Hypnagogia

From Wikipedia, the free encyclopedia

Hypnagogia, also referred to as "hypnagogic hallucinations", is the experience of the transitional state from wakefulness to sleep: the hypnagogic state of consciousness, during the onset of sleep (for the transitional state from sleep to wakefulness see hypnopompic). Mental phenomena that may occur during this "threshold consciousness" phase include lucid thought, lucid dreaming, hallucinations, and sleep paralysis. However, sleep paralysis and lucid dreaming are separate sleep conditions that are sometimes experienced during the hypnagogic state.

Definitions

The word hypnagogia is sometimes used in a restricted sense to refer to the onset of sleep, and contrasted with hypnopompia, Frederic Myers's term for waking up. However, hypnagogia is also regularly employed in a more general sense that covers both falling asleep and waking up, and Havelock Ellis has questioned the need for separate terms. Indeed, it is not always possible in practice to assign a particular episode of any given phenomenon to one or the other, given that the same kinds of experience occur in both, and that people may drift in and out of sleep. In this article hypnagogia will be used in the broader sense, unless otherwise stated or implied.

Other terms for hypnagogia, in one or both senses, that have been proposed include "presomnal" or "anthypnic sensations", "visions of half-sleep", "oneirogogic images" and "phantasmata", "the borderland of sleep", "praedormitium", "borderland state", "half-dream state", "pre-dream condition", "sleep onset dreams", "dreamlets", and "wakefulness-sleep transition" (WST).

Threshold consciousness (commonly called "half-asleep" or "half-awake", or "mind awake body asleep") describes the same mental state of someone who is moving towards sleep or wakefulness, but has not yet completed the transition. Such transitions are usually brief, but can be extended by sleep disturbance or deliberate induction, for example during meditation.

Signs and symptoms

Transition to and from sleep may be attended by a wide variety of sensory experiences. These can occur in any modality, individually or combined, and range from the vague and barely perceptible to vivid hallucinations.

Sights

Among the more commonly reported, and more thoroughly researched, sensory features of hypnagogia are phosphenes which can manifest as seemingly random speckles, lines or geometrical patterns, including form constants, or as figurative (representational) images. They may be monochromatic or richly colored, still or moving, flat or three-dimensional (offering an impression of perspective). Imagery representing movement through tunnels of light is also reported. Individual images are typically fleeting and given to very rapid changes. They are said to differ from dreams proper in that hypnagogic imagery is usually static and lacking in narrative content, although others understand the state rather as a gradual transition from hypnagogia to fragmentary dreams, i.e., from simple Eigenlicht to whole imagined scenes. Descriptions of exceptionally vivid and elaborate hypnagogic visuals can be found in the work of Marie-Jean-Léon, Marquis d'Hervey de Saint Denys.

Tetris effect

People who have spent a long time at some repetitive activity before sleep, in particular one that is new to them, may find that it dominates their imagery as they grow drowsy, a tendency dubbed the Tetris effect. This effect has even been observed in amnesiacs who otherwise have no memory of the original activity. When the activity involves moving objects, as in the video game Tetris, the corresponding hypnagogic images tend to be perceived as moving. The Tetris effect is not confined to visual imagery, but can manifest in other modalities. For example, Robert Stickgold recounts having experienced the touch of rocks while falling asleep after mountain climbing. This can also occur to people who have travelled on a small boat in rough seas, or have been swimming through waves, shortly before going to bed, and they feel the waves as they drift to sleep, or people who have spent the day skiing who continue to "feel snow" under their feet. People who have spent considerable time jumping on a trampoline will find that they can feel the up-and-down motion before they go to sleep. Many chess players report the phenomenon of seeing the chess board and pieces during this state. New employees working stressful and demanding jobs often report feeling the experience of performing work-related tasks in this period before sleep.

Sounds

Hypnagogic hallucinations are often auditory or have an auditory component. Like the visuals, hypnagogic sounds vary in intensity from faint impressions to loud noises, like knocking and crash and bangs (exploding head syndrome). People may imagine their own name called, crumpling bags, white noise, or a doorbell ringing. Snatches of imagined speech are common. While typically nonsensical and fragmented, these speech events can occasionally strike the individual as apt comments on—or summations of—their thoughts at the time. They often contain word play, neologisms and made-up names. Hypnagogic speech may manifest as the subject's own "inner voice", or as the voices of others: familiar people or strangers. More rarely, poetry or music is heard.

Other sensations

Gustatory, olfactory and thermal sensations in hypnagogia have all been reported, as well as tactile sensations (including those kinds classed as paresthesia or formication). Sometimes there is synesthesia; many people report seeing a flash of light or some other visual image in response to a real sound. Proprioceptive effects may be noticed, with numbness and changes in perceived body size and proportions, feelings of floating or bobbing, and out-of-body experiences. Perhaps the most common experience of this kind is the falling sensation, and associated hypnic jerk, encountered by many people, at least occasionally, while drifting off to sleep.

Cognitive and affective phenomena

Thought processes on the edge of sleep tend to differ radically from those of ordinary wakefulness. For example, something that you agreed with in a state of hypnagogia may seem completely ridiculous to you in an awake state. Hypnagogia may involve a "loosening of ego boundaries ... openness, sensitivity, internalization-subjectification of the physical and mental environment (empathy) and diffuse-absorbed attention." Hypnagogic cognition, in comparison with that of normal, alert wakefulness, is characterized by heightened suggestibility, illogic and a fluid association of ideas. Subjects are more receptive in the hypnagogic state to suggestion from an experimenter than at other times, and readily incorporate external stimuli into hypnagogic trains of thought and subsequent dreams. This receptivity has a physiological parallel; EEG readings show elevated responsiveness to sound around the onset of sleep.

Herbert Silberer described a process he called autosymbolism, whereby hypnagogic hallucinations seem to represent, without repression or censorship, whatever one is thinking at the time, turning abstract ideas into a concrete image, which may be perceived as an apt and succinct representation thereof.

The hypnagogic state can provide insight into a problem, the best-known example being August Kekulé’s realization that the structure of benzene was a closed ring while half-asleep in front of a fire and seeing molecules forming into snakes, one of which grabbed its tail in its mouth. Many other artists, writers, scientists and inventors — including Beethoven, Richard Wagner, Walter Scott, Salvador Dalí, Thomas Edison, Nikola Tesla and Isaac Newton — have credited hypnagogia and related states with enhancing their creativity. A 2001 study by Harvard psychologist Deirdre Barrett found that, while problems can also be solved in full-blown dreams from later stages of sleep, hypnagogia was especially likely to solve problems which benefit from hallucinatory images being critically examined while still before the eyes.

A feature that hypnagogia shares with other stages of sleep is amnesia. But this is a selective forgetfulness, affecting the hippocampal memory system, which is responsible for episodic or autobiographical memory, rather than the neocortical memory system, responsible for semantic memory. It has been suggested that hypnagogia and REM sleep help in the consolidation of semantic memory, but the evidence for this has been disputed. For example, suppression of REM sleep due to antidepressants and lesions to the brainstem has not been found to produce detrimental effects on cognition.

Hypnagogic phenomena may be interpreted as visions, prophecies, premonitions, apparitions and inspiration (artistic or divine), depending on the experiencers' beliefs and those of their culture.

