may need to be referred to a Sleep Disorders Clinic. Most patients with insomnia can be managed with lifestyle modifications and medication, and do not usually need a sleep study.
2. What causes abnormal behaviour in sleep?
   
   Abnormal behaviour in sleep often does not require specific treatment unless there is risk of injury, or if the abnormal movements disrupt sleep. Examples of abnormal movements disturbing sleep are restless legs syndrome and periodic limb movement disorder, in which excessive leg jerking before or during sleep causes insomnia or excessive daytime sleepiness.
   
   The parasomnias are abnormal behaviours during sleep which can occur in children or adults:
   1. Sleep terrors
   2. Nightmares
   3. Sleep talking
   4. Teeth grinding
   5. Sleep walking
   6. Acting out dreams
   A sleep study is frequently required to evaluate these conditions, which must be distinguished from seizures occurring during sleep, which can appear very similar.