Middle-of-the-night insomnia(MOTN), also calledterminal Insomniais characterized by having difficulty returning to sleep after waking up during the night or very early in the morning. This kind ofinsomnia(sleeplessness) is different from initial or sleep-onset insomnia, which consists of having difficulty falling asleep at the beginning of sleep.
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| Other names | Sleep maintenance insomnia, Nocturnal awakenings, Middle of the night awakenings, and Middle insomnia. |
| Specialty | Sleep medicine |
The disrupted sleep patterns caused by middle-of-the-night insomnia make many sufferers of the condition complain of fatigue the following day.Excessive daytime sleepinessis reported nearly two times higher by individuals with nocturnal awakenings than by people who sleep through the night.[1]
Sleep research conducted in the 1990s showed that such waking up during the night may be a natural sleep pattern, rather than a form of insomnia.[2]If interrupted sleep (called "biphasic sleeping" or "bimodal sleep") is perceived as normal and not referred to as" insomnia ", less distress is caused and a return to sleep usually occurs after about one hour.[3]
Causes
edit- Pain
- Pregnancy
- Anxiety
- Difficulty breathing /sleep apnea
- Urge to urinate or defecate
- Hunger or thirst
- Illness
- Shift work
- Erratic sleep schedule[4]
Nocturnal awakenings are more common in older patients and have been associated withdepressive disorders,chronic pain,obstructive sleep apnea,obesity,alcoholconsumption,hypertension,gastroesophageal reflux disease,heart disease,menopause,prostateproblems, andbipolar disorders.[4] Gastro-intestinal discomfort arising from food that has not been fully cooked, is also a contributor to middle of the night insomnia. Nocturnal awakenings can be mistaken asshift work disorder.
Treatment
editMiddle-of-the-night insomnia is often treated with medication, although currently Intermezzo (zolpidemtartrate sublingual tablets) is the onlyFood and Drug Administration-approved medication specifically for treating MOTN awakening.[5]Some studies have shown thatzaleplon,which has a short eliminationhalf-lifeof about 1 hour, may be suitable for middle-of-the-night administration because it does not impair next-day performance.[6][7][8][9][10][11]Because most medications usually require 6–8 hours of sleep to avoid lingering effects the next day, these are often used every night at bedtime to prevent awakenings.[12]Medication may not be prescribed in some cases, especially if the cause turns out to be the patient ingesting too much fluid during the day or just before they go to sleep.[citation needed]
Sleep restriction therapy and stimulus control therapy as described ininsomniahave shown significance in treating middle of night insomnia.[citation needed]
Prevalence
editWaking up in the middle of the night, or nocturnal awakening, is the most frequently reported insomnia symptom, with approximately 35% of Americans over 18 reporting waking up three or more times per week.[1]Of those who experience nocturnal awakenings, 43% report difficulty in resuming sleep after waking, while over 90% report the condition persisting for more than six months. Greater than 50% contend with MOTN conditions for more than five years.
A 2008 "Sleep in America" poll conducted by theNational Sleep Foundationfound that 42% of respondents awakened during the night at least a few nights a week, and 29% said they woke up too early and couldn't get back to sleep.[13]Other clinical studies have reported between 25% and 35% of people experience nocturnal awakenings at least three nights a week.[14]
See also
editReferences
edit- ^abOhayon MM (2008). "Nocturnal awakenings and comorbid disorders in the American general population".Journal of Psychiatric Research.43(1): 48–54.doi:10.1016/j.jpsychires.2008.02.001.PMID18374943.
- ^Wolchover N (16 February 2011)."Busting the 8-Hour Sleep Myth: Why You Should Wake Up in the Night".Live Science.Retrieved27 May2011.
- ^Hegarty S (2012-02-22)."The myth of the eight-hour sleep".BBC News.
- ^ab""Daytime pharmacodynamic and pharmacokinetic evaluation of low-dose sublingual transmucosal zolpidem hemitartrate" - Human Psychopharmacology: Clinical and Experimental, 2008;23(1):13-20, Thomas Roth, David Mayleben, Bruce C. Corser, Nikhilesh N. Singh ".Retrieved2008-05-27.
- ^"FDA approves first insomnia drug for middle-of-the-night waking followed by difficulty returning to sleep".Food and Drug Administration.2012-11-23.Retrieved2012-11-27.
- ^Abad VC, Guilleminault C (September 2018). "Insomnia in Elderly Patients: Recommendations for Pharmacological Management".Drugs & Aging.35(9): 791–817.doi:10.1007/s40266-018-0569-8.PMID30058034.S2CID51866276.
- ^Super ER, Johnson KP (2012). "Sleep Pharmacotherapeutics for Pediatric Insomnia".Therapy in Sleep Medicine.Elsevier. pp. 457–464.doi:10.1016/b978-1-4377-1703-7.10036-2.ISBN978-1-4377-1703-7.
Zaleplon (Sonata) is FDA approved for the short-term treatment of insomnia in adults. It has a very short half-life of 1 hour, making it particularly effective for initial insomnia. It also has a unique role as an as-needed medicine for middle-of-the-night insomnia.
- ^Bhandari P, Sapra A (2023)."Zaleplon".StatPearls.PMID31855398.Retrieved2023-11-14.
Several other studies have also confirmed that zaleplon has little or no residual effects the following morning, even when taken during the middle of the night for the inability to go back to sleep.
- ^Zammit GK, Corser B, Doghramji K, et al. (October 2006)."Sleep and residual sedation after administration of zaleplon, zolpidem, and placebo during experimental middle-of-the-night awakening".J Clin Sleep Med.2(4): 417–23.doi:10.5664/jcsm.26657.PMID17557470.
- ^Verster JC, Veldhuijzen DS, Patat A, Olivier B, Volkerts ER (January 2006). "Hypnotics and driving safety: meta-analyses of randomized controlled trials applying the on-the-road driving test".Curr Drug Saf.1(1): 63–71.doi:10.2174/157488606775252674.hdl:1874/19756.PMID18690916.S2CID34334648.
- ^Stone BM, Turner C, Mills SL, et al. (February 2002)."Noise-induced sleep maintenance insomnia: hypnotic and residual effects of zaleplon".Br J Clin Pharmacol.53(2): 196–202.doi:10.1046/j.-5251.2001.01520.x.PMC1874295.PMID11851645.
- ^""Nocturnal awakenings: a case study with decision points" - Journal of Family Practice, April 2008 "(PDF).Archived fromthe original(PDF)on 2010-07-14.Retrieved2008-07-11.
- ^"2008" Sleep in America "poll".Archived fromthe originalon 2008-07-03.Retrieved2008-07-10.
- ^Maurice M. Ohayon (2002). "Epidemiology of Insomnia: What We Know and What We Still Need to Learn".Sleep Medicine Reviews.6(2): 97–111.doi:10.1053/smrv.2002.0186.PMID12531146.