Physiology

Physiological studies have tended to concentrate on hypnagogia in the strict sense of spontaneous sleep onset experiences. Such experiences are associated especially with stage 1 of NREM sleep, but may also occur with pre-sleep alpha waves. Davis et al. found short flashes of dreamlike imagery at the onset of sleep to correlate with drop-offs in alpha EEG activity. Hori et al. regard sleep onset hypnagogia as a state distinct from both wakefulness and sleep with unique electrophysiological, behavioral and subjective characteristics, while Germaine et al. have demonstrated a resemblance between the EEG power spectra of spontaneously occurring hypnagogic images, on the one hand, and those of both REM sleep and relaxed wakefulness, on the other.

To identify more precisely the nature of the EEG state which accompanies imagery in the transition from wakefulness to sleep, Hori et al. proposed a scheme of 9 EEG stages defined by varying proportions of alpha (stages 1–3), suppressed waves of less than 20μV (stage 4), theta ripples (stage 5), proportions of sawtooth waves (stages 6–7), and presence of spindles (stages 8–9). Germaine and Nielsen found spontaneous hypnagogic imagery to occur mainly during Hori sleep onset stages 4 (EEG flattening) and 5 (theta ripples).

The "covert-rapid-eye-movement" hypothesis proposes that hidden elements of REM sleep emerge during the wakefulness-sleep transition stage. Support for this comes from Bódicz et al., who note a greater similarity between WST (wakefulness-sleep transition) EEG and REM sleep EEG than between the former and stage 2 sleep.

Respiratory pattern changes have also been noted in the hypnagogic state, in addition to a lowered rate of frontalis muscle activity.

Daydreaming and waking reveries

Microsleep (short episodes of immediate sleep onset) may intrude into wakefulness at any time in the wakefulness-sleep cycle, due to sleep deprivation and other conditions, resulting in impaired cognition and even amnesia.

Gurstelle and Oliveira distinguish a state which they call daytime parahypnagogia (DPH), the spontaneous intrusion of a flash image or dreamlike thought or insight into one's waking consciousness. DPH is typically encountered when one is "tired, bored, suffering from attention fatigue, and/or engaged in a passive activity." The exact nature of the waking dream may be forgotten even though the individual remembers having had such an experience. Gustelle and Oliveira define DPH as "dissociative, trance-like, [...] but, unlike a daydream, [...] not self-directed"—however, daydreams and waking reveries are often characterised as "passive", "effortless", and "spontaneous", while hypnagogia itself can sometimes be influenced by a form of autosuggestion, or "passive concentration", so these sorts of episodes may in fact constitute a continuum between directed fantasy and the more spontaneous varieties of hypnagogia. Others have emphasized the connections between fantasy, daydreaming, dreams, and hypnosis.

In his book, Zen and the Brain, James H. Austin cites speculation that regular meditation develops a specialized skill of "freezing the hypnagogic process at later and later stages" of the onset of sleep, initially in the alpha wave stage and later in theta.

History

Early references to hypnagogia are to be found in the writings of Aristotle, Iamblichus, Cardano, Simon Forman, and Swedenborg. Romanticism brought a renewed interest in the subjective experience of the edges of sleep. In more recent centuries, many authors have referred to the state; Edgar Allan Poe, for example, wrote of the "fancies" he experienced "only when I am on the brink of sleep, with the consciousness that I am so."

Serious scientific inquiry began in the 19th century with Johannes Peter Müller, Jules Baillarger, and Alfred Maury, and continued into the 20th century with Leroy.

Charles Dickens' Oliver Twist contains an elaborate description of the hypnagogic state in Chapter XXXIV.

The advent of electroencephalography (EEG) has supplemented the introspective methods of these early researchers with physiological data. The search for neural correlates for hypnagogic imagery began with Davis et al. in the 1930s, and continues with increasing sophistication. While the dominance of the behaviorist paradigm led to a decline in research, especially in the English speaking world, the later twentieth century has seen a revival, with investigations of hypnagogia and related altered states of consciousness playing an important role in the emerging multidisciplinary study of consciousness. Nevertheless, much remains to be understood about the experience and its corresponding neurology, and the topic has been somewhat neglected in comparison with sleep and dreams; hypnagogia has been described as a "well-trodden and yet unmapped territory".

The word hypnagogia entered the popular psychology literature through Dr. Andreas Mavromatis in his 1983 thesis, while hypnagogic and hypnopompic were coined by others in the 1800s and noted by Havelock Ellis. The term hypnagogic was originally coined by Alfred Maury to name the state of consciousness during the onset of sleep. Hypnopompic was coined by Frederic Myers soon afterwards to denote the onset of wakefulness. The term hypnagogia is used by Dr. Mavromatis to identify the study of the sleep-transitional consciousness states in general, and he employs hypnogogic (toward sleep) or hypnapompic (from sleep) for the purpose of identifying the specific experiences under study.

Important reviews of the scientific literature have been made by Leaning, Schacter, Richardson and Mavromatis.

Research

Self-observation (spontaneous or systematic) was the primary tool of the early researchers. Since the late 20th century, this has been joined by questionnaire surveys and experimental studies. All three methods have their disadvantages as well as points to recommend them.

Naturally, amnesia contributes to the difficulty of studying hypnagogia, as does the typically fleeting nature of hypnagogic experiences. These problems have been tackled by experimenters in a number of ways, including voluntary or induced interruptions, sleep manipulation, the use of techniques to "hover on the edge of sleep" thereby extending the duration of the hypnagogic state, and training in the art of introspection to heighten the subject's powers of observation and attention.

Techniques for extending hypnagogia range from informal (e.g. the subject holds up one of their arms as they go to sleep, so as to be awakened when it falls), to the use of biofeedback devices to induce a "theta" state – produced naturally the most when we are dreaming – characterized by relaxation and theta EEG activity.

Another method is to induce a state said to be subjectively similar to sleep onset in a Ganzfeld setting, a form of sensory deprivation. But the assumption of identity between the two states may be unfounded. The average EEG spectrum in Ganzfeld is more similar to that of the relaxed waking state than to that of sleep onset. Wackerman et al. conclude that "the Ganzfeld imagery, although subjectively very similar to that at sleep onset, should not be labeled as 'hypnagogic'. Perhaps a broader category of 'hypnagoid experience' should be considered, covering true hypnagogic imagery as well as subjectively similar imagery produced in other states."

Astral projection

From Wikipedia, the free encyclopedia

"The Separation of the Spirit Body" from The Secret of the Golden Flower, a Chinese handbook on alchemy and meditation

Astral projection (or astral travel) is a term used in esotericism to describe a willful out-of-body experience (OBE) that assumes the existence of a soul or consciousness called an "astral body" that is separate from the physical body and capable of travelling outside it throughout the universe.

The idea of astral travel is ancient and occurs in multiple cultures. The modern terminology of 'astral projection' was coined and promoted by 19th century Theosophists. It is sometimes reported in association with dreams, and forms of meditation. Some individuals have reported perceptions similar to descriptions of astral projection that were induced through various hallucinogenic and hypnotic means (including self-hypnosis). There is no scientific evidence that there is a consciousness or soul which is separate from normal neural activity or that one can consciously leave the body and make observations, and astral projection has been characterized as a pseudoscience.

Accounts

Western

According to classical, medieval and renaissance Hermeticism, Neoplatonism, and later Theosophist and Rosicrucian thought the astral body is an intermediate body of light linking the rational soul to the physical body while the astral plane is an intermediate world of light between Heaven and Earth, composed of the spheres of the planets and stars. These astral spheres were held to be populated by angels, demons and spirits.

The subtle bodies, and their associated planes of existence, form an essential part of the esoteric systems that deal with astral phenomena. In the neo-platonism of Plotinus, for example, the individual is a microcosm ("small world") of the universe (the macrocosm or "great world"). "The rational soul...is akin to the great Soul of the World" while "the material universe, like the body, is made as a faded image of the Intelligible". Each succeeding plane of manifestation is causal to the next, a world-view known as emanationism; "from the One proceeds Intellect, from Intellect Soul, and from Soul - in its lower phase, or that of Nature - the material universe".

