Insomnia. The causes of insomnia . Drowsiness. The causes of drowsiness

The nature of insomnia is also very complex and it is not easy to understand it differential-diagnostic. Three forms of insomnia can be distinguished : the patient is hard to fall asleep, wakes up in the middle of the night, wakes up early in the morning. 

a) In most cases, insomnia is psychogenic , but the causes are extremely diverse. There is a whole range of reasons for the varying severity of insomnia, starting from the inability to forget from the questions that patients are intensively occupied with (mental workers, difficult experiences, etc.), to the pavor nocturnus of old doctors, which is characterized by an indefinite sense of pressure, a terrible feeling of suffocation, but without pain, associated in adults, if there are no organic causes, almost always with sexual dissatisfaction. 

b) The second place as a cause of insomnia is taken by the ingestion of food or copper kament. Caffeine (in coffee or tea), thyroid medications, and recently phenamine in some individuals have caused insomnia. With the widespread desire to take sleeping pills , insomnia is often observed also when trying to wean them.  

c) Of organic diseases, heart diseases should be mentioned first. With heart failure, dyspnea interferes with the normal onset of sleep; in some patients with heart disease, a hidden chain-Stokes type of breathing as an expression of the prevalence of the vagus during falling asleep can be very painful: patients stay awake all night. Nocturia also interferes with night sleep.
Patients with angina pectoris in advanced stages are awakened from pain attacks that are caused by various mechanisms (prevalence of the vagus, position on the back, creating a large load on the left ventricle). 

d) In chronic respiratory diseases, insomnia often causes nocturnal cough. e) Insomnia due to diseases of the gastrointestinal tract is caused by a hernia of the esophageal opening of the diaphragm, in which pain usually appears soon after going to bed; duodenal ulcer – here the pain appears after many hours of sleep or in the morning; with an expanded stomach – after a plentiful meal.  

f) Of the diseases of the genitourinary tract, insomnia is mainly caused by hypertrophy of the prostate, which causes frequent urination. g) In endocrine diseases, insomnia is the most important symptom of thyrotoxicosis. Insomnia is a common occurrence in the menopause. h) Sometimes it is necessary to differentiate the so-called troubled legs – a state of anxiety at night, which appears for no apparent reason – from pain conditions in cases of arterial blood supply in advanced stages and from the pain and neuritic pains.  

Drowsiness . Compared to insomnia, patients complain of drowsiness much less frequently. The mental causes here far outweigh the rest. An increased need for sleep is also observed when recovering from serious illnesses, myxedema and encephalitis. However, drowsiness of patients is always suspicious of drug abuse.

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