- Stimulants
- Antidepressants
- Corticosteroids
- Beta agonists
- Antiparkinsonian agents

Drugs that induce insomnia:

- Trouble falling asleep
- Difficulty staying asleep
- Waking up too early
- Poor quality of sleep overall

Symptoms of insomnia

- sleep-onset insomnia
- sleep-maintenance insomnia

Kinds of Insomnia

The metacognitive model of insomnia posits that the hyperarousal experienced during insomnia can be split into two areas. The first area is primary arousal, which includes the cognitive activities related to ones inability to fall asleep. The second area is secondary arousal, which refers to one’s relationship with their thoughts about sleep. 

Metacognitve Model of Insomnia

For a clinical diagnosis of insomnia, the characteristic difficulties with falling or staying asleep must meet specific frequency and duration thresholds. The symptoms are required to be present for at least three nights per week and must persist for a minimum of one month.

Diagnostic Criteria for Insomnia (Frequency and Duration)

A common issue for those with insomnia is developing anxiety about their inability to sleep. This anxiety increases physiological arousal, which in turn makes falling asleep more difficult, thereby reinforcing the anxiety and creating a self-perpetuating cycle.

Self-Perpetuating Cycle of Insomnia and Anxiety

Chronic insomnia is almost invariably linked with feeling overtired. Additionally, it often co-occurs with symptoms of depression, indicating a strong association between long-term sleep difficulties and mood disorders.

Association Between Chronic Insomnia, Fatigue, and Depression

A variety of factors can contribute to the development of insomnia. These include an individual's age, use of certain drugs, amount of physical exercise, mental state, and established bedtime routines.

Factors Contributing to Insomnia

For many college students, the inability to get the recommended 7–9 hours of sleep nightly is not a result of lifestyle choices like partying or studying late. Instead, it often stems from feeling overwhelmed and stressed, which directly interferes with their ability to fall asleep or stay asleep.

Stress-Induced Insomnia in College Students

Insomnia, the most prevalent sleep disorder, is characterized by a persistent difficulty in initiating or maintaining sleep. Individuals with this condition often experience significant delays before falling asleep and may wake up frequently during the night, struggling to resume sleep. According to diagnostic criteria, these sleep disturbances must occur at least three nights a week for a minimum of one month.

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- Cerebrovascular Effect
- Cognitive Impairment and Delirium
- Neuroleptic Malignant Syndrome
- Movement Disorders
- Seizure Disorders
- Serotonin Syndrome
- Insomnia

Examples of Drug-Induced Neurologic Conditions

Older adults are most commonly are diagnosed with depression, anxiety, insomnia, substance abuse, suicidal ideation, and dementia. 

Common Mental Health Conditions in Geriatric Adults

A subcategory of overall health relating to one's emotional well-being by one's ability to successfully overcome everyday stressors, to realize one's inner potential, and to work in a manner that gives back to the self and to their community.

Mental Health

The DSM-5-TR separates Sleep-Wake Disorders into the following specific disorders and groups:
-	Insomnia Disorder
-	Hypersomnolence Disorder
-	Narcolepsy
-	Breathing Related Sleep-Disorders*
-	Circadian Rhythm Sleep-Wake Disorders*
-	Parasomnias*
-	Restless Leg Syndrome
-	Substance / Medication-Induced Sleep Disorder
-	Other Specified Insomnia Disorder
-	Unspecified Insomnia Disorder
-	Other Specified Hypersomnolence Disorder
-	Unspecified Hypersomnolence Disorder
-	Other Specified Sleep-Wake Disorder
-	Unspecified Sleep-Wake Disorder

Note: * Groups that separate into further specific disorders

[DSM-5-TR] List of Sleep-Wake Disorders

Lane RJ, Routledge PA. Drug-induced neurological disorders. Drugs. 1983;26(2):124-147. doi:10.2165/00003495-198326020-00002



Drug-Induced Neurologic Conditions

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

Also known as cerebellar syndrome
It is a consequence of disrupting the normal function of the brain that is responsible for coordination and balance. Many cases are reversible but the permanent cerebellar syndrome can occur.

Cerebrovascular Effect

A drug-induced neurologic disorder caused by neuroleptic and antipsychotic drugs. Thought to result from dopamine receptor D2 blockade in the corpus striatum, spinal cord, and hypothalamus. Once begun, symptoms progress rapidly and reach peak severity at 72 hours. 

Neuroleptic Malignant Syndrome

Delirium can be a side effect of drugs, especially in elderly patients. It is acute in onset and results in fluctuations in cognition, mood, attention, and arousal. Delirium can also be reversed when the underlying causative agent is removed. Prescribers can refer to the Beers Criteria to determine which drugs are linked to cognitive impairment.

Delirium and Cognitive Impairment 

Serotonin Syndrome (SS) include predictable symptoms resulting from excess serotonin  and overstimulation of 5-HT receptors. SS can range from mild to severe and is potentially fatal, although its incidence is low.  SS rarely occurs with use of a single agent; it is more commonly the result of a drug-drug interaction. 

Serotonin Syndrome

- Symptoms associated with drug-induced seizures are similar to those of non-drug related seizures.
- Majority of seizures induced by drugs present as generalized tonic-clonic seizures
- The withdrawal of drugs such as benzodiazepines may provoke seizures
- It is important to consider whether the suspected drug has seizure potential at normal doses or at higher serum concentrations (as is the case with tricyclic antidepressants, theophylline, and clozapine)
- Many substances can lower the seizure threshold and cause seizures




Seizure Disorders

Drug-induced movement disorders (DIMDs) can reduce the quality of life, decrease drug adherence, and cause compromised performance of motor skills. 
Parkinsonism, akathisia, tardive syndrome, and acute dystonia are associated with DIMDs. 

Movement Disorders

Insomnia is a common health concern that causes significant distress and disruption in daily life, due to difficulty with and lack of sleep. Insomnia tends to be associated with an increased risk of developing physical health problems, anxiety, and depression.

Insomnia 

A sleep disorder that consists of not getting enough sleep.

Insomnia

Generally speaking, anxiety is a reaction by the body that ensues negative internal experiences such as negative thoughts or feelings. Physical changes may also follow, such as an increase in blood pressure, rapid heartbeat, trembling, and so on.

Anxiety

Dementia is characterized by memory loss and impairment of mental functioning that. Depression, paranoia, anxiety, confusion, and wandering are symptoms of the illness.

Dementia

Alcohol abuse is responsible for one in eight deaths among older Americans. It is predicted that there will be an increase in illicit drug use and alcohol abuse among the baby boomer cohort as many have showcased addiction to prescription medication in the past.

Substance Abuse in Geriatric People 

Older white Americans have the highest rates of suicide. Two-fifths of older adults who committed suicide visited their primary care physician in the past week and about three-quarters did so in the past month.

Suicide in Geriatric People

Geriatric nurses undergo chronic lack of time, irregular worktime, limiting career growth, disruptive patients and patient families, and stressors from losing patients. Altogether, this leads to anger, anxiety, depression, and frustration.

Common Mental Conditions in Geriatric Nurses

It is a mental disorder that affects a person's brain and behavior, leading to their inability to control their use of substances such as legal or illegal drugs, alcohol, or medication. Symptoms can range from moderate to severe, with addiction being the most powerful form of SUDs.

Substance Use Disorder

Between 10 and 20% of adolescents worldwide experience a mental health problem within a given 12-month period. Mental health problems impact on an adolescent’s potential to live a fulfilling and productive life and lead to challenges such as stigma, isolation and discrimination. 

Adolescent Mental Health

There is a need for global emphasis on more comprehensive mental health promotion and intervention in schools. The SMHILE (School Mental Health International Leadership Exchange) identified 5 critical themes for nations to advance SMH (=school mental health). Doing so, we can accomplish cross-nation collaboration among research and policy leaders from diverse countries and share experiences/lessons to improve SMH.


Comprehensive Mental Health Promotion & Intervention in School

The long-term physical, mental, emotional, and psychological effects of racism.

Weathering

Defines strategies that typically involve health-oriented public policies, an improvement in community action, significant positive changes in regards to creating healthy environments, development of essential personal skills, and the redistribution and improvement of health-related services.

Mental Health Promotion Strategies 

Assessments, treatments, and counseling resources offered in private, public, outpatient and inpatient facilities that focus on serving individuals experiencing mental health crises and issues. 

Mental Health Services

NIMH. (2022). Anxiety Disorders. National Institute of Mental Health. Retrieved March 12, 2022, from https://www.nimh.nih.gov/health/topics/anxiety-disorders 

Panic Disorder Reference

NIMH. (2022). NIMH. National Institute of Mental Health. Retrieved April 6, 2022, from https://www.nimh.nih.gov/ 

NIMH

Gender is a determinant of mental health. Different factors different genders face impacting their mental health and lives, social position, status, and treatment in society. Gender differences also occur in the rates of common mental disorders.

Gender and Mental Health

Emotion regulation is the process by which individuals manage their emotional responses to various situations and experiences. This involves altering their emotional experiences and how they are expressed.

Emotional Regulation

While wellbeing does not have a clear and universal definition, people believe that it can be conceptualized in a few ways:

- Positive Construct
- Subjective Construct
- Multi-dimensional Construct

Wellbeing

Shim, R. S., Compton, M. T., Rust, G., Druss, B. G., & Kaslow, N. J. (2009). Race-Ethnicity as a Predictor of Attitudes Toward Mental Health Treatment Seeking. Psychiatric Services, 60(10), 1336–1341. https://ps.psychiatryonline.org/doi/pdf/10.1176/ps.2009.60.10.1336 

Reference for Predictors in Mental Health Seeking Behaviors

 Societal or internal criticism that shames the desire for professional mental health support and can lead to negative changes in help seeking behaviors.

Mental Health Stigma

Conner, K. O., Copeland, V. C., Grote, N. K., Koeske, G., Rosen, D., Reynolds, C. F., 3rd, & Brown, C. (2010). Mental health treatment seeking among older adults with depression: the impact of stigma and race. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 18(6), 531–543. https://doi.org/10.1097/JGP.0b013e3181cc0366

Reference for Predictors in Mental Health Seeking Behaviors(Age)

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association in 2013, is the primary classification system used by most mental health professionals in the United States to diagnose psychological disorders.

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)

Non-Rapid Eye Movement Sleep Arousal (NREM) Disorders are characterized by repeated episodes incomplete awakenings during sleep that usually last about 1-10 minutes but can also last as long as 1 hour without any recollection. Little to no dream imagery is recalled. 

NREM Sleep Arousal Disorders


Narcolepsy is a sleep disorder characterized by an uncontrollable urge to fall asleep at inopportune times. These sleep episodes are frequently accompanied by cataplexy, a sudden loss of muscle tone. Narcoleptic attacks often exhibit features characteristic of REM sleep; for instance, about a third of those with the disorder report experiencing vivid, dream-like hallucinations during an episode.

Narcolepsy

Sleep apnea is a disorder characterized by episodes in which a person's breathing stops during sleep. These cessations can last for 10-20 seconds or longer and often result in brief arousals. Although individuals with sleep apnea may be unaware of these repeated sleep disruptions, they frequently experience significant daytime fatigue. The condition is commonly associated with loud snoring and is more prevalent in overweight people.

Sleep Apnea

A sleep disorder in which someone physically acts out their dream. This disorder typically presents after age 50, is more common in men than women, and usually followed by Parkinson’s and/or dementia symptoms, suggesting it’s the start of widespread neurodegeneration. Usually controlled by anti-anxiety drugs like benzodiazepines at night. 

REM Behavior Disorder

Somnambulism, or sleepwalking, is a condition more common in childhood that can persist into adulthood. It involves episodes of complex behaviors, lasting from seconds to minutes, which are often not remembered. While these episodes most frequently occur during stage 3 slow-wave sleep (SWS), they can happen at any time during a sleep period. Sleepwalkers are not acting out their dreams.

Somnambulism

Substance/medication-induced sleep disorders are characterized by a severe sleep disturbance that occurs during or soon after substance intoxication, medication exposure, or substance/medicine withdrawal.

Substance/Medication-Induced Sleep Disorder

* Obstructive Sleep Apnea Separate Specific Disorder
* Central Sleep Apnea
* Sleep-Related Hypoventilation


Specific Breathing Sleep-Related Disorders

Circadian rhythm sleep-wake disorders happen when constant patterns of sleep disturbances occur. These disturbances can be caused by a new circadian rhythm or discrepancies between the person’s circadian rhythm and the sleep-wake schedule that is demanded by the person’s social life, occupation, or environment.

Circadian Rhythm Sleep-Wake Disorders

Hypersomnolence disorder consists of sleeping for too many hours at night, trouble staying completely awake after being woken up, or frequent episodes of sleep throughout the day. 

Hypersomnolence Disorder

Reference for Sleep-Wake Disorders

REM behavior disorder (RBD), sleepwalking, restless leg syndrome, and night terrors are examples of parasomnias, which involve unwanted motor behaviors or experiences during the sleep cycle.

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