Often these bodies and their planes of existence are depicted as a series of concentric circles or nested spheres, with a separate body traversing each realm. The idea of the astral figured prominently in the work of the nineteenth-century French occultist Eliphas Levi, whence it was adopted and developed further by Theosophy, and used afterwards by other esoteric movements.

Biblical

Carrington, Muldoon, Peterson, and Williams—renowned experts in the field of astral projection—claim that the subtle body is attached to the physical body by means of a psychic silver cord. The final chapter of the Book of Ecclesiastes is often cited in this respect: "Before the silver cord be loosed, or the golden bowl be broken, or the pitcher be shattered at the fountain, or the wheel be broken at the cistern." Scherman, however, contends that the context points to this being merely a metaphor, comparing the body to a machine, with the silver cord referring to the spine.

Paul's Second Epistle to the Corinthians is more generally agreed to refer to the astral planes: "I know a man in Christ who fourteen years ago was caught up to the third heaven. Whether it was in the body or out of the body I do not know—God knows." This statement gave rise to the Visio Pauli, a tract that offers a vision of heaven and hell, a forerunner of visions attributed to Adomnan and Tnugdalus as well as of Dante's Divine Comedy.

Ancient Egypt

Similar concepts of soul travel appear in various other religious traditions. For example, ancient Egyptian teachings present the soul (ba) as having the ability to hover outside the physical body via the ka, or subtle body.

China

Taoist alchemical practice involves creation of an energy body by breathing meditations, drawing energy into a 'pearl' that is then "circulated". "Xiangzi ... with a drum as his pillow fell fast asleep, snoring and motionless. His primordial spirit, however, went straight into the banquet room and said, "My lords, here I am again." When Tuizhi walked with the officials to take a look, there really was a Taoist sleeping on the ground and snoring like thunder. Yet inside, in the side room, there was another Taoist beating a fisher drum and singing Taoist songs. The officials all said, "Although there are two different people, their faces and clothes are exactly alike. Clearly he is a divine immortal who can divide his body and appear in several places at once. ..." At that moment, the Taoist in the side room came walking out, and the Taoist sleeping on the ground woke up. The two merged into one."

Buddhism

In early Buddhism the ability to do Astral Projection is one of many believed super normal powers for those who reach 4th Jhana.

According to Samaññaphala Sutta: The Fruits of the Contemplative Life (Digha Nikaya 2.85-87) Buddha said.

"With his mind thus concentrated, purified, and bright, unblemished, free from defects, pliant, malleable, steady, and attained to imperturbability (reaching 4th Jhana), he directs and inclines it to creating a mind-made body. From this body he creates another body, endowed with form, made of the mind, complete in all its parts, not inferior in its faculties. Just as if a man were to draw a reed from its sheath. The thought would occur to him: 'This is the sheath, this is the reed. The sheath is one thing, the reed another, but the reed has been drawn out from the sheath.' Or as if a man were to draw a sword from its scabbard. The thought would occur to him: 'This is the sword, this is the scabbard. The sword is one thing, the scabbard another, but the sword has been drawn out from the scabbard.' Or as if a man were to pull a snake out from its slough. The thought would occur to him: 'This is the snake, this is the slough. The snake is one thing, the slough another, but the snake has been pulled out from the slough.' In the same way — with his mind thus concentrated, purified, and bright, unblemished, free from defects, pliant, malleable, steady, and attained to imperturbability, the monk directs and inclines it to creating a mind-made body. From this body he creates another body, endowed with form, made of the mind, complete in all its parts, not inferior in its faculties."

India

Similar ideas such as the Lin'ga S'ari-ra are found in ancient Hindu scriptures such as the YogaVashishta-Maharamayana of Valmiki. Modern Indians who have vouched for astral projection include Paramahansa Yogananda who witnessed Swami Pranabananda doing a miracle through a possible astral projection.

The Indian spiritual teacher Meher Baba described one's use of astral projection:

In the advancing stages leading to the beginning of the path, the aspirant becomes spiritually prepared for being entrusted with free use of the forces of the inner world of the astral bodies. He may then undertake astral journeys in his astral body, leaving the physical body in sleep or wakefulness. The astral journeys that are taken unconsciously are much less important than those undertaken with full consciousness and as a result of deliberate volition. This implies conscious use of the astral body. Conscious separation of the astral body from the outer vehicle of the gross body has its own value in making the soul feel its distinction from the gross body and in arriving at fuller control of the gross body. One can, at will, put on and take off the external gross body as if it were a cloak, and use the astral body for experiencing the inner world of the astral and for undertaking journeys through it, if and when necessary....The ability to undertake astral journeys therefore involves considerable expansion of one’s scope for experience. It brings opportunities for promoting one’s own spiritual advancement, which begins with the involution of consciousness.

Astral projection is one of the Siddhis considered achievable by yoga practitioners through self-disciplined practice. In the epic The Mahabharata Drona leaves his physical body to see if his son is alive.

Japan

The 'ikiryō' as illustrated by Toriyama Sekien

In Japanese mythology, an ikiryō (生霊) (also read shōryō, seirei, or ikisudama) is a manifestation of the soul of a living person separately from their body. Traditionally, if someone holds a sufficient grudge against another person, it is believed that a part or the whole of their soul can temporarily leave their body and appear before the target of their hate in order to curse or otherwise harm them, similar to an evil eye. Souls are also believed to leave a living body when the body is extremely sick or comatose; such ikiryō are not malevolent.

Inuit

In some Inuit groups, people with special capabilities are said to travel to (mythological) remote places, and report their experiences and things important to their fellows or the entire community; how to stop bad luck in hunting, cure a sick person etc., things unavailable to people with normal capabilities.

Amazon

The yaskomo of the Waiwai is believed to be able to perform a "soul flight" that can serve several functions such as healing, flying to the sky to consult cosmological beings (the moon or the brother of the moon) to get a name for a new-born baby, flying to the cave of peccaries' mountains to ask the father of peccaries for abundance of game or flying deep down in a river to get the help of other beings.

"Astral" and "etheric"

The expression "astral projection" came to be used in two different ways. For the Golden Dawn and some Theosophists it retained the classical and medieval philosophers' meaning of journeying to other worlds, heavens, hells, the astrological spheres and other imaginal landscapes, but outside these circles the term was increasingly applied to non-physical travel around the physical world.

Though this usage continues to be widespread, the term, "etheric travel", used by some later Theosophists, offers a useful distinction. Some experients say they visit different times and/or places: "etheric", then, is used to represent the sense of being "out of the body" in the physical world, whereas "astral" may connote some alteration in time-perception. Robert Monroe describes the former type of projection as "Locale I" or the "Here-Now", involving people and places that actually exist: Robert Bruce calls it the "Real Time Zone" (RTZ) and describes it as the non-physical dimension-level closest to the physical. This etheric body is usually, though not always, invisible but is often perceived by the experient as connected to the physical body during separation by a "silver cord". Some link "falling" dreams with projection.

According to Max Heindel, the etheric "double" serves as a medium between the astral and physical realms. In his system the ether, also called prana, is the "vital force" that empowers the physical forms to change. From his descriptions it can be inferred that, to him, when one views the physical during an out-of-body experience, one is not technically "in" the astral realm at all.

