Insomnia Flashcards
What is insomnia ?
In the DSM-V, insomnia is defined as difficulty initiating or maintaining sleep, or early-morning awakening that leads to dissatisfaction with sleep quantity or quality. This is despite adequate time and opportunity for sleep and results in impaired daytime functioning.
Chronic vs acute insomnia?
Insomnia may be considered acute or chronic. Acute insomnia is more typically related to a life event and resolves without treatment. Chronic insomnia may be diagnosed if a person has trouble falling asleep or staying asleep at least three nights per week for 3 months or longer.
Risk factors?
Female gender
Increased age
Lower educational attainment
Unemployment
Economic inactivity
Widowed, divorced, or separated status
Alcohol and substance abuse
Stimulant usage
Medications such as corticosteroids
Poor sleep hygiene
Chronic pain
Diagnostic factors that are less common?
Daytime napping
Enlarged tonsils or tongue
Micrognathia (small jaw) and retrognathia
Lateral narrowing of oropharynx
Investigation?
Diagnosis is primarily made through patient interview, looking for the presence of risk factors.
Sleep diaries and actigraphy may aid diagnosis. Actigraphy is a non-invasive method for monitoring motor activity.
Polysomnography is not routinely indicated. It may be considered in patients with suspected obstructive sleep apnoea or periodic limb movement disorder, or when insomnia is poorly responsive to conventional treatment.
Short term management of insomnia ?
Identify any potential causes e.g. mental/ physical health issues or poor sleep hygiene.
Advise the person not to drive while sleepy.
Advise good sleep hygiene: no screens before bed, limited caffeine intake, fixed bed times etc.
ONLY consider use of hypnotics if daytime impairment is severe.
The hypnotics recommended for treating insomnia are short-acting benzodiazepines or non-benzodiazepines (zopiclone, zolpidem and zaleplon).
Review for CBT 2 weeks after
