Skip to Main Content

++

SOURCE

++

Source: Dopp JM, Phillips BG. Sleep–wake disorders. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=134128126. Accessed January 7, 2017.

++

CONDITION/DISORDER SYNONYM

++

  • Sleeplessness.

++

DEFINITION

++

  • Complaint of difficulty in falling asleep, maintaining sleep, or experiencing nonrestorative sleep.

++

EPIDEMIOLOGY

++

  • One-year prevalence of insomnia in the U.S. reports that one-third of surveyed individuals complain of insomnia.

  • Women complain of insomnia twice as much as men.

  • Those who are elderly, unemployed, separated, widowed or with lower socioeconomic status report higher incidence of insomnia.

++

ETIOLOGY

++

  • See Table 1 for common causes of insomnia.

++
Table Graphic Jump Location
TABLE 1.Common Causes of Insomnia
++

CLINICAL PRESENTATION

++
SIGNS AND SYMPTOMS
++

  • Difficulty falling asleep or staying asleep.

  • Not feeling rested despite sufficient opportunity to sleep.

  • Intermittent awakenings during night.

  • Early morning awakening.

++

DIAGNOSIS

++
MEANS OF CONFIRMATION AND DIAGNOSIS
++

  • Assess:

    • Onset, duration, and frequency of symptoms.

    • Effect on daytime functioning.

    • Sleep hygiene habits.

    • History of prior treatment.

  • Transient (2 or 3 nights) and short-term (<3 weeks) insomnia usually related to precipitating factor.

  • Chronic insomnia (>1 month) may be related to medical or psychiatric disorders, medications, or psychophysiologic causes. Perform physical and mental status examinations and routine laboratory tests in these patients.

++

DESIRED OUTCOMES

++

  • Identify and remove underlying cause.

  • Consolidate sleep.

  • Improve daytime functioning and sleepiness.

  • Avoid side effects and complications of pharmacologic therapy.

++

TREATMENT: GENERAL APPROACH

++

  • Educate patient about sleep hygiene, manage stress, monitor for mood symptoms, and eliminate unnecessary pharmacotherapy.

  • Treat transient and short-term insomnia with good sleep hygiene and cautious use of sedative-hypnotics if necessary.

  • For chronic insomnia: assess for medical causes, employ nonpharmacologic treatments, and use sedative-hypnotics cautiously.

++

TREATMENT: NONPHARMACOLOGIC THERAPY

++

  • Stimulus control therapy (Table 2)

  • Sleep hygiene education.

  • Short-term cognitive behavioral therapy.

  • Relaxation therapy.

  • Cognitive therapy.

  • Sleep restriction.

  • Paradoxical intention.

  • Biofeedback.

++
Table Graphic Jump Location
TABLE 2.Nonpharmacologic Recommendations ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.