Other experients may describe a domain that has no parallel to any known physical setting. Environments may be populated or unpopulated, artificial, natural or abstract, and the experience may be beatific, horrific or neutral. A common Theosophical belief is that one may access a compendium of mystical knowledge called the Akashic records. In many accounts the experiencer correlates the astral world with the world of dreams. Some even report seeing other dreamers enacting dream scenarios unaware of their wider environment.

The astral environment may also be divided into levels or sub-planes by theorists, but there are many different views in various traditions concerning the overall structure of the astral planes: they may include heavens and hells and other after-death spheres, transcendent environments, or other less-easily characterized states.

Notable practitioners

Astral projection according to Carrington and Muldoon, 1929

Emanuel Swedenborg was one of the first practitioners to write extensively about the out-of-body experience, in his Spiritual Diary (1747–65). French philosopher and novelist Honoré de Balzac's fictional work "Louis Lambert" suggests he may have had some astral or out-of-body experience.

There are many twentieth century publications on astral projection, although only a few authors remain widely cited. These include Robert Monroe, Oliver Fox, Sylvan Muldoon, and Hereward Carrington, and Yram.

Robert Monroe's accounts of journeys to other realms (1971–1994) popularized the term "OBE" and were translated into a large number of languages. Though his books themselves only placed secondary importance on descriptions of method, Monroe also founded an institute dedicated to research, exploration and non-profit dissemination of auditory technology for assisting others in achieving projection and related altered states of consciousness.

Robert Bruce, William Buhlman, and Albert Taylor have discussed their theories and findings on the syndicated show Coast to Coast AM several times. Michael Crichton gives lengthy and detailed explanations and experience of astral projection in his non-fiction book Travels.

In her book, My Religion, Helen Keller tells of her beliefs in Swedenborgianism and how she once "traveled" to Athens:

"I have been far away all this time, and I haven't left the room...It was clear to me that it was because I was a spirit that I had so vividly 'seen' and felt a place a thousand miles away. Space was nothing to spirit!"

The soul's ability to leave the body at will or while sleeping and visit the various planes of heaven is also known as "soul travel". The practice is taught in Surat Shabd Yoga, where the experience is achieved mostly by meditation techniques and mantra repetition. All Sant Mat Gurus widely spoke about this kind of out of body experience, such as Kirpal Singh.

Eckankar describes Soul Travel broadly as movement of the true, spiritual self (Soul) closer to the heart of God. While the contemplative may perceive the experience as travel, Soul itself is said not to move but to "come into an agreement with fixed states and conditions that already exist in some world of time and space". American Harold Klemp, the current Spiritual Leader of Eckankar practices and teaches Soul Travel, as did his predecessors, through contemplative techniques known as the Spiritual Exercises of ECK (Divine Spirit).

In occult traditions, practices range from inducing trance states to the mental construction of a second body, called the Body of Light in Aleister Crowley's writings, through visualization and controlled breathing, followed by the transfer of consciousness to the secondary body by a mental act of will.

Scientific reception

There is no known scientific evidence that astral projection as an objective phenomenon exists.

There are cases of patients having experiences suggestive of astral projection from brain stimulation treatments and hallucinogenic drugs, such as ketamine, phencyclidine, and DMT.

Robert Todd Carroll writes that the main evidence to support claims of astral travel is anecdotal and comes "in the form of testimonials of those who claim to have experienced being out of their bodies when they may have been out of their minds." Subjects in parapsychological experiments have attempted to project their astral bodies to distant rooms and see what was happening. However, such experiments haven't produced clear results.

According to Bob Bruce of the Queensland Skeptics Association, astral projection is "just imagining", or "a dream state". Bruce writes that the existence of an astral plane is contrary to the limits of science. "We know how many possibilities there are for dimensions and we know what the dimensions do. None of it correlates with things like astral projection." Bruce attributes astral experiences such as "meetings" alleged by practitioners to confirmation bias and coincidences.
Psychologist Donovan Rawcliffe has written that astral projection can be explained by delusion, hallucination and vivid dreams.

Arthur W. Wiggins, writing in Quantum Leaps in the Wrong Direction: Where Real Science Ends...and Pseudoscience Begins, said that purported evidence of the ability to astral travel great distances and give descriptions of places visited is predominantly anecdotal. In 1978, Ingo Swann provided a test of his alleged ability to astral travel to Jupiter and observe details of the planet. Actual findings and information were later compared to Swann's claimed observations; according to an evaluation by James Randi, Swann's accuracy was "unconvincing and unimpressive" with an overall score of 37 percent. Wiggins considers astral travel an illusion, and looks to neuroanatomy, human belief, imagination and prior knowledge to provide prosaic explanations for those claiming to experience it.

In popular culture

• Ring-a-Ding Girl—fictional treatment of astral projection in popular media The Twilight Zone, in which a fading actress (Maggie McNamara) is able to project her consciousness from her body by means of magic and rescue the inhabitants of her hometown from an impending natural disaster;
• Insidious (film)—A film about a boy named Dalton whose astral body gets caught in a demonic world known as The Further. His father, from who he acquired these abilities, must find him and bring him back to the living world;
• The Three Investigators #23 in the children's mystery series, "The Mystery of the Invisible Dog", features a character that performs astral projection;
• Aahat (Episode 164) - A popular TV horror show in India had an episode about astral projection;
• In the television series Charmed, the character of Prue, a witch played by Shannon Doherty, has the power of astral projection and has used it many times in the series dealings with the supernatural;
• In the Gothic soap opera Dark Shadows, the characters of Barnabas Collins and Julia Hoffman have used the mystic powers of the IChing wands to project their astral body into the past while their bodies remain in a trance in the present.

Insomnia

From Wikipedia, the free encyclopedia

Insomnia
Synonyms	Sleeplessness
A drawing of someone with insomnia from the 14th century
Pronunciation	/ɪnˈsɒmniə/
Specialty	Psychiatry, sleep medicine
Symptoms	Trouble sleeping, daytime sleepiness, low energy, irritability, depressed mood
Complications	Motor vehicle collisions
Causes	Unknown, psychological stress, chronic pain, heart failure, hyperthyroidism, heartburn, restless leg syndrome, others
Diagnostic method	Based on symptoms, sleep study
Differential diagnosis	Delayed sleep phase disorder, restless leg syndrome, sleep apnea, psychiatric disorder
Treatment	Sleep hygiene, cognitive behavioral therapy, sleeping pills
Frequency	~20%

Insomnia, also known as sleeplessness, is a sleep disorder where people have trouble sleeping. They may have difficulty falling asleep, or staying asleep as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, irritability, and a depressed mood. It may result in an increased risk of motor vehicle collisions, as well as problems focusing and learning. Insomnia can be short term, lasting for days or weeks, or long term, lasting more than a month.

Insomnia can occur independently or as a result of another problem. Conditions that can result in insomnia include psychological stress, chronic pain, heart failure, hyperthyroidism, heartburn, restless leg syndrome, menopause, certain medications, and drugs such as caffeine, nicotine, and alcohol. Other risk factors include working night shifts and sleep apnea. Diagnosis is based on sleep habits and an examination to look for underlying causes. A sleep study may be done to look for underlying sleep disorders. Screening may be done with two questions: "do you experience difficulty sleeping?" and "do you have difficulty falling or staying asleep?"

Sleep hygiene and lifestyle changes are typically the first treatment for insomnia. Sleep hygiene includes a consistent bedtime, exposure to sunlight, a quiet and dark room, and regular exercise.  Cognitive behavioral therapy may be added to this. While sleeping pills may help, they are associated with injuries, dementia, and addiction. These medications are not recommended for more than four or five weeks. The effectiveness and safety of alternative medicine is unclear.

