GABA released from the presynaptic neuron activates the ligand-gated ion channel to increase chloride ion permeability, leading to hyperpolarization of the membrane and a decrease in the excitability of the neuron. The GABAA receptors contain alpha, beta, and gamma receptors in the vast majority in the 2:2:1 stoichiometry. Most sedative-hypnotics used in the treatment of insomnia target the GABAA receptors. In the central nervous system, GABA exerts its influence via ionotropic GABAA and GABAC receptors and metabotropic GABAB receptors. In the central nervous system (CNS), there is a balance between the excitatory effects of the Glutamate receptors and the inhibitory effects of the GABA receptors. Hence, it is imperative to understand the changes occurring at the neurotransmitter level for planning the optimum pharmacology. There has been a proposal that insomnia is a hyperarousal disorder that could reflect a deficit in sleep homeostasis. Regardless of the chosen modality, therapy aims to improve the quality and quantity of sleep while minimizing daytime impairments as well as improving the overall quality of life. Various pharmacologic and non-pharmacologic modalities have been tried to help patients with this condition. This result of insomnia has far-reaching adverse consequences on the physical, social, mental, and emotional health and wellbeing of the patient, including increased risk of accidents, decreased work productivity, increased risk of comorbid psychiatric disorder, decreased quality of life, and increased usage of healthcare resources. Insomnia symptoms are seen in approximately 33% to 50% of the adult population, insomnia symptoms with distress or impairment in 10% to 15%, and specific insomnia disorders in 5% to 10%. The actual prevalence of insomnia varies according to the stringency of the definition used. The criterion used to distinguish individuals with insomniacs from good sleepers are self-reported sleep symptoms, such as sleep latency (time to fall asleep) or wakefulness after sleep onset (WASO) greater than 30 minutes. These criteria differ from the previous classification by considering the frequency criterion and the increase in the duration of symptoms from one to three months. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association 2013) and the third edition of the International Classification of Sleep Disorders (ICSD-3) (American Academy of Sleep Medicine 2014), dissatisfaction with sleep quantity or quality has to occur at least three nights per week over at least three months to merit a diagnosis of chronic insomnia. The definition of insomnia is the presence of "long sleep latency, frequent nocturnal awakenings, or prolonged periods of wakefulness during the sleep period or even frequent transient arousals." Another definition describes insomnia disorder as the 'subjective report of difficulty with sleep initiation, duration, consolidation, or quality which occurs despite having an adequate opportunity for sleep and resulting in some form of daytime impairment. Insomnia is a highly prevalent disorder in the US and worldwide.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |