insomnia Flashcards
what are the symptoms of insomnia?
- Disturbed sleep
- Trouble getting to sleep
- Unintentional early morning waking
- Feeling tired throughout the day despite having had a full night of sleep
what are the red flag warnings for insomnia?
• Chronic insomnia
• Patients whose alertness is compromised by insomnia and puts them at risk of danger
from accidents (for example, lorry drivers) should be referred to the GP
• Suspected adverse effect from a medication, e.g.:
o Fluoxetine
o Monoamine oxidase inhibitors (MAOIs) o Corticosteroids
o Phenytoin
o Theophylline
• Suspected depression
o Insomnia and early morning waking are often presenting symptoms of depression
and/or drug abuse. It is important to refer these patients to the GP for assessment
• Children under 16 years
• Patients with conditions that would mean antihistamine treatment of insomnia is contraindicated, e.g. those with prostatic hypertrophy or closed angle glaucoma
what are the lifestyle advice for insomnia?
• Avoiding caffeine and alcohol near bedtime
• Avoiding screens before bed
• Having a warm bath or shower before bed
• Finding methods to reduce snoring
• Avoidance of daytime napping, as this increases the likelihood of insomnia
• Stress reduction and relaxation techniques such as yoga and meditation
• Regular exercise can aid sleep, but it is important to not do so near to bedtime
• If unable to sleep for a while, it may be more helpful to go into another room to relax, and
then return to bed when drowsy
• Some patients may find it useful to keep a sleep diary to note down the factors which can
influence their sleep
what are some of the drug treatment options for insomnia?
antihistamines, complementary medicines
which antihistamines can be used for insomnia?
Promethazine, Diphenhydramine
who should not use antihistamines for insomnis?
- Diphenhydramine is not suitable for use in children under the age of 16 years
- Not suitable in pregnancy or breastfeeding
what are examples of complementary medicines?
Valerian, Skullcap, Passionflower, Chamomile, Melatonin
who is rebound insomnia common in?
Rebound insomnia can occur due to withdrawal of hypnotic medications (e.g. zopiclone) or antidepressants. It is important to explain this to patients who have recently stopped taking these medications and to advise on slow, gradual withdrawal under medical supervision.