Between 10% and 30% of adults have insomnia at any given point in time and up to half of people have insomnia in a given year. About 6% of people have insomnia that is not due to another problem and lasts for more than a month. People over the age of 65 are affected more often than younger people. Females are more often affected than males. Descriptions of insomnia occur at least as far back as ancient Greece.

Signs and symptoms

Potential complications of insomnia

Symptoms of insomnia:

• difficulty falling asleep, including difficulty finding a comfortable sleeping position;
• waking during the night and being unable to return to sleep;
• feeling unrefreshed upon waking;
• daytime sleepiness, irritability or anxiety.

Sleep-onset insomnia is difficulty falling asleep at the beginning of the night, often a symptom of anxiety disorders. Delayed sleep phase disorder can be misdiagnosed as insomnia, as sleep onset is delayed to much later than normal while awakening spills over into daylight hours.

It is common for patients who have difficulty falling asleep to also have nocturnal awakenings with difficulty returning to sleep. Two-thirds of these patients wake up in the middle of the night, with more than half having trouble falling back to sleep after a middle-of-the-night awakening.

Early morning awakening is an awakening occurring earlier (more than 30 minutes) than desired with an inability to go back to sleep, and before total sleep time reaches 6.5 hours. Early morning awakening is often a characteristic of depression.

Poor sleep quality

Poor sleep quality can occur as a result of, for example, restless legs, sleep apnea or major depression. Poor sleep quality is defined as the individual not reaching stage 3 or delta sleep which has restorative properties.

Major depression leads to alterations in the function of the hypothalamic-pituitary-adrenal axis, causing excessive release of cortisol which can lead to poor sleep quality.

Nocturnal polyuria, excessive nighttime urination, can be very disturbing to sleep.

Subjectivity

Some cases of insomnia are not really insomnia in the traditional sense, because people experiencing sleep state misperception often sleep for a normal amount of time. The problem is that, despite sleeping for multiple hours each night and typically not experiencing significant daytime sleepiness or other symptoms of sleep loss, they do not feel like they have slept very much, if at all. Because their perception of their sleep is incomplete, they incorrectly believe it takes them an abnormally long time to fall asleep, and they underestimate how long they remain asleep.

Causes

Symptoms of insomnia can be caused by or be associated with:

• Use of psychoactive drugs (such as stimulants), including certain medications, herbs, caffeine, nicotine, cocaine, amphetamines, methylphenidate, aripiprazole, MDMA, modafinil, or excessive alcohol intake;
• Use of or withdrawal from alcohol and other sedatives, such as anti-anxiety and sleep drugs like benzodiazepines;
• Use of or withdrawal from pain-relievers such as opioids;
• Previous thoracic surgery;
• Heart disease;
• Deviated nasal septum and nocturnal breathing disorders;
• Restless legs syndrome, which can cause sleep onset insomnia due to the discomforting sensations felt and the need to move the legs or other body parts to relieve these sensations;
• Periodic limb movement disorder (PLMD), which occurs during sleep and can cause arousals of which the sleeper is unaware;
• Pain, an injury or condition that causes pain can preclude an individual from finding a comfortable position in which to fall asleep, and can in addition cause awakening;
• Hormone shifts such as those that precede menstruation and those during menopause;
• Life events such as fear, stress, anxiety, emotional or mental tension, work problems, financial stress, birth of a child, and bereavement;
• Gastrointestinal issues such as heartburn or constipation;
• Mental disorders such as bipolar disorder, clinical depression, generalized anxiety disorder, post traumatic stress disorder, schizophrenia, obsessive compulsive disorder, dementia, and ADHD;
• Disturbances of the circadian rhythm, such as shift work and jet lag, can cause an inability to sleep at some times of the day and excessive sleepiness at other times of the day. Chronic circadian rhythm disorders are characterized by similar symptoms;
• Certain neurological disorders, brain lesions, or a history of traumatic brain injury;
• Medical conditions such as hyperthyroidism and rheumatoid arthritis;
• Abuse of over-the counter or prescription sleep aids (sedative or depressant drugs) can produce rebound insomnia;
• Poor sleep hygiene, e.g., noise or over-consumption of caffeine;
• A rare genetic condition can cause a prion-based, permanent and eventually fatal form of insomnia called fatal familial insomnia;
• Physical exercise --exercise-induced insomnia is common in athletes in the form of prolonged sleep onset latency;
• Increased exposure to the blue light from artificial sources, such as phones or computers.

Sleep studies using polysomnography have suggested that people who have sleep disruption have elevated nighttime levels of circulating cortisol and adrenocorticotropic hormone. They also have an elevated metabolic rate, which does not occur in people who do not have insomnia but whose sleep is intentionally disrupted during a sleep study. Studies of brain metabolism using positron emission tomography (PET) scans indicate that people with insomnia have higher metabolic rates by night and by day. The question remains whether these changes are the causes or consequences of long-term insomnia.

Genetics

Heritability estimates of insomnia vary between 38% in males to 59% in females. A genome-wide association study (GWAS) identified 3 genomic loci and 7 genes that influence the risk of insomnia, and showed that insomnia is highly polygenic. In particular, a strong positive association was observed for the MEIS1 gene in both males and females. This study showed that the genetic architecture of insomnia strongly overlaps with psychiatric disorders and metabolic traits.

Substance-induced

Alcohol-induced

Alcohol is often used as a form of self-treatment of insomnia to induce sleep. However, alcohol use to induce sleep can be a cause of insomnia. Long-term use of alcohol is associated with a decrease in NREM stage 3 and 4 sleep as well as suppression of REM sleep and REM sleep fragmentation. Frequent moving between sleep stages occurs, with awakenings due to headaches, the need to urinate, dehydration, and excessive sweating. Glutamine rebound also plays a role as when someone is drinking; alcohol inhibits glutamine, one of the body's natural stimulants. When the person stops drinking, the body tries to make up for lost time by producing more glutamine than it needs. The increase in glutamine levels stimulates the brain while the drinker is trying to sleep, keeping him/her from reaching the deepest levels of sleep. Stopping chronic alcohol use can also lead to severe insomnia with vivid dreams. During withdrawal REM sleep is typically exaggerated as part of a rebound effect.

Benzodiazepine-induced

Like alcohol, benzodiazepines, such as alprazolam, clonazepam, lorazepam, and diazepam, are commonly used to treat insomnia in the short-term (both prescribed and self-medicated), but worsen sleep in the long-term. While benzodiazepines can put people to sleep (i.e., inhibit NREM stage 1 and 2 sleep), while asleep, the drugs disrupt sleep architecture: decreasing sleep time, delaying time to REM sleep, and decreasing deep slow-wave sleep (the most restorative part of sleep for both energy and mood).

Opioid-induced

Opioid medications such as hydrocodone, oxycodone, and morphine are used for insomnia that is associated with pain due to their analgesic properties and hypnotic effects. Opioids can fragment sleep and decrease REM and stage 2 sleep. By producing analgesia and sedation, opioids may be appropriate in carefully selected patients with pain-associated insomnia. However, dependence on opioids can lead to long-term sleep disturbances.

Risk factors

Insomnia affects people of all age groups but people in the following groups have a higher chance of acquiring insomnia;

• Individuals older than 60;
• History of mental health disorder including depression, etc.;
• Emotional stress;
• Working late night shifts;
• Traveling through different time zones.

Mechanism

Two main models exists as to the mechanism of insomnia, (1) cognitive and (2) physiological. The cognitive model suggests rumination and hyperarousal contribute to preventing a person from falling asleep and might lead to an episode of insomnia.

