MIDDLE & TERMINAL INSOMNIA:
SYMPTOMS AND SIDE EFFFECTS
SYMPTOMS AND SIDE EFFFECTS
SUMMARY:
1. SYMPTOMS OF INNATE, BIOLOGICAL (ENDOGENOUS) DEPRESSION, INCLUDING BIPOLAR DEPRESSION, AS WELL AS GENERALIZED ANXIETY DISORDER, PANIC DISORDER, AND OTHER MAJOR ANXIETY SYNDROMES, ARE USUALLY WORST FIRST THING IN THE MORNING, AFTER A PERIOD OF PROLONGED SLEEP, AND IMPROVE AS THE DAY WEARS ON. CONVERSELY, EXOGENOUS SYNDROMES, WHICH ARE TRIGGERED BY EXTERNAL OR ENVIRONMENTAL STRESSORS IN THE ABSENCE OF PREDISPOSING BIOLOGICAL (GENETIC) FACTORS, SUCH AS ADJUSTMENT DISORDERS WITH ANXIETY, OFTEN SHOW THE REVERSE PATTERN, EXACERBATED BY QUOTIDIAN STRESSORS AS THEY ARE ENCOUNTERED AND AS THE INDIVIDUAL ENGAGES THE DAY.
2. INITIAL INSOMNIA, TROUBLE FALLING ASLEEP, IS EITHER PRIMARY (CHRONIC AND IDIOPATHIC, MEANING OF UNKNOWN CAUSE), OR ELSE IS SECONDARY TO (I.E., A RESULT OF) STRESS OR A MAJOR MOOD DISTURBANCE. PATIENTS WITH GENERALIZED ANXIETY DISORDER, PANIC DISORDER AND OTHER ENDOGENOUS MAJOR ANXIETY SYNDROMES OFTEN BEGIN TO EXPERIENCE TROUBLE FALLING ASLEEP AT A VERY EARLY AGE (PRIMARY INSOMNIA), OFTEN UNRELATED TO WORRYING ITSELF.
3. MIDDLE INSOMNIA IS WAKING UP FREQUENTLY AND SPONTANEOUSLY THROUGHOUT THE NIGHT (NOT DUE TO OTHER CAUSES, SUCH AS NEEDING TO VOID ONE'S BLADDER, WHICH IS COMMON, AND NOT NECESSARILY PATHOLOGICAL, IN THE ELDERLY, OR INDIVIDUALS WHO EXPERIENCE URINARY RETENTION). IT INDICATES SHALLOW SLEEP; I.E., LESS TIME SPENT IN THE DEEPER, RESTORATIVE STAGES 3 AND 4. MULTIPLE AWAKENINGS ARE POSSIBLE, BUT INDIVIDUALS ARE USUALLY ABLE TO EASILY FALL BACK TO SLEEP.
TERMINAL INSOMNIA IS WAKING UP SEVERAL HOURS BEFORE THE DAY BEGINS, AND BEING UNABLE TO GET BACK TO SLEEP. AN INDIVIDUAL CAN EXPERIENCE MIDDLE INSOMNIA, TERMINAL INSOMNIA, OR BOTH. BOUTS OF INITIAL INSOMNIA CAN ALSO PERIODICALLY BE EXPERIENCED BY INDIVIDUALS EXPERIENCING MIDDLE AND/OR TERMINAL INSOMNIA.
4. INITIAL, MIDDLE AND TERMINAL INSOMNIA CAN ALL BE SIDE EFFECTS OF MEDICATIONS. STIMULATING OR ACTIVATING MEDICATIONS (E.G., THOSE THAT INCREASE DOPAMINE, OR ADRENALINE) WILL CAUSE INITIAL INSOMNIA IF TAKEN TOO CLOSE TO BEDTIME. THESE MEDICATIONS, AS WELL AS SEROTONERGIC MEDICATIONS (MEDICINES THAT INCREASE SEROTONIN, SUCH AS PROZAC AND ZOLOFT AND OTHER SSRIS) CAN ALSO CAUSE MIDDLE AND TERMINAL INSOMNIA, REGARDLESS OF WHAT TIME OF THE DAY THEY ARE DOSED, AS BRIEF, OR MORE CHRONIC, SIDE EFFECTS THAT DO TEND TO IMPROVE OVER TIME WITH CONTINUED USE AND THAT RESPOND WELL TO HYPNOTIC AGENTS (SLEEPING PILLS).
