Insomnia

Question 1

diagnosis criteria for chronic insomnia

Answer 1

Chronic insomnia may be diagnosed after three months, if a person has trouble falling asleep or staying asleep at least three nights per week

Question 2

DSM-V insomnia definition

Answer 2

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.

Question 3

Insomnia clinical features

Answer 3

• decreased daytime functioning,
• decreased periods of sleep (delayed sleep onset or awakening in the night)
• or increased accidents due to poor concentration
• . Often the partner’s rest will also suffer. It is important to identify the aetiology of the insomnia, as management can differ.

Question 4

diagnostic factors and risk factors in insomnia

Answer 4

The following features are associated with insomnia:
* Female gender
* Increased age
* Lower educational attainment
* Unemployment
* Economic inactivity
* Widowed, divorced, or separated status

Other risk factors include:
* Alcohol and substance abuse
* Stimulant usage
* Medications such as corticosteroids
* Poor sleep hygiene
* Chronic pain
* Chronic illness: patients with illnesses such as diabetes, CAD, hypertension, heart failure, BPH and COPD have a higher prevalence of insomnia than the general population.
* Psychiatric illness: anxiety and depression are highly correlated with insomnia. People with manic episodes or PTSD will also complain of extended periods of sleeplessness.

Less common diagnostic factors may include:
* Daytime napping
* Enlarged tonsils or tongue
* Micrognathia (small jaw) and retrognathia
* Lateral narrowing of oropharynx

Question 5

Investigations in insomnia

Answer 5

• 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.

Question 6

Short term management of insomnia and advice on drug management

Answer 6