The physiological model is based upon three major findings in people with insomnia; firstly, increased urinary cortisol and catecholamines have been found suggesting increased activity of the HPA axis and arousal; second increased global cerebral glucose utilization during wakefulness and NREM sleep in people with insomnia; and lastly increased full body metabolism and heart rate in those with insomnia. All these findings taken together suggest a dysregulation of the arousal system, cognitive system, and HPA axis all contributing to insomnia. However, it is unknown if the hyperarousal is a result of, or cause of insomnia. Altered levels of the inhibitory neurotransmitter GABA have been found, but the results have been inconsistent, and the implications of altered levels of such a ubiquitous neurotransmitter are unknown. Studies on whether insomnia is driven by circadian control over sleep or a wake dependent process have shown inconsistent results, but some literature suggests a dysregulation of the circadian rhythm based on core temperature. Increased beta activity and decreased delta wave activity has been observed on electroencephalograms; however, the implication of this is unknown.

Around half of post-menopausal women experience sleep disturbances, and generally sleep disturbance is about twice as common in women as men; this appears to be due in part, but not completely, to changes in hormone levels, especially in and post-menopause.

Changes in sex hormones in both men and women as they age may account in part for increased prevalence of sleep disorders in older people.

Diagnosis

In medicine, insomnia is widely measured using the Athens insomnia scale. It is measured using eight different parameters related to sleep, finally represented as an overall scale which assesses an individual's sleep pattern.

A qualified sleep specialist should be consulted for the diagnosis of any sleep disorder so the appropriate measures can be taken. Past medical history and a physical examination need to be done to eliminate other conditions that could be the cause of insomnia. After all other conditions are ruled out a comprehensive sleep history should be taken. The sleep history should include sleep habits, medications (prescription and non-prescription), alcohol consumption, nicotine and caffeine intake, co-morbid illnesses, and sleep environment. A sleep diary can be used to keep track of the individual's sleep patterns. The diary should include time to bed, total sleep time, time to sleep onset, number of awakenings, use of medications, time of awakening, and subjective feelings in the morning. The sleep diary can be replaced or validated by the use of out-patient actigraphy for a week or more, using a non-invasive device that measures movement.

Workers who complain of insomnia should not routinely have polysomnography to screen for sleep disorders. This test may be indicated for patients with symptoms in addition to insomnia, including sleep apnea, obesity, a thick neck diameter, or high-risk fullness of the flesh in the oropharynx. Usually, the test is not needed to make a diagnosis, and insomnia especially for working people can often be treated by changing a job schedule to make time for sufficient sleep and by improving sleep hygiene.

Some patients may need to do an overnight sleep study to determine if insomnia is present. Such a study will commonly involve assessment tools including a polysomnogram and the multiple sleep latency test. Specialists in sleep medicine are qualified to diagnose disorders within the, according to the ICSD, 81 major sleep disorder diagnostic categories. Patients with some disorders, including delayed sleep phase disorder, are often mis-diagnosed with primary insomnia; when a person has trouble getting to sleep and awakening at desired times, but has a normal sleep pattern once asleep, a circadian rhythm disorder is a likely cause.

In many cases, insomnia is co-morbid with another disease, side-effects from medications, or a psychological problem. Approximately half of all diagnosed insomnia is related to psychiatric disorders. In depression in many cases "insomnia should be regarded as a co-morbid condition, rather than as a secondary one;" insomnia typically predates psychiatric symptoms. "In fact, it is possible that insomnia represents a significant risk for the development of a subsequent psychiatric disorder." Insomnia occur in between 60% and 80% of people with depression. This may partly be due to treatment used for depression.

Determination of causation is not necessary for a diagnosis.

DSM-5 criteria

The DSM-5 criteria for insomnia include the following:

Predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms:

• Difficulty initiating sleep; (In children, this may manifest as difficulty initiating sleep without caregiver intervention.)
• Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings; (In children, this may manifest as difficulty returning to sleep without caregiver intervention.)
• Early-morning awakening with inability to return to sleep;

In addition,

• The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning;
• The sleep difficulty occurs at least 3 nights per week;
• The sleep difficulty is present for at least 3 months;
• The sleep difficulty occurs despite adequate opportunity for sleep;
• The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia);
• The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication);
• Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia;

Types

Insomnia can be classified as transient, acute, or chronic.

1. Transient insomnia lasts for less than a week. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe depression, or by stress. Its consequences – sleepiness and impaired psychomotor performance – are similar to those of sleep deprivation.
2. Acute insomnia is the inability to consistently sleep well for a period of less than a month. Insomnia is present when there is difficulty initiating or maintaining sleep or when the sleep that is obtained is non-refreshing or of poor quality. These problems occur despite adequate opportunity and circumstances for sleep and they must result in problems with daytime function. Acute insomnia is also known as short term insomnia or stress related insomnia.
3. Chronic insomnia lasts for longer than a month. It can be caused by another disorder, or it can be a primary disorder. People with high levels of stress hormones or shifts in the levels of cytokines are more likely than others to have chronic insomnia. Its effects can vary according to its causes. They might include muscular weariness, hallucinations, and/or mental fatigue. Chronic insomnia can cause double vision.

Prevention

Prevention and treatment of insomnia may require a combination of cognitive behavioral therapy, medications, and lifestyle changes.

Among lifestyle practices, going to sleep and waking up at the same time each day can create a steady pattern which may help to prevent insomnia. Avoidance of vigorous exercise and caffeinated drinks a few hours before going to sleep is recommended, while exercise earlier in the day may be beneficial. Other practices to improve sleep hygiene may include:

• Avoiding or limiting naps;
• Treating pain at bedtime;
• Avoiding large meals, beverages, alcohol, and nicotine before bedtime;
• Finding soothing ways to relax into sleep, including use of white noise;
• Making the bedroom suitable for sleep by keeping it dark, cool, and free of devices, such as clocks, a cell phone, or television.

Management

It is important to identify or rule out medical and psychological causes before deciding on the treatment for insomnia. Cognitive behavioral therapy has been found to be as effective as medications for the short-term treatment of chronic insomnia. The beneficial effects, in contrast to those produced by medications, may last well beyond the stopping of therapy. Medications have been used mainly to reduce symptoms in insomnia of short duration; their role in the management of chronic insomnia remains unclear. Several different types of medications are also effective for treating insomnia. However, many doctors do not recommend relying on prescription sleeping pills for long-term use. It is also important to identify and treat other medical conditions that may be contributing to insomnia, such as depression, breathing problems, and chronic pain.

Non-medication based

Non-medication based strategies have comparable efficacy to hypnotic medication for insomnia and they may have longer lasting effects. Hypnotic medication is only recommended for short-term use because dependence with rebound withdrawal effects upon discontinuation or tolerance can develop.

Non medication based strategies provide long lasting improvements to insomnia and are recommended as a first line and long-term strategy of management. The strategies include attention to sleep hygiene, stimulus control, behavioral interventions, sleep-restriction therapy, paradoxical intention, patient education, and relaxation therapy. Some examples are keeping a journal, restricting the time spent awake in bed, practicing relaxation techniques, and maintaining a regular sleep schedule and a wake-up time. Behavioral therapy can assist a patient in developing new sleep behaviors to improve sleep quality and consolidation. Behavioral therapy may include, learning healthy sleep habits to promote sleep relaxation, undergoing light therapy to help with worry-reduction strategies and regulating the circadian clock.

