insomnia_flashcards
What is insomnia according to the DSM-V?
Difficulty initiating or maintaining sleep, or early-morning awakening that leads to dissatisfaction with sleep quantity or quality, despite adequate time and opportunity for sleep, resulting in impaired daytime functioning.
How is acute insomnia typically related and how does it resolve?
Typically related to a life event and resolves without treatment.
When is chronic insomnia diagnosed?
If a person has trouble falling asleep or staying asleep at least three nights per week for 3 months or longer.
What are the common symptoms patients with insomnia present with?
Decreased daytime functioning, decreased periods of sleep, increased accidents due to poor concentration, and partner’s rest suffering.
Why is it important to identify the aetiology of insomnia?
Because management can differ based on the cause.
What features are associated with insomnia?
Female gender, increased age, lower educational attainment, unemployment, economic inactivity, widowed, divorced, or separated status.
What are some other risk factors for insomnia?
Alcohol and substance abuse, stimulant usage, medications such as corticosteroids, poor sleep hygiene, chronic pain, chronic illness, psychiatric illness.
What are some less common diagnostic factors for insomnia?
Daytime napping, enlarged tonsils or tongue, micrognathia, retrognathia, lateral narrowing of oropharynx.
How is the diagnosis of insomnia primarily made?
Through patient interview and looking for the presence of risk factors.
What tools may aid in the diagnosis of insomnia?
Sleep diaries and actigraphy.
When is polysomnography considered for insomnia patients?
In patients with suspected obstructive sleep apnoea or periodic limb movement disorder, or when insomnia is poorly responsive to conventional treatment.
What are the key steps in short-term management of insomnia?
Identify potential causes, advise not to drive while sleepy, advise good sleep hygiene, consider hypnotics only if daytime impairment is severe.
What are the potential adverse effects of hypnotic drugs?
Daytime sedation, poor motor coordination, cognitive impairment, and concerns about accidents and injuries.
What is the guidance on using hypnotics for treating insomnia?
Use short-acting benzodiazepines or non-benzodiazepines (zopiclone, zolpidem, zaleplon), use the lowest effective dose for the shortest period, review after 2 weeks, consider CBT referral.
Why is diazepam not recommended for insomnia, and when can it be useful?
Not recommended due to potential adverse effects but can be useful if insomnia is linked to daytime anxiety.