5. AS SYMPTOMS, MIDDLE AND TERMINAL INSOMNIA ARE HARBINGERS OF ENDOGENOUS ILLNESS; THE PRESENCE OF THESE AS SYMPTOMS (AS OPPOSED TO MEDICATION SIDE EFFECTS), INDICATES THAT AN EPISODE OF DEPRESSION IS PROBABLY BIOLOGICAL (THAT IS, DUE TO MAJOR DEPRESSIVE DISORDER OR BIPOLAR DEPRESSION, AS OPPOSED TO AN ADJUSTMENT DISORDER WITH DEPRESSION AND OTHER REACTIVE DEPRESSIONS) OR THAT AN EXACERBATION OF AN INDIVIDUAL'S ANXIETY IS LIKEWISE BEST UNDERSTOOD IN THE CONTEXT OF A PRE-EXISTING GENERALIZED ANXIETY DISORDER OR AN UNDERLYING PANIC DISORDER, AS OPPOSED TO AN ADJUSTMENT DISORDER WITH ANXIETY, ESPECIALLY IF SYMPTOMS OF DEPRESSION OR ANXIETY, INCLUDING PANIC, ARE WORST IN THE MORNINGS, UPON AWAKENING AND IMPROVE AS AN INDIVIDUAL BECOMES ACTIVE.
6. CARDIOVASCULAR EXERCISE IS A PANACEA, AND GREATLY IMPROVES ALL FORMS OF DEPRESSION, AND ESPECIALLY ANXIETY, AND IS THE SINGLE-MOST EFFICACIOUS NON-PHARMACOLOGICAL LIFESTYLE VARIABLE, IN MY PROFESSIONAL OPINION.
1. SYMPTOMS OF INNATE, BIOLOGICAL (ENDOGENOUS) DEPRESSION, INCLUDING BIPOLAR DEPRESSION, AS WELL AS GENERALIZED ANXIETY DISORDER, PANIC DISORDER, AND OTHER MAJOR ANXIETY SYNDROMES, ARE USUALLY WORST FIRST THING IN THE MORNING, AFTER A PERIOD OF PROLONGED SLEEP, AND IMPROVE AS THE DAY WEARS ON. CONVERSELY, EXOGENOUS SYNDROMES, WHICH ARE TRIGGERED BY EXTERNAL OR ENVIRONMENTAL STRESSORS IN THE ABSENCE OF PREDISPOSING BIOLOGICAL (GENETIC) FACTORS, SUCH AS ADJUSTMENT DISORDERS WITH ANXIETY, OFTEN SHOW THE REVERSE PATTERN, EXACERBATED BY QUOTIDIAN STRESSORS AS THEY ARE ENCOUNTERED AND AS THE INDIVIDUAL ENGAGES THE DAY.
2. INITIAL INSOMNIA, TROUBLE FALLING ASLEEP, IS EITHER PRIMARY (CHRONIC AND IDIOPATHIC, MEANING OF UNKNOWN CAUSE), OR ELSE IS SECONDARY TO (I.E., A RESULT OF) STRESS OR A MAJOR MOOD DISTURBANCE. PATIENTS WITH GENERALIZED ANXIETY DISORDER, PANIC DISORDER AND OTHER ENDOGENOUS MAJOR ANXIETY SYNDROMES OFTEN BEGIN TO EXPERIENCE TROUBLE FALLING ASLEEP AT A VERY EARLY AGE (PRIMARY INSOMNIA), OFTEN UNRELATED TO WORRYING ITSELF.