Music may improve insomnia in adults. EEG biofeedback has demonstrated effectiveness in the treatment of insomnia with improvements in duration as well as quality of sleep. Self-help therapy (defined as a psychological therapy that can be worked through on one's own) may improve sleep quality for adults with insomnia to a small or moderate degree.

Stimulus control therapy is a treatment for patients who have conditioned themselves to associate the bed, or sleep in general, with a negative response. As stimulus control therapy involves taking steps to control the sleep environment, it is sometimes referred interchangeably with the concept of sleep hygiene. Examples of such environmental modifications include using the bed for sleep or sex only, not for activities such as reading or watching television; waking up at the same time every morning, including on weekends; going to bed only when sleepy and when there is a high likelihood that sleep will occur; leaving the bed and beginning an activity in another location if sleep does not result in a reasonably brief period of time after getting into bed (commonly ~20 min); reducing the subjective effort and energy expended trying to fall asleep; avoiding exposure to bright light during nighttime hours, and eliminating daytime naps.

A component of stimulus control therapy is sleep restriction, a technique that aims to match the time spent in bed with actual time spent asleep. This technique involves maintaining a strict sleep-wake schedule, sleeping only at certain times of the day and for specific amounts of time to induce mild sleep deprivation. Complete treatment usually lasts up to 3 weeks and involves making oneself sleep for only a minimum amount of time that they are actually capable of on average, and then, if capable (i.e. when sleep efficiency improves), slowly increasing this amount (~15 min) by going to bed earlier as the body attempts to reset its internal sleep clock. Bright light therapy, which is often used to help early morning wakers reset their natural sleep cycle, can also be used with sleep restriction therapy to reinforce a new wake schedule. Although applying this technique with consistency is difficult, it can have a positive effect on insomnia in motivated patients.

Paradoxical intention is a cognitive reframing technique where the insomniac, instead of attempting to fall asleep at night, makes every effort to stay awake (i.e. essentially stops trying to fall asleep). One theory that may explain the effectiveness of this method is that by not voluntarily making oneself go to sleep, it relieves the performance anxiety that arises from the need or requirement to fall asleep, which is meant to be a passive act. This technique has been shown to reduce sleep effort and performance anxiety and also lower subjective assessment of sleep-onset latency and overestimation of the sleep deficit (a quality found in many insomniacs).

Sleep hygiene

Sleep hygiene is a common term for all of the behaviors which relate to the promotion of good sleep. These behaviors are used as the basis of sleep interventions and are the primary focus of sleep education programs. Behaviors include reducing caffeine, nicotine, and alcohol consumption, maximizing the regularity and efficiency of sleep episodes, minimizing medication usage and daytime napping, the promotion of regular exercise, and the facilitation of a positive sleep environment. Exercise can be helpful when establishing a routine for sleep but should not be done close to the time that you are planning on going to sleep. The creation of a positive sleep environment may also be helpful in reducing the symptoms of insomnia. In order to create a positive sleep environment one should remove objects that can cause worry or distressful thoughts from view.

Cognitive behavioral therapy

There is some evidence that cognitive behavioural therapy (CBT) for insomnia is superior in the long-term to benzodiazepines and the nonbenzodiazepines in the treatment and management of insomnia. In this therapy, patients are taught improved sleep habits and relieved of counter-productive assumptions about sleep. Common misconceptions and expectations that can be modified include:

1. unrealistic sleep expectations (e.g., I need to have 8 hours of sleep each night);
2. misconceptions about insomnia causes (e.g., I have a chemical imbalance causing my insomnia);
3. amplifying the consequences of insomnia (e.g., I cannot do anything after a bad night's sleep);
4. performance anxiety after trying for so long to have a good night's sleep by controlling the sleep process.

Numerous studies have reported positive outcomes of combining cognitive behavioral therapy for insomnia treatment with treatments such as stimulus control and the relaxation therapies. Hypnotic medications are equally effective in the short-term treatment of insomnia, but their effects wear off over time due to tolerance. The effects of CBT-I have sustained and lasting effects on treating insomnia long after therapy has been discontinued. The addition of hypnotic medications with CBT-I adds no benefit in insomnia. The long lasting benefits of a course of CBT-I shows superiority over pharmacological hypnotic drugs. Even in the short term when compared to short-term hypnotic medication such as zolpidem (Ambien), CBT-I still shows significant superiority. Thus CBT-I is recommended as a first line treatment for insomnia.

Metacognition is a recent trend in approach to behaviour therapy of insomnia.

Internet interventions

Despite the therapeutic effectiveness and proven success of CBT, treatment availability is significantly limited by a lack of trained clinicians, poor geographical distribution of knowledgeable professionals, and expense. One way to potentially overcome these barriers is to use the Internet to deliver treatment, making this effective intervention more accessible and less costly. The Internet has already become a critical source of health-care and medical information. Although the vast majority of health websites provide general information, there is growing research literature on the development and evaluation of Internet interventions.

These online programs are typically behaviorally-based treatments that have been operationalized and transformed for delivery via the Internet. They are usually highly structured; automated or human supported; based on effective face-to-face treatment; personalized to the user; interactive; enhanced by graphics, animations, audio, and possibly video; and tailored to provide follow-up and feedback.

There is good evidence for the use of computer based CBT for insomnia.

Medications

Many people with insomnia use sleeping tablets and other sedatives. In some places medications are prescribed in over 95% of cases. They, however, are a second line treatment.

The percentage of adults using a prescription sleep aid increases with age. During 2005–2010, about 4% of U.S. adults aged 20 and over reported that they took prescription sleep aids in the past 30 days. Rates of use were lowest among the youngest age group (those aged 20–39) at about 2%, increased to 6% among those aged 50–59, and reached 7% among those aged 80 and over. More adult women (5.0%) reported using prescription sleep aids than adult men (3.1%). Non-Hispanic white adults reported higher use of sleep aids (4.7%) than non-Hispanic black (2.5%) and Mexican-American (2.0%) adults. No difference was shown between non-Hispanic black adults and Mexican-American adults in use of prescription sleep aids.

Antihistamines

As an alternative to taking prescription drugs, some evidence shows that an average person seeking short-term help may find relief by taking over-the-counter antihistamines such as diphenhydramine or doxylamine. Diphenhydramine and doxylamine are widely used in nonprescription sleep aids. They are the most effective over-the-counter sedatives currently available, at least in much of Europe, Canada, Australia, and the United States, and are more sedating than some prescription hypnotics. Antihistamine effectiveness for sleep may decrease over time, and anticholinergic side-effects (such as dry mouth) may also be a drawback with these particular drugs. While addiction does not seem to be an issue with this class of drugs, they can induce dependence and rebound effects upon abrupt cessation of use. However, people whose insomnia is caused by restless legs syndrome may have worsened symptoms with antihistamines.

Melatonin

The evidence for melatonin in treating insomnia is generally poor. There is low quality evidence that it may speed the onset of sleep by 6 minutes. Ramelteon, a melatonin receptor agonist, does not appear to speed the onset of sleep or the amount of sleep a person gets.

Most melatonin drugs have not been tested for longitudinal side effects. Prolonged-release melatonin may improve quality of sleep in older people with minimal side effects.

Studies have also shown that children who are on the Autism spectrum or have learning disabilities, Attention-Deficit Hyperactivity Disorder (ADHD) or related neurological diseases can benefit from the use of melatonin. This is because they often have trouble sleeping due to their disorders. For example, children with ADHD tend to have trouble falling asleep because of their hyperactivity and, as a result, tend to be tired during most of the day. Another cause of insomnia in children with ADHD is the use of stimulants used to treat their disorder. Children who have ADHD then, as well as the other disorders mentioned, may be given melatonin before bedtime in order to help them sleep.

