Insomnia caused by medical disorders

Abstract

Virtually any medical condition can cause sleep disruption. The incidence of insomnia increases with age as medical problems increasingly occur, and patients with chronic insomnia are more likely to develop adverse health outcomes due to medical disease. There are multiple ways in which insomnia may be caused or aggravated by medical illness or bodily injury. Unpleasant stimuli can directly impede initiation of sleep, or they may cause frequent arousals or awakenings. Changes in basic systemic physiology (such as disorders of ventilation) may produce similar disruption in sleep continuity. There may be humoral changes that have direct neurochemical or neurophysiological effects, augmenting vigilance and lowering the threshold to arousal from sleep. The effects of acute and subacute sleep disruption can lead to chronic psychophysiological insomnia by creating the anticipation of disturbed sleep and by altering circadian entrainment, further accentuating the disruptive effects of the underlying medical condition. Difficulties with insomnia may persist long after the causative medical condition has been effectively managed. © Springer Science+Business Media, LLC 2003, 2010.