3. MIDDLE INSOMNIA IS WAKING UP FREQUENTLY AND SPONTANEOUSLY THROUGHOUT THE NIGHT (NOT DUE TO OTHER CAUSES, SUCH AS NEEDING TO VOID ONE'S BLADDER, WHICH IS COMMON, AND NOT NECESSARILY PATHOLOGICAL, IN THE ELDERLY, OR INDIVIDUALS WHO EXPERIENCE URINARY RETENTION). IT INDICATES SHALLOW SLEEP; I.E., LESS TIME SPENT IN THE DEEPER, RESTORATIVE STAGES 3 AND 4. MULTIPLE AWAKENINGS ARE POSSIBLE, BUT INDIVIDUALS ARE USUALLY ABLE TO EASILY FALL BACK TO SLEEP.
TERMINAL INSOMNIA IS WAKING UP SEVERAL HOURS BEFORE THE DAY BEGINS, AND BEING UNABLE TO GET BACK TO SLEEP. AN INDIVIDUAL CAN EXPERIENCE MIDDLE INSOMNIA, TERMINAL INSOMNIA, OR BOTH. BOUTS OF INITIAL INSOMNIA CAN ALSO PERIODICALLY BE EXPERIENCED BY INDIVIDUALS EXPERIENCING MIDDLE AND/OR TERMINAL INSOMNIA.
4. INITIAL, MIDDLE AND TERMINAL INSOMNIA CAN ALL BE SIDE EFFECTS OF MEDICATIONS. STIMULATING OR ACTIVATING MEDICATIONS (E.G., THOSE THAT INCREASE DOPAMINE, OR ADRENALINE) WILL CAUSE INITIAL INSOMNIA IF TAKEN TOO CLOSE TO BEDTIME. THESE MEDICATIONS, AS WELL AS SEROTONERGIC MEDICATIONS (MEDICINES THAT INCREASE SEROTONIN, SUCH AS PROZAC AND ZOLOFT AND OTHER SSRIS) CAN ALSO CAUSE MIDDLE AND TERMINAL INSOMNIA, REGARDLESS OF WHAT TIME OF THE DAY THEY ARE DOSED, AS BRIEF, OR MORE CHRONIC, SIDE EFFECTS THAT DO TEND TO IMPROVE OVER TIME WITH CONTINUED USE AND THAT RESPOND WELL TO HYPNOTIC AGENTS (SLEEPING PILLS).
5. AS SYMPTOMS, MIDDLE AND TERMINAL INSOMNIA ARE HARBINGERS OF ENDOGENOUS ILLNESS; THE PRESENCE OF THESE AS SYMPTOMS (AS OPPOSED TO MEDICATION SIDE EFFECTS), INDICATES THAT AN EPISODE OF DEPRESSION IS PROBABLY BIOLOGICAL (THAT IS, DUE TO MAJOR DEPRESSIVE DISORDER OR BIPOLAR DEPRESSION, AS OPPOSED TO AN ADJUSTMENT DISORDER WITH DEPRESSION AND OTHER REACTIVE DEPRESSIONS) OR THAT AN EXACERBATION OF AN INDIVIDUAL'S ANXIETY IS LIKEWISE BEST UNDERSTOOD IN THE CONTEXT OF A PRE-EXISTING GENERALIZED ANXIETY DISORDER OR AN UNDERLYING PANIC DISORDER, AS OPPOSED TO AN ADJUSTMENT DISORDER WITH ANXIETY, ESPECIALLY IF SYMPTOMS OF DEPRESSION OR ANXIETY, INCLUDING PANIC, ARE WORST IN THE MORNINGS, UPON AWAKENING AND IMPROVE AS AN INDIVIDUAL BECOMES ACTIVE.
6. CARDIOVASCULAR EXERCISE IS A PANACEA, AND GREATLY IMPROVES ALL FORMS OF DEPRESSION, AND ESPECIALLY ANXIETY, AND IS THE SINGLE-MOST EFFICACIOUS NON-PHARMACOLOGICAL LIFESTYLE VARIABLE, IN MY PROFESSIONAL OPINION.