Antidepressants

While insomnia is a common symptom of depression, antidepressants are effective for treating sleep problems whether or not they are associated with depression. While all antidepressants help regulate sleep, some antidepressants such as amitriptyline, doxepin, mirtazapine, and trazodone can have an immediate sedative effect, and are prescribed to treat insomnia. Amitriptyline and doxepin both have antihistaminergic, anticholinergic, and antiadrenergic properties, which contribute to both their therapeutic effects and side effect profiles, while mirtazapine's side effects are primarily antihistaminergic, and trazodone's side-effects are primarily antiadrenergic. Mirtazapine is known to decrease sleep latency (i.e., the time it takes to fall asleep), promoting sleep efficiency and increasing the total amount of sleeping time in people with both depression and insomnia.

Agomelatine, a melatonergic antidepressant with sleep-improving qualities that does not cause daytime drowsiness, is licensed for marketing in the European Union and TGA Australia. After trials in the United States its development for use there was discontinued in October 2011 by Novartis, who had bought the rights to market it there from the European pharmaceutical company Servier.

Benzodiazepines

Normison (temazepam) is a benzodiazepine commonly prescribed for insomnia and other sleep disorders

The most commonly used class of hypnotics for insomnia are the benzodiazepines. Benzodiazepines are not significantly better for insomnia than antidepressants. Chronic users of hypnotic medications for insomnia do not have better sleep than chronic insomniacs not taking medications. In fact, chronic users of hypnotic medications have more regular nighttime awakenings than insomniacs not taking hypnotic medications. Many have concluded that these drugs cause an unjustifiable risk to the individual and to public health and lack evidence of long-term effectiveness. It is preferred that hypnotics be prescribed for only a few days at the lowest effective dose and avoided altogether wherever possible, especially in the elderly. Between 1993 and 2010, the prescribing of benzodiazepines to individuals with sleep disorders has decreased from 24% to 11% in the US, coinciding with the first release of nonbenzodiazepines.

The benzodiazepine and nonbenzodiazepine hypnotic medications also have a number of side-effects such as day time fatigue, motor vehicle crashes and other accidents, cognitive impairments, and falls and fractures. Elderly people are more sensitive to these side-effects. Some benzodiazepines have demonstrated effectiveness in sleep maintenance in the short term but in the longer term benzodiazepines can lead to tolerance, physical dependence, benzodiazepine withdrawal syndrome upon discontinuation, and long-term worsening of sleep, especially after consistent usage over long periods of time. Benzodiazepines, while inducing unconsciousness, actually worsen sleep as—like alcohol—they promote light sleep while decreasing time spent in deep sleep. A further problem is, with regular use of short-acting sleep aids for insomnia, daytime rebound anxiety can emerge. Although there is little evidence for benefit of benzodiazepines in insomnia compared to other treatments and evidence of major harm, prescriptions have continued to increase. This is likely due to their addictive nature, both due to misuse and because—through their rapid action, tolerance and withdrawal—they can "trick" insomniacs into thinking they are helping with sleep. There is a general awareness that long-term use of benzodiazepines for insomnia in most people is inappropriate and that a gradual withdrawal is usually beneficial due to the adverse effects associated with the long-term use of benzodiazepines and is recommended whenever possible.

Benzodiazepines all bind unselectively to the GABA_A receptor. Some theorize that certain benzodiazepines (hypnotic benzodiazepines) have significantly higher activity at the α₁ subunit of the GABA_A receptor compared to other benzodiazepines (for example, triazolam and temazepam have significantly higher activity at the α₁ subunit compared to alprazolam and diazepam, making them superior sedative-hypnotics – alprazolam and diazepam, in turn, have higher activity at the α₂ subunit compared to triazolam and temazepam, making them superior anxiolytic agents). Modulation of the α₁ subunit is associated with sedation, motor impairment, respiratory depression, amnesia, ataxia, and reinforcing behavior (drug-seeking behavior). Modulation of the α₂ subunit is associated with anxiolytic activity and disinhibition. For this reason, certain benzodiazepines may be better suited to treat insomnia than others.

Other sedatives

Drugs that may prove more effective and safer than benzodiazepines for insomnia is an area of active research. Nonbenzodiazepine sedative-hypnotic drugs, such as zolpidem, zaleplon, zopiclone, and eszopiclone, are a class of hypnotic medications that are similar to benzodiazepines in their mechanism of action, and indicated for mild to moderate insomnia. Their effectiveness at improving time to sleeping is slight, and they have similar—though potentially less severe—side effect profiles compared to benzodiazepines.

Suvorexant is FDA approved for insomnia, characterized by difficulties with sleep onset and/or sleep maintenance. Prescribing of nonbenzodiazepines has seen a general increase since their initial release on the US market in 1992, from 2.3% in 1993 among individuals with sleep disorders to 13.7% in 2010.

Barbiturates, while once used, are no longer recommended for insomnia due to the risk of addiction and other side affects.

Antipsychotics

The use of antipsychotics for insomnia, while common, is not recommended as the evidence does not demonstrate a benefit and the risk of adverse effects is significant. Concerns regarding side effects is greater in the elderly.

Alternative medicine

Some insomniacs use herbs such as valerian, chamomile, lavender, cannabis, hops, Withania somnifera, and passion-flower. L-Arginine L-aspartate, S-adenosyl-L-homocysteine, and delta sleep-inducing peptide (DSIP) may also be helpful in alleviating insomnia. It is unclear if acupuncture is useful.

Prognosis

Disability-adjusted life year for insomnia per 100,000 inhabitants in 2004

.

  no data

  less than 25

  25–30.25

  30.25–36

  36–41.5

  41.5–47

  47–52.5

  52.5–58

  58–63.5

  63.5–69

  69–74.5

  74.5–80

  more than 80

A survey of 1.1 million residents in the United States found that those that reported sleeping about 7 hours per night had the lowest rates of mortality, whereas those that slept for fewer than 6 hours or more than 8 hours had higher mortality rates. Getting 8.5 or more hours of sleep per night was associated with a 15% higher mortality rate. Severe insomnia – sleeping less than 3.5 hours in women and 4.5 hours in men – is associated with a 15% increase in mortality.

With this technique, it is difficult to distinguish lack of sleep caused by a disorder which is also a cause of premature death, versus a disorder which causes a lack of sleep, and the lack of sleep causing premature death. Most of the increase in mortality from severe insomnia was discounted after controlling for co-morbid disorders. After controlling for sleep duration and insomnia, use of sleeping pills was also found to be associated with an increased mortality rate.

The lowest mortality was seen in individuals who slept between six and a half and seven and a half hours per night. Even sleeping only 4.5 hours per night is associated with very little increase in mortality. Thus, mild to moderate insomnia for most people is associated with increased longevity and severe insomnia is associated only with a very small effect on mortality. It is unclear why sleeping longer than 7.5 hours is associated with excess mortality.

Epidemiology

Between 10% and 30% of adults have insomnia at any given point in time and up to half of people have insomnia in a given year. About 6% of people have insomnia that is not due to another problem and lasts for more than a month. People over the age of 65 are affected more often than younger people. Females are more often affected than males. Insomnia is 40% more common in women than in men.

There are higher rates of insomnia reported among university students compared to the general population.

Society and culture

The topic of insomnia is discussed in many cultural contexts.

The word insomnia is from Latin: in + somnus "without sleep" and -ia as nominalizing suffix.
The popular press have published stories about people who supposedly never sleep, such as that of Paul Kern and Al Herpin; however, these stories are not accurate.